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Renal Flashcards

1
Q

Cystitis

A

Bladder and urethra infection (lower urinary tract)

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2
Q

Pyelonephritis

A

Renal pelvis and kidney infection (upper urinary tract)

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3
Q

Important things which UTI in kids may indicate

A

Structural abnormality in UT.

Can lead to scarring, predisposing kids to HTN, impaired GFR and renal failure.

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4
Q

Symptoms indicating pyelonephritis

A 
HIGH GRADE Fever
Bacteriuria
Systemically unwell - maliase
Septicaemia illness
Vomiting
Loin/abdo pain in older children
Jaundice and failure to thrive in infants
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5
Q

Clinical features of a UTI in infants

A 
Lethargy
Vomiting
Poor feeding
Failure to thrive
Irritability
Jaundice
Offensive urine
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6
Q

Clinical features of a UTI in children

A 
Dysuria
Frequency
Abdo or loin pain
Cloudy urine or haematuria
Lethargy
Vomiting
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7
Q

Microscopy of UTI

A

Bacteriuria and pyuria (bacteria and pus in urine)

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8
Q

Investigations for UTI

A

Urine dip = WCC and nitrates +
Clean voided urine sample MSC or suprapublic aspiration.
USS if 1st incidence of a UTI for structural abnormality
Micturating cystourethrography for vesicoureteral reflex
DMSA scan for renal scarring
More thorough Ix if under 6months.

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9
Q

Ix for vesicoureteric reflex

A

Micturating cystourethrogram

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10
Q

Thorough Ix for under 6months babies or recurrent UTI

A

USS
Micturating cystourethrography
DMSA scan

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11
Q

Rx for cystitis

A 
If under 3months = amoxicillin and gentamicin.
3m-15yrs = Trimethoprim PO .
Good fluid intake.
Avoid constipation.
Clean perineum front to back.
Complete voiding.
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12
Q

Rx for pyelonephritis

A

If under 3months refer to specialist care.
3m-15yrs = oral trimethoprim plus gentamicin if v ill.
Good fluid intake.
Avoid constipation.
Clean perineum front to back.
Complete voiding.

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13
Q

Rx for UTI in <3months

A

IV amoxicillin and gentamicin.

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14
Q

Physiology causes of increased interstitial fluid

A

Inadequate lymph drainage (lymphoedema)
Poor venous drainage or increased venous pressure (VTE)
Low oncotic pressure from low proteins e.g. albumin (nephrotic syndrome)
Salt and water retention (Heart failure)

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15
Q

Triad of features in nephrotic syndrome

A

Heavy proteinuria (3+ on dip)
Hypoalbuminemia (<25g/l)
Oedema

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16
Q

Blood results of nephrotic syndrome and where is the oedema?

A

Hypoalbuminaemia
Hyperlipidaemia
Low Calcium
Periorbital oedema, worse in morning.

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17
Q

Types of nephrotic syndrome

A

Congenital
Steroid sensitive
Steroid resistant

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18
Q

Features indicating a steroid sensitive nephrotic syndrome

A

Normal BP
No macroscopic haematuria
Normal renal function
Responds to steroid Rx
Mostly Minimal change disorder on histology.
Patient likely to be: male, 2-5yrs, Asian.

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19
Q

Features suggestive of steroid resistant nephrotic syndrome

A 
High BP
Haematuria
Impaired renal function
May have features of nephritis
Unresponsive to steroids
Underlying pathologies on histology e.g. glomerulonephritis.
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20
Q

Rx of steroid sensitive nephrotic syndrome

A

Prednisolone with tapering dose after 4weeks.

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21
Q

Rx for steroid resistant nephrotic syndrome

A

Diuretic, ACEi (Enalapril), salt restriction and fluid balance.

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22
Q

Causes of proteinuria in children

A 
Minimal change disease
Glomerulonephritis
HTN
Basement membrane abnormaility
SLE
Poor DM control
23
Q

Causes of haematuria in children

A 
Infective endocarditis
Acute glomerulonephritis
IgA nephropathy
Thin basement membrane disease
Henoch-Schonlein purpura.
24
Q

Acute glomerulonephritis clinical features

A 
Symptoms = Oedema - periorbital, loin pain, fever, Oliguria/decreased urine output
Signs = oliguria, haematuria, HTN.
Urine = Macroscopic haematuria, RED CELL CASTS, Proteinuria
Bloods = Impaired GFR, Uraemia
25
Features of uraemia
Twitching, acidosis, stupor, coma
26
Rx of acute glomerulonephritis
Fluid and electrolyte balance.
27
Infection which can cause post-infection glomerulonephritis
Group A beta-haemolytic streptococcus. | 10days after strep infection e.g. pharyngitis or impetigo
28
Urine with post-strep glomerulonephritis
Cola colour/brown. | Haematuria
29
Bloods with post-strep glomerulonephritis
``` High urea (acidosis) High creatinine Low complement 3 Anaemia Raised ASO/anti-DNAase B titres ```
30
Symptoms and signs in post-strep glomerulonephritis
``` Oliguria Oedema HTN Malaise Fever Abdo pain Anorexia ```
31
Rx for post-strep glomerulonephritis
Fluid and electrolyte balance Diuretics Penicillin
32
Male, a week ago had URTI now has purple rash on buttocks and extensors of arms and legs, pain around ankles, abdo pain =
Henoch-Schonlein purpura vasculitis
33
Clinical features of Henoch-Schonlein purpura
Blanching purpura rash on buttocks and extensors of arms and legs. Arthritis/arthralgia Abdo pain - can become intussusception Haematuria, proteinuria & glomerulonephritis Scrotal oedema Fever Raised IgA
34
Bloods for Henoch-Shonlein and other Ix
Raised ESR Raised IgA High ASO titres Urine dip
35
Rx for Henoch-Shonlein purpura
Analgesia | Prednisolone
36
Complications of Henoch-schonlein purpura
Chronic renal failure | GI bleed
37
Vesicoureteric reflux
Water can flow back from bladder, up ureter and into kidneys. Ureters become distended. Cause recurrent UTI
38
Renal pathology causing oligohydramnios in utero and syndrome which ensues in life
Bilateral renal agenesis | Potter Syndrome = low set ears, beak nose, epicanthic folds, downward slant eyes.
39
Management of nocturnal enuresis
Decrease fluid intake Toilet behaviour Reward system Drugs = desmopressin
40
Girl, Asian, face rash on sunlight exposure, proteinuria, haematuria, oral ulcers, pleuritic pain, pericarditis.
SLE | Rash = malar/butterfly rash on face and discoid rash rare in children.
41
Haematuria, proteinuria, eye abnormalities, hearing loss
Alport syndrome
42
Nephrotic syndrome hallmark features
Hypoalbuminemia Proteinuria (>3.5g in 24hrs/3+) Oedema Hyperlipidaemia
43
Nephritic syndrome hallmark features
Haematuria (3+, red cell casts) Proteinuria (2+) HTN Olioguria (<300ml/24hrs)
44
Pre-renal causes of AKI
Gastroenteritis Sepsis Haemorrhage
45
Renal causes of AKI
Haemolytic uraemic syndrome Vasculitis = SLE, Henoch-Schenloin purpura Glomerulonephritis Pyelonephritis
46
Post renal causes of AKI
Urinary catheter blockage | Congenital obstruction e.g. valves.
47
Renal failure bloods
``` Metabolic acidosis - give sodium bicarbonate Hyperphosphateamia Hyperkalaemia High creatinine Low sodium and low chloride ```
48
Triad of haemolytic uraemic syndrome
Acute renal failure Haemolytic anaemia Thrombocytopenia
49
Cause of haemolytic uraemic syndrome
E.coli O157H7 - from cattle
50
Symptoms and signs in haemolytic uraemic syndrome
``` Diarrhoea, may be bloody. Afebrile. Abdo pain N+V Proteinuria, haematuria Confusion Oedema ```
51
Investigations for haemolytic uraemic syndrome
High lactate dehydrogenase from destroyed RBC. FBC = High WCC, anaemia. LFT = High creatinine
52
Mx of haemolytic uraemic syndrome
IV isotonic crystalloids Blood transfusion Dialyisis Renal transplant
53
Most common UTI organism
E.coli
54
Treatment for hypertensive emergency
Sodium nitroprusside

Paediatrics (16 decks)

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