Chronic Pediatric Disease

Question 1

What is the most common cause of hypertension in children?

Answer 1

kidney and heart disease

other rare causes:
-hyperthyroidism
-Wilm’s tumor (kidney)
-CNS abnormalities
-systemic corticosteroids

Question 1

When is a child considered hypertensive?

Answer 1

children with a BP that is at or above the 95th percentile + 5 mmHg compared to children of the same age, sex and height

Question 2

How is hypertension in children treated?

Answer 2

start with lifestyle changes

drugs:
-ACEi/ARBS
-CCB
-ß-blockers (if rate is needed)
-alpha-blockers
-diuretics )in chronic lung diseases)

Question 3

What are the common causes of Cerebral palsy in children?

Answer 3

-prenatal and perinatal complications
-Complications of premature birth
-postnatal problems (meningitis, encephalitis, brain injury)

Question 4

What are the symptoms of Cerebral palsy?

Answer 4

Movement disorders:
-Spasticity (most common)
-dystonia
-choreoathetosis
-ataxia

Question 5

What are the pharmacologic treatment options for Cerebral palsy?

Answer 5

-Diazepam, clonazepam or baclofen (for Spasticity)

-Dantrolene, tizanidine, Botulism toxin A (muscle relaxants)

-Glycopyrrolate (anticholinergic) and
scopolamine (antimuscarinic) for drooling

Question 6

What are the core features of autism in children?

Answer 6

-deficits in socialization and communication

-repetitive patterns of behavior, interests, or activities:
repetitive movements, doing things over and over, fixated interests

Question 7

What are pharmacologic treatment options in autism?

Answer 7

-Melatonin for insomnia

-alternative therapy: Omega-3 fatty acids, levocarnitine, N-acetylcysteine

-Aripiprazole and risperidone (aggression, irritability)

-SSRIs (stereotypes, anxiety, depression): citalopram, escitalopram, fluoxetine, paroxetine, sertraline

-Atomoxetine, clonidine and guanfacine (ADHD)

Question 8

What are the common causes of the development of DVT in children?

Answer 8

-Central venous catheters (CVCs) are the underlying factor for the development of a DVT (in upper and lower extremities)

also:
-sepsis
-nephrotic syndrome
-malignancy
-surgery
-heart disease
-L-asparaginase
-oral contraceptive use

Question 9

Which drug is commonly used for DVT therapy in children?

Answer 9

-Enoxaparin
-Heparin
-Dipyridamole
-Aspirin (for Kawasaki disease)
-Clopidogrel
-Warfarin (not usual)
dosing is higher in children than in adults!

(DOACs are being studied right now)

Question 10

What are the signs and symptoms of nephrotic syndrome (NS)?

Answer 10

-proteinuria (leads to edema and hypoalbuminemia)
-edema (low oncotic pressure)
-hypoalbuminemia

-> leading to hyperlipidemia (compensatory: increased protein synthesis + lipidproteins) and hypertension (fluid moves into tissues, less volume in the blood -> activation of RAAS)

-elevated cholesterol levels (>200 mg/dl)
-elevated TG

Question 11

What are the 3 types of NS?

Answer 11

-minimal change?
-membranoproliferative glomerulonephritis
-focal segment glomerulonephritis

any glomerular injury associated with proteinuria

Question 12

What does the urine look like in patients with Nephrotic syndrome?

Answer 12

Foamy urine, caused by protein in the urine

Question 13

Which drugs are used to control edema in nephrotic syndrome?

Answer 13

IV albumin then a large dose of furosemide (need large dose bc furosemide binds to albumin, albumin moves furosemide effectively to the kidney
(elevated in the tubular lumen in NS))

Question 14

How is nephrotic syndrome treated in children?

Answer 14

-Steroids (large doses) -> reducing the inflammation
can cause adrenal suppression

-calcineurin inhibitors (cyclosporin, tacrolimus)

Question 15

What are the side effects associated with calcineurin inhibitors?

Answer 15

Cyclosporin:
-renal arteriolar vasoconstriction
-HTN
-electrolyte abnormalities
-nephrotoxic

Tacrolimus:
-HTN
-altered mental status
-electrolyte abnormalities
-nephrotoxic

Mycophenolate mofetil (purine synthetase inhibitor):
-dyspepsia
-diarrhea
-leukopenia, lymphoma (rare)
-nephrotoxicity is less common

Question 16

What are alternative drug options for Nephrotic syndrome?

Answer 16

-Mycophenolate mofetil:
lesser side effects (better if they already have low renal function) - not known how it works in NS

-cytotoxic agents (to reduce the dose of steroids, and extends the time between relapses)
drugs: Cyclophosphamide, Chlorambucil

Question 17

Which drugs are used in Steroid-resistant Nephrotic syndrome?

Answer 17

-higher doses of the drugs used in NS (steroids, cyclosporin, tacrolimus)
-immunosuppressive therapy

-ACEi (antiproteinuric and antihypertensive) for HTN
-> also diet change: less sodium and proteins

-Rituximab (targets B-cells, immunosuppressive)

others:
-anticoagulation
-Ig therapy
-Hyperlipidemia (HMG-CoA)

-treatment for anemia (erythropoiesis-stimulating agents)
-bone and mineral disorders
-growth hormones long-term

Question 18

What is used to estimate the renal function in children?

Answer 18

Updated Bedside Schwartz Equation

Question 19

When might dialysis be considered in children with Nephrotic syndrome?

Answer 19

GFR <15 ml/min

-Peritoneal dialysis (in the abdomen) is preferred as less complicated than hemodialysis (HD)

-hemodialysis if peritoneal dialysis has failed or if they had abdominal surgery