נפרולוגיה Flashcards
when we will see RBC casts + protenuria> 100
Hematuria from the glomeruli
most common reason for hematuria and what is the definiton of hematuria?
hematuria = > 5RBC /HPF
most common reason- UTI
ddx for painful hematuria?
kidney cysts bleeding
pressure on kidney bein
stones in urinary tract
menagment of persistent asymptomatic isolated hematuria?
מעקב ל”ד ושתן כל 3 חודשים עד שההמטוריה נעלמת.
הפניה לנפרולוג- בהמטוריה מעל שנה / עדות לנפריטיס יל”ד וכדומה
Which kidney disease are a/w low complement levels?
- Lupus nephritis (both C3-C4)
- PSGN- C3
- MPGN- C3
What is the most common reason for persistent protenuria in kids? and how we dgx?
orthostatic protenuria
הפרשה מוגברת של חלבון בעמידה ובשכיבה כמויות תקינות.
אבחנה איסוף שתן בוקר (יהיה ללא חלבון) במשך 3 יממות
מהו השלב הראשון בבירור של פרוטינוריה בילדים?
בדיקת שתן כללית של שתן ראשון של הבוקר
ממצא שכיח המופיע ב-10% מהילדים בזמן נטילת דגימת שתן אקראית
Triad of nephritis syndrome?
Hematuria
protenuria < 3 gr
HTN
Which disease is close related to Alport syndrome?
and present with
מיקרוהמטוריה לסירוגין ומאקרוהמטוריה בזמן מחלת חום
Thin BM disease
המטוריה משפחתית שפירה
Alport Syndrome
inheritance?
mutation?
Dgx?
X-linked 85%
mutation in collagen type 4- found in BM, eyes.
Triad:
1. מיקרוהמטוריה ומאקרואמטוריה 1-2 ימים לאחר מחלת URTI
2. פגיעה בראייה- ant. lenticonus
3. פגיעה בשמיעה
Dgx- family Hx, שתן לכללית לקרוב משפיה דרגה 1, בדיקות ראיה ושמיעה.
Tx and prognosis of Alport syndrome?
Tx- ACEi
prognosis - 75% ESDR < age 30
What is the most common type of ** Chronic** GN in kids?
IgA nephropathy
macrohematuria after infection
Tx for IgA nephropathy
ARBs/ ACEi - low BP and protenuria
consider Steroids
chence of ESRD- 30%
Post Strep GN
ages and timeline
7-14 days after pharyngitis
or
3-6 wks after impetigo
age mainly 5-12, more in boys
Risk of PSGN?
- Lung edema
- encephalopathy
- CHG
Labs result of PSGN
and how we dgx PSGN?
low C3
hematuria
RBC Casts
protinurea
Dgx- lab and clinical presentation + prove GAS infection (also or culture)
Tx for PSGN?
prognosis?
diuretics + lowering BP medications
penecillin for 10d- to eradicate nephrogenic species.
prognosis- 95% full recovery. microhematuria can last for 1-2 yrs
What is the most common etiology for primary nephrotic syndrome?
minimal change disease
Which complications are a/w nephropaty snydrome
- hypercoagulability- loss of protein C + S in urine
- Infection with capsulated pathogens
- hypovulemia- use of diuretics
Which infections are a/w congenital nephrotic syndrome?
התייצגות בלידה / ב-3 חודשים הראשונים
- intra uterine infections - TORCHeS
- mercury exposure
- SLE
Dgx of miniaml change disease?
איחוי רגלי הפודוציטים במיקרוסקופ אלקטרונים
Tx for minimal change disease and when we will start it:
first and second line tx
kids < 8 yrs old - can start Tx w/o biopsy
Tx:
1st line- high dose steroids- resuce reccurent
2nd line- cyclosporine/ cyclophospamis
what we have to do prior Tx of minimal change disease?
pneumoccoc vaccine + mentuo test
chance of reccurence of minimal change disease?
80%
In minimal change disease
when its indicate to perform kidney biopsy?
- age > 12
- Full course of steroids without satisfying reaction (8wks)
- a-typical presentation of MCD- like low C3, gross hematuria, age < 1 or above 12
RPGN
Tx?
presentation?
Tx- steroids
presentation- combine nephritic + nephrotic syndrome with acute progressive renal insuff.
biopsy- סהרונים
other pathogens for HUS?
E.coli 157
Shigella
pneumoccoc
Compylobacter
Triad of HUS?
- Hemolytic anemia (MAHA)
- AKI
- thrombocytopenia
Complication of HUS?
Seizures, severe Encephalopathy.
if present also with fever its TTP
also:
pancreatitis
CHF
intestine perforation
What is the Tx in HUS + neurologic involvment?
Plasmapheresis (like TTP)
in HUS- supportive and consider dialysis
Oliguria
urine NA > 30
BUN/Cr < 20
hyperkalemia
hyperuricemia
hyperphophatemia
hyponathremia
hypocalcemia
metabolic acidosis
with muddy brown casts
ATN
RTA acid balance?
Non AG metabolic acidosis hyperchloremic
placed in the nephron:
RTA1
RTA2
RTA4
RTA2- PCT»_space; Fanconi syn.
RTA1»_space; DCT
RTA4»_space; CD - hyperkalemia. aldosterone deff. or resistant to it
Bertter Syndrome
elctrolyte disbalance
בססת מטבולית
היפוקלמיה
היפרקלצאוריה
אבדן מלח
כלור גבוה בשתן (בשונה מהקאות- כלור נמוך)
like fusid
What is the presentation of Classical Bartter syndrome
chilhhod
FTT and recurent dehydration episodes
most common primery tumor in kidney in kids?
Wilms tumor- Nephroblastoma
(second most common of all- after neuroblastoma)
can be seen in beckwith - wendhem syndrome
WAGR syndrome, Deny-drash syndrome
Clinical presentation of wilms tumor?
Abdominal mass
HTN
hematuria
Which kidney condition is highly a/w renal vein thrombosis?
Membranous nephropathy
Clinical menefestation of Renal vein thrombosis?
Sudden onset hematuria and unilateral כאב מותניים
Tx- mainly supportive
indication for dialysis?
AEIOU
A- Acidosis PH < 7.1
E- Electrolyte- Hyperkalemia persistent
I- intoxication
O- overlaod fluid refactory to Tx
U- uremia - enephalopathy or pericarditis
also anauriya or oligureya
What are the 2 options of Tx for Vesiculo-urethral reflux
- שמרני- אנטיביוטיקה מניעתית, עד שהרפלוקס חולף / שהסיכון פוחת
- ניתוחי- בכשלון טיפול שמרני / רפלוקס קשה
Posterior urethral valve
dgx ?
most Dgx in pre-natal phase with US- Bi-lateral hydronephrosis with enlrage bladder
