RENAL DISORDERS

PROTEINURIA
Measure the urine protein/creatinine ratio in an
early morning
> 20mg/mmol of creatinine

Common causes is postural proteinuria

CAUSES OF PROTEINURIA
Causes Pathophysiology
Orthostatic proteinuria Elevated protein excretion while in the upright
position and normal protein excretion in a
supine or recumbent position

Glomerular abnormalities Minimal change disease

Glomerulonephritis
Abnormal glomerular basement membrane

Increased in glomerular Increase filtration rate, increased in protein

filtration pressure filtration
Reduced renal mass
Hypertension High blood pressure can cause damage to
kidney causing proteinuria
Tubular proteinuria Affecting the tubulo-interstitial component of
the kidney. It comprises low molecular proteins
such as beta-2 microglobulin, which in normal
conditions are completely reabsorbed by
proximal tubules
HAEMATURIA
Urine that is red or test positive for haemoglobin on
urine sticks should be examine by microscope to
confirm hematuria
>10 red blood cells per high-power field

Glomerular haematuria brown urine, presence of

deformed cells and casts, accompanied by proteinuria
Lower urinary tract haematuria red, beginning or
end of urinary steam, not accompanied by proteinuria,
unusual in children
 CAUSES OF HAEMATURIA
Non-gromerular Glomerular

Infection (bacterial, viral, Acute

TB, schistosomiasis) glomerulonephritis (w
proteinuria)
Trauma
Chronic
Stones glomerulonephritis (w
Tumours proteinuria)
Sickle cell disease IgA Nephropathy
Bleeding disorders Familial nephritis eg;
Alport syndrome
Renal vein thrombosis
Thin basement
Hypercalciuria membrane disease
INVESTIGATION OF HEMATURIA

All patients: If suggestive of

glomerular hematuria:

Urine microscopy and ESR, complement levels, anti-

culture DNA antibodies
Protein and calcium Throat swab. Atnistreptolysin
excretion O/anti-DNAse B titres
Kidney and urinary Hep B and hep C
tract ultrasound Renal biopsy if indicate:
Significant persistent proteinuria
Plasma urea,
Recurrent macroscopic haematuria
electrolytes, Renal function normal
creatinine, calcium, Complement level persistently
abnormal
phosphate, albumin
Test mothers urine
FBC, platelets,
clotting screen, sickle Hearing test (alport
cell screen syndrome)
NEPHROTIC SYNDROME
Characteristics of nephrotic syndrome:
Heavy proteinuria
Edema
Hypoalbuminemia
Hypercholesteronemia

Common in less than 6 years old until preschool

age
More common in boys
ETIOLOGY
Primary Nephrotic Secondary Nephrotic
Syndrome Syndrome
Idiopathic nephrotic Systemic disease (DM,
syndrome Post-infection GN,
(commonest) hepatitis, amyloidosis)
Minimal change Systemic vasculitides (
disease (85%) SLE, and HSP)
Focal segmental Drugs ( NSAIDs,
glomerulosclerosis mercury)
(10%) Malignancy
Membranoproliferativ
e GN (5%)
COMPLICATIONS
Hypovolemia Acute Kidney Injury
Abdominal pain Hypovolemic features
Weak and poor Tachycadia
peripheral pulse Pallor
Low blood pressure
and
hemoconcentration Steroid toxicity
Oligouria Short stature
Cushingoid features (
moon face, buffalo
Peritonitis hump, abdominal
Fever striae, upper body
Abdominal pain and obesity with thin arms
tenderness and legs)
INVESTIGATIONS
TESTS REASONS
Urine Dipstick Test Basic diagnostic tool for
pathological changes in patients
urine ( 2+ readings on dipstick)

Urine culture and sensitivity To rule out urinary tract

infection
Renal profile Low sodium level (less than 10
mmol/L)
Serum albumin Low serum albumin ( less than
25g/L)
Lipid profile High total cholesterol level (more
than 250mg/L)
ACUTE GLOMELURONEPHRITIS
Associated with 1 or more features of acute
nephritic syndrome
Hematuria
Edema (facial puffiness)
Oligouria
Hypertension
Azotemia
Common in age between 6-10 years old
ETIOLOGY
Post infectious
Bacteria: Streptococcal (most common),
staphylococcus, Mycoplasma pneumonia and
Salmonella
Virus: Herpes virus
Fungi: Candida and aspergillus
Parasites: Toxoplasma, Malaria

Other causes
Ig A nephropathy
Systemic Lupus Erythematous
Henoch-Schlein purpura
COMPLICATIONS
Hypertension Hyperkalaemia
Headache Drowsiness
Vomitting Apathy
Loss of vision Bradycardia
Convulsion Abdominal cramp
Pulmonary edema Nausea
Respiratory distress Vomitting
Cough
Tachycardia
INVESTIGATIONS
Urinalysis and culture Chest X Ray
Hematuria If suspect to have fluid
Proteinuria overload
Renal profile Antistreptolysin O
Urea Titer
Serum creatinine Look for antibody
against streptococcus
Full blood count A bacteria
Low Haemoglobin
Leukocytosis
URINARY TRACT INFECTION

Urinary tract infection (UTI) is an infection that affects part of the urinary
tract
The bacteria that cause urinary tract infections typically enter the bladder via
the urethra. However, infection may also occur via the blood or lymph.

INFANT:
Fever, vomiting, lethargy/irritability, poor feeding, jaundice,
septicaemia, offensive urine, febrile convulsions (more than 6
months).
CHILDREN:
Dysuria, abdominal pain/loin tenderness, fever, lethargy and
anorexia, vomiting, diarrhoea, heamaturia, offensive/cloudy
urine, febrile convulsion, recurrence of enuresis.
INVESTIGATION

Urine specimen collection

A midstream, clean-catch specimen may be obtained
from children who have urinary control
Suprapubic aspiration or urethral catheterization
should be used in the infant or child unable to void on
request
HEMOLYTIC-UREMIC SYNDROME (HUS)
It is a disease characterized by acute renal failure,
microangiopathic hemolytic anemia and thrombocytopenia

The most common cause in children is E. coli infection of the

digestive system.

A child with hemolytic uremic syndrome may develop signs

and symptoms similar to those seen with gastroenteritis
vomiting
bloody diarrhea
abdominal pain
fever and chills
headache
PROGRESSION
As infection progresses, toxins released in the intestine begin to destroy
RBC leading to signs and symptoms of anemia:
fatigue, or feeling tired
weakness
fainting
paleness

When hemolytic uremic syndrome causes acute kidney injury, a child may
have the following signs and symptoms:
Edema most often in the legs, feet, or ankles and less often in the
hands or face
Albuminuria
Decreased urine output
Hypoalbuminemia
Hematuria