Renal disease in childhood Flashcards
When should a urine sample always be sent in children?
children with unexplained fever >38
UTI presentation in infants
fever
vomiting
lethargy
poor feeding
faltering growth
jaundice
sepsis
offensive urine
febrile convulsions
UTI presentation in children
dysuria
frequency
urgency
abdominal pain/loin pain
fever +/- rigors
lethargy
vomiting
haematuria
offensive urine
febrile seizure
enuresis
Urine collection methods in children
bag urine
clean catch
catheterised specimen
suprapubic aspiration
What causes high leucocytes in urine?
leukocyte esterase produced by neutrophils
may signal pyuria
What causes nitrites to be in urine?
produced when bacteria reduce urinary nitrates to nitrites
What is a DMSA scan?
static radionuclide scan
evaluates renal structure and morphology
detection of scarring
allows better assessment of differential renal function
Describe MAG3 scan
radioisotope scan
assess renal function
assess structure and location of kidneys
looks for obstruction/dilatationM
Management of vesicoureteric reflux
grade 1-3 = medical management as most will resolve spontaneously
grade 4 = trial of medical treatment
grade 5 = medical/surgery
Nephrotic syndrome features in children
heavy proteinuria - protein:creatinine ratio >200mg/mmol
hypoalbuminaemia - serum albumin <30g/L
oedema
Complications of nephrotic syndrome
hypovolaemia
infection
hyperlipidaemia
hypercoagulability
anaemia
progression to end stage renal failure
Minimal change disease management
fluid resuscitation
20% albumin and furosemide if needed
IV abx
corticosteroids (prednisolone)
2nd line steroid sparing agent:
- tacrolimus
- levamisole
- ciclosporin
- cyclophosphamide
- MMF
- rituximab infusion
HSP features
IgA nephritis
abdominal pain
palpable purpuric rash
joint pain
Causes of haematuria in children
glomerular:
- glomerulonephritis (eg. post-strep)
- IgA nephropathy
- familial
non-glomerular:
- infection
- trauma
- steroids
- tumours
- bleeding disorders
- sickle cell
- renal vein thrombosis
Wilms tumour features
haematuria
large abdominal mass
Differentials of glomerulonephritis in children
IgA nephropathy
membranoproliferative glomerulonephritis
vasculitides:
- IgA vasculitis - HSP
- SLE
- ANCA +ve vasculitis
Alport syndrome
Haemolytic uraemic syndrome features
AKI
haemolytic anaemia
thrombocytopaenia
AKI features children
oliguria <0.5ml/kg/hr
raised creatinine
hyperkalaemia >6 mmol/L
fluid overload - hypertension, oedema
Prerenal AKI causes in children
impaired perfusion:
- cardiac failure
- sepsis
- blood loss
- dehydration
- vascular occlusion
Renal AKI causes in children
glomerulonephritis
small vessel vasculitis
acute tubular necrosis (drugs, toxins, prolonged hypotension)
interstitial nephritis (drugs, toxins, inflammatory disease, infection)
Post-renal AKI causes in children
urinary calculi
urethral stricture/valves
meatal stenosis/phimosis
AKI management in children
fluid balance
circulatory status
electrolyte management
blood pressure
medications
look for cause
