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Paediatrics > Renal > Flashcards

Renal Flashcards

1
Q

What is acute pyelonephritis

A

An upper tract UTI

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2
Q

What is acute cystitis

A

A lower tract UTI

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3
Q

What increases your risk of developing UTIs

A
  • Urinary Tract normal in most UTIs BUT:
    Vesicoureteric Reflux
    Renal Abnormality
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4
Q

What is vesicoureteric reflux

A

Retrograde flow/Reflux of urine from bladder into ureter and sometimes to kidneys usually due to abnormal ureter

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5
Q

What are the grades of vesicoureteric reflux

A

Severity grade 1-5: (severity of reflux, dilation)

  1. Incomplete filling of upper urinary tract without dilation
  2. complete filling +/- dilation
  3. ballooned calyces
  4. Megaureter
  5. Megaureter +/- Hydronephrosis
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6
Q

What are some examples of renal abnormality

A

Malpositions e.g ectopic kidney
Duplications e.d double ureter
Megaureter + Hydronephrosis
Horseshoe Kidney

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7
Q

How may an infant present with a UTI

A

@ Often Non-specific

May present collapse with septicaemia

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8
Q

How may a toddler present with a UTI

A 
@ Often Non-specific 
Vomiting, 
'Gastroenteritis symptoms', 
Failure to Thrive, 
Colic, 
Fever
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9
Q

What specific symptoms may be seen in an Upper UTI

A

Fever
Systemic Illness (meningitis infancy)
Loin/Abdo Pain
Failure to thrive/Jaundice - infancy

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10
Q

What specific symptoms may be seen in a lower UTI

A 
Dysuria
Urinary Frequency/ Urgency 
Incontinence 
Lower Abdo pain
Haematuria
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11
Q

What are the long term complications of recurrent UTIs

A

Renal Scarring
Hypertension
Renal failure
Chronic Pyelonephritis

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12
Q

How does renal failure occur from UTIs

A

Due to renal scarring secondary to UTI +/- VUR and chronic pyelonephritis

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13
Q

What does chronic pyelonephritis cause

A

Hypertension

Renal Failure

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14
Q

How is a UTI diagnosed

A

MSU sample - dipstick and MC&S

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15
Q

What would you likely see on a dipstick if UTI was present

A

Nitrates and WCC +ve

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16
Q

How would you get a urine sample in a child

A

Clean catch sample - least invasive
Catheter - invasive
Suprapubic Aspirate - invasive

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17
Q

When may you investigate UTIs in children further

A

Contraversial but investigate more intensily those under 6 mths - imaging dependent on age and type of infection

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18
Q

What investigations may you do to investigate UTIs further

A

US
DMSA scan
Micturating Cystourethrogram

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19
Q

What can an US detect for UTIs and why may it be used first

A
  • Its cheap/ non invasive and effective!
  • Size, location and drainage of kidney and bladder
  • Scars may be visible
  • Good predictor for abnormal DMSA scan
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20
Q

What is a DMSA scan and what’s it used for

A

Radionucleotide Imaging

Shows Renal scarring

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21
Q

What is micturating Cystourethrogram and what are its disadvantages

A

Its Invasive and Unpleasant

BUT best way of investigating vesicoureteric reflux

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22
Q

How do you manage a UTI in those under 3 months

A

IV amoxicillin + Gentamicin

- Increase oral fluids and give pain relief

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23
Q

How do you manage a UTI in those over 3 months

A

Trimethoprim or Nitrofurantoin

  • Increase oral fluids
  • give pain relief
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24
Q

How can you prevent recurrent UTIs

A
  • Prophylaxis: Trimethoprim
  • Screen for reflux if prophylaxis fails
  • Avoid predisposing factors
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25
Q

What are predisposing factors for UTIs

A
  • Constipation
  • Back to front wiping
  • Nylon
  • Bubble Bath
  • Low fluid intake
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26
Q

What can cause Enuresis

A
  • Diabetes
  • UTI
  • GU abnormality
  • Overactive Bladder
  • Child Abuse
  • Systemic Illness
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27
Q

What is secondary Enuresis

A
  • enuresis after >6 mths dryness
  • Raises concerns
  • e.g Child Abuse, Systemic illness
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28
Q

How is eneureis managed

A
  • Ix possible causes
  • Reassurance and advice to parents
  • Avoiding Caffine
  • Reward Systems
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29
Q

What is Hypospadias

A

Abnormal position of external urethral meatus on ventral penis

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30
Q

What is Epispadias

A

Abnormal position of external urethral meatus on dorsal of penis

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31
Q

What may concern people with Hypospadias/Epispadias

How is it managed?

A

Cosmetic Appearance
Difficulty urinating while standing
RX: Surgical repair

32
Q

What are the 2 cause of increased interstitial fluid

A
  • Reduced Oncotic pressure due to increased loss of albumin - Nephrotic Syndrome
  • Salt and Water Retention due to the kidneys impaired GFR - Nephritic Syndrome
33
Q

What is AKI

A

Rapid increase in creatine or development of oliguria/anuria

34
Q

What can cause AKI

A
  • Cardiac Surgery
  • Bone Marrow Transplant
  • Toxicity/Drugs (NSAIDs, Vancomycin, Acyclovir)
  • Acute Tubular Necrosis
  • Sepsis
  • Diarrhoea/Dehydration
  • Glomerulonephritis
  • Drug induced haemolysis
  • Snake Biyes
  • Haemolytic Uraemic Syndrome
35
Q

What causes Acute Tubular Necrosis

A 
Crush Injurys
Burns 
Dehydration 
Shock
Sepsis
Malaria
36
Q

How is AkI severity assessed

A

RIFLE criteria - based on changes to eGFR or urine output and outcome measures e.g end stage renal failure/loss of kidney function

37
Q

What investigations may be performed in AKI

A

Plasma: Increased K+, Creatine and Urea, Low Ca2+, Na+ and Cl, Clotting (DIC)
MSU: Red cell casts or dipstick may be +ve for microhaematuria
US: Ureters dilated, stones
ECG
Immunology: C3, C4, ANA, ASO titre

38
Q

How do you treat AKI

A
  • Treat shock and dehydration
  • Fluid balance: avoid overhydration, replace losses
  • Monitor BP - and treat with diuretics
  • Monitor K+ with ECG - tall tented T waves (give salbutamol or glucose with soluble insulin)
  • Monitor Acidosis
  • Dialysis - uncommon
39
Q

What is haemolytic Uraemic Syndrome

A

RARE

  • Haemolytic anaemia, thrombocytopenia, renal failure + endothelial damage to glomerular capillaries
  • Typical HUS: Associated with Diarrhoea
40
Q

What is the cause of Typical HUS

A

Shigella Toxin producing E.coli

41
Q

How does HUS present

A
  1. Colitis
  2. Haemoglobinuria
  3. Oliguria +/- CNS signs
  4. Encephalopathy
  5. Coma
42
Q

What may be found on investigations off HUS

A

LDH high
WCC high
Coombs -ve
PCV low

43
Q

How do you treat HUS

A

Paediatric Nephrology for early dialysis and treatment of renal failure

44
Q

What causes chronic renal failure

A 
Congenital dysplastic kidneys 
Pyelonephritis 
Glomerulonephritis 
Recurrent UTIs and VUR
AKI
45
Q

What are complications of Chronic renal failure

A

Acidosis
Renal Osteodystrophy - poor mineralisation
Anaemia - low erythropoietin

46
Q

How does chronic renal failure present

A 
Weakness
Tiredness
Vomiting
Headache
restlessness
twitches
raised BP
Anemia 
Failure to thrive 
Seizures
Coma
47
Q

How do you treat chronic renal failure

A

Haemodialysis

Kidney transplant

48
Q

What are the key features of glomerulonephritis (nephritic syndrome)

A

Haematuria and Oliguria

+/ raised BP +/- uraemia

49
Q

What are the causes of Glomerulonephritis

A
  • Beta Haemolytic Strep via proceeding sore throat
  • Henoch - Schonlein Purpura
  • Others: Toxins, Heavy metals, malignancy , viruses, SLE
50
Q

How does uncomplicated glomerulonephritis present

A
  • Haematuria
  • Oligouria
  • BP raised
  • Periorbital Oedema
  • Fever
  • GI disturbance
  • Loin Pain
51
Q

How does complicated glomerulonephritis present

A
  • Hypertensive Encephalopathy: headache, fits, loss of vision, vomiting, coma
  • Uraemia: acidosis, twitching, coma
  • Cardiac: gallop rhythm, cardiac failure
52
Q

What investigations should you do for glomerulonephritis

A
  • FBC & U&Es - Urea and Creatine raised
  • Compliments - C3 low and C4 normal
  • ASO titre
  • ANA and ANCA
  • Syphillis serology, blood cultures, virolgy
  • MSU: haematuria, proteinuria, & RBC casts
  • Throat Swab
  • Renal US and CXR for fluid overload
53
Q

How do you manage Glomerulonephritis

A
  • Treat the cause!
  • HTN - Salt restriction and Diuretics
  • Fluid Management to prevent overload in those with oligouria
54
Q

How does poststreptococcal Glomerulonephritis present

A

Clinical nephritis 10 days post infection following:

  • Nasopharyngeal Infection (pharyngitis)
  • Skin Infection (Impetigo)
55
Q

How does poststreptococcal glomerulonephritis occur

A

Antigen- Antibody complexes deposited in Glomerus leads to complement activation

56
Q

How does poststreptococcal glomerulonephritis present

A 
Gross haematuria and oliguria 
Oedema and HTN
Malaise, 
Anorexia, 
Fever, 
Abdominal pain
57
Q

How is post step glomerulonephritis diagnosed

A

Urinalysis: proteinuria, RBC casts +/- oliguria
Blood: raised urea, creatine, low C3
Step infection confirmed - raised ASO titre
throat swab

58
Q

How do you treat post strep Glomerulonephritis

A

Prognosis is good!

  • HTN: Monitor BP, Na+ restriction, Fluid Balance, diuretics and antihypertensives
  • Restrict protein in oliguria phase
  • Give penicillin
  • Dialysis - uncommon
59
Q

What is Henoch - Schonlein Purpura (HSP)

A
  • Acute immune complex mediated vasculitis caused by IgA deposition in the vessels e.g kidneys - Glomerulonephritis
60
Q

when do most people develop HSP

A
  • most people have a proceeding URTI
61
Q

How does HSP present

A

The classic Triad:

  • Purpura (purple spots/nodules)
  • Arthritis/ Arthalgia often knees/ ankles
  • Abdo Pain

Other signs: renal involvement: haematuria/proteinuria, acute nephritis, renal impairment, HTN

62
Q

What investigations may be performed in HSP

A 
ESR raised
IgA raised 
Proteinuria 
ASO titre raised
U&Es 
BP raised
63
Q

What are the complications of HSP

A

Massive GI bleeds

Acute Renal Failure

64
Q

What is the treatment for HSP

A
  • Usually self limiting
  • Steroids can be effective e.g prednisalone
  • Steroid resistant? - Immunosupression with Cyclophosphamide
65
Q

How do you suppress SLE

A

Steroids and Cyclophosphamide

66
Q

What is nephrotic syndrome

A

Massive increase of filtration of macromolecules across glomerulus causing massive proteinuria

67
Q

What are the key features of nephrotic syndrome

A

Heavy Proteinuria
Hypalbuminaemia
Oedema: pitting oedema, gravitational
Hyperlipidaemia

68
Q

How does steroid sensitive nephrotic syndrome present

A
  • normal BP
  • No macroscopic haematuria
  • Normal renal function
  • No features of nephritis
  • Responds to steroids
  • Histology: minimal change usually
69
Q

How does steroid resistant nephrotic syndrome present

A
  • Elevated BP
  • Haematuria
  • Impaired renal function
  • features may suggest nephritis
  • fails to respond to steroids
  • histology: various underlying glomerulopathy e.g basement membrane
70
Q

What type of nephrotic sndrome is most common in children

A

Steroid Sensitive - mainly minimal change GN

associated with allergy and IgE production

71
Q

What are the symptoms of Nephrotic Syndrome

A 
Oedema 
Anorexia
GI disturbance 
Infections 
Irritability
72
Q

What would you find on investigation of nephrotic syndrome

A

urinalysis: frothy, increased protein +/- casts, low sodium
Blood: low albumin, urea and creatine usually normal
Renal Biopsy: older children/ treatment failures

73
Q

Wha are the complications of nephrotic syndrome

A

Increased infections - due to Ig loss in urine

AKI doe to hypovolaemia

74
Q

How do you treat nephrotic syndrome

A
  • Prednisolone
  • If steroid toxic or relapsing - Cyclophosphamide
  • Eat healthy - Na, protein and fluid moderation
  • Consider diuretics if very oedematous
  • Albumin Infusion in symptomatic hypovolaemia
  • Consider routine vaccination for pneumococcal, Measles etc.
75
Q

Key differences between nephrotic and nephritic syndrome

A

Nephritic

  • Haematuria
  • High BP
  • Oliguria
  • Uraemia and high creatine in blood
  • Slight proteinurea
  • Normal Albumin

Nephrotic

  • Heavy proteinuriea
  • Hypoalbuminaemia
  • Oedema
  • Usually normal BP
  • Normal creatine and urea in blood

Paediatrics (13 decks)

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