Pediatric Nephrology PDF 2024

PEDIATRIC NEPHROLOGY Dr. Ana Flor Somera Abad, Balmores, Cabauatan, Clarete, de Leon, Duruin, Lim, Maramag, Tumamao, Urbano OUTLINE FIXED I. Proteinur...

PEDIATRIC NEPHROLOGY Dr. Ana Flor Somera Abad, Balmores, Cabauatan, Clarete, de Leon, Duruin, Lim, Maramag, Tumamao, Urbano OUTLINE FIXED I. Proteinuria First morning urine sample that is >1+ on dipstick testing with A. Transient a urine SG >1.015 or with a urine protein-to-creatinine ratio of B. Orthostatic >0.2 C. Fixed Indicates a potential kidney disease caused by either II. Nephrotic Syndrome glomerular or tubular disorders III. Renal Tubular Acidosis A. Distal (Type I) Glomerular Proteinuria B. Proximal (Type II) Range widely from 30g of protein in a 24 hr period, C. Hyperkalemic (Type IV) patient with a first morning urine protein-to-creatinine ratio >1.0, IV. Nephrogenic Diabetes Insipidus or significant proteinuria of any degree V. Bartter Syndrome Accompanied by: VI. Gitelman Syndrome ✓ Hypertension VII. Acute Kidney Injury ✓ Hematuria with active urine sediment VIII. Chronic Kidney Disease IX. End-Stage Renal Disease ✓ Edema ✓ Renal dysfunction (elevated BUN, creatinine) LEGEND Tubular Proteinuria Book PowerPoint Lecturer Involve the tubulointerstitial compartment of the kidney Can cause low-grade fixed proteinuria (urine protein-to- creatinine ratio 0.2:1.0) PROTEINURIA Clinical Evaluation of the Child with Proteinuria NEPHROTIC SYNDROME Three possible mechanisms: Proteinuria > 3.5 g/24 hr ✓ Glomerular Proteinuria - Occurs as a result of disruption Urine protein:creatinine ratio >2 of the glomerular capillary Triad of clinical findings ✓ Tubular Proteinuria - Tubular injury or dysfunction that ✓ Large urinary losses of protein or hypoalbuminemia leads to ineffective reabsorption of mostly low-molecular- (200 mg/dL) myeloma, rhabdomyolysis, or hemolysis Affects 1-3 per 100,000 children 250 cells/uL are highly Children with features that make MCNS less likely (gross suggestive of spontaneous bacterial peritonitis hematuria, hypertension, renal insufficiency, Hypercoagulability hypocomplementemia or age 12 yr) should be ✓ Vascular stasis from hemoconcentration and intravascular considered for renal biopsy before treatment volume depletion, increased platelet number and Corticosteroids (in the treatment for MCD) aggregability, and changes in coagulation factor levels ✓ Single dose of 60 mg/m2/day or 2 mg/kg/day (max of 60 ✓ Deep venous thrombosis may occur in any venous bed, mg daily for 4-6 wk) including the cerebral venous sinus, renal vein, and ✓ Followed by alternate-day prednisone (40 mg/m2 qod or pulmonary veins 1.5 mg/kg qod) from 8 wk to 5 mo ✓ KDIGO Glomerulonephritis Work Group recommends at IDIOPATHIC NEPHROTIC SYNDROME least 12 wk of steroid treatment 90% of children ✓ Approx. 80-90% children respond to steroid therapy Associated with primary glomerular disease without an identifiable disease or drug Terminologies ✓ Minimal change disease (MCD) Response: attainment of remission within initial 4 wk CS ✓ Mesangial proliferation therapy ✓ Focal Segmental Glomerulosclerosis Remission: urine protein:crea