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Indications of renal biopsy

– Age less than 1 year or more than 8 year. – Nephritic picture( gross hematuria,hypertension) Renal insufficiency/raised creatinine Persistent hypocomplementemia( low C3) Steroid resistance

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Lecture notes taken from pediatricsbydranand

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pathcend

This would have come in handy prior to my ED rotations. 😖

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TORCH Mnemonics

Cerebrospinal fluid: -Stimulation of of the adrenergic system diminishes CSF production,whereas excitation of the cholinergic nerves may double the normal CSF production rate . -Approximately 20ml /hr of CSF is produced. -Total volume of CSF Approx 50ml in an infant and 150ml in an adult. -Most of CSF is extraventricular . -intraventricular pressure may be as high as 180mmh2o ,whereas pressure in superior sagital sinus is in the range of 90mmhg . -Aqueduct of sylvius approx 3mm long and 2mm in diameter. -hydrocephalus resulting from obstruction within the ventricular system is called obstructive or non communicating hydrocephalus. -Hydrocephalus resulting from obliteration of the subarachnoid cisterns or malfunction of the arachnoid villi is called non obstructive or communicating hydrocephalus.

#nelsonbookof pediatric 21ed #pediatrics #fcps #nelson21

Bilirubin metabolism

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CHEMO MAN 2.0

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Patent Ductus Arteriosus

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Atrial Septal Defect

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Ventricular Septal Defect

Henoch-schonlein purpura

Most common small vessel vascullitis syndrome in childern.

Inflammation of small vessels ,and capillaries particularly thise of the skin,git,and kidney.

It may be precipqted by infection ,particularly hemolytic streptococci in the preceding 1-3weeks.

Onset is generally after the age of 3years .male predominence

Pathogenesis:

An igA -mediated vasculitis of small vessels.

Immunofluroescence techniques show deposition of lgA and C3 in dmall vessels of skin and renal glomeruli.

Clinical features:

Mos common and earliest symptom is palpable purpura. It results from extravasation of erythrocytes into yhe tissue surrounding the involoved venule. Purpuric macules,are usually present on the legs,feet and buttocks but the entire body may be involoved.

Arthritis is transient involoving large joints.

There is colicky abdominal pain and or git bleeding.

25-50% have renal involvement.

Testicular torsion may occur.

Investigation:

ESR normal or high.

Cbc is normal.

Blood coagulation studies are normal.

Hematuria and /or proteinuria.

IgA complexes in glomeruli and involoved skin.

Serum LgA is often raised .

Aso titer is frequenly raised and the throat culture is poaitive for group A beta hemolytic streptococci.

Differential diagnosis:

Thrombocytopenia purpura

Meningicoccemua

Child abuse

Complication:

Intussusception of the small intestine

Renal failure

Mangement:

Supportive treatment

Corticosteroids are yaed in severe cases. It may provide symptomatic relief for severe gastrointestinal or joint manifestation but does not help for skin or renal manifestation.

Aspirin is used for the pain of arthritis.

ASO titer is positiv,pencillin is given for 10 days.

Prognosis:

HSP episodes are self limiting.prognosis for recovery is generally good .

Recurrence occasionally occur in 25-50 %.

Long term morbidity is related to renal involvement.

Hepatitis A

Route of spread is fecal-oral route.

No carrier state .

Incubation period 15 to 40 days.

With increasing age,infection is usually symptomatic.

Mortality is increased if the age of the patient is less than 5years.

Risk factors:

Travel to endemic area.

Household contact with HAV.

Child of age 3-10years.

Clinical features:

Prodromal illness:anorexia,nausea,malaise and fever.within a few days to a week ,jaundice,pale stools and dark urine. There may be tender liver,splenomegaly and posterior cervical lymphadenopathy.

HAV infection may lead to fulminant hepatic failure or prolonged cholestasis.

Diagnosis:

Anti-HAV igM is indicative of recent infection,it persists for 4to 6months after infection. Aminotranferases and conjugated and unconjugated bilirubin levels are elevated. Hypoalbuminemia,hypoglycemia and marked prolongation of prothrombin time are serious prognostic findings.

Complications:

Guillan-barre syndrome

Post viral encephalitis

Acute interstitial nephritis

Autoimmune hemolytic anemia

Treatment:

Has a good prognosis with full recovery.

Supportive treatment.

In fulminant hepatic failure liver transplantation should be provided.

Prevention:

Improving sanitation,basic standards of basic hygiene.

Vaccine is approved childern older than 2years,second dose given 6-12 months after first dose.

The spread of hepatitis A can be reduced by:

adequate supplies of safe drinking water;

proper disposal of sewage within communities; and

personal hygiene practices such as regular hand-washing with safe water.

Prognosis is poor in case of hrpatic coma,deepening jaundice,or development of ascities.

#hepatitis A #hepatitis #pediatrics

Definition: Failure of mineralization of growing bones or osteoid tissue. -Metabolic disturbance of bone growth and results from dietary lack vitamin D or ultavoilet rays of sunlight,overcroweded multistoried buildings. -An infacnt requires only 30 mints per week of total body sun exposure or 2 hrs per week of head exposure to maintain adequate vitamin D status. -Usually occures in the first 2year of life .if it persists beyond 2 years of age ,then consider vitamin D resistent rickets. -Deficiency may occur in dark-skinned infants or in breast fed infants of mothers unexposed to sunlight.