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Final Notes > Paeds: Haematuria > Flashcards

Paeds: Haematuria Flashcards

1
Q

Presentation

A
  • Episode of marcoscopic haematuria (causes alarm to child/family)
  • Incidental finding
  • Family screening and routine urinalysis
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2
Q

Other causes of ‘red urine’:

A
  • Haemoglobinuria/myoglobinuria.
  • Foods – colouring (e.g. beetroot)
  • Drugs (e.g. rifampicin)
  • Urate crystals (in young infants, usually ‘pink’ nappies).
  • External source (e.g. menstrual blood losses).
  • Fictitious –consider if no cause found.
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3
Q

Causes of haematuria:

A

Non-glomerular or glomerular

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4
Q

Non-glomerular

A
  • Infection (bacterial, viral, TB, schistomiasis)
  • Trauma to genitalia, urinary tract or kidneys
  • Stones
  • Tumours
  • Sickle cell disease
  • Bleeding disorders
  • Renal vein thrombosis
    Hypercalciuria
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5
Q

Glomerular

A
  • Acute glomerulonephritis (usually with proteinuria)
  • Chronic glomerulonephritis (usually with proteinuria)
  • IgA nephropathy, Henoch-Schonlein purpura, SLE
  • Familial nephritis e.g. Alport syndrome, thin basement membrane
    Thin basement membrane disease
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6
Q

Other way to differentiate the causes

A 
Urinary tract infections
Glomerular
Urinary tract stones
Trauma
Other renal tract pathology
Vascular
Haematological
Drugs
Exercise-induced
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7
Q

Urinary tract infections

A

Bacterial
Viral (e.g. adenovirus in outbreaks);
Schistosomiasis (hx of foreign travel)
TB

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8
Q

Glomerular

A
  • Postinfectious glomerulonephritis
  • Henoch-Schonlein purpura IgA nephropathy, SLE
    Hereditary – thin basement membrane, Alport’s syndrome
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9
Q

Urinary tract stones

A

E.g. due to hypercalciuria

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10
Q

Other renal tract pathology

A
  • Renal tract tumour

Polycystic kidney disease

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11
Q

Vascular

A
  • Renal vein thrombosis

Arteritis

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12
Q

Haematological

A

Coagulopathy/sickle cell disease

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13
Q

Drugs

A

Cyclophosphamide

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14
Q

Hx

A 
UTI
Renal stones:
Glomerular
Coagulopathy
Trauma
Family Hx
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15
Q

UTI symptoms

A

fever/freqeuncy/dysuria

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16
Q

Renal stones:

A

colicky abdominal pain

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17
Q

Glomerular

A

Sore throat/rashes

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18
Q

Coagulopathy

A

Easy bruising

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19
Q

Family Hx

A

Haematuria
Deafness (Alport’s)
Sickle cell disease

20
Q

Brown urine:

A

Glomerular haematuria – often accompanied with proteinuria

21
Q

Red urine:

A

Lower urinary tract haematuria – beginning or end of stream, no proteinuria –Unusual in children!

22
Q

Examination:

A
  • BP
  • Abdomen: palpable masses
  • Skin: rashes
  • Joints: pain/swelling
23
Q

Investigations:

A

During acute illness: exclude UTI by urine culture.

***Asymptomatic or ‘benign haematuria’ in children without growth failure, hypertension, oedema, proteinuria, urinary casts or renal impairment is a frequent finding.

24
Q

Investigation list

A 
Urine
Bloods
US urinary tract
Urinalysis of parents (hereditary causes).
Cystoscopy; rarely indicated in children
25
Q

Urine

A
  • Microscopy (look for cats –suggestive of nephritis) and culture;
  • Protein excretion: creatinine ratio (normal,
26
Q

Bloods

A
  • U&E/creatinine/albumin,
  • FBC/clotting
  • Complement – C3/C4, ASOT titres;
    ANA/anti-dsDNA
27
Q

ASOT titres

A

help determine whether a recent strep infection with group AStreptococcus:
• Is the cause of a person’s orglomerulonephritis, a form ofkidney disease
• Causedrheumatic feverin a person with signs and symptoms

28
Q

Treatment:

A
  • If obvious cause (e.g. UTI) treat

- Complex diagnosis (impaired renal function, proteinuria, or family Hx) refer to paediatric nephrology unit

29
Q

When do you monitor until it resolves

A
  • If no cause found and normal renal function, BP, and no proteinuria monitor until resolves
30
Q

If no resolution after 6 months or change in any of above parameters

A

refer

31
Q

Post-streptococcl and post-infectious nephritis:

Description

A

Usually follows a streptococcal sore throat or skin infection

32
Q

Post-streptococcl and post-infectious nephritis: Diagnosis

A

Evidence of a recent streptococcal infection
Culture of the organism
Raised ASO/anti-DNAse B titres
Low Complement C3 levels (return to normal after 3-4 weeks)

33
Q

Post-streptococcl and post-infectious nephritis: Epi

A

Common in developing countries

34
Q

Post-streptococcl and post-infectious nephritis: Prognosis

A

Good

35
Q

Henoch-Schnolein purpura: Signs and Symptoms

A
  • Preceded by URTI
  • Characteristic skin rash
  • Arthralgia
  • Peri-articular oedema
  • Abdominal pain
    Glomerulonephritis
36
Q

Henoch-Schnolein purpura:

Aetiology

A
  • Between the ages of 3 and 10 years
  • 2:1 boys:girls
    Peaks during winter months
37
Q

Henoch-Schnolein purpura:

Presentation

A

Increase in circulating IgA and IgG interact to produce complexes that activate complement and are dposited in affected organs, precipitating an inflammatory response with vasculitis.

38
Q

Henoch-Schnolein purpura: Presentation

A

Rash
- Buttocks
- Extensor surfaces of legs and arms
- Ankles
Joint pain and swelling: knees and ankles
Abdominal pain:
- Haematemesis and melaena (gastrointestinal petechiae)
- Intussusception
Renal
- Microscopic/macroscopic haematuria (80%)
Nephrotic syndrome (rare)

39
Q

Henoch-Schnolein purpura:

Rash type

A

Initially uticarial, rapidly becoming maculopapular and purpuric.
Characteristically palpable and may recur over several weeks.

40
Q

Henoch-Schnolein purpura: Rare complications

A

Ileus
Protein-losing enteropathy
Orchitis
Occasionally CNS involvement

41
Q

Henoch-Schnolein purpura: Prognosis

A

Children without risk factors for progressive renal disease make a full recovery

42
Q

Henoch-Schnolein purpura:

Risk factors for progressive disease

A

Heavy proteinuria
Oedema
Hypertension
Deteriorating renal function

43
Q

Henoch-Schnolein purpura:

Treatment

A

Severe cases can be treated with corticosteroids

44
Q

Vasculitis: Causes

A 
Henoch-schlonein purpura
Renal involvement in:
-	Polyarteritis nodosa
-	Microscopic polyarteritis
Wegener gramulomatosis
45
Q

Vasculitis: Characteristic symptoms

A 
Fever
Malaise
Weight-loss
Skin rash
Arthropathy with prominent involvement of the respiratory tract in Wegener disease
46
Q

Vasculitis: Diagnosis

A
  • ANCA are present and diagnostic in these disease

Renal arteriography, to demonstrate the presence pf aneurysms, will diagnose polyarteritis nodosa

47
Q

Vasculitis:

Treatment

A

Steroids
Plasma exchange
IV cyclophosphamide

Final Notes (196 decks)

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