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RENAL II Exam 3 > Brandau Pediactric 1 > Flashcards

Brandau Pediactric 1 Flashcards

1
Q

gross hematuria

A

bright red blood, clots in urine or tea colored urine

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2
Q

microscopic hematuria

A

> 5 RBCs per higher power field on MORE THAN two occasions

-so check on second occasion before working up further

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3
Q

DDx for gross hematuria

A 
kidney stones
trauma
AV malformation
renal vein thrombosis
acute tubular necrosis
IgA nephropathy
Alport nephritis
glomerular nephritis
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4
Q

renal vein thrombosis

A

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

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5
Q

renal AV malformations

A

congenital or acquired
-complication of renal biopsy

-gross hematuria and decreasing renal function

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6
Q

complication of renal biopsy

A

renal AV malformation**

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7
Q

acute tubular necrosis

A

ischemia or toxins

critically ill child - nephrotoxic or ischemic insult
-tubular cell necrosis

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8
Q

meds cause acute tubular necrosis

A

aminoglycosides
cyclosporine
oncologic drugs
heavy metals

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9
Q

aminoglycosides

A

good against gram negative

-but damage kidney

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10
Q

IgA nephropathy

A

most common chronic glomerular disease worldwide

  • IgA mesangial deposits
  • absence of systemic disease

-gross hematuria following respiratory infection

mild proteinuria

C3 levels are normal**

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11
Q

alport nephritis

A

mutations in type IV collagen

  • proteinuria - more in males
  • hearing loss
  • ocular abnormalities
  • leiomyomatosis of esophagus and bronchial
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12
Q

acute post-strep GN

A

gross hematuria, edema, HTN, renal insufficiency

  • follows group A beta hemolytic streptococci
  • skin or throat

children age 5-12

C3 levels depressed**

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13
Q

approach to hematuria

A

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
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14
Q

RBC casts

A

suggests glomerular pathology

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15
Q

low C3

A

suggest SLE

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16
Q

normal C3

A 
henoch schonlein
HUS
wegeners granulomatosis
goodpastures syndrome
polyarteritis nodosa
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17
Q

common organism with HUS

A

e. coli

18
Q

atypical HUS

A

alternate complement overactivation

19
Q

low C3

A 
PSGN
MPGN
SBE
HIV
Hep B
20
Q

normal C3

A

IgA nephropathy
alports
thin glomerular basement membrane
idiopathic progressive GN

21
Q

non-glomerular hematuria

A 
interstitial nephritis
sickle cell trait
polycystic kidney disease
tumors
renal vein thrombosis
A/V malformation
22
Q

most common renal tumor in kidneys

A

wilms

23
Q

von willebrands disease

A

can cause hematuria

24
Q

child with post-strep GN

A

-likely HTN and headache

normal systolic <94 in child

25
Q

IgA nephropathy in child

A

aka bergers

-several episodes of hematuria

26
Q

lab studies to confirm post-strep GN

A

urinanalysis-RBC casts

  • complement level decrease
  • ASO titer
27
Q

post-strep GN prognosis

A
  • majority get better

- rare - to renal failure

28
Q

hematuria, mild proteinuria, difficulty swallowing

A

do barium swallow

  • lymphoma
  • wilms tumor?

scope - see mass

biopsy

Dx - alport syndrome with leiomyomatosis

29
Q

wilms tumor metastasis

A

most to lungs

30
Q

alport

A

mutation in type IV collagen alpha 3, 4, 5 chains

also possible leiomyomatosis

31
Q

vesicoureteral reflux

A

UTIs

-urine reflux to kidney

grade 3 - dilation of ureter
grade 4 - worse than 3
grade 5 - even worse

32
Q

imaging for VUR

A

voiding cystourethrogram

33
Q

dimercaptosiccinic acid renal scan

A

DMSA

-can show scarring in kidney

34
Q

VCU

A

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

35
Q

reflux

A

inflammatory process

  • cytokines reaks havoc
  • typically bilateral
36
Q

prophylactic antibiotics for reflux

A

possible attempt to get rid of reflux

37
Q

chronic renal disease in child

A

will not grow
-failure to thrive

always monitor growth over time

38
Q

chronic VUR

A

options:

  • careful watching
  • antibiotic prophylaxis
  • surgery repair for VUR
39
Q

VUR watchful waiting

A
  • inherited - goes away with time
  • patients that develop ESRD - most damage in utero
  • antibiotics can cause resistance
40
Q

VUR continuous prophylaxis

A
  • 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?
41
Q

surgical repair VUR

A
  • children with UTI - can get again - ESRD
  • prophylaxis - nonadherence
  • surgery - turns cost and morbidity of VUR into cure

RENAL II Exam 3 (17 decks)

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