Common Nephrology Problems in Childhood Flashcards
what parameter defines nephrotic syndrome
when protein is >200mg/mmol, or >40 in a 24 hour protein (10x normal)
physiologic causes of proteinuria in ped population
transient, exercise, fever, orthostatic
3 key symptoms of proteinuria
triad: edema, proteinuria due to loss of albumin, hypoalbuminemia
+hypovoemema, funcationlly asplenic (loss of complement, igG), risk of thrombosis (loss of anti-thrombin III), hyperlipidemia (increase in cholesterol), cool extremities, reduced urine output.
how is FeNa influenced in nephrotic syndrome
low fena (UNa<20)
most common pediatriuc disease that causes nephrotic syndrome in ages 2-6yo
minimal change disease, 2M:1F
in older children, what is the MCD parble?
focal sefmental glomerular sclerosis
management of focal segmental glomerular sclerosis
steroids +/- albumin +/- acei.
- cyclosporin or cyclophosphamide
how can you determine the source of hematuria based on the part of the stream that blood appears in?
Urethral origin → initial part of the stream
Bladder origin → terminal part of stream
Bright red +/- clots → lower urinary tract origin
Tea or cola colored → renal parenchymal origin
how could you confirm its hematuria?
- look for RBC casts, dysmorphic RBC (glomerular problem).
etiology of gross hematuria
gross hematuria : >30 RBC
etiologies: stones, truama, UTI, glomerulonephritis, hypercalciuria, vigorous exercise, AV malformation
Presents with hematuria on exercises, sensorineural hearing loss, ESRD in males by the 4th decade
Asymptomatic microscopic hematuria is usually a benign process
Alports Disease: X linked defect in collagen 4
investigations of asymptomatic microscopic hematuria
Etiology: hypercalciuria, thin GBM (aka benign familial hematuria), Alport’s (end-stage renal disease and hearing loss with older years)
investigations: URINE CALCIUM, urine analysis
investigations to symptomatic microscopic hematuria
Symptoms include: fever, malais, rash, purpura, arthritis, jaundice, respiratory or GI associates, dysuria, frequency, enuresis, edema, hypertension.
Diagnosis: UTIs, IgA vasculitis, SLE, hypercalciuria, urolithiasis. Consul peds nephro.
4 key symptoms of glomerulonephritis
Glomerulonephritis: hematuria ,proteinuria ,kidney failure, hypertension.
Tea colored urine
outline Dx for glomerulonephritis after URTI 2 days after
think igA nephropathy
glomerulonephritis after diarrhea
glomerulonephritis with a throat infection
PSGN (post strep glomerulonephritis)
key bugs in pediatriuc UTI
Etiology: Klebsiella, E. coli, Enterobacter, Pseudomonas, staph
investigations when you suspect pediatriuc UTI
Investigation: pyuria (1x10^8 CFU/L); U/S (required for UTI <2yr, UTI in this age group are suggestive of congenital abnormality); VCUG (if abnormal kidney on U/S); in <6mo due full septic work-up
manaagement of pediatric UTI (cystitis vs pyelonephritis)
Management: cystitis with 3-7d TMP or nitrofurantoin; pyelonephritis with 10d IV cefixime or IV ciprofloxacin
risk factors for UTI’s in children
girls>boys
Vesicoureteral reflux: retrograde flow of urine back up to the kidneys.
Can be treated with: sting procedure to create an artificial valve to prevent backflow
Infancy → up to 65% of infants under 6 months have VUR
Bladder dysfunction
Bowel dysfunction
Being uncircumcised
Anatomical malformations (ex/ meningomyelocele)
key causes of pediatric hypertension
Vascular causes: RVT, RAT, coarctation, ARPKD
Renal disease
Essential BP hypertension.
the main effect of beta blockers on reducing high BP is through :
reducing the production of renin
first line therapy for a kid with hypertension with CKD+ proteinuria
ACE inhibitor
first line therapy for pediatric hypertensive urgency
treat with oral (nifedpipine) or IV (labetolol)
note: severe elevation in BP without evidence of end-organe damage
criteria for diagnosing hypertension in kid
BP has to be high on 3 or more occasions
