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Renal - Proteinuria + Hypertension - Coggle Diagram
Renal - Proteinuria + Hypertension
Epidemiology
Markery of kidney damage and disease
Leads to progressive renal injury
10% of children 8-15 yrs test (+) for proteinuria at some time
Protein Origin
Glomerular
Albumin
Change in any part of the glomerular capillary wall
Tubular
Low molecular weigth proteins
Failure to reabsorb
Overflow
Myeloma
RARE in children
Detection
Qualitative
Dipstick Measuremet
Colourimetric method
Concentration dependent
False positive
Alkaline urine
Radiocontrast
Quantitative
24h urine collection
Difficult in children
Inconsistent, incorrectly collected, time consumin
Urine creatinine
First morning Urine Protein / Creatinine ratio
Types of Proteinuria
Orthosatic / Postural Proteinuria
Abnormally high protein excretion in upright position
Less than 1gram /day
Normal excretion when patient in recumbent (1st morning void or split urine
Result of altered haemodynamics - activation of RAS
Benign
Girls > Boys
Follow uo : Repeat 1st morning UA yearly
Transient Proteinuria
Causes
Fever
Exercise
Heart failure
Aetiology
Haemodynamic alterations most likely
Resolves in 10-14 days of defervescence
Resolves within 48h of rest from vigorous exercise
Benign - does not indicate underlying renal disease
Proteinuria Dxx
Glomerular
Nephrotic syndrome
Minimal change disease
FSGS
Congenital nephrotic syndrome
PIGN
MPGN
Membranous nephropathy
IgA / HSP
SLE
Vasculitis
Diabetes
Sickle cell disease
HIV nephropathy
Malaria
Hep B/C
Heredity nephropahty (Alports)
Tubular
Reflux nephropathy
Ptelonephritis
Kidney injury
Aminoglycosides
Heavy metals
Lithium
Ischaemic injury
Dysplasia / hypoplasia
Polycystic kidney disease
Fanconi syndrome / Proximal RTA
Dent's disease
Nephrotic Syndrome
Criteria
Oedema
Hypoalbuminaemia <25
Hypercholesterolemia
Proteinuria >200
Epidemiology
80% Minimal change disease
90% respon to steroids
70% relapse
80% will remit over time
Idiopathic Nephrotic Syndrome
Remission
Negative / trace for 3 consecutive dayse
Relapse
3+ or more for 3 days
Frequently replapsing
2 or more times in the 1st 6months, 4 or more in 12months
Steroid dependent
Relapse on steroids or within 14 days of stopping
Steroid resistant
No resolution in 28 days on 60mg/m2/day
Investigations
Dipstick urine for blood/protein
Early morning urine for PCR
Urine for M, C and S
Urinary NA
Plasma U&E, albumin, creatinine
FBC - low haem
Complement levels
Varicella zoster serology
Hep B and C serology
Atypical nephrotic syndrome
Age <12 months - >12 years
Persistent hypertension and impaired renal fx
Gross haematuria
Low C3
Hep B or C positive
Complications
Infection - pneumococcal
Hypovolaemia
Prerenal failure and thrombotic risk
Nutritional
Due to high dose steroids
Treatment side effects
Treatment
Prednisolone
Penicillin prophyllaxis (occasionally)
Education / diet
Vaccination issue
Fluid management
Hypertension
Epidemiology
95th centrile for age, height, and gender
Severe undiagnoses and untreated - high morbidity and mortality
Mainly renal in origin
Measurement
Cuff size
Widest cuff that can be applied
90-100% circumfrence arm
Too small - high inaccurate BP
Investigations / Assessment
Confirmation
FHx
Essential / familial HTN
PMHx
Symptoms of renal disease
Polyuria
Dysuria
Enuresis
Palpations
Flushing
UTI hx
Symptoms of high BP
FTT
Lethargy
Visual
Headaches~
Nausea
Vomiting
Examination
Femoral delay
Rashes
Cafe au lait spots
Axillary freckling
Abdominal bruit
SIgns of CRF
Ambiguous genitalia
Urinalysis
Target Organ Damage
ECG
ECHO
Opthalmology
1st line Investigations
FBC
Electrolytes
U&E
Urate and fasting lipids
Urine dipstick for protein and blood
Urine culture for leucocyturia
Urine albumin: creatinine ration if (+) proteinuria
Abdominal and doppler renal US
CXR
2nd Line Investigations
Should be performed in all cases of more severe HTN as with eg target organ damage
Plasma renin and aldosterone
Urinary catecholamines
Urinary VMA/HVA
Pre and post captopril DMSA and MAG3
3rd Line Investigations
REnal angiography and renal vein renin studies
MIBG scan
