Renal

Question 1

Top three reasons a child has an AKI?

Answer 1

• sepsis
• haemolytic uraemic syndrome
• post streptococcal glomerulonephritis

Question 2

normal creatinine in micromol/L in children?

Answer 2

25 - 65

Question 3

Specific investigations for AKI and why

Answer 3

• CK , myoglobin: rhabdo
• urinary electrolytes and protein: pre renal vs intrinsic
• Urine MCS -exclude infection
• USS/CT: excude obstruction
• serum electrolytes and lactate, HCO3: assess degree of failure

Question 4

Indications for dialysis

Answer 4

• uraemic: consider if > 30 or encephalopathic, pericaritis
• Met acidosis pH < 7.2
• Hyperkalaemia > 6.5 not responding to medical treatment
• Fluid overload refractory to medical treatment
• Toxin removal: small, non protein bound

Question 5

Causes of haematuria

Answer 5

• UTI
• IGA nephropathy
• thin basement membrane disease
• poststreptococcal glomerulonpheritis or other glomerulonephritis
• HUS
• hypercalciuria
• malignancy (only 1% in children)

If microscpoic 80% no underlying renal disease found (tempory due to fever, exercise, trauma)
If macroscopic 60% will be due to an identifiable disease

Question 6

Management of asymptomatic microscopic haematuria

Answer 6

• exclude proteinurea
• exclude UTI
• palpate or renal mass
• Enquire about family hx renal disease or deafness (Alport disease)
• refer to GP for repeat testing when well in 2 weeks time

Question 7

What Ix and managmenet for a pt with a urine dip with protein and blood

Answer 7

• quantify with microscopy, casts and protein:creatinine ratio
• culture
• check BP and weight
• If child refer for admission: suggest glomerular disease. Adult: DW medics

Question 8

Most common cause of HTN in children?

Answer 8

renal disease

Question 9

Ix to assess for end organ damage in hypertensive child

Answer 9

• fundoscopy (retinopathy)
• ECG (LV hypertrophy(
• urine - (proteinurea)
• U&Es

Question 10

IV medication of choice for hypertensive emergency in a child

Answer 10

• beta blocker - emsolol or labetolol

Question 11

In what age group is urine dipstick unreliable in diagnosing UTI in children?

Answer 11

< 2 years

sent for formal MCS

Question 12

In children what age group should be admitted to SSU or ward for IV/IM antibiotics if diagnosed with a UTI ?

Answer 12

Age < 3 months

high risk of septicaeia
SSU if well looking
Admit if abnormal obs

Question 13

An infant presents with a fever and has a urine sample indicating UTI. They have no flank pain and look well. Do they have cystitis or pyelonephritis?

Answer 13

Treat as pyelonephritis

Question 14

Which children with a UTI need a renal USS before safe discharge?

Answer 14

• unwell enough to be admitted
• boys < 3 months
• renal impairment

to exclude obstruction

Question 15

What is the triad of haemolytic uraemic syndrome?

Answer 15

• haemolytic anaemia
• thrombocytopaenia
• renal failure

Most common age < 5. Most common cause of paediatric acute renal failure

Question 16

Triggers of haemolyic uraemic syndrome

Answer 16

• Infections: shiga toxin E.coli diarrhoea (90%), pneumococcus pneumonia (10%)
• immunosupression (malignancy, drugs)
• congenital or acquired complement disorders
• inborn errors of metabolism

Question 17

When does haemolytic uraemic sydrome occur after exposure to shiga toxin?

Answer 17

2-6 days after enteritis begins but 6-14 days after exposure to the contaiminated food/water

Question 18

Three features found on urinalysis, bloods and examination that would lead to a presumptive diagnosis of nephrotic syndrome?

Answer 18

• proteinura +
• hypoalbuminaemia +
• oedema

without oedema are said to have nephrotic level proteinurea
In patient teams use hyperlipidaemia as part of diagnosis but this will not be available in ED

Question 19

A child with a hx of nephrotic syndrome presents with a distended abdomen and scrotam oedema. Urine dip shows protein +++. They have abdominal pain and fever. What disease should be suspected and what specific Ix is needed to confirm it?

Answer 19

Spontaneous bacterial peritonitis
Peritoneal sample for MCS

nephrotic syndrome can have a relapsing and remitting course

Question 20

Pt with nephrotic syndrome are at risk of venous thrombosis. What are features of a renal vein thrombosis?

Answer 20

Flank pain, possibly with haematuria, decreased renal function

Question 21

What are signs of symptoms of Henoch-Schonlein Purpura (IgA vasculitis)

Answer 21

• skin changes 100% (urticaria, erytehma, purpura, bullous lesions)
• Joints 75% ( arthralgia knees and ankles)
• Renal (30 - 50% (haematuria, proteinurea)
• Abdominal 60% ( pain)

Question 22

A child has a K of 7 with ECG. What is the dose of insulin and dextrose?

Answer 22

0.1unit/kg rapid acting insulin IV +
5ml/kg 10% dextrose