Renal

Question 1

what is the triad for nephrotic syndrome?

Answer 1

generalised oedema, heavy proteinuria (>200mg/mmol) and hypoalbuminaemia (<25g/L)

Question 2

what age is most affected by nephrotic syndrome?

Answer 2

4

Question 3

with what features during nephrotic syndrome would prompt for consideration for a renal biopsy ?

Answer 3

Age < 1 year or > 12 years
Hypertension
Impaired renal function
Frank haematuria
Steroid resistant nephrotic syndrome

Question 4

what are some DD for nephrotic syndrome?

Answer 4

heart failure
allergic reaction
malnutrition

Question 5

what investigations should be done for nephrotic syndrome,?

Answer 5

urine dip
urinary protein:creatinine ratio
urea & electrolytes
full blood count
serum albumin
varicella zoster serology

Question 6

what is the treatment for nephrotic syndrome?

Answer 6

high dose steroids
low salt diet
prophylactic antibiotics

Question 7

why would prophylactic antibiotics be given for nephrotic syndrome?

Answer 7

children with nephrotic syndrome leak immunoglobulins through their kidneys and are therefore at high risk of infection.

Question 8

what is the treatment for steroid resistant nephrotic syndrome?

Answer 8

low-dose maintenance steroid therapy or immunomodulatory drugs such as levamisole, cyclophosphamide, ciclosporin or tacrolimus.

Question 9

what are some complications of nephrotic syndrome?

Answer 9

intravascularly deplete (may require diuretics)

infection

Varicella zoster

thrombosis (PE, mesenteric ischaemia)

Question 10

A patient on high dose steroids who develops chicken pox may need what treatment?

Answer 10

VZV immunoglobulin

Question 11

state three species that can cause UTIs?

Answer 11

E.Coli (about 85% or more), Klebsiella species and Staphylococcus saprophyticus

Question 12

what are some risk factors for UTIs in children?

Answer 12

<1yr 
female 
caucasian 
voiding dysfunction 
vesicoureteral reflex 
sexual abuse 
spinal abnormalities 
constipation 
immunosuppression

Question 13

what symptoms of UTI may an infant have?

Answer 13

Vomiting
Fever
Lethargy
Poor feeding
Failure to thrive

Question 14

What are DD for UTIs?

Answer 14

vulvovaginitis 
kawasaki disease 
voiding dysfunction 
sepsis 
threadworms 
meningitis

Question 15

when should a DMSA and MCUG be done in a child if <6months?

Answer 15

for atypical or recurrent infections

Question 16

if a UTI responds within 48hrs of antibiotics should an urgent US be done if <6months?

Answer 16

no

Question 17

if a UTI responds within 48hrs of antibiotics when should an US be done if <6months?

Answer 17

after 6 weeks

Question 18

should MCUG be done if child is >6months

Answer 18

no

Question 19

if a child is >6months in what circumstance should a follow up US be done?

Answer 19

if recurrent infections

Question 20

what are some atypical UTI features ?

Answer 20

Poor urine flow
Abdominal or bladder mass
Raised creatinine
Sepsis
Failure to respond to treatment within 48 hours
Non-E.Coli organism

Question 21

what defines recurrent UTIs?

Answer 21

Two or more episodes of upper UTI (pyelonephritis)

One episode of upper UTI and one episode of lower UTI

Three episodes of lower UTI

Question 22

what is the gold standard investigation for reflux?

Answer 22

Micturating cystography

- however is invasive and require catheterisation

Question 23

what is DMSA Scintigraphy used to detect?

Answer 23

gold standard for detecting renal parenchyma defects and scarring