Common Nephrology Problems in Childhood

Question 1

what parameter defines nephrotic syndrome

Answer 1

when protein is >200mg/mmol, or >40 in a 24 hour protein (10x normal)

Question 2

physiologic causes of proteinuria in ped population

Answer 2

transient, exercise, fever, orthostatic

Question 3

3 key symptoms of proteinuria

Answer 3

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.

Question 4

how is FeNa influenced in nephrotic syndrome

Answer 4

low fena (UNa<20)

Question 5

most common pediatriuc disease that causes nephrotic syndrome in ages 2-6yo

Answer 5

minimal change disease, 2M:1F

Question 6

in older children, what is the MCD parble?

Answer 6

focal sefmental glomerular sclerosis

Question 7

management of focal segmental glomerular sclerosis

Answer 7

steroids +/- albumin +/- acei.

• cyclosporin or cyclophosphamide

Question 8

how can you determine the source of hematuria based on the part of the stream that blood appears in?

Answer 8

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

Question 9

how could you confirm its hematuria?

Answer 9

• look for RBC casts, dysmorphic RBC (glomerular problem).

Question 10

etiology of gross hematuria

Answer 10

gross hematuria : >30 RBC

etiologies: stones, truama, UTI, glomerulonephritis, hypercalciuria, vigorous exercise, AV malformation

Question 11

Presents with hematuria on exercises, sensorineural hearing loss, ESRD in males by the 4th decade

Asymptomatic microscopic hematuria is usually a benign process

Answer 11

Alports Disease: X linked defect in collagen 4

Question 12

investigations of asymptomatic microscopic hematuria

Answer 12

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

Question 13

investigations to symptomatic microscopic hematuria

Answer 13

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.

Question 14

4 key symptoms of glomerulonephritis

Answer 14

Glomerulonephritis: hematuria ,proteinuria ,kidney failure, hypertension.

Tea colored urine

Question 15

outline Dx for glomerulonephritis after URTI 2 days after

Answer 15

think igA nephropathy

Question 16

glomerulonephritis after diarrhea

Question 17

glomerulonephritis with a throat infection

Answer 17

PSGN (post strep glomerulonephritis)

Question 18

key bugs in pediatriuc UTI

Answer 18

Etiology: Klebsiella, E. coli, Enterobacter, Pseudomonas, staph

Question 19

investigations when you suspect pediatriuc UTI

Answer 19

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

Question 20

manaagement of pediatric UTI (cystitis vs pyelonephritis)

Answer 20

Management: cystitis with 3-7d TMP or nitrofurantoin; pyelonephritis with 10d IV cefixime or IV ciprofloxacin

Question 21

risk factors for UTI’s in children

Answer 21

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)

Question 22

key causes of pediatric hypertension

Answer 22

Vascular causes: RVT, RAT, coarctation, ARPKD

Renal disease

Essential BP hypertension.

Question 23

the main effect of beta blockers on reducing high BP is through :

Answer 23

reducing the production of renin

Question 24

first line therapy for a kid with hypertension with CKD+ proteinuria

Answer 24

ACE inhibitor

Question 25

first line therapy for pediatric hypertensive urgency

Answer 25

treat with oral (nifedpipine) or IV (labetolol)

note: severe elevation in BP without evidence of end-organe damage

Question 26

criteria for diagnosing hypertension in kid

Answer 26

BP has to be high on 3 or more occasions