31. Kidney Disease in Children Flashcards
with hematuria and either systemic s/s, or otherwise asymptomatic presentation, should I be thinking glomerular or non-glomerular?
glomerular. (glomerulonephritis)
urine will be dark/coke colored, RBC casts, acanthocytes.
with hematuria and localized s/s of disease, should I be thinking glomerular or non-glomerular?
non-glomerular. acronym is TTICCHSS
urine will be pink/red, with normal RBCs
what does TTICCHSS stand for?
non-glomerular causes of hematuria:
Trauma, Tumors, Infection, Cystic dz, Congenital Obstruction, HyperCa, Stones, Sickle Cell
Ddx of glomerulonephritis in children?
(remember Peeing blood Means Lupus and hemATurIgA) -post-infectious (most common) -membranouproliferative GN -lupus -Alport -Thin Basement Membrane -IgA nephropathy Also: henoch schonlein purpura
Ddx of glomerulonephrosis in children?
Minimal change (most common)
FSGS
Lupus (if secondary)
presentation of patient with MCD?
periorbital edema, post-URI. edematous, proteinuria, urine microscopy negative, high cholesterol.
what is the most common cause of anasarca in children?
nephrotic sx (anasarca = generalized edema)
If there is dysfunction at the proximal tubule, what might we see in the patient? (in general, and the most significant problems that will result)
overall decrease in reab of water, Na, bicarb, Ca, phosphate, uric acid, glucose, AAs.
sig problems: poor growth, metabolic acidosis, rickets
most common causes of dysfunction at the prix tubule?
metabolic or congenital causes
if there is dysfunction at the LOH, what symptoms will we see?
(Bartter’s Sx: like being on chronic furosemide)
- polyuria, polydipsia, salt craving
- dehydration, RAAS activation, high aldo
- hypoK, metabolic acidosis
- HyperCa (loss of paracellular Ca)
- stones, Ca deposits, renal failure
what can cause dysfunction at the LOH?
Bartter’s Sx: auto recessive loss of function.
dysfunction at the DCT will cause what?
- Wasting of Na, Cl -> hypokalemia and metabolic alkalosis
- HypoMg because of Mg wasting
- HyperCa because of increased Ca reabsorption
kids with dysfunction at the DCT crave what?
pickle juice, V8! because they are Mg-deficient and these contain Mg
hyper function at the DCT of the Na-Cl symporters can lead to what symptoms? Tx?
Salt and fluid retention
HTN with low renin
HyperK, metabolic acidosis
Tx = thiazides
dysfunction at the collecting duct will cause what?
(Liddle’s Sx)
GOF mutation of the ENaC channel. sodium retention, HTN with low renin
hypokalemia and metabolic alkalosis
what symptoms will we see with nephrogenic DI?
(tubular non-responsiveness to ADH)
polyuria, polydipsia
hypernatremic dehydration if no access to free water
Nephrogenic DI: if medication-caused, what are the meds?
lithium, tetracycline
MultiCystic Dysplastic Kidney (MCKD) is an example of what kind of disease?
cystic/dysplastic disease. usually do not have hereditary implications
How does MCKD appear grossly?
like a collection of grapes, no identifiable renal tissue
MCKD: unilateral or bilateral?
UNI, because bilateral is not survivable
MCKD: what is the cause?
embryological: the ureteric bud does’t find the mesonephric duct it is supposed to join with. the tissue becomes cystic.
MCKD: symptoms?
unilateral kidney function, if bad kidney is big and cystic, may have GERD or feeding problems. may be asx
what kind of disease is ARPKD, ADPKD? what are the problems?
inherited cystic kidney diseases
kidneys form normally, but tubular cystic changes form gradually and kidneys progressively lose function.
Prune Belly syndrome is an example of what? occurs in males or females?
Genitourinary Malformation
males only
Prune Belly: what happens, how does it present?
weak abdominal wall musculature, undescended testes, weak muscles around the urinary tract (low urine pressure, infections, renal failure)
cloacal anomaly: males or females? how does it present?
females only
failure of urorectal septum to develop, urethra/vag/colon may be interconnected
one or more tracts may be obstructed
bladder outlet obstruction in utero can result in what?
if severe, Potter’s syndrome (renal failure, pulmonary hypoplasia, limb deformities). may result in oligohydramnios, hydronephrosis, dysplasia
