Paeds Renal/Uro Flashcards
What is the most common cause of significant proteinuria in paeds?
IgA nephropathy in 1st world
Post strep glomerulonephritis 3rd world
What are the causes of acute renal failure in kids?
Pre-renal
- Dehydration, burns, haemorrhage, cardiogenic shock, 3rd spacing, sepsis
Renal
- Glomerular disease (post infectious, pyelo)
- Inflammatory disorders (HSP, HUS, SLE)
- Toxins (Gentamicin, phenytoin, iodine dye, heavy metals, rhabdo)
Post renal
- Posterior urethral valves
- tumour, stone
- Chronic infection
What are the causes of hypertension in children?
- PSGN
- HUS
- HSP
- Kawasakis disease
- Vesicoureteric reflux with renal impairment
- Renal artery stenosis/thrombosis
- Tumour (Wilm, neuoblastoma, Phaeo)
- Iatrogenic fluid overload
- Lead and mercury poisoning
- Betablocker/clonidine withdrawal
- Long term corticosteroids
- Raised ICP
- Coarctation, other cardiac issues
What are the most common drugs used to treat hypertensive crisis in children?
Nifedipine 0.25mg/kg max 20mg oral is 1st line
IV therapy in consultation with specialist, includes labetalol, hydralzine etc
What are the 2 types of Haemolytic Uraemic Syndrome?
Primary
- Caused by complement dysregulation, very rare and atypical
Secondary
- Largely post infectious but can also be caused by drugs (chemotherapy) and idiopathic (pregnancy, lupus)
- STEC, Shigella, strep pneumoniae, HIV and UTIs all implicated
How does HUS usually present?
Starts with crampy abdominal pain, fevers and watery diarrhoea (up to 80% have blood in diarrhoea)
Progresses fast to the triad of microangiopathic haemolytic anaemia, thrombocytopaenia and renal insufficiency
Can also get toxic megacolon, ischaemic colitis and intussusception
Also get seizures, hypertensive emergencies, multi organ failure, pancreatic insufficiency and severe anaemia
12% death rate, 60% will need dialysis during treatment
How is HUS treated
Transfuse PRBC if Hb <60-70
Early dialysis, however not actually shown to improve outcomes
Consider plasmapharesis, benefit only shown in primary atypical HUS
Treat associated pneumonia if caused by strep pneumoniae
Treat hypertension, seizures and electrolytes, aggressive supportive care
Platelets are contraindicated!
What is Henoch-Schonlein Purpura?
The most common vasculitis of childhood, usually occurs between 2-8 years of age
Small vessel vasculitis affecting the skin (rash), GI system (abdo pain), joints (arthralgias, myalgias) and renal system (glomerulonephritis)
Clinical diagnosis with needing the typical Purpuric rash (100% of cases) and 1 other of nephritis, arthralgias and GI pain
Rash typically involves the dependent areas (legs and buttocks) symmetrically
May get oedema of hands, feet and periorbital region
What are the complications of HSP?
Initial investigations should include urinalysis (protein and blood) and blood pressure (HTN)
Complications can include renal failure, severe hypertension, bowel perforation, pulmonary and neurological involvement
How is HSP treated?
largely focussed on treating pain, initial treatments dont affect the rash or kidney involvment
Prednisolone 1mg/kg can reduce abdominal pain and arthralgias
Regular panadol, neurofen if no evidence of GI or renal involvement
What is a varicocoele and when is it concerning?
Varicose spermatic veins in the scrotum due to poor drainage of the pampiniform plexus
Usually on the left as the left spermatic vein opens into the L) renal vein at a sharp angle, whereas on the R) it goes directly into the vena cava
Varicocoele on the right is suspicious for an intrabdominal mass/tumour
What are the most common causes of nephrotic syndrome in kids?
<5yrs most common is minimal change disease
>5yrs PSGN/IgA, SLE most common
Can also be caused by HUS, HSP, Wegeners, Goodpastures and Alport syndrome
Nephrotic syndrome is >3.5gm/24hrs protein excreted in urine which is >3+ on urine dipstick
How long can a urine sample be held for?
It should be cultured within 4hrs
If this cant be done it can be placed in a refrigerator or it can be preserved with Boric Acid
When should a suspected UTI always be referred to paeds?
If <3months of age
Which is more specific for UTI out of nitrites and leuks?
Nitrites are more specific, positive nitrites should be considered the equivalent of a UTI
Positive leuks only sample should be sent for culture but may be caused by other infections so should be screened for and treated based on findings
