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Paediatrics > Renal > Flashcards

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
Q

Features of uraemia

A

Twitching, acidosis, stupor, coma

26
Q

Rx of acute glomerulonephritis

A

Fluid and electrolyte balance.

27
Q

Infection which can cause post-infection glomerulonephritis

A

Group A beta-haemolytic streptococcus.

10days after strep infection e.g. pharyngitis or impetigo

28
Q

Urine with post-strep glomerulonephritis

A

Cola colour/brown.

Haematuria

29
Q

Bloods with post-strep glomerulonephritis

A 
High urea (acidosis)
High creatinine
Low complement 3
Anaemia
Raised ASO/anti-DNAase B titres
30
Q

Symptoms and signs in post-strep glomerulonephritis

A 
Oliguria
Oedema
HTN
Malaise
Fever
Abdo pain
Anorexia
31
Q

Rx for post-strep glomerulonephritis

A

Fluid and electrolyte balance
Diuretics
Penicillin

32
Q

Male, a week ago had URTI now has purple rash on buttocks and extensors of arms and legs, pain around ankles, abdo pain =

A

Henoch-Schonlein purpura vasculitis

33
Q

Clinical features of Henoch-Schonlein purpura

A

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
Q

Bloods for Henoch-Shonlein and other Ix

A

Raised ESR
Raised IgA
High ASO titres
Urine dip

35
Q

Rx for Henoch-Shonlein purpura

A

Analgesia

Prednisolone

36
Q

Complications of Henoch-schonlein purpura

A

Chronic renal failure

GI bleed

37
Q

Vesicoureteric reflux

A

Water can flow back from bladder, up ureter and into kidneys. Ureters become distended. Cause recurrent UTI

38
Q

Renal pathology causing oligohydramnios in utero and syndrome which ensues in life

A

Bilateral renal agenesis

Potter Syndrome = low set ears, beak nose, epicanthic folds, downward slant eyes.

39
Q

Management of nocturnal enuresis

A

Decrease fluid intake
Toilet behaviour
Reward system
Drugs = desmopressin

40
Q

Girl, Asian, face rash on sunlight exposure, proteinuria, haematuria, oral ulcers, pleuritic pain, pericarditis.

A

SLE

Rash = malar/butterfly rash on face and discoid rash rare in children.

41
Q

Haematuria, proteinuria, eye abnormalities, hearing loss

A

Alport syndrome

42
Q

Nephrotic syndrome hallmark features

A

Hypoalbuminemia
Proteinuria (>3.5g in 24hrs/3+)
Oedema
Hyperlipidaemia

43
Q

Nephritic syndrome hallmark features

A

Haematuria (3+, red cell casts)
Proteinuria (2+)
HTN
Olioguria (<300ml/24hrs)

44
Q

Pre-renal causes of AKI

A

Gastroenteritis
Sepsis
Haemorrhage

45
Q

Renal causes of AKI

A

Haemolytic uraemic syndrome
Vasculitis = SLE, Henoch-Schenloin purpura
Glomerulonephritis
Pyelonephritis

46
Q

Post renal causes of AKI

A

Urinary catheter blockage

Congenital obstruction e.g. valves.

47
Q

Renal failure bloods

A 
Metabolic acidosis - give sodium bicarbonate
Hyperphosphateamia
Hyperkalaemia
High creatinine
Low sodium and low chloride
48
Q

Triad of haemolytic uraemic syndrome

A

Acute renal failure
Haemolytic anaemia
Thrombocytopenia

49
Q

Cause of haemolytic uraemic syndrome

A

E.coli O157H7 - from cattle

50
Q

Symptoms and signs in haemolytic uraemic syndrome

A 
Diarrhoea, may be bloody.
Afebrile.
Abdo pain
N+V
Proteinuria, haematuria
Confusion
Oedema
51
Q

Investigations for haemolytic uraemic syndrome

A

High lactate dehydrogenase from destroyed RBC.
FBC = High WCC, anaemia.
LFT = High creatinine

52
Q

Mx of haemolytic uraemic syndrome

A

IV isotonic crystalloids
Blood transfusion
Dialyisis
Renal transplant

53
Q

Most common UTI organism

54
Q

Treatment for hypertensive emergency

A

Sodium nitroprusside

Paediatrics (16 decks)

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