Paediatric Nephrology - Part 2 Flashcards
What is the definition of acute kidney injury (AKI)?
Abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume + electrolytes
Anuria/ oliguria, hypertension with fluid overload an rapid rise in plasma creatinine
What are the ranges seen in AKI?
Serum creatinine is >1.5 x age specific reference creatinine
Urine output is less than 0.5ml/kg for more than 8hrs
AKI1-3
What is the management of AKI?
3 Ms - monitor (urine output + weight), maintain good hydration + electrolytes and minimise damage
What are the causes of AKI - prerenal?
Perfusion problem Glomerular disease - HUS
Tubular injury - acute tubular necrosis from hypoperfusion or drugs
Interstitial nephritis - NSAIDs and autoimmune
What are the post-renal causes of AKI?
Obstructive uropathies - stones, tumours, drugs and constipation
Describe haemolytic uraemic syndrome
Packed cell volume less than 30% and haemoglobin level is <10g/dl and fragmented erythrocytes on blood film
Thrombocytopenia - low platelets
AKI - serum creatinine greater than normal age limit, GFR low and proteinuria
What are the causes of HUS?
Typical HUS - post diarrhoea from entero-haemorrhagic E. coli and other causes like pneumococcal infection or drugs
Atypical HUS - genetic condition and overactivation seen
What are the presenting symptoms of HUS?
E. coli O157:H7 serotype
Period of risk of HUS - up to 14 days after onset of diarrhoea
Bloody diarrhoea is a medical emergency in children
What is the triad seen in HUS?
Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI/ acute renal failure
What is the management of bloody diarrhoea and HUS?
Association with intravenous volume expansion
What is the treatment for HUS?
3 Ms - monitor, maintain with IV normal saline + fluid and RRT, and minimise damage (no antibiotics or NSAIDs)
What can AKI lead to?
BP, proteinuria monitored and CKD evolution
What are the causes of CKD?
Congenital - reflux nephropathy, dysplasia and obstructive uropathy
Hereditary conditions - Cystic kidney disease and cystinosis
Glomerulonephritis
What are the stages of CKD?
Normal is 90-120 creatinine
CKD2 is 60-89
CKD3 - 30-59
CKD4 - 15-29
CKD5 - ESRD
What is the presentation of CKD?
Hyponatraemia, hyperkalaemia, poor growth, anaemia, hypertensive/ hypotensive, polyuria/ oliguria, bone disease and bladder dysfunction
What are the symptoms of UTI in children?
Fever, abdominal pain, vomiting, poor feeding, lethargy and irritability
Systemic symptoms seen more in younger children
Dysuria and frequency increase
How is UTI diagnosed in children?
Dipstix - leukocyte and unreliable under 2 years
Microscopy - polyuria and bacteriuria
Culture >10^5 colony forming units/ml (usually E. coli gram negative)
Why do we worry about UTIs in children?
Vesico-ureteric reflux (VUR)
Grades 1-5
Can be high grade and bilateral
UTI, vulnerable kindey and VUR lead to scaring
What is investigated in VUR?
Congenital vs acquired
Screening for risk of progressive scaring
Capture those with renal dysplasia
Urological abnormalities and unstable bladder
All children with UTIs, younger and recurrent
What investigations are done for VUR?
US, DMSA (isotope scan) for scaring + function and micturating cyto-urethrogram MAG 3 scan (gold standard)
What is the treatment for UTI in children?
Lower tract - 3 days oral antibiotic
Upper tract - 7-10 days antibiotics
Prevention with fluids, hygiene and constipation management
Manage voiding dysfunction
What are the factors affecting progressive of CKD?
Late referral, hypertension, proteinuria, high intake of protein/ phosphate/ salt, bone health, acidosis and recurrent UTIS
Describe BP in children
Gold standard - sphigmanometer
Oscillometry
Need 3 occasions of high BP
Hypertensive >95th percentile and borderline is >90th
What is the management of CKD?
Dependant on the function affected
Describe metabolic bone disease
Kidneys facilitate exit of phosphate so high phosphate from increased PTH
Also kidneys activate Vitamin D3
How is metabolic bone disease treated?
Low phosphate diets, phosphate binders and active vitamin D
If ongoing poor growth then GH
What is the cardiovascular risk of renal patients?
Accelerated atherosclerosis
Anaemia and metabolic bone disease increase the risk
