Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paediatrics > Renal > Flashcards

Renal Flashcards

1
Q

What is nephrotic syndrome?

A

Clinical triad of hypoalbuminemia, nephrotic range proteinuria, edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is nephrotic range proteinuria?

A

> 40mg/m2/hr OR UPCR >200mg/mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is hypoalbuminemia?

A

<25g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the significance of UTI in children?

A

Renal scarring in developing kidney -> HT -> CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sx of UTI?

A

Fever, malodorous urine
Infant: poor feeding, vomiting, irritability, seizure, FTT
Children: LUTS, suprapubic pain, loin pain, secondary enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What pathogens cause UTI?

A

E coli > klebsiella > proteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the RF of UTI?

A

VUR, constipation, indwelling catheter, intermittent catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to investigate UTI?

A

Urine multistix, culture & microscopy

Blood: RFT, ESR, CRP, (culture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to follow up UTI?

A

NICE guideline

Good response + first time: USG in 6w for <6m
Atypical UTI: <6m (acute USG, DMSA, MCUG), 6m-3y (acute USG, DMSA), >3y (acute USG)
Recurrent: <6m (acute USG, DMSA, MCUG), >6m (USG in 6w, DMSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to manage UTI?

A

ABX: oral cephalosporin / augmentin x 7-14d (IV for <3m, repeated vomiting, urosepsis)
FU growth & RFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to manage recurrent UTI?

A

Surgery: circumcision, anti-reflux surgery

Long term prophylactic ABX: daily trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is VUR?

A

Incompetent ureterovesicular junction -> short intravesicular ureter -> UVJ x close during bladder contraction -> reflux to ureter -> recurrent UTI, renal scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to manage VUR?

A

Periodic monitoring by MCUG (most resolve spontaneously)
Prophylactic ABX: grade 3
Surgery: high grade after 3yo, failed ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of nephrotic syndrome?

A

Primary: MCD, IgA nephropathy, FSGS
Secondary: AI (SLE, HSP), inf (Hep B, APSGN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What PE to perform for nephrotic syndrome?

A

Volume status (CR, BP/P, RR)
Ascites, pleural effusion
Abdominal pain
Sx of secondary causes: rash, arthritis, purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to investigate nephrotic syndrome?

A

Urine: multistix, PCR, timed urine, specific gravity >1.035
Blood: CBC, LRFT, ESR, AI markers, serology
Renal biopsy (atypical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the indications for renal biopsy in nephrotic syndrome?

A

Atypical case: <12m, >12y, gross hematuria, persistent HT, persistent low complement, impaired RFT unrelated to hypovolemia, Hep B/C +ve, failed steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are and how to manage the Cx of nephrotic syndrome?

A

Hypovolemia: IV albumin then IV furosemide
Infection (loss of Ig): prophylactic ABX (penicillin V)
Thrombosis (loss of ATIII + hemoconcentration): encourage ambulation, renal USG & doppler
Hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to manage nephrotic syndrome?

A

Monitor I/O
Avoid bed rest, encourage ambulation
Steroid-sensitive type: PO prednisolone
Steroid-resistant: refer
Adjunctive therapy of H2RA (famotidine/ranitidine), calcium, Vit D
Significant ascites/edema: low salt diet, fluid restriction, PPX ABX, IV albumin + furosemide, paracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the prognosis of nephrotic syndrome?

A

1/3 recover, 1/3 occasional relapse, 1/3 frequent relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the DDx of sterile pyuria?

A

Infective: partially treated bacterial UTI, UTI w/ urinary obstruction, renal TB, renal abscess, inflammation near bladder/ureter, other febrile disorders
Non-infective: stone, structural abnormality, GN, interstitial nephritis, SLE, interstitial cystitis, Kawasaki

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is sterile pyuria?

A

High WCC, x bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is enuresis?

A

Bedwetting after developmental age when bladder control should be established (>5yo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the types of enuresis?

A

Primary: never achieved night dryness >6m
Secondary: enuresis after night dryness of >6m
Daytime VS nocturnal
Monosymptomatic: x LUTS or hx of bladder dysfunction
Non-monosymptomatic: w/ LUTS or hx of bladder dysfunction

25
What are the causes of enuresis?
Primary: primary nocturnal enuresis, bladder dysfunction, ectopic ureter Secondary: psychological, DM, constipation, OSA, CKD, UTI, neuropathic bladder (spinal injury e.g. trauma, neuroblastoma, spina bifida)
26
What history would you take for enuresis?
``` Voiding habit Drinking habit Any daytime or LUTS symptoms A/S: movement disorder, constipation, development FH SH ```
27
What PE would you perform for enuresis?
Abdominal mass Bladder distention Neuro: gait, spina bifida Others: anal tone, growth, tonsillar hypertrophy
28
How to investigate enuresis?
Urine: multistix, culture, specific gravity USG kidney & bladder Urodynamics XR/MRI spine
29
How to manage enuresis?
General: tx constipation, reassure, advice, motivation therapy w/ star chart Specific: enuresis alarm, demopressin Overactive bladder: anticholinergic (oxybutinin), beta3 agonist (mirabegron)
30
What is hemolytic uremic syndrome?
Triad of microangiopathic hemolytic anemia, thrombocytopenia, AKI
31
What are the types of hemolytic uremic syndrome?
Typical: E coli O157:H7, shigella -> prodromal diarrhea, better prognosis Atypical: strep pneumoniae -> prodromal pneumonia, worse prognosis
32
What are the sx of hemolytic uremic syndrome?
Sudden onset of oliguria, pallor, seizures | Prodromal diarrhea or pneumonia
33
What PE would you perform for hemolytic uremic syndrome?
Pallor Hepatosplenomegaly AKI: edema, proteinuria, hematuria
34
How to investigate hemolytic uremic syndrome?
Blood: CBC, PBS, LRFT, clotting, culture CT brain Workup for pneumonia: sputum, CXR
35
How to manage hemolytic uremic syndrome?
``` PICU Supportive - Blood products: packed RC, plt - Hypovolemia: fluid resuscitation - AKI: monitor RFT, fluid & electrolytes, RRT - Seizure: phenytoin, diazepam ABX for atypical: 3G cephalosporin ```
36
What is the prognosis of hemolytic uremic syndrome?
95% survive acute phase, most resolve completely, 40% w/ irreversible kidney injury
37
What is acute kidney injury?
Abrupt deterioration in kidney function, potentially reversible High serum Cr: 26.5 micromol/L or 1.5X of baseline in 48hr Low UO: <0.5ml/kg/hr for 6h
38
What are the causes of acute kidney injury?
Pre-renal (MC): hypovolemia, hypotension, RAS Renal: vascular (vasculitis, RVT, thrombotic microangiopathy e.g. HUS, ITP), glomerular (GN), tubular & interstitial (ATN, drug, inf) Post-renal: posterior urethral valve, stone, clot
39
What are the sx of acute kidney injury?
Edema Low UO Gross hematuria HT
40
What PE would you perform for acute kidney injury?
Dehydration Edema & HT Rash Ballotable kidney
41
How to investigate acute kidney injury?
BP/P Urine: output, microscopy, biochemistry (Na & osmolality) Blood: RFT (high Cr, urea, K), Ca, metabolic acidosis, CBC, C3/4, ASOT Renal USG
42
How to manage acute kidney injury?
Monitor: BP, fluid balance, Ca, RFT, ABG, ECG Fluid: hypovolemic (fluid resuscitation), RF or HT (IV furosemide, low salt, fluid restriction) Electrolyte - Hyperkalemia: calcium gluconate (myocardium), sodium bicarbonate, glucose + insulin, IV salbutamol (ITC K shift), oral sodium polystyrene sulfonate (intestinal excretion) - Metabolic acidosis: sodium bicarbonate - Hyperphosphatemia: calcium carbonate, diet restriction Nutrition (high calories) RRT (e.g. HD, PD)
43
What are the indications of RRT for acute kidney injury?
Refractory electrolyte disturbance, severe fluid overload, symptomatic azotemia (lethargy, neuro sx), affect nutritional support
44
What is the prognosis of acute kidney injury?
Risk of progression to CKD -> req long term FU
45
What is acute nephritis?
Acute onset of hematuria, proteinuria, oliguria, edema, HT
46
What are the features & pathophysiology of acute nephritis?
Glomerular leak -> hematuria, proteinuria Glomerular block (low GFR) -> oliguria, fluid retention Leak + block -> anemia Malaise, N/V, lumbar pain
47
How to investigate acute nephritis?
BP Blood: CBC, LRFT, CaPO4, ESR Urine: multistix, culture, microscopy, UPCR, timed urine Microbiology: ASOT, throat swab, HBsAg, anti-HCV AI markers: C3/C4, anti-dsDNA, ANA USG Renal biopsy
48
What are the indications of renal biopsy in acute nephritis?
Rapidly deteriorating RFT Atypical: x post-strep infection, systemic symptoms of SLE, nephrotic range proteinuria Delayed resolution: persistent sx, persistent low complement, persistent impaired RFT
49
What is an atypical UTI?
Abdominal mass, septicemia, non-E Coli organism, x respond to ABX within 48 hrs, impaired RFT
50
How to manage acute nephritis?
Monitoring: I/O, BP, RFT, proteinuria, C3/C4 Fluid: low salt, fluid restriction, anti-HT (nifedipine, furosemide) Electrolyte: correct hyperkalemia RRT
51
What are the causes of acute nephritis?
Inf: APSGN (85%) AI: IgA nephropathy
52
How to diagnose APSGN?
Recent strep infection: pharyngitis, skin, OM (2w ago) | Lab: low C3/C4, high ASOT / anti-DNAse B titre
53
How to manage APSGN?
x require ABX -> resolve spontaneously
54
What is IgA nephropathy?
Synpharyngitic hematuria: occurs during/shortly after URTI
55
What are the features of IgA nephropathy?
Wide range of presentation - Microscopic hematuria/proteinuria - Gross hematuria, AKI - Nephritic / nephrotic syndrome - Crescentic GN
56
How to diagnose IgA nephropathy?
Renal biopsy (immunostaining of IgA immune complex)
57
What is the prognosis of APSGN?
Good, resolve spontaneously, unlikely to recur
58
What is the prognosis of IgA nephropathy
Stable or slow progression to CKD -> long term monitoring

Paediatrics (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions