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Paediatrics > Renal > Flashcards

Renal Flashcards

1
Q

Features of Potter’s Syndrome

A 
Pulmonary Hypoplasia
Low set ears
Beaked Nose
Prominent epicanthic folds
Downwards slanting eyes
Limb Deformity
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2
Q

Mechanism of Multicystic Dysplastic Kidney

A

Failure of union of the uterine bud with nephrogenic mesenchyme

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3
Q

Management of Multicystic Dysplastic Kidney

A

50% involuted by aged 2

Nephrectomy indications: very large/ hypertension develops

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4
Q

Causes of large Cystic Kidneys

A

Autosomal recessive/dominant polycystic Kidney disease
Multicystic Dysplastic Kidney
Tuberous Sclerosis

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5
Q

Presentation of Autosomal dominant polycystic kidney disease

A

Childhood hypertension

Renal failure in adulthood

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6
Q

Extra Renal feature of Autosomal Dominant Polycystic Kidneys

A

Cysts in liver and pancreas
Cerebral Aneurysm
Mitral Valve prolapse

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7
Q

Abnormal Caudal migration of the kidneys results in…

A

Horseshoe kidney or pelvic kidney

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8
Q

Duplex System is due to?

A

Premature division of the uterine bud

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9
Q

Complications of duplex system

A

Lower pole moiety- Reflux

Upper pole moiety- Ectopic drainage to urethra or vagina, prolapse into bladder, obstruction urging flow

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10
Q

Features of Absent Musculature Syndrome (Prune Belly)

A

Wrinkled appearance of abdomen
Large Bladder
Dilated Ureters
Crytorchidism

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11
Q

Site of urinary tract obstruction

A

Pelviuretric Junction
Vesicoureteric Junction
Bladder Neck
Urethra

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12
Q

Features of bilateral hydronehritis

A

Hydronephrosis
Hydroureters
Thickened bladder wall
Diverticula

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13
Q

Management of urinary tract anomalies

A

Start prophylactic antibiotics
US within 24hours, in males with bilateral hydronephrosis
-Normal: US repeat at 2-3 months, stop Abx
-Abnormal: MCUG and surgery
US within 4-6 weeks, in females or unilateral hydronephrosis
- Normal: US repeat at 2-3 months, stop Abx
-Abnormal: Further Ix

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14
Q

Renal Function Assessment in children

A 
Plasma creatinine concentration: 
eGFR
Insulin/EDTA GFR
Creatinine Clearance
Plasma Urea Concnetration
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15
Q

Radiological Investigation of Kidneys and Urinary Tract

A

Ultrasound: anatomy
DMSA scan: renal scarring (2 months after UTI- sensitive)
MCUG: detects reflux and urethral obstruction
MAG3 renogram (Children over 4 years): detects reflux, given with furosemide
Plain abdominal X-ray: spinal abnormalities

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16
Q

Features of UTI in infants

A 
Offensive Urine
Septicaemia
Jaundice
Poor Feeding
Lethargy
Irritability
Vomitting
Fever
Febrile siezure
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17
Q

Features of UTI in children

A 
Secondary Enuresis
Dysuria
Frequency
Urgency
Abdominal Pain
Loin Tenderness
Fever
Anorexia
Lethargy
Vommitting and Diarrhoea
Haematuria
Cloudy Urine
Febrile Seizure
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18
Q

dDx Dysuria

A

Girls- Cystitis or Vulvitis

Boys- Balanitis (Uncircumcised)

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19
Q

Collection of Urine Samples

A 
Clean catch sample (recommended method)
Adhesive plastic bag
Urethral catheter
Suprapubic aspiration (fine needle inserted above pubic symphysis under US guidance)
Midstream sample- Older children
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20
Q

Dipstick Interpretation

A

Nitrate- positive indicates UTI
Leukocyte- present in fever without UTI, balanitis, and cystitis
Blood/Protein/Glucose- not UTI specific

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21
Q

Predisposing factors UTI

A

Renal or urinary tract abnormality
Incomplete Bladder emptying
Vesicoureteric reflux

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22
Q

Incomplete bladder emptying factors

A 
Infrequent voiding
Vulvitis
Incomplete micturition 
Obstruction from constipation
Neuropathic bladder
Vesicoureteric reflux
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23
Q

Anatomy of vesicoureteric reflux

A

Anomaly of vesicoureteric junctions
Ureters displaced laterally
Ureters enter bladder directly
Shorted or absent intramural course

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24
Q

Complications of vesicoureteric reflux

A

Incomplete Bladder emptying
Increased risk of infection
Risk of pyelonephritis
Renal damage due to pressure transmission

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25
Q

Features Atypical UTIs

A 
Seriously ill or septicaemia
Poor urine flow
Abdominal or Bladder Mass
Raised Creatinine
Failure to respond to Abx within 48hrs
Non-E.coli organism
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26
Q

Mx UTI Infants <3 months

A

Immediate referral to hospital
IV Abx .e.g. Co-amoxiclav for 5-7 days
Oral prophylaxis

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27
Q

Mx Pyelonephritis Children >3m

A

Oral Abx .e.g. Trimethoprim 7days

OR IV Abx .e.g. Co-amoxiclav 2-4 days + oral (total course 7days)

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28
Q

Mx Simple UTI Child >3m

A

Oral Abx .e.g. Trimethoprim or Nitrofurantoin 3 days

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29
Q

Prevention of UTIs

A 
High fluid intake
Regular voiding
Complete bladder emptying- sitting on toilet/double voiding
Treatment of constipation 
Good Perineal hygiene
Lactobacillus Acidophilus (pro-biotic)
Antibiotic prophylaxis
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30
Q

UTI Abx prophylaxis

A

Children <2-3years with congenital abnormality/upper UTI/reflux
Continue until out of nappies
Trimethoprim 2mg/Kg NOCHE

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31
Q

Follow-up recurrent UTIs, reflux and scarring

A

Urine dipstick in any non-specific infection
Long term low dose Abx prophylaxis
Circumcision in boys
Anti-VUR surgery in progressive scarring
Annual blood pressure in renal defects
Urinalysis to check proteinuria (CKD)
Regular assessment renal growth and function

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32
Q

Causes of daytime enuresis

A 
Lack of attention to bladder sensation 
Detrusor instability
Bladder neck weakness
Neuropathic bladder
UTI/Diabetes
Constipation
Ectopic ureter
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33
Q

Signs of neuropathic bladder

A 
Distended bladder
Abnormal perineal sensation
Abnormal anal tone
Abnormal leg reflexes and gait
Sensory loss in S2-S4
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34
Q

Typical Hx of ectopic ureter

A

Girls who are dry by day but with wetting on morning waking

Pooling of urine from vaginal ureter opening

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35
Q

Ix for daytime enuresis

A 
Urine dipstick, and MCS
US- ?incomplete bladder emptying and thickening of bladder wall
Urodynamics
X-ray- ?vertebral abnormality
MRI- ?cord tethering
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36
Q

Mx daytime enuresis

A 
Star charts
Bladder training
Pelvic floor exercises
Constipation treatment
Urine alarm
Anticholinergics .e.g. Oxybutynin
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37
Q

Causes secondary enuresis

A

Emotional upset (most common)
UTI
Diabetes (osmotic diuresis)
Renal concentrating disorder .e.g. Sickle cell, CKD, DI

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38
Q

Ix secondary enuresis

A

UDS- infection, glycosaria, proteinuria
Early morning osmalality
Formal water deprivation test
US renal tract

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39
Q

Physiological proteinuria

A

Febrile illnesses

After exercise

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40
Q

Normal protein:creatinine

A

<20mg/mmol early morning sample

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41
Q

Causes of proteinuria

A 
Orthostatic proteinuria
Glomerular abnormality:
-Minimal change disease
-Glomerulonephritis
-Abnormal glomerular basement membrane
Increased glomerular filtration pressure
Reduced renal mass in CKD
Hypertension
Tubular proteinuria
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42
Q

Features of nephrotic syndrome

A

Periorbital odema esp. on waking
Scrotal, vulva, leg, ankle odema
Ascites
Breathlessness: abdominal distension and pleural effusion
Infection .e.g. Peritonitis, septic arthritis, sepsis (loss of Ig)

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43
Q

Systemic disease associated with nephrotic syndrome

A

HSP
Vasculitides .e.g SLE
Infection .e.g. malaria
Allergens .e.g. bee sting

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44
Q

Epidemiology steroid sensitive nephrotic syndrome

A

Age 1-10 years
More common in boys
Asian children
Associated with atopy

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45
Q

Biochemistry steroid sensitive nephrotic syndrome

A

No macroscopic haematuria
Normal BP
Normal complement levels
Normal renal function

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46
Q

Management steroid sensitive nephrotic syndrome

A

Oral corticosteroids .e.g. prednisolone 60mg/m^2 daily
Reduce dose to 40mg/m^2 after 4 weeks alternate days
Wean after 8 weeks

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47
Q

Histology steroid sensitive nephrotic syndrome

A

Normal on light microscopy
Electron microscopy- fusion of specialised epithelial cells investing glomerular capillaries
Minimal change disease

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48
Q

Complication of nephrotic syndrome

A

Hypovolaemia
Thrombosis
Infection
Hypercholestrolaemia

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49
Q

Mx hypovolaemia in nephrotic syndrome

A

IV 0.9% saline or 4.5% albumin solution

IV 20% albumin with furosemide if severe

50
Q

Complications of albumin

A

Precipitates pulmonary odema and hypertension from fluid overload

51
Q

Prognosis of nephrotic syndrome

A

1/3 resolve spontaneous
1/3 infrequent relapses
1/3 steroid dependant with frequent relapses
Identified by parents on urine testing

52
Q

Steroid sparing agents in relapsing nephrotic syndrome

A

Levamisole- immunomodulator
Cyclophosphamide- alkylating agents
Tacrolimus/cephalosporin A- calcineurin inhibitors
Mycophenolate mofetil- immunosuppressant
Rituximab- Anti B cell monoclonal antibody

53
Q

Mx steroid resistant nephrotic syndrome

A

Diuretic therapy
Salt restriction
Angiotensin-converting enzyme inhibitors
NSAIDs

54
Q

Epidemiology Congenital nephrotic syndrome

A 
Presents in first 3 months of life
RARE
Recessively inherited
Consanguinity and Finnish populations
High mortality
55
Q

Cx Congenital nephrotic syndrome

A

Hypoalbuminemia- high mortality

56
Q

Mx congenital nephrotic syndrome

A

Unilateral nephrectomy for albumin control

Dialysis for stage 5 CKD continued until transplant

57
Q

Ix nephrotic syndrome

A 
Urine protein
FBC and ESR
Urea, electrolytes, creatinine, albumin
Complement C3 and C4
Anti-streptolysin O or anti-DNAase B titres/throat swab
Urine MCS
Urinary sodium concentration
Hep B and hep C screening
Malaria screening (foreign travel)
58
Q

Steroid resistant nephrotic syndrome

A

Focal segmental glomerulosclerosis
Mesangiocapillary glomerulonephritis
Membranous nephropathy

59
Q

Focal segmental glomeruloscleosis features

A

Most common steroid resistant nephrotic syndrome
30% progress to renal failure
Mx: cyclophosphamide, cyclosporin, tacrolimus, rituximab
Recurrence post-transplant common

60
Q

Mesangiocapillary glomerulonephritis feature

A

More common in older children
Haematuria
Low complement level
Decline in renal function over years

61
Q

Membranous nephropathy

A

Associated with hep B and SLE

Usually remits spontaneously within 5 years

62
Q

Non glomerular causes of haematuria

A 
Infection
Trauma
Stones
Tumours
Sickle cell disease
Bleeding disorders
Renal vein thrombosis
Hypercalciuria
63
Q

Glomerular causes of haematuria

A 
Acute nephritis (with proteinuria)
Chronic glomerulonephritis
IgA nephropathy
Familial nephritis .e.g. Alport
Thin basement membrane
64
Q

Indications for renal biopsy in haematuria

A

Significant persistent proteinuria
Recurrent macroscopic haematuria
Renal function in abnormal
Abnormal complement levels

65
Q

Glomerular haematuria features

A

Brown urine
Deformed red cells
Casts
Associated with proteinuria

66
Q

Lower urinary tract haematuria features

A

Red urine
Occurs at beginning or end of urinary stream
Unusual in children

67
Q

Ix haematuria

A

Urine MCS
Protein and calcium excretion
Kidney and urinary tract US
Plasma urea, electrolytes, creatinine, calcium, phosphate, albumin
FBC, platelet, coagulation screen, sickle cell screen

68
Q

Ix Glomerula haematuria

A

ESR, complement levels, anti-DNA antibodies
Hep B and C screen
Throat swab and antitreptolysin O/anti-DNAase titres
Renal biopsy
Test mothers urine and hearing test (Alports)

69
Q

Causes of Acute nephritis

A

Post infectious .e.g. strep
Vasculitis .e.g. HSP, SLE, Wegners, polyarteritis nodose, microscopic polyarteritis
IgA nephropathy and mesangiocapillary glomerulonephritis
Antiglomerular basement membrane disease (Goodpastures)

70
Q

Acute nephritis presentation

A 
Decreased urine output
Volume overload
Hypertension- seizures
Periorbital odema
Haematuria
Proteinuria
71
Q

Post-strep nephritis features

A

Follows sore throat or skin infection
Raise strep titre or culture
Low C3 returning to normal after 3-4 weeks

72
Q

Henoch-Schonein Pupura Presentation

A 
Purpuric rash affecting extensor surfaces
Arthralgia
Periarticular oedema
Abdominal pain
Glomerulonephritis
Boys aged 3-10 years
73
Q

Henoch-Schonein Purpura Pathology

A

Genetic predisposition and antigen exposure

IgA and IgG complex activate complement and precipitate inflammation

74
Q

HSP Rash

A 
Symmetrical distribution
Buttocks, extensor surfaces of arms and legs
Ankles
Trunk sparing
Urticarial initially
Progression to maculopapular
Characteristically palpable
75
Q

HSP Arthralgia

A

Knees and Ankles

Periarticular oedema

76
Q

HSP Abdominal Pain

A

Colicky
Melaena and haematemesis
Mx: corticosteroids

77
Q

Cx Henoch Schonlein Purpura

A 
Interssusception
Ileus
Protein loosing eneteropathy
Orchitis
CNS involvement
78
Q

HSP Renal Involvement

A

Common

Haematuria +/- proteinuria

79
Q

Risk factors for CKD in HSP

A

Heavy proteinuria
Oedema
Hypertension
Deteriorating renal function

80
Q

IgA nephropathy presentation

A

Macroscopic haematuria
URTI
Treat as HSP

81
Q

Alport syndrome

A

X linked recessive condition
CKD by early adulthood
Neural deafness and ocular defects
Maternal haematuria

82
Q

Causes Hypertension

A 
Renal
Coarctation of the aorta
Catecholamine excess: pheochromocytoma/neuroblastoma
Endocrine
Essential hypertension
83
Q

Presentation hypertension

A 
Vomiting
Headaches
Facial palsy
Hypertensive retinopathy
Convulsions
Proteinuria
Faltering growth
Cardiac failure
Paroxysmal palpations/sweating (pheochromocytoma)
84
Q

Causes unilateral palpable kidneys

A 
Multicystic kidneys
Compensatory hypertrophy
Obstructed hydronephrosis
Renal tumour .e.g. Wilms
Renal vein thrombosis
85
Q

Causes bilateral palpable kidneys

A

Polycystic kidney disease
Tuberous sclerosis
Renal vein thrombosis

86
Q

Predisposing factors renal calculi

A

UTI esp. proteus
Structural anomalies of urinary tract
Metabolic abnormalities
Hypercalcaemia - calcium stones

87
Q

Presentation renal calculi

A 
Haematuria
Loin pain
Abdominal pain
UTI
Passage of a stone
88
Q

Mx renal calculi

A

Passage spontaneously
Lithotripsy
Surgical removal
High fluid intake

89
Q

Complication of furosemide therapy in neonates

A

Nephrocalcinosis

90
Q

Causes Fanconi syndrome- metabolic

A 
Cystinosis
Glycogen storage disorders
Lowe syndrome
Galactosaemia
Fructose intolerance
Tyrosinaemia
Wilson disease
91
Q

Causes Fanconi syndrome- acquired

A

Heavy metals
Drugs and toxins
Vitamin D deficiency

92
Q

Defition Fanconi Syndrome

A

Generalised proximal tubular dysfunction

93
Q

Presentation Fanconi Syndrome

A 
Polydipsia
Polyuria
Salt depletion
Dehydration 
Hypercalcaemic metabolic acidosis
Rickets
Poor/faltering growth
94
Q

Urinary electrolyte loss in Fanconi syndrome

A 
Amino acids
Glucose
Phosphate
Bicarbonate
Sodium
Calcium
Potassium
Magnesium
95
Q

Classification of AKI

A

Pre-renal
Renal: salt and water retention, blood/protiein/casts in urine
Post-renal: urinary obstruction

96
Q

Management of AKI

A

Monitoring of circulation and fluid balance

97
Q

Ix in AKI

A

US:

  • obstruction of urinary tract
  • small kidneys in CKD
  • large bright kidneys in CKD
98
Q

Pre-renal acute failure features

A

Hypovolaemia

Low secretion of sodium

99
Q

Cx Pre-renal Acute failure

A

Acute tubular injury and necrosis

100
Q

Features Acute Renal Failure

A

Circulatory overload

Most commonly HUS and acute tubular injury

101
Q

Causes of acute tubular injury

A

Cardiac surgery

Multisystem failure in ICU

102
Q

Mx Acute Renal failure

A

Restriction of fluid intake
High calorie, normal protein feed
Renal biopsy

103
Q

Causes of Pre-Renal AKI

A

Hypovolaemia

Circulatory failure

104
Q

Causes of Renal AKI

A

Vascular .e.g. HUS, vasculitis, emboli, renal vein thrombosis
Tubular: acute necrosis, ischaemia, toxic, obstructive
Glomerulonephritis
Interstitial nephritis
Pyelonephritis

105
Q

Causes of Post-renal AKI

A

Obstruction

106
Q

Dialysis indications in AKI

A 
Failure of conservative management
Hyperkalaemia
Severe hyper/hypo-natraemia
Pulmonary oedema
Severe hypertension
Severe metabolic acidosis
Multisystem failure
107
Q

Proximal tubule transport defects

A

Glycosuria- asymptomatic (glucose)
Cystinuria- renal calculi (cystine amino acids)
Vitamin D resistant rickets (phosphate)
Pseudohypoparathyroidism- obesity, depressed nasal bridge, short fingers (phosphate)
Hyperuricosuria- renal calculi (uric acid)
Renal tubular acidosis- metabolic acidosis, alkaline urine, faltering growth (bicarbonate)
Hypercalciuria- renal calculi (calcium)

108
Q

Bartter syndrome

A 
Chloride transporter defect
Loop of Henle
Hypokalaemic metabolic acidosis
Hypercalciuria
Normal bp
Raised renin
Polydipsia
Polyuria
Faltering Growth
109
Q

Nephrogenic Diabetes Insipidus

A

Polydipsia
Polyuria
Fever
Faltering growth

110
Q

Haemolytic Uraemic Syndrome Triad

A

Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

111
Q

Typical HUS features

A

Follows GI infection (verocytotoxin E.coli- farm animal or uncooked beef)
Diarrheal prodrome
Persistent proteinuria
Cx: htn and CKD

112
Q

Mx metabolic acidosis in renal failure

A

Sodium bicarbonate

113
Q

Mx hyperphosphataemia in renal failure

A

Calcium carbonate

Dietary restriction

114
Q

Mx hyperkalaemia in renal failure

A 
Calcium gluconate in ECG changes
Salbutamol (neb or IV)
Calcium exchange resin
Glucose and insulin
Dietary restriction
Dialysis
115
Q

Features Atypical HUS

A

No diarrheal prodrome
Frequent relapses
High risk htn and CKD

116
Q

Mx Atypical HUS

A

Eculizumab: Monoclonal anti-terminal complement antibody

Plasma exchange

117
Q

Features CKD

A 
Anorexia
Lethargy
Polydipsia
Polyuria
Faltering growth/growth failure
Bony deformity (renal osteodystrophy)
Hypertension
Acute-on-Chronic renal failure (dehydration/infection)
Proteinuria
Normochromic, normocytic anaemia
118
Q

Staging CKD

A 
I >90ml/min
II 60-90ml/min
III 30-60ml/min
IV 15-30 ml/min
V <15ml/min
119
Q

Mx CKD

A 
Calorie supplementation and NG feeds
Phosphate restriction
Calcium carbonate as phosphate binder
Vitamin D supplementation
Salt supplementation
Free access to water
Bicarbonate supplements
Recombinant human erythopoetin- subcut
Growth hormone supplementation
120
Q

Renal Transplant Criteria

A

Weight >10kg

Risk of renal vein thrombosis

121
Q

Immunosuppression with transplantation

A

Tacrolimus
Mycophenolate Mofetil
Prednisolone

Paediatrics (22 decks)

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