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Paediatric Nephrology

Paediatric Nephrology. Teaching website. http://paedstudent.cardiff.ac.uk. UTI – cumulative incidence. When to suspect a UTI. Infants Pyrexia (>38.5 o C) Poor feeding Vomiting Abdominal discomfort Febrile seizure. When to suspect a UTI (2). Older children Frequency Dysuria Wetting

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Paediatric Nephrology

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  1. Paediatric Nephrology

  2. Teaching website • http://paedstudent.cardiff.ac.uk

  3. UTI – cumulative incidence

  4. When to suspect a UTI • Infants • Pyrexia (>38.5oC) • Poor feeding • Vomiting • Abdominal discomfort • Febrile seizure

  5. When to suspect a UTI (2) • Older children • Frequency • Dysuria • Wetting • Abdominal pain • Pyrexia

  6. Diagnosis • Collect a urine specimen • MSU • Clean catch specimen • Bag specimen • Catheter specimen • Suprapubic aspirate • Pad specimen

  7. Leucocyte esterase • Identifies presence of white blood cells • High sensitivity for UTI but low specificity

  8. Nitrite test • Reliable sign of infection when positive • BUT high false negative rate • Urine has to have been in the bladder for at least an hour. This lowers the false negative rate.

  9. Use of both nitrite & leucocyte esterase tests Has not replaced urine culture in patients suspected of having a UTI.

  10. What do you do with the urine?

  11. Aims of treatment • Prevention of renal scarring • Achieved through prompt initiation of antibiotic therapy, particularly in those groups at highest risk • Infants • Children with vesicoureteric reflux

  12. Ultrasound - Normal

  13. Ultrasound - Hydronephrosis

  14. Ultrasound - Scarring

  15. DMSA scan - normal

  16. DMSA - scarring

  17. DMSA - scarring

  18. MCUG - normal

  19. MCUG - normal

  20. MCUG – R sided grade II VUR

  21. MCUG – Bilateral VUR

  22. MCUG – Bilateral VUR

  23. Management of VUR • Antibiotic prophylaxis until 4 -5 years old • Surgery if continue to get UTIs • Reimplantation • Injection of Deflux

  24. IMPORTANT MESSAGE • Only do an investigation if the result will potentially alter your management of the patient.

  25. Any questions?

  26. Nephrotic syndrome Triad of: • Heavy proteinuria • Hypoalbuminaemia • Oedema

  27. Normal glomerulus (em)

  28. EM showing foot process fusion

  29. Interstitial fluid Ph - Hydrostatic pressure Po - Oncotic pressure

  30. Mechanisms of oedema formation (2) • Increased hydrostatic pressure • Hypervolaemia • Increased venous pressure • Reduced oncotic pressure • Hypoalbuminaemia • Increased capillary permeability • Sepsis

  31. Complications • Oedema • Hypovolaemia • Cool peripheries • Prolonged capillary refill time • Abdominal pain • Increased blood pressure • Infection • Hypogammaglobulinaemia

  32. Complications (2) • Hypercoaguable state • Raised haematocrit • Loss of anti-thrombin III

  33. VQ scan in nephrotic patient

  34. Complications (2) • Hypercoaguable state • Raised haematocrit • Loss of anti-thrombin III • Hyperlipidaemia • Hypothyroidism

  35. Treatment • Lots of steroids

  36. Any questions?

  37. Red cell cast

  38. Tubules filled with red blood cells – source of red cell casts

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