1 / 72

Comprehensive Approach to Pediatric Kidney Disease in Jordan

Gain insights into pediatric kidney disease patterns in Jordan, explore cultural influences, and optimize patient care strategies to avoid unnecessary investigations and save resources. Covers key topics such as congenital anomalies, antenatal diagnosis, acute kidney injury, chronic kidney disease, urinary tract infections, glomerular diseases, and more.

samuelsd
Download Presentation

Comprehensive Approach to Pediatric Kidney Disease in Jordan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Approach to Pediatric Kidney Disease Kamal Akl MD Professor of Pediatrics & Pediatric Nephrology July 2019

  2. Objectives • To familiarize medical students with the pattern of Pediatric Kidney Disease in Jordan • To approach children in a focused, geographically, and culturally oriented manner • Such approach will save time, money, and unnecessary investigations

  3. Pediatric Kidney Disease in Jordan

  4. Pediatric Kidney Disease in Jordan • Including influence of : • Cultural Habits • Religion • Economics

  5. Approach to Pediatric Kidney Disease • Children are not small adults • Importance of the history and physical exam • Treat the Patient , not the lab • Developing Clinical sense(Sans Clinique)

  6. Congenital Anomalies of the Kidney and Urinary Tract(CAKUT) • Kidneys • Pelvis • Ureters • Bladder • Urethra

  7. CAKUT

  8. CAKUT • Importance of Antenatal Diagnosis

  9. Antenatal Diagnosis • Severity of Hydronephrosis based on AP pelvic diameter: • Severe > 10 mm in 2nd trimester • Severe > 15 mm in 3rd trimester

  10. Antenatal Diagnosis • Society for fetal urology(SFU) hydronephrosis grading system: • Grade O – no dilatation • Grade 2- Urine fills intrarenal pelvis+/- major calyces • Grade 3- all calyces are visualized • Grade 4- Grade 3+ parenchymal thininng • Nguyen HT et al • J Pediatr Urol. 2010 Jun;6(3):212-31. doi: 10.1016/j.jpurol.2010.02.205. Epub 2010 Apr 15. • The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis.

  11. Antenatal Diagnosis • Red flags for significant pathology: • Oligohydramnios • Additional renal or extrarenal anomalies • Sinha A • Indian J Nephrol. 2013 Mar-Apr; 23(2): 83–97.

  12. Antenatal Diagnosis • Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). • Sinha A et al Indian J Nephrol. 2013 Mar-Apr; 23(2): 83–97.

  13. Acute Kidney Injury • Prerenal • Intrinsic Renal • Postrenal • Causes in Jordan

  14. Chronic Kidney Disease(CKD) • Should know • CKD stages • Updated Shwartz Formula • Causes in Jordan

  15. CKD Stages • I • II • III • IV • V

  16. Updated Shwartz Formula [Height(cm)/serum creatinine(mg%] x 0.413

  17. End Stage Renal Failure(ESRF) In Jordan • Most Common causes in Jordan • CAKUT: Reflux Nephropathy • Neurogenic Bladder • Posterior Urethral Valve • Heredofamilial • Glomerular Disease • Etc • Akl KF et al • Aetiology of Paediatric End-stage Renal Failure in Jordan: A Multicentre Study. West Indian Med J. 2015 May 11;65(2):263-266.

  18. Urinary Tract Infection(UTI) • UTI in Jordan • E coli resistance • New AAP guidelines 2011

  19. Not all Dysuria is UTI • Causes of Dysuria: • Infectious: • APN • Cystitis • Vaginitis • Balanitis

  20. Not all Dysuria is UTI • Noninfectious: • Dysfunctional voiding • Labial adhesions • Crystalluria Meatal stenosis Chemical irritants Trauma

  21. Vesicoureteral Reflux • Primary • Secondary

  22. Asymptomatic urinary abnormalities • Hematuria • Proteinuria • Hematuria+ Proteinuria

  23. Glomerular Disease • Primary • Secondary • Jordan

  24. Should distinguish • Between - • Glomerular vs Non Glomerular Hematuria

  25. Should distinguish • Between • Acute Nephritis vs Nephrotic syndrome

  26. Classification of glomerular disease • May be based on serum complement • Presentation • Histopathology

  27. Classification based on serum complement • Hypocomplementemic : • (1) Poststrepeptococcal acute GN • (2) Mesangiocapillary GN • (3) Lupus nephritis • (4) Shunt nephritis • Normocomplementemic : Others eg MCD,FSGS , IgA N , HSP nephritis

  28. Classification according to clinical presentation • Asymptomatic urinary abnormalities • Nephritic syndrome • Rapidly progressive glomerulonephritis • Nephrotic syndrome • Chronic glomerulonephritis • Hypertension

  29. Classification based on histopathology • Proliferative • Nonproliferative

  30. Primary Glomerular Disease • IgA Nephropathy • Poststreptococcal Glomerulonephritis • Jordan

  31. Primary Glomerular Disease • Poststreptococcal AGN

  32. Poststreptococcal AGN

  33. Poststreptococcal AGN

  34. Secondary Glomerular Disease • Henoch Schonlein purpura • Systemic Lupus Erythematosis • Hemolytic Uremic Syndrome

  35. Hereditary Nephropathy • Alport syndrome • Nail Patella syndrome • New syndromes in Jordan

  36. Acute Interstitial Nephritis • Mostly under diagnosed • Causes AKI with minimal or no proteinuria

  37. Nephrotic Syndrome • Minimal Change Disease • Focal Segmental Glomerulosclerosis(FSGS) • Mesangioproliferative Glomerulonephritis • Mesangiocapillary Glomerulonephritis • Membranous Glomerulopathy • Seconary causes

  38. Nephrotic syndrome • Most common causes of Steroid resistance in Jordan • FSGS • MesProliferative GN

  39. Not all Edema is secondary to Kidney Disease • Causes of Edema: • Increased Capillary Permeability • Decreased Capillary Oncotic Pressure • Increased Plasma Volume • Lymphatic Obstruction

  40. Should distinguish • Between • Glomerular Disease vs Tubular Disease

  41. Tubular Disorders • Approach to Metabolic acidosis • Calculate Serum anion Gap • Urine Anion Gap

  42. Metabolic Acidosis • Normal Anion Gap( 8-16) • Increased Anion Gap

  43. Normal AG Metabolic Acidosis • Diarrhea • RTA

  44. RTA • Type 1 • Type 2 • Type 4

  45. RTA Type 1 • Ser K: low • Urine pH during acidosis :high • Ser HCO3: 10-20 • Urine pCO2: <20 • Urine citrate:low • Urolithiasis

  46. RTA Type 2 • Ser K:Low • Urine pH during acidosis: low • Serum HCO3: 16-18 • Urine pCO2: > 20 • Urine citrate: high • Fanconi syndrome: may be present

  47. RTA Type 4 • Ser K: High • Urine pH during acidosis: low or high • Serum HCO3: 16-22 • Urine pCO2: >20 • Urine citrate: low

  48. Increased anion Gap Metabolic Acidosis • Poisoning: Salicylate; Toluene; ethylene Glycol;Methanol • Ketoacidosis: Diabetic; starvation • Medications • Shock • Inborn errors of Metabolism; Methanol

  49. Metabolic Alkalosis • Chloride Responsive(U cl < 15 mEq/L) • Chloride Resistant(U cl > 20 mEq/L)

  50. Chloride Responsive Metabolic Alkalosis • Vomiting • Cystic Fibrosis • Pyloric Stenosis

More Related