Brandau Pediactric 1 Flashcards
gross hematuria
bright red blood, clots in urine or tea colored urine
microscopic hematuria
> 5 RBCs per higher power field on MORE THAN two occasions
-so check on second occasion before working up further
DDx for gross hematuria
kidney stones trauma AV malformation renal vein thrombosis acute tubular necrosis IgA nephropathy Alport nephritis glomerular nephritis
renal vein thrombosis
primary in neonates
- hemoconcentration and reduced renal blood flow
- abdominal mass and tenderness, hematuria, oligria, thrombocytopenia (low platelets - used in clot)
-ULTRASOUND will show enlarged kidneys with hyperechogenicity
renal AV malformations
congenital or acquired
-complication of renal biopsy
-gross hematuria and decreasing renal function
complication of renal biopsy
renal AV malformation**
acute tubular necrosis
ischemia or toxins
critically ill child - nephrotoxic or ischemic insult
-tubular cell necrosis
meds cause acute tubular necrosis
aminoglycosides
cyclosporine
oncologic drugs
heavy metals
aminoglycosides
good against gram negative
-but damage kidney
IgA nephropathy
most common chronic glomerular disease worldwide
- IgA mesangial deposits
- absence of systemic disease
-gross hematuria following respiratory infection
mild proteinuria
C3 levels are normal**
alport nephritis
mutations in type IV collagen
- proteinuria - more in males
- hearing loss
- ocular abnormalities
- leiomyomatosis of esophagus and bronchial
acute post-strep GN
gross hematuria, edema, HTN, renal insufficiency
- follows group A beta hemolytic streptococci
- skin or throat
children age 5-12
C3 levels depressed**
approach to hematuria
urinanalysis
- no Hg or cell elements - look for causes of red urine
- Hg but no cell elements - causes of Hg-uria or Mg-uria (muscle breakdown)
- cellular elements - casts - suggest glomerular cause
RBC casts
suggests glomerular pathology
low C3
suggest SLE
normal C3
henoch schonlein HUS wegeners granulomatosis goodpastures syndrome polyarteritis nodosa
common organism with HUS
e. coli
atypical HUS
alternate complement overactivation
low C3
PSGN MPGN SBE HIV Hep B
normal C3
IgA nephropathy
alports
thin glomerular basement membrane
idiopathic progressive GN
non-glomerular hematuria
interstitial nephritis sickle cell trait polycystic kidney disease tumors renal vein thrombosis A/V malformation
most common renal tumor in kidneys
wilms
von willebrands disease
can cause hematuria
child with post-strep GN
-likely HTN and headache
normal systolic <94 in child
IgA nephropathy in child
aka bergers
-several episodes of hematuria
lab studies to confirm post-strep GN
urinanalysis-RBC casts
- complement level decrease
- ASO titer
post-strep GN prognosis
- majority get better
- rare - to renal failure
hematuria, mild proteinuria, difficulty swallowing
do barium swallow
- lymphoma
- wilms tumor?
scope - see mass
biopsy
Dx - alport syndrome with leiomyomatosis
wilms tumor metastasis
most to lungs
alport
mutation in type IV collagen alpha 3, 4, 5 chains
also possible leiomyomatosis
vesicoureteral reflux
UTIs
-urine reflux to kidney
grade 3 - dilation of ureter
grade 4 - worse than 3
grade 5 - even worse
imaging for VUR
voiding cystourethrogram
dimercaptosiccinic acid renal scan
DMSA
-can show scarring in kidney
VCU
bladder filled - child voids
- checks for reflux to ureter
- lots of radiation exposure
can do as nuclear (less exposure), easier to do
-done after initial study
reflux
inflammatory process
- cytokines reaks havoc
- typically bilateral
prophylactic antibiotics for reflux
possible attempt to get rid of reflux
chronic renal disease in child
will not grow
-failure to thrive
always monitor growth over time
chronic VUR
options:
- careful watching
- antibiotic prophylaxis
- surgery repair for VUR
VUR watchful waiting
- inherited - goes away with time
- patients that develop ESRD - most damage in utero
- antibiotics can cause resistance
VUR continuous prophylaxis
- grade 3 VUR - 4-6x more likely to develop renal scarring
- chance of recurrent infection
study looking at >grade 3 VUR nothing vs. prophylaxis vs. surgery
- prophylaxis most effective
- what stat design appropriate?
surgical repair VUR
- children with UTI - can get again - ESRD
- prophylaxis - nonadherence
- surgery - turns cost and morbidity of VUR into cure
