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Phase 3a - Paediatrics > Renal > Flashcards

Renal Flashcards

1
Q

What are two signs that a patient may be suffering from acute pyelonephritis?

A
  • Temperature >38C
  • Loin pain or tenderness
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2
Q

A young brother and sister both present with dysuria alone, consider what may be the diagnoses for each?

A

Girl - cystitis, vulvitis
Boy - balantitis

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3
Q

A baby is suffering for a fever. They are vomiting not feeding well. Their skin appears slightly yellow and their urine smells funny. What may they be suffering from and name some causative organisms?

A

UTI:
- E.coli
- Klebsiella
- Proteus
- Pseudomonas
- Strep faecalis

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4
Q

A child has been diagnosed with a UTI. Compared to an infant who will present with non-specific symptoms such as a fever, what may an older child complain of in addition?

A
  • Dysuria
  • Frequency of urination
  • Loin pain
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5
Q

What do nitrites in urine indicate?

A
  • Nitrites: gram negative bacteria breaking down nitrates to nitrites
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5
Q

Considering the presence of nitrites and leukocytes in a clean catch urine sample, what may point towards a UTI?

A
  • Nitrites and leukocytes –> Tx as UTI
  • Nitrites only –> Tx as UTI
  • Leukocytes only –> only Tx as UTI if clinical evidence that it’s one
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5
Q

What do leukocytes in urine suggest?

A

If significant increase then suggests infection or cause of inflammation

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6
Q

What is vesico-ureteric reflex (VUR)?

A

Tendency of urine to flow from bladder to ureters

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6
Q

Alongside antibiotics what investigative method should be carried out for children with a suspected UTI?

A

Ultrasound of the kidneys and urinary tract

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6
Q

What are typical antibiotics for a UTI?

A

Ceftriaxone, trimethoprim, cefalexin, amoxicillin
(Nitrofurantoin given in older child)

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7
Q

What is a patient with vesico-ureteric reflex (VUR) predisposed to?

A

Upper UTI and subsequent renal scarring

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8
Q

How is vesico-ureteric reflex diagnosed?

A

Micturating cystourethrogram (MCUG)

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9
Q

What is the management of vesico-ureteric reflex (VUR)?

A

Avoid constipation or excessively full bladder. Prophylactic abx.

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10
Q

What level of single organism is required in a clean catch urine sample for diagnosis of UTI?

A

> 10^5/ml single organism

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11
Q

What factors can predispose a child to a UTI?

A

Incomplete bladder emptying
Constipation
Vesicoureteric reflex

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12
Q

Nocturnal enuresis is more common in which sex?

A

Boys in a 2:1 ratio tend to grow out of it.

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13
Q

What are two non-organic causes of nocturnal enuresis?

A
  • Emotional stress
  • Lack of parental approval facilitating learnt nigh-time continence
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14
Q

What are organic causes of nocturnal enuresis?

A
  1. UTI
  2. Faecal retention severe enough to reduce bladder volume and cause bladder neck dysfunction
  3. Polyuria from osmotic diuresis
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15
Q

What is a medication that can be given to children suffering from nocturnal enuresis?

A

Desmopressin

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16
Q

What is desmopressin?

A

ADH analogue, achieving suppressant effect as opposed to a lasting one.

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17
Q

When a child is suffering from nocturnal enuresis, what is important to be carried out to rule out…?

A

Urine sample for glucose and protein to rule out infection

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18
Q

What is neuropathic bladder and what is it associated with in young children?

A

Enlarged bladder that fails to empty properly with an irregular thick wall - associated with daytime enuresis (caused by spina bifida and neuro conditions)

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19
Q

What are some causes of daytime enuresis?

A
  • Lack of attention to bladder sensation
  • Detrusor instability
  • Bladder neck weakness
  • Neuropathic bladder
  • UTI, constipation
  • Ectopic ureter (dribbling, child always damp)
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20
Q

What levels of spinal lesion should be checked to determine a possible cause of daytime enuresis?

A

S2, S3, S4 dermatomes

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21
Q

What are potential signs that a patient may have a neuropathic bladder?

A

Bladder found distended, abnormal perineal sensation and anal tone, abnormal leg reflexes and gait.

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22
Q

What management options may be used for daytime enuresis?

A
  • Star charts, bladder training, pelvic floor exercises
  • Portable alarm activated by wee
  • Anticholinergic drugs e.g. oxybutynin
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23
Q

What may cause daytime enuresis relapse?

A
  • Emotional upset (most common)
  • UTI
  • Polyuria from osmotic diuresis in diabetes mellitus or renal concentrating disease
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24
Q

What is the pathophysiological mechanism that causes nephrotic syndrome?

A

Basement membrane in the glomerulus becomes highly permeable to protein
–> proteins leak from blood into the urine

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25
Q

What is the classic triad of nephrotic syndrome?

A
  1. Low serum albumin
  2. High urine protein content (>3+ protein on urine dipstick)
  3. Oedema
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26
Q

A 4 year old presents with frothy urine, generalized oedema and pallor with breathlessness due to pleural effusion and abdominal distension. Dx?

A

Nephrotic syndrome

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27
Q

What is the commonest cause of nephrotic syndrome in children?

A

Minimal change disease

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28
Q

What is present on renal biopsy and standard microscopy for minimal change disease?

A

Normal

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29
Q

What is present on urinalysis for minimal change disease?

A

Small molecular weight proteins and hyaline casts

30
Q

What is the management for minimal change disease?

A

Corticosteroids (e.g. prednisolone)

31
Q

Nephrotic disease is secondary to causes that include?

A

Intrinsic kidney disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis)
Underling systemic illness (HSP, diabetes, infection e.g. HIV, hepatitis, malaria)

32
Q

What is the management medical options for nephrotic disease?

A
  • Prednisolone (high dose steroid)
  • Low salt diet
  • Diuretics to treat oedema
  • Prophylactic antibiotics if severe
33
Q

What is the steroid course of treatment for nephrotic syndrome?

A

High dose for 4 weeks then wean for 8 weeks

34
Q

What should be given in conjunction should patients be receiving steroid therapy for nephrotic syndrome?

A

Cyclosporine, tacrolimus, rituximab (ACEi and immunosuppressants)

35
Q

What are potential complications of nephrotic syndrome?

A
  1. Hypovolemia
  2. Thrombosis
  3. Infection
  4. Acute or chronic renal failure
  5. Relapse
36
Q

Why is hypovolemia a complication of nephrotic syndrome?

A

Fluid leaks from intravascular space to interstitial space causing oedema and low blood pressure

37
Q

Why does nephrotic syndrome have thrombosis as a complication?

A

Proteins which prevent blood clotting are lost in the kidneys

38
Q

Why can infection result from nephrotic syndrome?

A

Kidney leaks immunoglobulins weakening the capacity of the immune system to respond to infection.
This is combined with steroid which will further weaken the immune system

39
Q

What is the inheritance pattern of congenital nephrotic syndrome?

A

Recessive inheritance - common in consanguineous families

40
Q

What is the management of congenital nephrotic syndrome?

A

Unilateral nephrectomy followed by dialysis (if renal failure) - until old enough for renal transplantation

41
Q

What is nephritis?

A

Inflammation within nephrons of the kidneys

42
Q

What does nephritis cause (consider triad)?

A
  1. Reduced kidney function
  2. Haematuria (visible or invisible amounts of blood in the urine)
  3. Proteinuria
43
Q

A patient suffered tonsillitis confirmed to be caused by streptococcus pyogenes 20 days ago. They are now suffering from haematuria and have confirmed proteinuria. What is the possible diagnosis?

A

Post-streptococcal glomerulonephritis

44
Q

What is the pathophysiology of post-streptococcal glomerulonephritis?

A

Immune complexes stuck in glomeruli of kidney cause acute deterioration of renal function and therefore AKI

45
Q

What are the components of the immune complex in post-streptococcal glomerulonephritis?

A

Streptococcal antigens
Antibodies
Complement proteins

46
Q

What is the management of post-streptococcal glomerulonephritis?

A

Supportive - 80% recover with potential progressive deterioration of the renal function possible leading to HTN + oedema
Tx: antihypertensive meds, diuretics

47
Q

IgA nephropathy (Berger’s disease) pathophysiology?

A

Related to HSP; IgA deposits in the nephrons of the kidney causing inflammation

48
Q

What will be seen on renal biopsy in a patient with IgA nephropathy?

A

IgA deposits and glomerular mesangial proliferation

49
Q

What is the management for IgA nephropathy?

A

Supportive of renal failure
Immunosuppressant medication e.g. steroids, cyclophosphamide to slow disease progression

50
Q

What is Henoch-Scholein Purpura preceded by?

A

URTI or gastroenteritis

51
Q

What is the pathophysiology of HSP?

A

IgA and IgG interact to produce complexes activating complement and deposited in affected organs precipitating inflammatory response to vasculitis

52
Q

What is the management for HSP?

A

Supportive and monitor (urine dip and BP)

53
Q

What are the clinical findings of HSP?

A
  • Fever, joint pain, swelling
  • Rash (symmetrical; buttocks, arms, ankles, legs)
  • Periarticular oedema
  • Colicky abdominal pain
  • Renal involvement with haematuria and proteinuria
54
Q

What can treat the abdominal pain associated with HSP?

A

Corticosteroids

55
Q

What is the genetic inheritance pattern of Alport Syndrome?

A

X-linked recessive disorder

56
Q

Alport syndrome is associated with?

A

Nerve deafness and ocular defects
Progresses to end-stage renal failure by early adult life in males

57
Q

What is the management of nephritis?

A
  • Fluid and electrolyte balance
  • Diuretics
  • Monitor for rapid deterioration in renal function
58
Q

What is the commonest cause of AKI in children (think pre, renal, post)?

A

Prerenal
- Hypovolemia (gastroenteritis, burns, sepsis, haemorrhage, nephrotic syndrome)
- Circulatory failure

59
Q

What is the management of pre-renal failure (to prevent what)?

A

Prevent acute tubular necrosis
- Treat hypovolemia with fluid replacement and circulatory support

60
Q

How to treat metabolic acidosis in renal failure?

A

Sodium bicarbonate

61
Q

What are three complications of renal failure (intrarenal) causing AKI?

A
  1. Metabolic acidosis
  2. Hyperphosphatemia
  3. Hyperkalemia
62
Q

What is the treatment for hyperphosphatemia as a complication of AKI?

A

Calcium carbonate
Dietary restriction

63
Q

What is a treatment of hyperkalemia?

A

CALCIUM GLUCONATE (if ECG change)
Nebulised or IV salbutamol
Glucose and insulin, dietary restriction
Dialysis

64
Q

What is the classic triad of haemolytic uraemic syndrome?

A
  1. Haemolytic anaemia
  2. AKI
  3. Thrombocytopenia
65
Q

What is haemolytic uraemic syndrome?

A

Thrombosis within the small blood vessels throughout the body

66
Q

What triggers haemolytic uraemic syndrome?

A

Shiga toxin most commonly E.coli 0157 (shigella also)

67
Q

How will a patient suffering for haemolytic uraemic syndrome tend to present?

A

Brief gastroenteritis with bloody diarrhoea followed by symptoms ~5 days later:
- Haematuria or dark brown urine
- Lethargy, irritability
- Confusion
- Oedema
- HTN
- Bruise
- Reduced urine output, abdominal pain

68
Q

A patient has suffered acute gastroenteritis 5 days ago, they are now suffering from AKI symptoms and have been found to have haemolytic anaemia and thrombocytopenia on blood test. What is the possible diagnosis?

A

Haemolytic uraemic syndrome

69
Q

What is the management of haemolytic uraemic syndrome?

A

Renal dialysis, antihypertensive, blood transfusion with careful management of fluid balance
Note: tends to be self-limiting and only support is supportive

70
Q

Is chronic kidney disease common?

A

Rare

71
Q

What is the ultimate aim of management for chronic kidney disease in children?

A

Prevent symptoms and metabolic abnormalities of chronic renal failure to facilitate normal growth and development whilst preserving renal function
(consider multifaceted nature)

72
Q

Give examples of what may be done to support a patient in managing their chronic kidney disease?

A

Diet
- Supplement calories
- Sufficient protein intake

Prevent renal osteodystrophy
- Phosphate restriction

Control salt and water balance and acidosis

Anaemia - give recombinant human EPO

Hormonal abnormalities
- Recombinant human GH as often delayed puberty

Dialysis and transplantation - need to give immunosuppression with combination of pred, tacrolimus, AZA, MMF

73
Q

What is hypospadias?

A

Urethral meatus abnormally displaced to the ventral side (towards scrotum) in lads

74
Q

What is epispadias?

A

Meatus displace to dorsal side of penis

75
Q

Chordee?

A

Head of penis bent down

76
Q

What is the management of hypospadias in lads?

A

Surgery after 3-4 months of age to correct position and straighten penis

77
Q

Complications of hypospadias?

A
  • Difficulty directing urine
  • Cosmetic/psychological concerns
  • Sexual dysfunction

Phase 3a - Paediatrics (11 decks)

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