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NP- Phase 3a Medicine > Paeds- Renal/ GU > Flashcards

Paeds- Renal/ GU Flashcards

1
Q

what is Henoch-Schonlein Purpura (HSP) and what does it affect?

A

IgA mediated, autoimmune hypersensitivity vasculitis of childhood

  • skin, joints, gut, kidneys
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2
Q

risk factors for the development of HSP

A
  • infections- group A strep, mycoplasma, epstein-barr
  • vaccinations
  • environmental- pesticides, cold exposure, insect bites
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3
Q

epidemiology of HSP

A
  • 4-6 years old
  • more common in males (2:1)
  • winter months
  • 50-90% of cases have a preceding URTI
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4
Q

how does HSP present clinically? (general + triad)

A

general:
- fever, rash, scrotal oedema, intusseception

triad:
- purpura (NON-BLANCHING)

  • arthritis/ arthralgia of the knees/ ankles
  • abdo pain
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5
Q

give 3 differential diagnosis of HSP

A
  • intussusception
  • SLE
  • thrombocytopenia
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6
Q

how is HSP diagnosed?

A
  • urinalysis- haematuria/ proteinuria
  • raised ESR
  • raised serum IgA
  • FBC- raised WCC
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7
Q

how is HSP managed?

A
  • usually self limiting
  • NSAIDS- joint pain
  • corticosteroids for arthralgia and abdo pain
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8
Q

what are some serious but rare complications of HSP?

A

massive GI bleed

ileus

haemoptysis

AKI

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9
Q

explain the physiology of oedema

A
  • lymphatic drainage issues
  • lowered oncotic pressure
  • salt and water retention
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10
Q

causes of Nephrotic syndrome

A

minimal change disease !

  • vasculidities- HSP, SLE
  • infections- malaria
  • allergens- bee sting
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11
Q

how does nephrotic syndrome present clinically?

A
  • oedema- periobital, scortal, leg and ankle
  • ascites
  • breathlessness due to pleural effusions and abdo distension
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12
Q

give the classic triad seen in nephrotic syndrome

A
  • heavy proteinuria
  • hypoalbuminaemia
  • oedema
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13
Q

how would you investigate a patient with nephrotic syndrome?

A
  • urinalysis- MSU (dipstick, MC+S)
  • BP
  • Bloods- fbc, esr, low serum albumin !
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14
Q

what are the 3 types of nephrotic syndrome?

A

congenital

steroid sensitive nephrotic syndrome (SSNS)

steroid resistant nephrotic syndrome (SRNS)

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15
Q

describe the features of steroid sensitive nephrotic syndrome

A
  • no haematuria !
  • normal BP
  • normal renal function
  • minimal change disease on histology
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16
Q

how is steroid sensitive nephrotic syndrome managed?

A
  • prednisolone

- renal biopsy

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17
Q

how does steroid resistant nephrotic syndrome present?

A
  • elevated BP
  • haematuria
  • impaired renal function
  • nephritis
  • failure to respond to steroids
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18
Q

how is steroid resistant nephrotic syndrome managed?

A
  • oedema- diuretic, salt restriction ace inhibitor

- NSAIDS

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19
Q

describe the presentation of congenital nephrotic syndrome

A
  • first 3 months
  • rare
  • high mortality
  • Albuminuria and hypoalbuminaemia
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20
Q

causes of nephritic syndrome

A
  • post infection- group A Beta-haemolytic strep
  • vasculitis- HSP and SLE
  • IgA nephropathy
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21
Q

clinical features of acute glomerulonephritis

A
  • haematuria
  • proteinuria
  • decreased urine output
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22
Q

how does acute glomerulonephritis present on urinalysis?

A
  • macroscopic haematuria
  • dipstick- albumin: creatinine ratio indicates proteinuria
  • microscopy- RBC casts
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23
Q

how is acute glomerulonephritis managed?

A
  • fluid balance- fluid moderation etc
  • diuretics
  • penicillin if infection
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24
Q

describe the presentation of post streptococcal nephritis

A
  • follows strep sore throat/ skin infection- 7-21 days after
  • diagnosis by evidence of recent strep infection- cultures etc
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25
Q

what is Alport syndrome?

A

X linked recessive disorder associated with hearing loss, ocular defects and progressive kidney disease

Almost always have haematuria

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26
Q

what is juvenille SLE?

A

chronic autoimmune disease affecting every organ of the body

has a relasping remitting pattern

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27
Q

what is the diagnostic criteria for juvenille SLE (SOAP BRAIN MD)

A

SOAP BRAIN MD

Serositis (pleuritis/pericarditis)
Oral ulcers
Arthritis
Photosensitivity

Blood (pancytopenia)
Renal (proteinuria)
ANA +ve (anti-nuclear antibody)
Immunological
Neurological (psych/seizures)

Macular rash
Discoid rash

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28
Q

in terms of UTI’s, what are acute pyelonephritis and acute cystitis?

A

acute pyelonephritis- upper tract UTI

acute cystitis- lower tract UTI

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29
Q

what organisms cause UTI’s?

A
  • most common- E.coli

Klebsiella, Proteus, Pseudomonas, Streptococcus Faecalis

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30
Q

how does an upper tract UTI present clinically?

A
  • fever, septicaemic illness
  • general malaise, vomiting
  • loin/abdo pain
  • failure to thrive and jaundice
31
Q

how does a lower tract UTI present clinically?

A
  • dysuria
  • urinary frequency/ urgency
  • incontinence
  • lower abdominal pain
  • haematuria
32
Q

if a patient presents with only dysuria, what is indicated in females and boys?

A
  • vulvitis in girls

- balanitis (circumsized boys)

33
Q

what is bacteriuria?

A

bacteria in urine contaminated by urethral flora

34
Q

what are some atypical UTI features?

A
  • poor urine flow
  • abdominal flow
  • seriously ill
  • raised creatinine
35
Q

what are the 3 (general) methods of diagnosis and investigation of a paediatric patient with a UTI?

A
  • urine sample
  • urine analysis
  • imaging
36
Q

describe the urinalysis done in a paeds patient with a suspected UTI

A
  • visual inspection
  • disptick- nitrates, WCC, leucoytes, e.coli, klebsiella etc
  • M,C&S
37
Q

what imaging is done in a patient with a suspected UTI?

A
  • US
  • micturating cystourethrogram scan (MCUG)

DMSA scan (dimercaptosuccinc acid scan)

38
Q

How is a UTI managed (aged less than 3 months and over 3 months)?

A

<3 months- IV amoxicillin and gentamicin

> 3 months- 3 day course of trimethorpim/ nitrofurantoin/ amoxicillin

  • circumcision may be required if regular UTI’s
39
Q

what is vesicouteric reflux?

A
  • developmental abnormality of the vesicoureteric junction

- ureter is displaced laterally

40
Q

what is severe Vesicouteric reflux?

A

gross dilatation of the ureter, renal pelvis and calyces

predisposes to infrarenal reflux and scarring

41
Q

what are the consequences of Vesicouteric reflux associated dilatation?

A
  • incomplete emptying- risk of infection
  • pyelonephritis
  • renal damage due to increased bladder voiding pressure
  • scarring of renal tissue- reflux nephropathy
42
Q

When do the majority of children achieve continence?

A

3-4 years old

43
Q

what is the difference between primary and secondary nocturnal enuresis?

A

primary- child never achieved continence

secondary- child has been dry for at least 6 months before

44
Q

describe the aetiology of nocturnal enuresis

A
  • genetic- lack of sphincter continence
  • secondary- emotional stress
  • organic causes- UTI, faecal retention (severe enough to reduce bladder volume), osmotic diuresis (diabetes, CKD), learning difficulties/ developmental delay
45
Q

how is nocturnal enuresis managed?

A
  • explain fluid intaka management etc
  • star chart
  • enuresis alarm- alarms when wet
  • desmopressin- over 7 !
46
Q

What is AKI characterised by?

A

rapid rise in creatine plus the development of oliguria/anuria

47
Q

pre-renal causes of AKI?

A
  • hypovolaemia- nephrotic syndrome, gastroenteritis, burns, sepsis haemorrhage
  • circulatory failure
48
Q

renal causes of AKI (vascular, tubular, glomerular, interstitial)

A
  • vascular- haemolytic uraemia syndrome, vasculitis
  • tubular- acute tubular necrosis, ischaemic, toxic
  • glomerulonephirits
  • interstitial nephritis/ pyelonephritis
49
Q

post-renal causes of AKI

A

obstruction !

  • congenital- posterior urethral valves
  • acquired- blocked urinary catheter
50
Q

what is acute-on-chronic renal failure?

A

if the child is having growth failure, anaemia and disordered mineralisation

51
Q

in developed countries, what can AKI be secondary to?

A
  • cardiac surgery
  • bone marrow transplantation
  • toxicity (NSAIDs, vancomycin etc)
  • sepsis
52
Q

in developing countries, what can AKI be secondary to?

A

diarrhoea, glomerulonephritis, snake bite

53
Q

what blood results would be found in a patient with AKI?

A

RAISED- K+, creatinine, urea, phosphate

LOW- Ca2+, Na+, Cl-

54
Q

what are the management options of a patient with an AKI?

A
  • remove cause

- fluid balance monitored

55
Q

what is given to a patient with AKI if:

the urine/ plasma osmolality ratio is low?

A

furosemide

56
Q

what is given to a patient with AKI if:

BP is signifcantly raised?

A

nitroprusside

57
Q

what is given to a patient with AKI if:

they are hyperkalaemic?

A
  • IV calcium gluconate

- salbutamol nebuliser

58
Q

what is the triad seen in haemolytic uraemia syndrome?

A
  • acute microangipathic haemolytic anaemia
  • thrombocytopenia
  • renal failure
59
Q

what are 95% of cases of haemolytic uraemia syndrome associated with?

A

diarrhoea !

60
Q

how can haemolytic uraemia syndrome be aquired?

A

uncooked meat

contact with farm animals

(Shiga toxin)

61
Q

what clinical signs are seen in a patient with haemolytic uraemia syndrome?

A

colitis (bloody diarrhoea)

oliguria

encephalopathy

coma

62
Q

how is haemolytic uraemia syndrome treated?

A

early dialysis

treat renal failure

63
Q

Causes of CKD in paediatric patients

A
  • congenital dysplastic kidney
  • pyelonephritis
  • recurrent infection
  • reflux nephropathy
  • AKI
64
Q

how does CKD stage 4/5 present clinically?

A
  • anorexia, lethargy
  • polydipsia
  • headache and vomiting
  • restlessness
  • raised BP
  • failure to thrive, coma, seizures and anaemia
65
Q

what are the 5 essentials of managing CKD?

A
  • diet management
  • prevention of renal osteodystrophy (give calcium carbonate)
  • anaemia management
  • control of acidosis
  • dialysis
66
Q

what is hypospadias?

A

abnormal position of external urethral meatus on distal ventral penis

67
Q

describe the aetiology of hypospadias

A

common- 1/200 boys

68
Q

what are the 3 clinical features of hypospadias?

A
  • ventral urethral meatus
  • ventral curvature
  • hooded appearance of foreskin
69
Q

when is surgery appropriate in a patient with hypospadias?

A
  • if they cannot urinate straight
  • cosmetic
  • performed in first 2-3 years of life
70
Q

how does a horseshoe kidney present?

A

silent uropathy + renal infections

71
Q

what is Wilm’s tumour?

A

Most common renal tumour in childhood that is:

95% unilaterally

presents as unilateral abdominal mass

72
Q

how does a Wilm’s tumour present?

A
  • unilateral abdo mass
  • painless haematuria
  • flank pain
  • anorexia
  • anaemia
73
Q

differential diagnosis of proteinuria

A
  • orthostatic proteinuria
  • glomerular- minimal change (nephrotic syndrome), glomerulonephirits, DM
  • reduced renal mass
  • HTN
  • PKD
74
Q

differential diagnosis of haematuria

A
  • non-glomerular- infection, trauma, stones, tumours, sickle cell
  • glomerular- acute glomerulonephritis, vasculitis, IgA nephropathy, Alports, Goodpastures

NP- Phase 3a Medicine (22 decks)

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