Nephrology CME at Hotel Silvette, LKO on May 6, 2018.
Prof RN Srivastava, AIIMS, was the speaker.
Prof MMA Faridi Chaired the session .
Dr Wakhlu, renowned Pediatric Surgeon, Prof Ahuja, President LAP also there.
Key Messages
*Congenital Renal Anamolies*
Renal anomalies are very common 15%
Cause 40-50% of CKD in children
Bud theory anamolies depend on position of ureteric orifice
Antenatal diagnosis possible, oligohydramnios predict of poor function
UTI in utero may lead to dysplastic development
Unilateral hypoplasia well tolerated if other kidney normal
Bilateral aplasia lethal
Multicystic dysplastic kidney commonest u/l functionless, 1:2000, males, 2nd mc cause of abd lump in infants
PCKD AR 1:20000 poor px
PCKD AD commonest 1:500 detected by UTI, HTn, hematuria
Pelvic kidney commonest ectopic
Ectopic benign until interfere vasculature
Uretrocele leads to recurrent UTI, obs, VUR
Hydronephrosis antenatal benign <5mm, AbN >5mm in 2nd trim >7mm in 3rd
>15mm at 30 weeks is severe
Obstructive PUJ, UVJ , VUR
Oligohydramnios: risk of obstruction & pulmonary hypoplasia
Percutaneous bladder decompression tried antenatal
PUJ in newborn USG on day 3
AP >50mm cortical thinning, Uti, dtpa function <30 % : surgery
PUV bl hydronephrosis, thick bladder wall, old age dribbling, UTI, poor stream
Neurogenic bladder: clean intermittent catheterization
Obstruction r severe need urgent intervention
U/l problems less severe need observation
ESRD: Chr PD, attention to nutrition, growth
Transplant at 10kg 65cm
–Nephrotic syndrome exclude infection & TB before steroids
-Response if albumin neg/trace for 3 days after 10-14 days of treatment
-If TB present, start ATT first and after 2 weeks steroids
-Relapse 2mg/kg till remission than 1.5mg/kg for 4 weeks
– 2 relapses in 6mth or 3 in ye frequent relapser
-Steroid dependant relapse on tapering or within 2 wk of omission
-Frequent relapse low dose steroids 6 mths
-Steroid sparing levamisole, endoxan, cyclophosphamide, tacrolimus, cyclosporine
-Steroid toxicity: bp, osteoporosis, height, eyes, cushingoid
-avoid additional salt, protein 1.5g/kg, fat<30% of diet
-OPV MMR can cause proteinuria
Pneumococcal Hib Varicella TCV to b given
Avoid live vaccines till 2 weeks after treatment complete
UTI in newborn
-hydration
– antibiotics upto 14 d
– no alkalization
-put on prophylaxis in follow up
-follow up usg, dmsa, MCU
-urine re and cs after treatment completion
– follow with usg if AP on usg is <8mm till 1 yr, if more follow with other investigation
– avoid constipation
-adequate hydration
