BRS Renal

Question 1

Total body fluid requirements =

Answer 1

maintenance fluid needs +
prior loss +
ongoing losses

Question 2

Two types of fluid losses

Answer 2

sensible (urine, etc. measurable)

insensible (sweat, skin etc…not measurable)

Question 3

Maintenance fluid requirements for children

Answer 3

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

Question 4

How much should maintenance fluids be increased during fever?

Answer 4

12% for every degree increase in temp above 38

Question 5

Normal sodium range + relevance to dehydration

Answer 5

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

Question 6

Three severities of dehydration

Answer 6

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

Question 7

Typical bolus amount

Answer 7

20ml/kg normal saline for all dehydrated patients What

Question 8

Composition of oral rehydration salts

Answer 8

glucose + electrolytes

coupled cotransport mechanism

Question 9

Define microscopic hematuria (#)

Answer 9

more than 6 RBCs per HPF

Question 10

Cause of false negative urine dipsticks

Answer 10

vitamin C

Question 11

Shape of RBCs from upper vs lower urinary tract

Answer 11

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

Question 12

Three hematologic causes of hematuria

Answer 12

sickle cell
thrombocytopenia
thrombosis

Question 13

Four glomerular diseases leading to hematuria

Answer 13

• bergers
• HSP
• PSGN
• Alports

Question 14

Proteinuria level considered pathologic

Answer 14

more than 100mg/m^2/day

Question 15

What causes incorrect measures of protein in urine

Answer 15

high concentration = false +

low concentration = false -

Question 16

Typical test for urine protein in children + normal levels

Answer 16

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

Question 17

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

Answer 17

hemoglobinuria, myoglobinuria

Question 18

Orthostatic proteinuria, protein is excreted when?

Answer 18

when upright but not supine

Question 19

Cause of glomerular proteinuria

Answer 19

increased permeability of the glomerular capillaries

Question 20

Cause of tubular proteinuria

Answer 20

decreased reabsorption due to injury

Question 21

Marker for tubular vs glomerular proteinuria

Answer 21

tubular: B(two)macroglobulin
glomerular: microalbumin

Question 22

Two types of glomerulonephritis

Answer 22

primary vs secondary

Question 23

Signs of acute nephritic syndrome

Answer 23

• gross hematuria
• hypertension
• fluid overload

Question 24

Signs of acute nephrotic syndrome

Answer 24

• heavy proteinuria
• hypercholesterolemia
• edema

Question 25

Labs for glomerulonephritis (6)

Answer 25

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

Question 26

How long after GAS infection does PSGN onset?

Answer 26

8-14 days

Question 27

PSGN assc labs

Answer 27

- low complement | - ASO+ 90%, ADB + for all

Question 28

When is renal biopsy indicated for PSGN

Answer 28

within 8 weeks if kidney function isn't normalized

Question 29

Most common acute glomerulonephritis worldwide? chronic?

Answer 29

acute: PSGN chronic: IgA Nephropathy (Bergers)

Question 30

Recurrent bouts of gross hematuria assc with URI: | cause

Answer 30

IgA Nephropathy (Bergers)

Question 31

Histo findings assc with PSGN + Bergers

Answer 31

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

Question 32

Prognosis PSGN vs Bergers

Answer 32

PSGN- usually full recovery | Bergers- 20-40% ESRD

Question 33

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

Answer 33

- arthritis | - hematuria

Question 34

What type of disease is HSP?

Answer 34

IgA mediated vasculitis

Question 35

When is renal biopsy indicated for HSP?

Answer 35

heavy or nephrotic range proteinuria

Question 36

Histo findings assc with MPGN

Answer 36

- lobular mesangial hypercellularity | - thickening of GBM

Question 37

Prognosis MPGN

Answer 37

almost all = ESRD

Question 38

Labs assc with MPGN

Answer 38

75% have low complement

Question 39

Most common cause nephrotic syndrome in US adults?

Answer 39

Membranous Nephropathy | =heavy proteinuria --> renal insufficiency

Question 40

Definition of nephropathy

Answer 40

heavy proteinuria greater than 50mg/kg/day

Question 41

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

Answer 41

- hypoalbuminemia - hypercholesterolemia - edema

Question 42

Most common cause primary nephropathy

Answer 42

minimal change disease

Question 43

Two systemic diseases that cause nephrotic syndrome

Answer 43

SLE | HSP

Question 44

Physiologic cause of nephrotic syndrome

Answer 44

loss of normal charge and size glomerular barrier

Question 45

When does edema occur in nephrotic syndrome?

Answer 45

following URI

Question 46

Two risks assc with nephrotic syndrome?

Answer 46

thrombosis infection with encapsulated bacteria (COD in 5%)

Question 47

CBC changes assc with nephrotic syndrome?

Answer 47

- elevated hematocrit | - hemoconcentration

Question 48

Nephrotic syndrome: | biopsy?

Answer 48

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

Question 49

Treatment of widespread edema in nephrotic syndrome

Answer 49

25% albumin IV no added salt in diet steroids

Question 50

Cause of ESRD in NS

Answer 50

FSGS

Question 51

Abx treatment for HUS?

Answer 51

NO! | and... abx treatment of hermorrhagic colitis= ^^ risk HUS

Question 52

E coli strain responsible for HUS ?

Answer 52

0157:H7

Question 53

Key to pathogenesis in HUS

Answer 53

injury to endothelial cells by shiga toxin

Question 54

Causes of death in HUS

Answer 54

toxic megacolon | CNS infarctions

Question 55

Poor prognostic signs in HUS

Answer 55

high WBC count | prolonged oliguria

Question 56

Alports: inheritance pattern defect

Answer 56

XD | type 4 collagen in basement membrane

Question 57

Three manifestations of alports

Answer 57

cant see cant pee cant hear high C

Question 58

Most common cause of a renal mass in the newborn

Answer 58

multicystic renal dysplasia

Question 59

Adult vs infantile polycystic kidney diseases

Answer 59

ARPKD (infantile) | ADPKD (adult)

Question 60

Two organ systems effected by ARPKD in addition to renal:

Answer 60

pulmonary hypoplasia | liver involvement= constant (portal HTN, cirrhosis)

Question 61

Prognosis of ARPKD/ ADPKD:

Answer 61

most = severe HTN + renal insufficiency and require transplant

Question 62

# Define: - normal HTN - significant HTN - severe HTN - malignant TN

Answer 62

- normal 90-95th %ile - significant 95th%ile+ - severe above 99th%ile - malignant: end organ damage

Question 63

Most hypertension in childhood is _____ HTN

Answer 63

secondary

Question 64

Three secondary causes of HTN in newborn

Answer 64

- renal artery embolus/ stenosis - coarctation - renal disease

Question 65

2 most common causes of HTN in kids 1-10

Answer 65

coarctation | renal disease

Question 66

2 most common causes of HTN in adolescents

Answer 66

renal disease | essential

Question 67

Consequences of chronic HTN in kids

Answer 67

growth retardation | poor school performance

Question 68

Initial evaluation of HTN in peds

Answer 68

- CBC/BMP/UA/BUNCr/renin | - CXR/RUS

Question 69

Signs of RTA

Answer 69

- calculi - weakness/ myalgias - FTT - vomiting

Question 70

Drug that may cause acquired RTA

Answer 70

amphotericin

Question 71

Classic electrolyte presentation of RTA

Answer 71

hypercholermic acidosis + normal serum anion gap

Question 72

How to calculate urine anion gap

Answer 72

Na+K-Cl

Question 73

``` hypokalemia hypophosphatemia aminoaciduria +RTA =suggestive of ```

Answer 73

Fanconis

Question 74

Defect assc with: | Type 1 vs Type 2 RTA

Answer 74

Type 1= distal= failure to excrete H+ | Type 2= proximal= failure to absorb bicarb

Question 75

Type III RTA defect

Answer 75

variant of type I but = proximal bicarb wasting in babies

Question 76

Hallmark of Type IV RTA

Answer 76

transient acidosis + hyperkalemia

Question 77

Treatment of all RTAs

Answer 77

oral alkali

Question 78

Treatment of Type IV RTA

Answer 78

oral alkali + furosemide

Question 79

Which type RTA is assc with: Fanconis amphotericin/nephrotic syndromes obstructive uropathy aldo def

Answer 79

- Fanconis= type II - amp/nephrotic syndromes (acquire)= Type I - obstructive/aldo def= Type IV

Question 80

Type RTA assc with stones

Answer 80

Type I

Question 81

Define oliguria

Answer 81

less than one ml/kg/hr

Question 82

Renal failure management

Answer 82

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

Question 83

Disease that manifests SECONDARY TO renal failure

Answer 83

renal osteodystrophy

Question 84

BUN/Cr and FeNa in prerenal ARF

Answer 84

^^^ BUNCR move than 20 | low FeNa less than 1

Question 85

Renal Tubular ARF assc FeNa + marker

Answer 85

high B2 microglobuin | FENA above 1

Question 86

ARF due to glomerular damage causes ____ and _____

Answer 86

hematuria and proteinuria

Question 87

Interstitial nephritis marker

Answer 87

eosinophilia/uria

Question 88

post renal ARF findings

Answer 88

renal dilation on US

Question 89

Vascular related ARF findings

Answer 89

decreased renal blood flow on nuclear renal scan

Question 90

Two types of ureteral obstruction

Answer 90

ureteropelvic | ureterovesical

Question 91

Cause of bladder outlet obstruction in males

Answer 91

posterior urethral valve obstruction

Question 92

Absence of rectus muscles + bladder outlet obstruction + cryptorchidism=

Answer 92

prune belly syndrome

Question 93

Most common newborn abdominal mass

Answer 93

multicystic dysplastic kidney +atretic ureter

Question 94

Most common anomaly assc with UTIs + inheritance pattern

Answer 94

vesicoureteral reflux =AD

Question 95

How to Dx VUR

Answer 95

voiding cystourethrogram

Question 96

Px treatment of VUR

Answer 96

low dose abx to prevent UTI until it is outgrown

Question 97

Grade 1-2 VUR

Answer 97

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

Question 98

Grade 3-5 VUR

Answer 98

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

Question 99

Workup for any kid with renal stones

Answer 99

rule out metabolic disorders

Question 100

What UTI type is assc with stones

Answer 100

proteus

Question 101

Three common stone components

Answer 101

calcium oxalate uric acid

Question 102

When are UTIs most common in boys?

Answer 102

more common in boys before 6 months | girls after 6 months

Question 103

Most common pathogenesis of UTI

Answer 103

ascending infection

Question 104

Sign of pyelo

Answer 104

fever + systemic illness

Question 105

gold standard dx of UTI

Answer 105

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

Question 106

When is imaging needed in case of UTI ?

Answer 106

pyelo recurrent UTI all males girls younger than 4 with cystitis

Question 107

Two options of treatment for empiric uti

Answer 107

TMP-SMX | cephalexin

Question 108

Neonate UTI treatment

Answer 108

amp & gent

Question 109

How to prevent renal scarring in infants

Answer 109

3 months px antibiotics after pyelo episode