renal

Question 1

nephrotic syndrome presentation

Answer 1

protienuria - urinary protein creatinine ratio >200mg/mmol
hypoalbuminaemia - <25g/L
oedema (pitting) - periorbital, scrotal/vulua, legs and ankles

+/- hypercholesterolaemia

Question 2

nephrotic syndrome 3 types

Answer 2

congential
steroid sensitive
steroid resistant

Question 3

steroid sensitive nephrotic syndrome features

Answer 3

Normal BP
No macroscopic haematuria
Normal renal function
No features to suggest nephritis
Respond to steroids
Histology – “minimal change” usually

Question 4

steroid resistant nephrotic syndrome features

Answer 4

Elevated BP
Haematuria
May be impaired renal function
Features may suggest nephritis
Failure to respond to steroids
Histology – various, underlying glomerulopathy, basement membrane abnormality

Question 5

steroid sensitive nephrotic syndrome management

Answer 5

prednisolone

Question 6

steroid resistant nephrotic syndrome management

Answer 6

ACE-i

diuretics for odema

Question 7

congenital nephrotic syndrome managment

Answer 7

rare. hypoalbuminaemia causes mortality, need a nephrectomy

Question 8

nephrotic syndrome remission criteria

Answer 8

3 days -ve dip stick test

Question 9

acute kidney injury presentation

Answer 9

rise in creatinine >26umol/L within 48hrs or
rise in creatinine >1.5 x baseline with 7 days or
urine output <0.5ml/kg/h for >6 consecutive hrs

Question 10

acute kidney injury causes

Answer 10

pre-renal (most common in children) - hypovalaemia e.g. haemorrhage, low CO e.g. MI, sepsis, D+V
renal - haemolytic uraemic syndrome, vasculitis, glomerulonephritis
post-renal - stones, malignancy

Question 11

acute kidney injury investigations

Answer 11

raised - k, creatinine, urea

low - ca, na, cl

Question 12

acute glomerulonephritis presentation

Answer 12

macroscopic haematuria
Proteinuria
Impaired GFR – rising creatinine, variable degree
Salt and water retention – hypertension, oedema
oliguria

Question 13

acute glomerulonephritis cause

Answer 13

group a b haemolytic strep (strep.pyogenes)

Question 14

acute glomerulonephritis investigations

Answer 14

FBC – mild normochromic, normocytic anaemia
U&Es – increased urea and creatinine, (hyperkalaemia, acidosis)
urinalysis - Haematuria (macroscopic), Proteinuria protein:creatinine

Question 15

acute glomerulonephritis management

Answer 15

fluid balance - salt restriction, diuretics

penicilin 10 days

Question 16

henoch-schonlein purpura cause

Answer 16

IgA mediated autoimmune hypersensitivity vasculitis

Question 17

henoch-schonlein purpura presentation

Answer 17

purpura (purple spots dont disappear on palpation)
arthritis (knees and ankle)
abdominal pain
renal involvement
Follows URTI – Step Pyogenes

Question 18

henoch-schonlein purpura investigations

Answer 18

raised IgA and ESR

proteinuria / haematuria

Question 19

bacteriuria definition

Answer 19

bacteria in urine uncontaminated by urethral flora

Question 20

UTI definition
upper
lower

Answer 20

symptomatic bacteriuria
pyelonephritis
cystitis

Question 21

upper UTI symptoms - pyelonephritis

Answer 21

Fever, septicaemic illness (with meningitis in infancy)
General malaise, vomiting
Loin/abdominal pain – older child
Failure to thrive, jaundice - infancy

Question 22

lower UTI symtoms - cystitis

Answer 22

Dysuria
Urinary frequency/urgency
Incontinence
Lower abdominal pain
Haematuria

Question 23

UTI cause

Answer 23

e.coli

also klebsiella

Question 24

atypical UTI definition

Answer 24

infection not by e.coli

Question 25

UTI investigations (5)

Answer 25

urine clean catch dipstick - nitrates, WCC, leucocyte esterase
mc+s
micturating cystourethrogram scan - for vesicouteric reflux
dimercaptosuccinc acid scan - for renal scaring
US

Question 26

UTI management

Answer 26

<3 months - IV amoxicillin and gentamicin

>3 months - trimethroprim / nitrofurantoin

Question 27

haemolytic uraemic syndrome presentation

Answer 27

acute microangipathic haemolytic anaemia
thrombocytopenia
renal failure

typical (95%) - associated with diarrhoea (shiga toxin from e.coli)
atypical is not

Question 28

chronic renal failure presentation

Answer 28

weakness
vomiting
headache
anaemia

Question 29

chronic renal failure managment

Answer 29

calcium carbonate and activated vit D supplements - prevents renal osteodystrophy
recombinant EPO - for anaemia
adequate proteins and nutrition (NG tube)