Paediatric Clinical Chemistry, Renal Physiology
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Common problems with low birth weight
• Respiratory distress syndrome • Retinopathy of prematurity • Intraventricular haemorrhage • Patent ductus arteriosus • Necrotizing enterocolitis - inflammation of bowel wall - necrosis and perforation
Paediatric Renal Function
• Functional maturity of glomerular filtration rate only by 2 years of age • Less reabsorption than adult due to short proximal tubule • Reduced concentrating ability due to short loops of Henle and distal collecting ducts • Persistant sodium loss due to distal tubule being relatively aldosterone insensitive
Normal glomerular filtration rate
(GFR) = 120ml/hr Age related decline of approx 1ml/hr/yr
Gold standard measure of GFR?
Inulin - requires steady state infusion and difficult to assay so it is reserved for research purposes only
AKI - Pre-renal
Reduced renal perfusion with no structural abnormality
AKI - Renal
Vascular, glomerular, tubular or intestinal
AKI - Post-renal
Characterised by obstruction to urinary flow
Chronic Kidney Disease - Stage 1 • description • GFR • Prevalence (% of pop)
• Kidney Damage with normal GFR • GFR>90ml/min • 3.3%
Chronic Kidney Disease - Stage 2 • description • GFR • Prevalence (% of pop)
• Mild decreased GFR • 60-89 • 3%
Chronic Kidney Disease - Stage 3 • description • GFR • Prevalence (% of pop)
• Moderately decreased GFR • 30-59 • 4.3%
Chronic Kidney Disease - Stage 4 • description • GFR • Prevalence (% of pop)
• Severely decreased GFR • 15-29 • 0.2%
Chronic Kidney Disease - Stage 5 • description • GFR • Prevalence (% of pop)
-End stage kidney failure -
Commonest causes of Chronic Kidney Disease?
-Diabetes -Atherosclerotic renal disease -Hypertension -Chronic Glomerulonephritis -Infective or obstructive uropathy Polycystic kidney disease
Consequences of Chronic Kidney Disease?
1) Progressive failure or homeostatic function - Acidosis - Hyperkalaemia 2) Progressive Failure of hormonal function - Anaemia - Renal Bone Disease 3) Cardiovascular disease - Vascular calcification - Uraemic cardiomyopathy 4) Uraemia and Death