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Pediatrics > BRS Renal > Flashcards

BRS Renal Flashcards

1
Q

Total body fluid requirements =

A

maintenance fluid needs +
prior loss +
ongoing losses

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2
Q

Two types of fluid losses

A

sensible (urine, etc. measurable)

insensible (sweat, skin etc…not measurable)

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3
Q

Maintenance fluid requirements for children

A 
1500 mL/m^2/day 
or.....
100ml/kg/day for first 10 kg 
50ml/kg/day for second 10 kg 
20 ml/kg/day for any additional 10 kg
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4
Q

How much should maintenance fluids be increased during fever?

A

12% for every degree increase in temp above 38

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5
Q

Normal sodium range + relevance to dehydration

A

130-150
above= hypernatremic dehydration, correct over 48 hours
below/equal= hypo/isonatremic, correct over 24 hours

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6
Q

Three severities of dehydration

A

3-5%: mild
7-10%: moderate
12%+: severe

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7
Q

Typical bolus amount

A

20ml/kg normal saline for all dehydrated patients What

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8
Q

Composition of oral rehydration salts

A

glucose + electrolytes

coupled cotransport mechanism

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9
Q

Define microscopic hematuria (#)

A

more than 6 RBCs per HPF

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10
Q

Cause of false negative urine dipsticks

A

vitamin C

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11
Q

Shape of RBCs from upper vs lower urinary tract

A

upper: dysmorphic, blebs in membrane
lower: normal biconcave discs

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12
Q

Three hematologic causes of hematuria

A

sickle cell
thrombocytopenia
thrombosis

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13
Q

Four glomerular diseases leading to hematuria

A
  • bergers
  • HSP
  • PSGN
  • Alports
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14
Q

Proteinuria level considered pathologic

A

more than 100mg/m^2/day

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15
Q

What causes incorrect measures of protein in urine

A

high concentration = false +

low concentration = false -

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16
Q

Typical test for urine protein in children + normal levels

A

TP/CR
6-24 months, less than 0.5 normal
2+ years, less than 0.2 normal

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17
Q

Dipstick + for blood but no RBS on U/A… cause?

A

hemoglobinuria, myoglobinuria

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18
Q

Orthostatic proteinuria, protein is excreted when?

A

when upright but not supine

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19
Q

Cause of glomerular proteinuria

A

increased permeability of the glomerular capillaries

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20
Q

Cause of tubular proteinuria

A

decreased reabsorption due to injury

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21
Q

Marker for tubular vs glomerular proteinuria

A

tubular: B(two)macroglobulin
glomerular: microalbumin

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22
Q

Two types of glomerulonephritis

A

primary vs secondary

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23
Q

Signs of acute nephritic syndrome

A
  • gross hematuria
  • hypertension
  • fluid overload
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24
Q

Signs of acute nephrotic syndrome

A
  • heavy proteinuria
  • hypercholesterolemia
  • edema
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25
Q

Labs for glomerulonephritis (6)

A
  • U/A
  • TP/CR
  • blood chem
  • complement levels
  • antibodies (DNAB, ASO)
  • IgA
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26
Q

How long after GAS infection does PSGN onset?

A

8-14 days

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27
Q

PSGN assc labs

A
  • low complement

- ASO+ 90%, ADB + for all

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28
Q

When is renal biopsy indicated for PSGN

A

within 8 weeks if kidney function isn’t normalized

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29
Q

Most common acute glomerulonephritis worldwide? chronic?

A

acute: PSGN
chronic: IgA Nephropathy (Bergers)

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30
Q

Recurrent bouts of gross hematuria assc with URI:

cause

A

IgA Nephropathy (Bergers)

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31
Q

Histo findings assc with PSGN + Bergers

A

mesangial cell proliferation + increased mesangial cell matrix for both + IgA deposition in Bergers

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32
Q

Prognosis PSGN vs Bergers

A

PSGN- usually full recovery

Bergers- 20-40% ESRD

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33
Q

In addition to purpura, abdominal pain, what signs are assc with HSP ?

A
  • arthritis

- hematuria

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34
Q

What type of disease is HSP?

A

IgA mediated vasculitis

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35
Q

When is renal biopsy indicated for HSP?

A

heavy or nephrotic range proteinuria

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36
Q

Histo findings assc with MPGN

A
  • lobular mesangial hypercellularity

- thickening of GBM

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37
Q

Prognosis MPGN

A

almost all = ESRD

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38
Q

Labs assc with MPGN

A

75% have low complement

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39
Q

Most common cause nephrotic syndrome in US adults?

A

Membranous Nephropathy

=heavy proteinuria –> renal insufficiency

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40
Q

Definition of nephropathy

A

heavy proteinuria greater than 50mg/kg/day

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41
Q

In addition to proteinuria, what labs are assc with nephropathy?

A
  • hypoalbuminemia
  • hypercholesterolemia
  • edema
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42
Q

Most common cause primary nephropathy

A

minimal change disease

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43
Q

Two systemic diseases that cause nephrotic syndrome

A

SLE

HSP

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44
Q

Physiologic cause of nephrotic syndrome

A

loss of normal charge and size glomerular barrier

45
Q

When does edema occur in nephrotic syndrome?

A

following URI

46
Q

Two risks assc with nephrotic syndrome?

A

thrombosis
infection with encapsulated bacteria
(COD in 5%)

47
Q

CBC changes assc with nephrotic syndrome?

A
  • elevated hematocrit

- hemoconcentration

48
Q

Nephrotic syndrome:

biopsy?

A

only if creatinine clearance is impaired/ corticosteroids don’t work

49
Q

Treatment of widespread edema in nephrotic syndrome

A

25% albumin IV
no added salt in diet
steroids

50
Q

Cause of ESRD in NS

A

FSGS

51
Q

Abx treatment for HUS?

A

NO!

and… abx treatment of hermorrhagic colitis= ^^ risk HUS

52
Q

E coli strain responsible for HUS ?

A

0157:H7

53
Q

Key to pathogenesis in HUS

A

injury to endothelial cells by shiga toxin

54
Q

Causes of death in HUS

A

toxic megacolon

CNS infarctions

55
Q

Poor prognostic signs in HUS

A

high WBC count

prolonged oliguria

56
Q

Alports:
inheritance pattern
defect

A

XD

type 4 collagen in basement membrane

57
Q

Three manifestations of alports

A

cant see
cant pee
cant hear high C

58
Q

Most common cause of a renal mass in the newborn

A

multicystic renal dysplasia

59
Q

Adult vs infantile polycystic kidney diseases

A

ARPKD (infantile)

ADPKD (adult)

60
Q

Two organ systems effected by ARPKD in addition to renal:

A

pulmonary hypoplasia

liver involvement= constant (portal HTN, cirrhosis)

61
Q

Prognosis of ARPKD/ ADPKD:

A

most = severe HTN + renal insufficiency and require transplant

62
Q

Define:

  • normal HTN
  • significant HTN
  • severe HTN
  • malignant TN
A
  • normal 90-95th %ile
  • significant 95th%ile+
  • severe above 99th%ile
  • malignant: end organ damage
63
Q

Most hypertension in childhood is _____ HTN

A

secondary

64
Q

Three secondary causes of HTN in newborn

A
  • renal artery embolus/ stenosis
  • coarctation
  • renal disease
65
Q

2 most common causes of HTN in kids 1-10

A

coarctation

renal disease

66
Q

2 most common causes of HTN in adolescents

A

renal disease

essential

67
Q

Consequences of chronic HTN in kids

A

growth retardation

poor school performance

68
Q

Initial evaluation of HTN in peds

A
  • CBC/BMP/UA/BUNCr/renin

- CXR/RUS

69
Q

Signs of RTA

A
  • calculi
  • weakness/ myalgias
  • FTT
  • vomiting
70
Q

Drug that may cause acquired RTA

A

amphotericin

71
Q

Classic electrolyte presentation of RTA

A

hypercholermic acidosis + normal serum anion gap

72
Q

How to calculate urine anion gap

A

Na+K-Cl

73
Q 
hypokalemia 
hypophosphatemia 
aminoaciduria 
\+RTA 
=suggestive of
A

Fanconis

74
Q

Defect assc with:

Type 1 vs Type 2 RTA

A

Type 1= distal= failure to excrete H+

Type 2= proximal= failure to absorb bicarb

75
Q

Type III RTA defect

A

variant of type I but = proximal bicarb wasting in babies

76
Q

Hallmark of Type IV RTA

A

transient acidosis + hyperkalemia

77
Q

Treatment of all RTAs

A

oral alkali

78
Q

Treatment of Type IV RTA

A

oral alkali + furosemide

79
Q

Which type RTA is assc with:

Fanconis
amphotericin/nephrotic syndromes
obstructive uropathy
aldo def

A
  • Fanconis= type II
  • amp/nephrotic syndromes (acquire)= Type I
  • obstructive/aldo def= Type IV
80
Q

Type RTA assc with stones

A

Type I

81
Q

Define oliguria

A

less than one ml/kg/hr

82
Q

Renal failure management

A

-restore volume
-electrolyte intake to match losses
-protein restriction
+/-dialysis

83
Q

Disease that manifests SECONDARY TO renal failure

A

renal osteodystrophy

84
Q

BUN/Cr and FeNa in prerenal ARF

A

^^^ BUNCR move than 20

low FeNa less than 1

85
Q

Renal Tubular ARF assc FeNa + marker

A

high B2 microglobuin

FENA above 1

86
Q

ARF due to glomerular damage causes ____ and _____

A

hematuria and proteinuria

87
Q

Interstitial nephritis marker

A

eosinophilia/uria

88
Q

post renal ARF findings

A

renal dilation on US

89
Q

Vascular related ARF findings

A

decreased renal blood flow on nuclear renal scan

90
Q

Two types of ureteral obstruction

A

ureteropelvic

ureterovesical

91
Q

Cause of bladder outlet obstruction in males

A

posterior urethral valve obstruction

92
Q

Absence of rectus muscles + bladder outlet obstruction + cryptorchidism=

A

prune belly syndrome

93
Q

Most common newborn abdominal mass

A

multicystic dysplastic kidney +atretic ureter

94
Q

Most common anomaly assc with UTIs + inheritance pattern

A

vesicoureteral reflux =AD

95
Q

How to Dx VUR

A

voiding cystourethrogram

96
Q

Px treatment of VUR

A

low dose abx to prevent UTI until it is outgrown

97
Q

Grade 1-2 VUR

A

1: reflux into distal ureter only
2: reflux into pelvis without dilation

98
Q

Grade 3-5 VUR

A

3: into calyces + dilation
4: into calyxes + dilation + clubbing
5: gross dilation of entire collecting system + tortuosity of ureters

99
Q

Workup for any kid with renal stones

A

rule out metabolic disorders

100
Q

What UTI type is assc with stones

A

proteus

101
Q

Three common stone components

A

calcium
oxalate
uric acid

102
Q

When are UTIs most common in boys?

A

more common in boys before 6 months

girls after 6 months

103
Q

Most common pathogenesis of UTI

A

ascending infection

104
Q

Sign of pyelo

A

fever + systemic illness

105
Q

gold standard dx of UTI

A

more than 10k colones on catherized sample
any bacteria on suprapubic sample
more than 50k colonies on clean catch

106
Q

When is imaging needed in case of UTI ?

A

pyelo
recurrent UTI
all males
girls younger than 4 with cystitis

107
Q

Two options of treatment for empiric uti

A

TMP-SMX

cephalexin

108
Q

Neonate UTI treatment

A

amp & gent

109
Q

How to prevent renal scarring in infants

A

3 months px antibiotics after pyelo episode

Pediatrics (12 decks)

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