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FINALS > Renal > Flashcards

Renal Flashcards

1
Q

What are the five functions of the kidney?

A
  1. volume management 2. vitamin D physiology 3. EPO production 4. waste excretion and metabolism 5. acid-base balance
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2
Q

what does dialysis manage to do?

A

volume management waste excretion and metabolism acid-base balance

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3
Q

describe the RAAS?

A

insert picture

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4
Q

what is nephrotic syndrome?

A

presence of proteinuria causing hypo albumin and peripheral oedema

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5
Q

what is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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6
Q

What is the most common cause of nephrotic syndrome in young adults?

A

focal segmental glomerulosclerosis (and minimal change disease)

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7
Q

what is the most common cause of nephrotic syndrome in older adults?

A

Membranous neuropathy and systemic diseases such as diabetes

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8
Q

what are the causes of nephrotic syndrome?

A 
minimal change disease 
focal segmental glomerulosclerosis  
membranous nephropathy
 diabetic nephropathy  
amyloidosis/SLE
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9
Q

what is minimal change disease?

A

There is Podocyte effacement causing proteins to leak

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10
Q

what is the management of minimal change disease?

A

corticosteroids if it is then steroid resistance you must do a renal biopsy

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11
Q

what is focal segmental glomerulosclerosis?

A

scar tissue forming on some but not all of the glomeruli can be primary or secondary

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12
Q

what are the causes of secondary focal segmental glomerulosclerosis?

A

HIV obesity reflux nephropathy

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13
Q

what is the management of focal segmental glomerul0 sclerosis?

A

biopsies
- required to differentiate between idiopathic and secondary causes which informs management

corticosteroids

and reducing intra-glomeruli pressure with RAAS blockade (ACEi or ARB)

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14
Q

what is membranous nephropathy?

A

basement membrane thickening with IgG deposition through capillary walls causing a spike and dome appearance on electron imaging

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15
Q

what are the causes of membranous nephropathy?

A

usually idiopathic but can be due to: hepatitis B autoimmune diseases like lupus drug reactions (NSAIDs and penicillinamine)

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16
Q

what is the management of membranous nephropathy?

A

symptomatic relief with diuretics and our AAAS blockade plus reducing risk of clots with blood thinners or anticoagulants if there is a high risk of kidney disease developing in the next five years use of high-dose corticosteroids and immunosuppressants

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17
Q

how do you assess the risk of chronic kidney disease in membranous nephropathy/any disease really?

A

assess proteinuria and blood creatinine the amount which they rise in six months

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18
Q

what is diabetic nephropathy?

A

occurs in both type I and type II diabetes with basement membrane dysfunction and thickening, glomerulosclerosis

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19
Q

how often does diabetic nephropathy cause nephrotic syndrome?

A

rarely does it progress to proteinuria significant to be defined nephrotic syndrome usually classed as microalbuminea

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20
Q

how do you manage diabetic nephropathy?

A

diabetic control ACE inhibitors or/and ARB in serious cases dialysis and transplant may be needed

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21
Q

how does amyloidosis cause nephropathy?

A

Ig light chains from amyloid fibres are deposited within the kidney associated with chronic inflammatory disease (AL or AA chains)

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22
Q

what is the management of amyloidosis/ amyloidosis nephropathy?

A

treat amyloidosis with anti-plasma cell chemotherapy

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23
Q

what questions should you ascertain in a history of nephrotic syndrome?

A

looking at differentials of: diabetes malignancy SLE HIV be drug history connective tissue disorders amyloidosis - insert picture

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24
Q

what investigations should you perform in nephrotic syndrome?

A

urine dipstick spot urine protein to creatinine ratio EGFR FPC lipid profile (+)serum albumin(-) then look for differentials: serum-free light chains and urine electrophoresis (amyloidosis) HIV hepatitis syphilis screen ANA (SLE) renal biopsy if corticosteroid resistant

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25
Q

when are renal biopsy is contraindicated?

A

Avoided in general if possible but contraindicated in children

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26
Q

what is the management of nephrotic syndrome?

A

Corticosteroids in general - may also need ARB/ACE I diuretics

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27
Q

why does nephrotic syndrome lead to thromboembolic disease?

A

As well as albumin being lost clotting inhibitors are also lost

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28
Q

why does nephrotic syndrome caused pleural effusions?

A

Decrease in argument causes oedema and in the lungs this is a pleural effusion

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29
Q

why does an nephrotic syndrome cause hypercholesterolaemia?

A

there is decreased albumin force to bind to

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30
Q

what happens to sodium in nephrotic syndrome?

A

hyponatraemia due to excess bodily fluids (oedema)

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31
Q

what is nephrotic syndrome?

A

Proteinuria and haematuria

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32
Q

what are the common causes of nephritic syndrome?

A

IgA neophropathy, glomeruli nephritis including post infectious haemolytic uraemic syndrome henloch schonlein purpura, goodpasteures, SLE

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33
Q

what is the presentation of nephritic syndrome?

A

Haematuria oedema less than nephrotic reduced urine output/oliguria hypertension

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34
Q

what would urinealysis show for nephritic syndrome?

A

haematuria +++ proteinuria++ red-cell casts

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35
Q

what do red cell casts indicates in nephrotic syndrome?

A

Form in their frown and indicate the glomerular disease

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36
Q

what is IgA nephropathy?

A

a buildup of IgA in the kidneys

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37
Q

how do you manage IgA nephropathy?

A

ACE I or ARB + low sodium diet and water restrictions

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38
Q

How do you diagnose IgA nephropathy?

A

kidney biopsy and serum IgA (+)

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39
Q

what is glomerulonephritis?

A

An umbrella term encompassing minimal change disease FS GS IgA nephropathy post infectious SLE and vascular to causes

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40
Q

what is post-streptococcal glomerular nephritis?

A

Inflammation of the glomerulus after skin or throat infection

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41
Q

how do you diagnose post strap glomeruli nephritis?

A

skin or throat swab (positive) antibiotics to manage infection fluid and electrolyte balance if severe and very symptomatic diuretics and corticosteroids

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42
Q

what is haemolytic uraemic syndrome?

A

A group of syndromes characterised by low red blood cells and acute kidney failure

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43
Q

who does haemolytic uraemic syndrome are most affect?

A

children

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44
Q

What is a presentation of haemolytic uraemic syndrome?

A

Bloody diarrhoea fever vomiting and weakness progressing to kidney injury

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45
Q

what is a common trigger for haemolytic uraemic syndrome?

A

post infectious of E. coli

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46
Q

what is the management of haemolytic uraemic syndrome?

A

dialysis steroids blood transfusions and plasmapheresis

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47
Q

how do you diagnose haemolytic uraemic syndrome?

A

full blood count and blood smear (haemolytic anaemia and thrombocytopenia) EGFR urea and creatinine stool cultures (positive)

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48
Q

what is Henloch schonlen purpura?

A

a vasculitis IgA with a characteristic triad of 1.maculopapular rash 2. arthralgia 3. abdominal pain

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49
Q

what does the image below show?

A

the maculopapular, urticarial, rashassociated with HSP - insert image

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50
Q

what is the rash distribution of HSP?

A

Extensor surfaces and symmetrical, purpuric but blanching

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51
Q

what are consequences of HSP?

A

Intussusception chronic kidney disease

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52
Q

how does HSP cause chronic kidney disease?

A

There is IgA deposition and ischaemia

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53
Q

what is the management of HSP?

A

corticosteroids and one year follow-up

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54
Q

how do you diagnose HSP?

A

Symptomatic triad evidence of nephritic syndrome biopsy showing IGA deposition

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55
Q

when is kidney biopsy indicated in children?

A

unresponsive to corticosteroids or evidence of kidney decline and high blood pressure

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56
Q

how do you investigate nephritic syndrome?

A

Find underlying cause with urea (+) and creatinine (+) ESR potassium(+) igA (+ in IgA neph) ANA (lupus also complement c3 and 4) , dipstick measure BP

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57
Q

how do you manage nephritic syndrome?

A

supportive therapy: low sodium diet and water restrictions treating underlying cause if more severe add a CEI or ARB diuretics and a very severe renal replacement therapy

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58
Q

What is goodpasteures syndrome?

A

also antibodies to Alpha three chain of IV collagen causing pulmonary renal syndrome

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59
Q

why does Godpasteures syndrome cause pulmonary renal syndrome?

A

IV Collagen is primarily found in the basement membrane of the glomeruli and the alveoli thus its destruction will cause pulmonary renal syndrome

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60
Q

what are symptoms of Goospatures syndrome?

A

reduced urine output spontaneous haemoptysis oedema haematuria and accompanying symptoms of shortness of breath fever and nausea

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61
Q

what HLA protein is Goodpastueres associated with?

A

HLA DRB-1 or DR-4

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62
Q

what investigations would be diagnostic for Goodpasteures syndrome?

A

anti-GBM (+ve) biopsy renal showing IgG deposition chest x-ray showing pulmonary infiltrates

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63
Q

what is the management of Goodpasteures syndrome?

A

immunosuppression with oral corticosteroids and plasmapheresis

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64
Q

what is Wagner’s granulomatosis?

A

systemic vasculitis typically involving the small and medium vessels of the lower and upper respiratory tract which also affects the glomerulus (causing glomerulonephritis)

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65
Q

what does Wagner’s granulomatosis cause nephrotic or syndrome

A

nephritic

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66
Q

what is most important to remember about Px of Wagners granulomatosis?

A

has both respiratory and renal involvement particularly aware of with patients with nosebleeds , Haemoptysis, sob cough … symptoms of upper respiratory tract or lower respiratory tract disorders with also nephrotic syndrome

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67
Q

what is diagnostic for Wagner’s granulomatosis?

A

Positive ANCA and renal biopsy showing segmental cruising glomeruli nephritis with immune complex depositions

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68
Q

what is the management of Wagner’s granulomatosis?

A

immunosuppressants (corticosteroids) plasmapheresis

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69
Q

what is renal colic?

A

and acute severe flank pain radiating to the groin

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70
Q

what are symptoms of renal calculi?

A

renal colic nausea and vomiting due to pain urinary frequency/urgency haematuria

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71
Q

what are risk factors for renal calculi?

A

high protein intake high salt intake previous stone dehydration white male obesity

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72
Q

what investigation is diagnostic for renal calculi?

A

None contrast CT ultrasound scan can be performed if pregnant

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73
Q

what is an important differential in renal calculi?

A

ectopic pregnancy in females so do a urine pregnancy test

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74
Q

what is the management of a renal calculi where the stone is not visible?

A

conservative management with analgesia And antiemetics (+NSAIDS)

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75
Q

what is the management of a stone less than 10 mm?

A

medical expulsion therapy with tamsulosin

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76
Q

what is the management of a stone greater than 10 mm??

A

ESWL also do this if there is veiled medical expulsion therapy however if the stone is greater than 50 mm than do percutaneous urteroscopy

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77
Q

why is an FB C useful in stones?

A

Can show evidence of infection which can indicate antibiotics

78
Q

what is cystitis?

A

Infection of the bladder

79
Q

wall usually causes UTIs?

A

E. coli

80
Q

what can complicated UTIs be caused by?

A

Steph aureus P aerginosa or enterococci

81
Q

what are symptoms of pyleo nephritis?

A

Back/flank pain costo vertebral angle tenderness fever

82
Q

what are the general symptoms of a UTI?

A

Dysuria frequency haematuria urgency suprapubic pain

83
Q

if a man presents with symptoms of a UTI what should you also investigate?

A

prostate enlargement so do DRE +/- PSA

84
Q

what antibiotics are used for UTI?

A

nitrofurantoin or trimethoprim

85
Q

what antibiotics are used for complicated UTI?

A

Cephalexin or fluoroquinolone in males

86
Q

how does the management of UTI for males stiffer than the management for females which are not pregnant?

A

Two minutes seven days for males (also for pregnant individuals) in complicated/older men you can prescribe for 14 days

87
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

88
Q

apart from transitional cell carcinoma what are the other types of bladder cancer?

A

square miss cell carcinoma Adeno carcinoma

89
Q

what is the public health significance of bladder cancer?

A

It’s the 10th most common cancer in the UK

90
Q

what occupational risk factor is significant in bladder cancer

A

exposure to dies rather leather textiles and paints – aromatic amines are carcinogenic

91
Q

apart from occupational risks what other risk factors are associated with bladder cancer?

A

male smoking genetic conditions such as HNPCC schistosomiasis chronic cystitis long-term catheterisation or intermittent self catheterisation

92
Q

what is the presentation of bladder cancer?

A

chemo Tory – painless (usually visible) urgency recurrent UTI suprapubic pain suprapubic pelvic mass may be felt

93
Q

what investigations are required for anyone presenting with haematuria?

A

a scan such as ultrasound or CT and cystoscopy of the bladder

94
Q

what is diagnostic for bladder cancer?

A

Imaging showing mass urine cytology and cystoscopy (you should still perform a full set of bloods)

95
Q

where does bladder cancer usually originate from ?

A

renal power and climbable cortex

96
Q

describe the stages of bladder cancer?

A

see image below

97
Q

in what type of cancer is renal cancer?

A

renal cell carcinoma - adenocarcinoma

98
Q

apart from renal cell carcinoma what other types of real cancer are there?

A

transitional cell carcinoma

99
Q

what is the commonest type of renal cancer in children?

A

Wilms tumour A.k.a. Nephroblastoma

100
Q

what is the typical presentation of a Wilms’ tumour?

A

Asymptomatic mass unilateral in the abdomen

101
Q

what are the typical symptoms of renal cancer in adults?

A

Massive haematuria
loin pain
hypertension

possibly a left-sided variocele

NB less than 10% of patients present with the classic triad most cancers are identified incidentally

102
Q

what is paraneoplastic syndrome of renal cancer?

A

Results from polycythaemia due to the paraneoplastic EPO production (causing erythrocytosis)

103
Q

how is calcium affected in renal cancer?

A

Hypercalcaemia can occur due to the elevation/production of parathyroid hormone related hormone

104
Q

why does anaemia occur in renal cancer?

A

Haematuria may cause anaemia, chronic disease can cause anaemia

105
Q

what is rhabdomyolysis?

A

can be the end result of any disease process which causes damage to the myocyte cell membrane of skeletal muscle causing myocyte-lysis

106
Q

what are some causes of rhabdomyolysis?

A

physical exertion (inc. seizures or severe agitation) electrolyte disturbances (hypokalaemia hypocalcaemia hypophosphataemia hypo or hyponatraemia) muscle hypoxaemia (even from long immobilisation) metabolic disorders (hyperaldosteronism DKA hypothyroidism) direct muscular damage biological agents (including bacteria or viruses) genetic defects drugs and toxins (statins alcohol diuretics cocaine methadone heroin alkaloids antipsychotics)

107
Q

what is the presentation of rhabdomyolysis?

A

Usually just presents with muscular pain but can also have dark urine general malaise muscular tenderness

108
Q

how do you diagnose rhabdomyolysis?

A

serum creatine kinase ++++ / urine disptick shows haematuria in 50%

109
Q

what investigations should you do in a patient with rhabdomyolysis to find out the underlying cause?

A

TSH – hypothyroidism ESR – inflammatory disease ANA – autoimmune cause swabs+cultures - bacterial and a good history

110
Q

how do you treat rhabdomyolysis?

A

Managing the underlying cause hydration therapy and then diuretic therapy unless it’s being caused by diuretics if anuric or unresponsive to hydration therapy give haemodialysis

111
Q

what is polycystic kidney disease?

A

An inherited renal cystic disease which can be autosomal dominant (most common) or recessive

112
Q

what is the typical presentation of polycystic kidney disease?

A

Hypertension abdominal flank pain recurrent UTI with fever

113
Q

what are extra renal features of polycystic kidney disease?

A

Extra renal cysts intracranial aneurysms and elongated and distended arteries aortic root dilatations and aneurysms mitral valve prolapse and abdominal wall hernias polycystic liver disease

114
Q

what features would you find in a family history of polycystic kidney disease?

A

History of cerebrovascular events family history of cardiovascular events family history of end-stage renal disease

115
Q

what is the management of polycystic kidney disease?

A

Hypertension mainly treated with ACEi, managed underlying renal pain with analgesia and bed rest give prompt UTI antibiotics and consider prophylaxis if haematuria is present which is not caused by UTI drink lots of water and surgical intervention may be required / in end-stage renal disease give transplant and dialysis

116
Q

what is a common complication of polycystic kidney disease?

A

Infected renal cysts treated with ciprofloxacin (if that doesn’t work sister drainage if that doesn’t work in a fracture)

117
Q

what medication should you not give for the management of pain in polycystic kidney disease and why?

A

NSAIDs because they are nephrotoxic

118
Q

what is obstructive at uropathy?

A

Blockage of urinary flow which can occur at any level of the urinary tract affecting one or both kidneys depending on the level of obstruction

119
Q

what other causes of unilateral obstructive uropathy?

A

Renal stones iatrogenic from surgery commonly obstetric/gynaecology malignancy causing compression

120
Q

what causes of obstructive uropathy?

A 
The 4 S's
Stones
Strictures
Swelling (trauma etc)
Surrounding structures (cancers BHP and neurogenic)
-------------------------------------------------------------------------------
BPH 
neurogenic bladder 
renal or ureteric stones 
bladder tumour 
urethral stricture 
prostate cancer
121
Q

what is the presentation of obstructive uropathy?

A

Flank pain fever and UTI symptoms L UTS palpable enlarged bladder from inability to urinate and any symptoms of underlying cause

122
Q

what investigations should you perform in obstructive uropathy?

A

Renal ultrasound scan CT pyelogram CT abdomen and pelvis

123
Q

what is hydronephrosis?

A

swelling of the kidney due to urine backup this can cause a KI in progress to CKD

124
Q

define AKI stage I?

A

serum creatinine: 1.5 – 1.9 x baseline or >/0.3 urine output: <0.5 for 6-12h

125
Q

define AKI stage II?

A

Serum creatinine: 2 – 2.9 x baseline urine output:< 0.5 for 12h +

126
Q

defining AKI stage III?

A

serum creatinine: 3 x baseline decreasing EGFR to <35ml in patiemts <18 urine output:<0.3 for >24h or anuria for 12h

127
Q

what are pre-renal causes of AKI?

A

Anything which causes hypoperfusion – hypovolaemia (from haemorrhage ET C) sepsis over diuresis heart failure hepato-renal syndrome

128
Q

what are renal causes of AKI?

A

Glomeruli nephritis vascular causes such as HUS blood clots

129
Q

what are post renal causes of AKI?

A

Anything causing outflow obstruction – BPH tumours strictures stones UTI urinary retention

130
Q

what electrolyte disturbances can in acute kidney injury?

A

Hyperkalaemia so make sure you do an ECG

131
Q

how do you manage hyperkalaemia?

A

Ivy glucose and insulin

132
Q

when would you need to refer acute kidney injury to specialist?

A

Signs of abstraction kidney infection and sepsis hypovolaemia or an urgent complication

133
Q

what complications can occur in acute kidney injury?

A

Pulmonary oedema hyperkalaemia uraemic encephalopathy pericarditis

134
Q

what is the acute management of acute kidney injury?

A

Fluid bolus with IV fluids and less as congestive heart failure or pulmonary oedema in which case use loop diuretics

135
Q

how would you go about finding the cause of acute kidney injury?

A

See image

136
Q

what is chronic kidney disease?

A

Chronic renal failure causing either haematuria and/or proteinuria or a reduction of EGFR to <60 for 3 months +

137
Q

what is the most common cause of chronic kidney disease?

A

Diabetes then hypertension

138
Q

apart from diabetes and hypertension what other things can cause chronic kidney disease?

A

Polycystic kidney disease obstructive uropathy causes of nephrotic and nephrotic syndrome such as focal segmental glomerulosclerosis membranous neuropathy SLE amylodosis rapidly progressive glomerulonephritis

139
Q

what is the pathophysiology of chronic kidney disease?

A

once renal damage has occurred glomerular hypertrophy occurs in order to maintain GFR this increases the intra-glomeruli pressure and inflammatory processes mean that the glimmer glomerular permeability increases and causes the passage of inflammatory substances to their messenger deal matrix causing scarring fibrosis and more information renal injury also causes angiotensin II production which causes an increase in TGF beta causing collagen synthesis and renal scarring

140
Q

what are symptoms/features of CKD?

A

fatigue oede,a nausea and vomiting pruiritis anorexia - many symptoms caused by build up of toxins

141
Q

what are the stages of CKD?

A

insert picture

142
Q

when would urine microalbumin be increased in CKD?

A

diabetes or HTN

143
Q

what can CKD cause as a complication?

A

amaemia (decreased EPO) 2ry hyperthyroidism (vD conversion is decreased) acidosis (decreased ammonia and bicarbonate excretion)

144
Q

how do you manage stage 1-2 CKD?

A

Treat HTN and any compliations … reduce CVS risks with ACEi or ARB (2ry CCB) and statins - treat anaemia with EPO stimulating agent and /or iron suppliments treat 2ry hyperparathyroidism with calcium acetate +/- ercocaliferol +/- active vitamin D analogue treat metabolic acidosis wuth PO socium bicarb.

145
Q

how do you treat anaemia in CKD?

A

EPO stimulating agent and /or iron suppliments

146
Q

how do you treat 2ry hyperparathyroidism in CKD?

A

calcium acetate +/- ercocaliferol +/- active vitamin D analogue

147
Q

how do you treat metabolic acidosis in CKD?

A

PO biacrbonate

148
Q

what is the presentation of a UTI in an infant?

A

High fever over 39° irritability poor feeding suprapubic tenderness and abdominal/flank pain may be present

149
Q

what are common features of UTI presentation in older children/teens?

A

Foul-smelling urine dysuria and frequency (tends to be in order children) as well as suprapubic tenderness and abdominal/funk pain

150
Q

as well as the usual UTI investigations what other investigations should you perform in a ? UTI - in children?

A

do blood cultures and also Brown neonates/infants younger than 24 months

151
Q

What should you do as follow-up for UTIs in children once treatment has commenced?

A

Cultures are performed after 24 hours of initiation of treatment

152
Q

what should you do in young males presenting with UTIs?

A

Check genitourinary structures for abnormalities

153
Q

what is the management of UTI in a patient under six weeks old?

A

IV antibiotics ampicillin/gentamicin

154
Q

what is the management of a UTI and patient over six weeks old?

A

PO cefexime if stable - if unstable Ivy ampicillin/gentamicin - in teens management is the same as with adults

155
Q

what is nocturnal enuresis?

A

In voluntary urination whilst asleep after seven years of age

156
Q

what is the definition of primary nocturnal enuresis?

A

When the child hasn’t had a period of dryness and has never stopped bedwetting

157
Q

what is the definition of secondary nocturnal enuresis?

A

When a child starts bedwetting after period of dryness

158
Q

how do you diagnose nocturnal enuresis?

A

Take a voiding diary fluid intake diary check blood pressure check random blood glucose perform bladder ultrasound scan

159
Q

why should you check blood pressure in patients with nocturnal enuresis?

A

Hypertension indicates renal pathology

160
Q

what are the 3 potential mechanisms for nocturnal enuresis?

A

High nocturnal urine production high nocturnal bladder function sleep and arousal mechanism dysfunction

161
Q

what is the management of nocturnal enuresis?

A

Motivational therapy watch and wait bedwetting alarms waterproof mattress and absorbent underwear medical therapy with: amitriptyline or desmopressin

162
Q

what is the most common cause of chronic kidney disease in children?

A

Congenital and hereditary causes such as structural malformations glomerulonephropathies hereditary nephropathy is such as AD-PKD

163
Q

how do you diagnose current kidney disease in children?

A

Due to the nature of the causes of childhood CKD it is usually detected on faecal ultrasound otherwise : RFT, urinalysis showing + Al + Cr +/- Haematuria ultrasound/CT

164
Q

what is a presentation of CKD in childhood?

A

Hypertension anorexia and failure to thrive oedema caused by proteinuria possibly bone deformities and anaemia of chronic disease

165
Q

how do you manage childhood CKD?

A

encourage growth ACEi + Diuretics for HTN and calcium carbonate to decrease potassium

166
Q

how to stimulate growth in children with CKD?

A

Enteric feeds and caloric supplements controlling protein intake salt and bicarbonate supplements recombinant hGH

167
Q

what is the presentation of acute kidney injury in children?

A

anurea (<10ml x 24h) or oliguria (<400ml x 24h)

168
Q

what all causes of acute kidney injury in paediatrics?

A

Pretty much the same as adult however obstruction tends to be congenital rather than because of thrombosis or stone

169
Q

what is the management of acute kidney injury in paediatrics?

A

treating the underlying cause - if renal AKI Fluid restriction diuretics sodium control high-calorie diet normal protein feeds

170
Q

when is dialysis indicated for acute kidney injury in paediatrics?

A

If there is hyperkalaemia hypernatraemia or hypo notary mere or if there is a pulmonary oedema/pulmonary hypertension severe acidosis or multisystem organ failure

171
Q

what can precipitate acute on chronic kidney injury?

A

Dehydration or infection

172
Q

what are the most common congenital abnormalities (renal) in paediatrics?

A

pelvic ureteric junction obstruction horseshoe kidney renal Genesis and dysplasia renal cysts polycystic kidneys ectopic kidney

173
Q

describe the pelvic ureteric junction obstruction?

A

Can be caused by many things but is a narrowing in the yurt as it joins the renal pelvis obstructing flow of urine from the kidney

174
Q

What are the consequences of pelvic ureteric junction obstruction?

A

Risk of infections stones renal failure hydronephrosis

175
Q

what is a horseshoe kidney?

A

a fusion anomaly of the kidney joined at the isthmus

176
Q

What are the causes or horseshoe kidney?

A

Increased risk of kidney stones pyelonephritis from reflux and pelvic ureteric junction obstruction

177
Q

when would you treat a horseshoe kidney?

A

If obstruction is present causing symptoms

178
Q

what is renal agenesis and dysplasia?

A

The kidney is either absent or underdeveloped

179
Q

what does renal agenesis cause if it is bilateral?

A

Oligohydramnios
pulmonary hypoplasia

extremity and facial anomalies – all part of Potter’s syndrome
– which is fatal within minutes to hours of birth or leads to miscarriage

180
Q

which type of polycystic kidney disease usually affects children?

A

Autosomal recessive presents in childhood and is much more severe than autosomal dominant leading to renal failure and can involve liver pancreas leads to hypertension intracranial aneurysms and valve abnormalities

181
Q

what are duplex kidneys?

A

Duplex kidneys share a single renal unit with more than one collecting symptom they are usually asymptomatic and the patient has normal kidney function

182
Q

what duplex kidney is more at risk of developing?

A

vesico-ureteric reflux uterocele and an ectopic ureter

183
Q

what is vesico ureteric reflux?

A

urine does not flow out of the bladder properly and instead goes back up the ureter to the kidneys

184
Q

what are consequences of vesico ureteric reflux?

A

UTI damage and scarring to the kidney - nephropathy possibly hydronephrosis

185
Q

what is a uterocele?

A

balloon forms like an aneurysm in the ureter where it connects to the bladder urine collected in the balloon involving a narrowing causing obstruction

186
Q

what is the presentation of vesico ureteric refulx?

A

recurrent and often UTI infections / can have severe UTI symptoms

187
Q

what investigations should you perform for vesico ureteric reflux?

A

USS - MAG3 sees dye be taken up by the kidneys through x-ray imaging MCUG bladder is catheterisation filled with special dye patient is asked to pass urine while being scanned this is good for detecting severity of reflux DMS a assesses whether the kidneys have been affected by urinary infections

188
Q

what is the management of vesico ureteric reflux?

A

if reflexes mild key is with preventing kidney infections with good fluid intake and regular urination as well as avoiding constipation add profylaxis if needed and symptomatic and severe = surgery

189
Q

what is congenital nephrotic syndrome?

A

An inherited disorder characterised by protein in the urine and causing oedema developing shortly after birth

190
Q

what is a presentation of congenital nephrotic syndrome?

A

Low birthweight oedema decreased urine output for an appearance of your own poor appetite cough because of pulmonary oedema recurrent UTI malnutrition kidney failure if untreated

191
Q

one investigation should you perform for congenital nephrotic syndrome?

A

Hypertension amniotic fluid can be tested for increased alpha-fetoprotein

192
Q

what is the management of congenital nephrotic syndrome?

A

Diuretics ACEi NSAIDS prophylaxis/antibiotics sodium restriction dietary supplements fluid restriction to help control oedema in the end is definitively treated through dialysis and transplant it is typically resistant corticosteroids or other immunosuppressant

FINALS (24 decks)

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