Paeds RENAL Flashcards
causes of UTI?
E.coli enterobacter klebsiella Proteus (phosphate stones) pseudomonas (indicates structural defect)
symptoms of UTI in infants
poor feeding, vomiting, irritability, failure to thrive, diarrhoea
symptoms of UTI in children
abdominal pain, fever, dysuria, increased frequency, haematuria
lower UTI symptoms
urgency frequency nocturne dysuria suprapubic pain fever
upper UTU symptoms
abdominal pain
nausea and vomiting
rigors
UTI investigations
urine collection
bloods - cultures, FBC, U&E, ESR, CRP
urine dip MC and S
USS - check for abnormalities
management of UTI
General: fluid, analgesics, antiemetics
<3 months –> refer to specialist
>3 months
upper UTI - cephalosporin or co-amoxiclav 7-10 days
lower UTI - trimethoprim, nitrofurantoin, cephalosporin or co-amoxiclav for 3 days
what are the clinical features of pyelonephritis?
fever
loin pain
vomiting
white cells in urine
what is enuresis?
involuntary discharge of urine by day or night or both in children aged 5 years or older in the absence of congenital or acquired defects of the nervous system or urinary tract.
what is primary nocturnal enuresis?
the child had never achieved continence
what is nocturnal secondary enuresis?
the child has been dry for at least 6 months before
what is the management of nocturnal enuresis?
look for possible underlying causes/triggers (constipation, DM, UTI)
advise of fluid intake, diet and toilet behaviour
rewards systems
first line treatment for children under the age of 7 is an enuresis alarm
first line treatment for children over the age of 7 - desmopressin.
what can cause daytime enuresis?
lack of attention to the bladder sensation detrusor insability bladder neck weakness UTI, constipations neuropathic bladder
secondary - may be due to emotional upset, UTI, polyuria from DM
what are the classifications of acute kidney injury?
pre-renal - most common in children
renal - there is salt water retention
post renal - urinary obstruction
management of acute kidney injury?
metabolic acidosis –> sodium bicarbonate
hyerkalaemia –> calcium gluconate if ECG changes, salbutamol, calcium change resin, glucose and insulin, dietary restriction
how would you treat pre-renal AKI?
suggested by hypovolaemia - needs to be corrected with fluid replacement
how would you treat renal AKI?
if fluid overload - restrict fluids, emergency management of metabolic abnormalities
how would your treat post-renal AKI?
relief of obstruction with nephrostomy or catheterisation
what is acute kidney injury
oliguria - less than 0.5 ml/kg per hour
what are pre-renal causes of AKI
- most common cause in children - hypovolaemia (burns, sepsis, gastroenteritis, haemorrhage, nephrotic syndrome), circulatory failure
what are renal causes of AKI
vascular (haemolytic uraemia syndrome (HUS), vasculitis, embolus, renal vein thrombosis)
Tubular (acute tubular necrosis, ischaemic, toil, obstructive)
glomerular - glomerulpnephritis
interstitial - interstitial nephritis, pyelonephritis
what are post renal causes of AKI?
obstruction
congenital or acquired
what is the presentation if chronic kidney disease?
anorexia lethary polydipsia polyuria failure to thrive body deformities hypertension acute on chronic renal failure unexplained normochromic normocytic anaemia
management of chronic kidney disease
Reduce CV risk - Control BP, statin
Potassium control - Dietary restriction
Prevention osteodystrophy - Calcium carbonate, vit D
Treat anaemia - Subcut EPO
Treat acidosis - Sodium bicarbonate
Prophylaxis - Influenza and pneumococcal vaccinations
Calorie supplements
NG feeding
Fluid correction
Hormonal abnormalities
Dialysis and transplant
what causes chronic kidney disease?
hypertension diabetes glomerular sclerosis lupus RA HIV NSAIDS toxins - tobacco
what can uraemia cause?
nausea loss of appetite encephalopathy (tremor) pericarditis increase bleeding ureic most - crystals in skin
what happens to potassium levels in CKD?
less potassium is excreted which leads to mild up in blood
hyperkalemia - can cause arrhythmias
what happens to calcium levels in CKD?
low - hypocalcemia
kidneys activate vitamin D which aids the absorption of calcium
what happens when calcium levels are low?
parathyroid hormone is released which causes the bones to lose calcium
this leads to bone being brittle which is called renal osteodystrophy
how is CKD diagnosed ?
changes in GFR
less than 15ml/kg/1.73m2
kidney biopsy to look for changes such as glomerular sclerosis.
what are the three manifestations of nephrotic syndrome?
proteinuria
hypoalbuminaemia
oedema
what is the most common cause of nephrotic syndrome in children ?
minimal change disease
can also be caused by focal glomerulosclerosis and poost stept nephritis
what happens in nephrotic syndrome?
there is damage and inflammation to the podocytes which normally help protein loss from the glomerulus which leads to protein loss to the nephron tubule.
what is nephrotic syndrome treated?
90% of proteinuria resolves with corticosteorid therapy
what are the complications of nephrotic syndrome?
hypovolaemia
thrombosis
infection
hypercholestoleamia
how does minimal change disease present?
nearly always presents as nephrotic syndrome
What are the causes of minimal change disease?
the majority are idiopathic
drugs - NSAIDS, rifampicin
Hodgkin’s lypmhoma, thymoma
infectious mononucleosis
what are the features of nephrotic syndrome?
nephrotic syndrome
normotension - hypertension is rare
highly selective proteinuria
renal-biopsy: electron microscopy shows fusion of podocytes
how is minimal change disease managed?
80% of cases are steroid responsive
cyclophoshphamide in the next step for steroid-resistant cases
what is congenital nephrotic syndrome?
when nephrotic syndrome presents within the first 3 months of life.
it is rare
commonest kind is recessively inherited
associated with high mortality usually due to complications of hypoalbuminaemia
what are the causes of acute nephritis?
post infectious (including streptococcus)
Vasculitis (HSP, SLE, wegener granulomatosis)
IgA nephropathy and mesangiocapillary glomerulonephritis
anti-glomerular basement membrane disease (good pasture syndrome)
what are the clinical features of nephritic syndrome?
decreased urine output and volume overload
hypertension which may cause seizures
oedema, characteristically around the eyes
haematuria and proteinuria
how is nephritic syndrome. managed?
water and electrolyte balance and the use of diuretics when necessary
what are the features of henoch-schonlein purpura?
characteristic skin rash on buttocks and extensor surfaces of arms and legs arthralgia periarticular oedema abdominal pain glomerulonephritis
what is the common factors for HSP to occur?
between 3 and 10 years more common in boys peaks during winter months often preceded by a response infection cause is unknown
what is Alport syndrome
it is a familial nephritis
usually an X-linked recessive disorder that processes to end-stage renal failure by early adult life in males and is associated with nerve deafness and ocular defects.
what is hypospadias?
congenital abnormality of the penis which occurs in approx 3/1000 male infants
an abnormal opening below the urethra
can also happen in girls but way way more common in boys
what is hypospadias characterised by?
a ventral urethral meatus
a hooded prepuce
chord (ventral curvature of the pernis) in more sever form
the urethral meatus may open proximally in the more severe variants
is is hypospadias treated?
corrective surgery is performed before 2 years of age
what are the investigations for nephrotic syndrome
LFT lipids infection calcium (low) renal injury urine bloods CXR renal USS
what are the investigations for HSP?
bloods (raised IgA, raised ESP, ASO titre (check for PSG)
urine dip
what is the management for HSP?
analgesia for MSK pain
prednisolone is severe
what is the presentation of post streptococcal glomerulonephritis?
URTI or pharyngitis
then two weeks later
haematuria
oliguria
proteinuria
odema
hypertension
signs of CV overload
what are the investigations for post streptococcal glomerulonephritis?
bloods - FBC - anaemia - U&Es - increased urea and creatinine, increased potassium, acidosis - antistreptolysin O increased anti DNAase B titre low C3 urinalysis - haematuria, proteinuria renal biopsy
what is the management of post streptococcal glomerulonephritis?
penicillin - 10 days
treat hypertension and fluid overload
correct metabolic imbalances
what is vesicoureteric reflux?
there is abnormal back flow of urine from the bladder to the ureter and kidneys
there is abnormal vesicoureteric junction where the ureters enter the bladder - the ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle therefore shortened ureter, and the junction cannot function adequately
what is the grading of vesicoureteric reflux?
I - Reflux into the ureter only, no dilatation
II -Reflux into the renal pelvis on micturition, no dilatation
III-Mild/moderate dilatation of the ureter, renal pelvis and calyces
IV - Dilation of the renal pelvis and calyces with moderate ureteral tortuosity
V - Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
what are the investigations and management for vesicoureteric reflux
micturating cystourethrogram for diagnosis
DMSA should also be performed to check for scarring
what are the triad of features of haemolytic uraemia syndrome (HUS)?
acute renal failure
microangiopathic haemolytic syndrome
thrombocytopenia
what is typical HUS
secondary HUS
classically caused by shiga toxin producing E.coli (STEC)
what is atypical HUS?
primary HUS due to complement dysregulation
what investigations would you perform for HUS?
FBC (anaemia, thrombocytopenia, fragmented blood film)
U&E (acute kidney injury)
stool culture
What is the management of HUS?
supportive treatment - fluids, blood transfusion and dialysis if required.
