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Paeds RENAL Flashcards

1
Q

causes of UTI?

A 
E.coli
enterobacter 
klebsiella 
Proteus (phosphate stones)
pseudomonas (indicates structural defect)
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2
Q

symptoms of UTI in infants

A

poor feeding, vomiting, irritability, failure to thrive, diarrhoea

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3
Q

symptoms of UTI in children

A

abdominal pain, fever, dysuria, increased frequency, haematuria

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4
Q

lower UTI symptoms

A 
urgency 
frequency 
nocturne
dysuria
suprapubic pain 
fever
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5
Q

upper UTU symptoms

A

abdominal pain
nausea and vomiting
rigors

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6
Q

UTI investigations

A

urine collection
bloods - cultures, FBC, U&E, ESR, CRP
urine dip MC and S
USS - check for abnormalities

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7
Q

management of UTI

A

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

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8
Q

what are the clinical features of pyelonephritis?

A

fever
loin pain
vomiting
white cells in urine

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9
Q

what is enuresis?

A

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.

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10
Q

what is primary nocturnal enuresis?

A

the child had never achieved continence

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11
Q

what is nocturnal secondary enuresis?

A

the child has been dry for at least 6 months before

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12
Q

what is the management of nocturnal enuresis?

A

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.

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13
Q

what can cause daytime enuresis?

A 
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

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14
Q

what are the classifications of acute kidney injury?

A

pre-renal - most common in children
renal - there is salt water retention
post renal - urinary obstruction

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15
Q

management of acute kidney injury?

A

metabolic acidosis –> sodium bicarbonate
hyerkalaemia –> calcium gluconate if ECG changes, salbutamol, calcium change resin, glucose and insulin, dietary restriction

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16
Q

how would you treat pre-renal AKI?

A

suggested by hypovolaemia - needs to be corrected with fluid replacement

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17
Q

how would you treat renal AKI?

A

if fluid overload - restrict fluids, emergency management of metabolic abnormalities

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18
Q

how would your treat post-renal AKI?

A

relief of obstruction with nephrostomy or catheterisation

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19
Q

what is acute kidney injury

A

oliguria - less than 0.5 ml/kg per hour

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20
Q

what are pre-renal causes of AKI

A
  • most common cause in children - hypovolaemia (burns, sepsis, gastroenteritis, haemorrhage, nephrotic syndrome), circulatory failure
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21
Q

what are renal causes of AKI

A

vascular (haemolytic uraemia syndrome (HUS), vasculitis, embolus, renal vein thrombosis)
Tubular (acute tubular necrosis, ischaemic, toil, obstructive)
glomerular - glomerulpnephritis
interstitial - interstitial nephritis, pyelonephritis

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22
Q

what are post renal causes of AKI?

A

obstruction

congenital or acquired

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23
Q

what is the presentation if chronic kidney disease?

A 
anorexia 
lethary 
polydipsia 
polyuria 
failure to thrive 
body deformities 
hypertension 
acute on chronic renal failure 
unexplained normochromic normocytic anaemia
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24
Q

management of chronic kidney disease

A

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

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25
what causes chronic kidney disease?
``` hypertension diabetes glomerular sclerosis lupus RA HIV NSAIDS toxins - tobacco ```
26
what can uraemia cause?
``` nausea loss of appetite encephalopathy (tremor) pericarditis increase bleeding ureic most - crystals in skin ```
27
what happens to potassium levels in CKD?
less potassium is excreted which leads to mild up in blood | hyperkalemia - can cause arrhythmias
28
what happens to calcium levels in CKD?
low - hypocalcemia | kidneys activate vitamin D which aids the absorption of calcium
29
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
30
how is CKD diagnosed ?
changes in GFR less than 15ml/kg/1.73m2 kidney biopsy to look for changes such as glomerular sclerosis.
31
what are the three manifestations of nephrotic syndrome?
proteinuria hypoalbuminaemia oedema
32
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
33
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.
34
what is nephrotic syndrome treated?
90% of proteinuria resolves with corticosteorid therapy
35
what are the complications of nephrotic syndrome?
hypovolaemia thrombosis infection hypercholestoleamia
36
how does minimal change disease present?
nearly always presents as nephrotic syndrome
37
What are the causes of minimal change disease?
the majority are idiopathic drugs - NSAIDS, rifampicin Hodgkin's lypmhoma, thymoma infectious mononucleosis
38
what are the features of nephrotic syndrome?
nephrotic syndrome normotension - hypertension is rare highly selective proteinuria renal-biopsy: electron microscopy shows fusion of podocytes
39
how is minimal change disease managed?
80% of cases are steroid responsive | cyclophoshphamide in the next step for steroid-resistant cases
40
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
41
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)
42
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
43
how is nephritic syndrome. managed?
water and electrolyte balance and the use of diuretics when necessary
44
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 ```
45
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 ```
46
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.
47
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
48
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
49
is is hypospadias treated?
corrective surgery is performed before 2 years of age
50
what are the investigations for nephrotic syndrome
``` LFT lipids infection calcium (low) renal injury urine bloods CXR renal USS ```
51
what are the investigations for HSP?
bloods (raised IgA, raised ESP, ASO titre (check for PSG) | urine dip
52
what is the management for HSP?
analgesia for MSK pain | prednisolone is severe
53
what is the presentation of post streptococcal glomerulonephritis?
URTI or pharyngitis then two weeks later haematuria oliguria proteinuria odema hypertension signs of CV overload
54
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 ```
55
what is the management of post streptococcal glomerulonephritis?
penicillin - 10 days treat hypertension and fluid overload correct metabolic imbalances
56
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
57
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
58
what are the investigations and management for vesicoureteric reflux
micturating cystourethrogram for diagnosis | DMSA should also be performed to check for scarring
59
what are the triad of features of haemolytic uraemia syndrome (HUS)?
acute renal failure microangiopathic haemolytic syndrome thrombocytopenia
60
what is typical HUS
secondary HUS | classically caused by shiga toxin producing E.coli (STEC)
61
what is atypical HUS?
primary HUS due to complement dysregulation
62
what investigations would you perform for HUS?
FBC (anaemia, thrombocytopenia, fragmented blood film) U&E (acute kidney injury) stool culture
63
What is the management of HUS?
supportive treatment - fluids, blood transfusion and dialysis if required.

Phase 3a (41 decks)

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