Paediatrics > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

Paediatric most common cause for proteinuria/ haematuria

A

Glomerular disease

  • Nephrotic syndrome
  • nephritic syndrome
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2
Q

Paediatric most common cause for acute kidney injury

A

Haemolytic uraemic syndrome

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3
Q

Paediatric most common cause for chronic kidney disease

A 
Developmental anomalies (CAKUT)
-reflux nephropathy
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4
Q

5 kidney functions

A 
Waste handling (urea and creatinine)
Water handling 
Salt balance (Na, K, Ca, P)
Acid base control (bicarbonate)
Endocrine (red cells/ blood pressure/ bone health)
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5
Q

What makes up the glomerular filtration barrier

A

Endothelial cells:

  • Fenestrated
  • Vulnerable to immune mediated injury

GBM:

  • 2 proteins - Type IV collagen (COL4) and laminin
  • Synthesis from podocytes and endothelial cells
  • Mesangial cells playing a role in turnover

Podocyte:

  • Proteins
    • Podocin, nephrin

Mesangial cells:

  • Glomerular structural support
  • Embedded in GBM
  • Regulates blood flow of the glomerular capillaries
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6
Q

What makes up the EM glomerular filtration barrier

A

Fenestrated endothelial cell,
Glomerular basement membrane,
Podocyte with “slit diaphragms”

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7
Q

Clinical indication of glomerulopathy

A

Blood and protein

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8
Q

What does proteinuria normally signify?

A

Glomerular injury

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9
Q

Clinical symptoms of nephritic syndrome (PHARAOH)

A 
Proteinuria
Haematuria
Azotaemia
Red blood cell casts
Oliguria
Hypertension

Intravascular overload

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10
Q

Clinical symptoms of nephrotic syndrome

A

Proteinuria
Hypoalbuminaemia
Oedema

Hyperlipidaemia

Intravascular depletion

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11
Q

In acquired glomerulopathy what components are affected

A

Epithelial cells (podocyte)

  • Minimal Change Disease
  • FSGS
  • Lupus

Basement membrane

  • Post infectious glomerulonephritis
  • Membranous glomeruopathy
  • MPGN (Membranoproliferative glomerulonephritis)

Endothelial cell

  • PIGN
  • HUS
  • MPGN
  • Lupus
  • ANCA vasculitis

Mesangial cell

  • Henoch-Schonlein purpura
  • IgA nephropathy
  • Lupus
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12
Q

Congenital glomerulopathy layers involved

A

Podocyte cytoskeletal integrity
(congeital nephrotic syndrome)
-Proteins- Podocin, nephrin

Basement membrane proteins

  • Alport syndrome (XL)
  • Thin basement membrane disease

Endothelial/ microvascular integrity
-Complement regulatory protein

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13
Q

Testing for proteinuria

A

Dipstix (>2 usually abnormal)
Protein creatinine ratio (nephrotic range >250mg/mmol)
24hr urine collection (nephrotic range >1g/m2/24hrs)

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14
Q

Nephrotic syndrome treatment

A

Prednisolone 8 weeks

Second line immunosuppression

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15
Q

Who does nephrotic syndrome clinically present?

A 
pale, 
periorbital oedema,
pitting oedema legs,
ascites, 
small pleural effusions,
hypotension, 
frothy urine
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16
Q

Common cause of nephrotic presentation in children?

A

Minimal change disease,

Focal segmental glomerulosclerosis

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17
Q

Minimal change disease typical features

A

age 2-5
normal BP
resolving microscopic haematuria
normal renal function

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18
Q

Atypical features of MCD

What would you consider doing if someone presented with these?

A

Suggestions of autoimmune disease,
abnormal renal function,
steroid resistance

-Consider renal biopsy

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19
Q

Main side effects noticied by parents in children with glucocorticoid treatment

A

behaviour change,
mood change,
sleep disturbance

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20
Q

Glucocorticoid treatment, what must the dr think about before

A

hypertension,
pneumococcal vaccination,
antibiotic prophylaxis

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21
Q

what is on the spectrum for idiopathic nephrotic syndrome in childhood

A 
non relapsing,
infrequently relapsing, 
frequently relapsing, 
steroid dependent,
Steroid resistant (Focal segmental glomerulosclerosis)
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22
Q

Pathology behind steroid resistant nephrotic syndrome

A

Interaction between lymphocytes (t and B cells) and podocytes

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23
Q

Acquired cause of steroid resistant nephrotic syndrome

A

Focal Segmental Glomeruloscerosis

causes podocyte loss and progressive inflammation and sclerosis

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24
Q

Congenital causes of steroid resistant nephrotic syndrome

A

NPHS1-nephrin loss
NPHS2- podocin loss
infant presentation

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25
What does persistent haematuria and proteinuria suggest
glomerular disease
26
Causes of haematuria
systemic: -clotting disorders Renal: - Glomerulonephritis - Tumour (Wilm's nephroblastoma) - Cysts Malignancies: -Sarcomas Stones UTI Trauma Urethritis
27
What investigations to use in nephritic syndrome and their results
``` Creatinine (increased) Electrolytes- hyponatraemia hyperkalaemia FBC- anaemia, no haemolysis Albumin (slightly low) UTI (negative) ```
28
Presentation of nephritic syndrome
``` haematuria proteinuria reduced GFR -oliguria -fluid overload (raised JVP and oedema) - Hypertension -Worsening renal failure (=rapidly progressing) ```
29
Case: 7 day history of sore throat + nephritic syndrome Typical cause
Acute Post-Infectious Glomerulonephritis
30
Acute Post-Infectious Glomerulonephritis common cause and from what site?
Group A strep Beta haemolytic Site- throat 7-10 days Skin 2-4 weeks
31
Investigations for Acute Post-Infectious Glomerulonephritis as cause for nephritic syndrome
``` Renal USS ASOT Throat swab ANCA Complement levels ?Biopsy ```
32
Treatment for Acute Post-Infectious Glomerulonephritis
Antibiotics Electrolytes Diuretics
33
Second most common cause of nepritis in children
Henoch Schonlein Purpura (IgA related vasculitis)
34
What is Henoch Schonlein Purpura
Non streptococcal post infectious glomerulonephritis | Also known as IgA vasculitis
35
What needs to be present for clinical diagnosis of Henoch Schonlein Purpura
-Mandatory palpable purpura -One of 4: (BARA) Abdominal pain Renal involvement Arthritis or arthralgia Biopsy- IgA deposition
36
IgA vasculitis triggers and duration of symptoms
1-3 days post trigger presents: - viral URTI - streococcus or - drugs Duration: 4-6 weeks 1/3 relapse
37
Clinical presentation of IgA nephropathy
recurrent macroscopic haematuria +/- Chronic microscopic haematuria Varying degree of proteinuria
38
How to diagnosis IgA nephropathy
Autoimmune workup (negative) Compliement (normal) Biopsy
39
Treatment for IgA nephropathy
mild- ACEi | moderate-severe- Immunosuppression
40
Causes of nephritic syndrome in children
Post infectious glomerulonephritis IgA nephropathy Henoch-Schonlein purpura
41
Causes of nephrotic syndrome in children
FSGS | minimal change
42
Acute Kidney Injury definition
Abrupt loss of kidney function Resulting in: -the retention of urea and other nitrogenous waste products And -Dysregulation of extracellular volume and electrolytes
43
Acute renal failure presentation
Anuria/oliguria (<0.5ml/kg for >8 hours) Hypertension with fluid overload Rapid rise in plasma creatinine (>1.5x age specific reference)
44
Interpretation of AKI warning score
AK1- creatinine >1.5-2x reference AK2- creatinine 2-3x reference creatinine AK3- creatinine >3x reference creatinine
45
AKI management
``` Prevention 2Ms -Monitor (Paediatric early warning scores (BP), urine output, weight) -Maintain (Good hydration) -Minimise (drugs) ```
46
Causes of AKI | prerenal, intrinsic renal and post-renal
Pre-renal: -Perfusion problem Intrinsic renal: - Glomerular diease- HUS, Glomerulonephritis - Tubular injury- Acute tubular necrosis (consequence of hypoperfusion or drugs) - Interstitial nephritis- NSAID, autoimmune, drugs Post-renal: -Obstructive uropathies
47
Causes of Haemolytic-uraemic syndrome
Entero-haemorrhaic E.coli Pneumoccal infection drugs Atypical HUS
48
Period of risk of HUS after Ecoli o157:H7 serotype
up to 14 days after onset of diarrhoea
49
Triad of Haemolytic-uraemic syndrome
Microangiopathic haemolytic anaemia Thrombocytopenia AKI/ Acute renal failure
50
HUS management
``` Monitor: -5 kidney functions Maintain: -IV normal saline and fluid Minimise: -No antibiotics/NSAIDs ```
51
AKI long term complications
BP (hypertension) Proteinuria Evolution to CKD
52
Chronic kidney disease causes in paediatrics
Congenital anomalies of the kidney and urinary tract - Reflux nephropathy - Dysplasia - Obstructive uropathy hereditary conditions: - Cystic kidney disease - Cystinosis Glomerulonephritis
53
What conditions can be associated with CAKUT
turner trisomy 21 Branchio-oto-renal Prune belly syndrome
54
At what GFR do you begin to see symptoms
<60
55
Presentation of CKD
``` Waste handling: -Uraemic- loss of appetitie, weight loss, itch Water: -Polyuria Salt balance: -lethargy Endocrine -renal rickets Bladder dysfunction ```
56
UTI definition
Clinical signs plus - Bacteria culture from midstream urine - Any growths on suprapubic aspiration or catheter
57
What urine sample techniques to use for different age groups
clean catch urine or midstream urine | sick infants- catheter sample or suprapubic aspiration
58
what is vesico-ureteric reflux
e flow of urine travels backwards from the bladder, up the ureters
59
Grades of vesico-ureteric reflux
grade 1: reflux limited to the ureter grade 2: reflux up to renal pelvis grade 3: mild dilatation of ureter grade 4 :tortuous ureter with moderate dilatation grade 5: tortuous ureter with severe dilatation of ureter and pelvicalyceal system
60
Who to investigate when it comes to children and UTI
If: upper tract symptoms <6 months Recurrent UTIs
61
Investigations to conduct if worried about UTIs
Ultrasound DMSA (isotope scan) Micturating cysto-urethrogram MAG 3 scan
62
Treatment for children with UTIs
Lower tract- 3 days oral antibiotics | Upper tract/ pyelonephritis- 7-10 days
63
Factors affecting progression of CKD
``` late referral Hypertension Proteinuria High intake of protein, phosphate and salt Bone heath Acidosis Recurrent UTIs ```
64
How to measure childs BP
sphigmanomter | oscillomerty
65
Blood pressure chart children definition of hypertension
> or equal to 95th percentile
66
Metabolic bone disease treatment principles
low phospate diet oral phosphate binders active vitamin D
Paediatrics
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