Dr. Newman Renal Pediatrics Flashcards
What is the definition of Hematuria?
- presence of 5 or more RBCs per high power field in 3 consecutive fresh, centrifuged specimens obtained over the span of a few weeks
What are 4 drugs (R/N/P/SD) and 3 foods (B/R/FJ) that can color urine?
What could a brick red color in a childs diaper be caused by?
D: rifampin, nitrofurantoin, pyridium, sulfa drugs
F: beets, rhubarb, fruit juices
- brick red color could be caused by URIC ACID CRYSTALS
When are Urinalysis done for pediatric patients?
- NO LONGER recommended for annual screening at well child check-ups
- often done at 5 year old check up
- often done as part of PRE-PARTICIPATION PHYSICAL (before playing sports)
What are the differences between Glomerular and Extra-Glomerular hematuria:
- RBC casts
- RBC morphology
- Proteinuria
- Clots
- Color
- may be present (G) or absent (EG)
- dysmorphic (G) or uniform (EG)
- may be present (G) or absent (EG)
- absent (G) or may be present (EG)
- red or brown (G) or red (EG)
When is Gross Hematuria suspected and what are 5 common causes of Gross Hematuria (U/T/B/S/C)
GH: suspected when urine is discolored (red or tea-colored)
C: UTI, trauma, bleeding disorders, renal stones, cystitis (adenovirus)
Post-Infectious Acute Glomerulonephritis
When does it present, how does it present, and how is it treated?
- follows RECENT strep throat
C: gross hematuria, HTN, edema
Lab: inc. ASO titer, low C3, hematuria/proteinuria
Tx: supportive care; kids normally do fine
Henoch-Shonlein Purpura
What are its big 3 physical exam findings?
How do these kids present and how are they treated?
- abdominal pain
- purpura on butt, lower legs, and elbows (PALPABLE)
- joint pain
- condition is hard to diagnose, so kids feel crummy for a LONG time
Tx: symptomatically
Asymptomatic (Isolated) Hematuria
- rarely have any renal disease with no gross hematuria (25% of pts no longer have hematuria 5 years out)
- Benign Familial Hematuria is common example (thin basement membrane disorder)
- monitor pts for proteinuria and HTN
Hypercalcuria
What does it cause and what test value shows excess urine calcium secretion?
- causes asymptomatic microscopic hematuria
- urine Ca:Cr ratio > 0.2 = excess calcium secretion (calcium oxalate crystals seen in urine)
What is March Hematuria?
- hematuria in urine after vigorous exercise, usually after PE or sports practice
- repeat testing at more sedentary time to help make diagnosis (i.e. early in morning)
When is the prevalence for UTIs highest in male and female pediatric patients?
Male: highest when younger than ONE YEAR
Female: highest when younger than FOUR YEARS
How is a urine specimen in a suspected pediatric UTI patient collected?
When are bag urine samples helpful and what are they NOT appropriate for?
- CLEAN-CATCH URINE in child can void on command
- otherwise, if not potty trained –> catheterization or suprapubic aspiration (get sample before Abx is given)
- bag urine samples are ONLY helpful if negative and are NOT appropriate for CULTURE
What is the Criteria for UTI diagnosis using:
- Clean Catch
- Catheter
- Suprapubic Aspiration
- pyuria AND at least 50,000 colonies/mL of a SINGLE uro-pathogenic organism
- pyuria and a colony count of 50,000 CPM OR 10,000-50,000 CPM confirmed by repeat
- pyuria and ANY growth on culture
What are two molecules found in urine that could indicate possible UTI?
What is the most common bacterial cause of UTI in children?
- Leukocyte Esterase - present in WBCs
- inc. lvls due to inc. WBCs in urine
- Nitrites - some bacteria convert nitrates to nitrites
- E. coli MOST COMMON ORGANISM
What is the treatment for UTI patients that are not acutely ill vs acutely ill?
How long should patients be treated?
- not acutely ill: cefixime or cefdinir (cephalosporins)
- ORAL ANTIBIOTICS
- acutely ill: ceftriaxone (cephalosporins)
- PARENTERAL
- add ampicillin if enterococcus suspected
Tx: 7-10 days is fairly standard
- afebrile: 3-4 days may be sufficient
- febrile: 10-14 days
What imaging should be done for suspected UTI pediatric patients?
What are 3 reasons to include VCUG in suspected UTI pediatric patients?
- First UTI in boys or second in girls
- Renal/Bladder Ultrasound
- VCUG
- After second UTI
- VCUG (look for vesicoureteral reflux)
VCUG: anomalies on RBU/S, temp > 39 C AND pathogen other than E. coli, or poor growth AND hypertension
What is Renal Scarring?
What are 4 complications of this condition (H/RF/P/E)?
- loss of parenchyma between calyces and renal capsule
Complications: HTN, dec. renal function, proteinuria, ESRD
What are 4 common symptoms seen in children with UTI besides fever?
frequency, urgency, dysuria, loss of control (accidents or dribbling)
What is PARAMOUNT to obtaining a good Clean-Catch specimen?
CLEANLINESS
- do NOT want to contaminate the sample
What are the two most common obstructive uropathies seen in children?
- posterior urethral valves (boys ONLY)
2. ureteropelvic junction obstruction
What is the classic triad of signs/symptoms of a patient with Post-streptococcal glomerulonephritis?
What 3 lab findings would also help make this diagnosis?
T: hematuria, edema, HTN
Labs: inc. ASO titer, (+) anti-DNAse B, recent throat culture positive for strep pyrogenes
What is a prognostic indicator for long-term renal damage?
- protein in the urine along with blood
- amount of protein is KEY (if protein and blood in urine –> consult a nephrologist)
