Exam 3- Brandau Flashcards
what is classification for microscopic hematuria
> 5 RBCs/HPF on more than 2 occasions
What is Ddx for gross hematuria
kidney stones, trauma, AV malformation, renal vein thrombosis, ATN, IgA nephropathy, Alport, Glomerular nephritis
clinical presentation of renal vein thrombosis
abdominal mass, tenderness, hematuria, oliguria and thrombocytopenia
sonography shows enlarged kidneys with hyperechogenicity
renal vein thrombosis occurs in what childhood stage
neonates
Clinical presentation of renal AV malformations
gross hematuria and decreasing renal function
what are predisposing factors to renal vein thrombosis
hemoconcentration(hypercoaguable states), reduced renal blood flow
are renal AV malformations congenital or acquired
could be either
what is high Hct for neonate
> 60s
describe general presentation of ATN in child
occurs most often in critically ill child who suffered nephrotoxic or ischemic insults
what process is acute tubular necrosis
tubular cell necrosis
What medications are known to cause ATN
aminoglycosides, cyclosporine, oncologic drugs, heavy metals
What is most common chronic glomerular disease world wide
IgA nephropathy
clinical presentation IgA nephropathy
gross hematuria associated with URI
subnephrotic proteinuria
normal C3 levels
Describe micro of IgA
predominance IgA in mesangial deposis of glomerulus in absent of systemic disease like lupus of HSP
What causes alport syndrome
mutations in genes for type IV collagen
findings of alport syndrome
proteinuria, hematuria
ocular abnormalities, hearing loss,
leiomyomatosis of esophagus and trachea and female genitals
clinical presentation acute post strep glomerulonephritis
sudden onset gross hematuria, edema, HTN, renal insufficiency
hemturia
follow infection
What is age group post strep glomerulonephritis
age 5-12 uncommon before age 3
why to post strep GN have hypocomplementemia
using C3 up
What i first step of hematuria CC
UA to look for Hb
if still red but no RBC elements–> myoglobin
RBC casts suggest what as cause of hematuria
glomerulus
for multisystem diseases with hematuria and patient has low C3
what is top of Ddx
SLE
multisystem disease with hematuria and patient has normal C3
Ddx
HSP HUS Wegeners Goodpastures Polyarteritis
Typical HUS is associated with what
E. coli
Atypical HUS is associated with what
complement destruction
Factor H deficiency
a low C3 level in GN could be what?
PSGN, MPGN, SBE, HIV, HepB
normal C3 in GN could be what
IgA nephropathy
Alports
thin basement membrane
idiopathic, progressive GN
what are renal causes on nonglomerular hematuria
acute interstitial nephritis sickle cell trait PCKD tumors renal vein thrombosis A/V malformation
What are non glomerular causes of hematuria in urinary tract
cystisis, stones, hyperCa, vW disease
for acute post strep GN what is plan in PE
ask about Hx of strep and if got treated
abdominal exam, GU, HEENT(past strep)
acute post strep GN presents with what unique finding in kids
HA due to HTN most likely caused by GN
What titers would you pull on suspected post-strep GN
ASO
how do you differentiate post strep GN and IgA nephropathy if not so clear
IgA nephropathy comes and goes
have you had hematuria before?
What lab or imaging would you do to confirm post strep GN
UA- RBC Hb WBC total protein and albumin ASO titer complement level!!!
what is Tx for post strep GN
water and electrolyte
1.5 y/o girl with microscopic hematuria UA RBC casts, only a few normal C' and - for SLE opthamalgic and hearing exams normal macroscopic hematuria with infections and glomerular proteinuria develop and now difficulty swallowing food lab?
barium swallow CT
shows something displacing esophagus
Where does Wilms Tumor metastasize to almost always
lungs
What imaging helps Dx wilms tumor
ultrasound, enlarged kidneys
6 y/o female
management VUR
increased UA for E coli, Tx wih ampicillin
Grade III VUR on image age 4, stunted height and weight
renal scan shows normal sized kidneys
what do you do?
surgical repair
could do wishful waiting, could do antibiotic prophylaxis
What is grade I VUR
reflux just in ureter
what is grade II VUR
reflux reaches pelvis
what is grade III VUR
dilation of ureter and reached pelvis
what is grade IV VUR
dilation of ureters and pelvic calyces
what is grade V VUR
severe dilation ureter and calyceal system
DMSA contrast will light up what areas of kidney
the viable areas of kidneys, dark areas are renal scars
persistent VUR is caused by what
immune mediated from infection, like E coli
how does chronic renal disease affect childhood growth
stunt growth
low heigh and weight percentiles
what is pre term baby?
post term?
pre is 42 weeks
what is perinatal death
death occurring before 28th week of gestations and 28th day of life
what is APGAR scoring
0, 1, 2 for HR, RR, muscle tone, reflex irratability, skin color
if apgar is <5
BE CONCERNED
during first week of life infants lose weight why?
lose 10% birth weigh from water loss
What is fractional Na excretion in infants
same as adults <1%
in preterm infants what is Na loss propertional to
inverse to gestational age
What is hyper/hypo natremia
hyper >150 mmol/L
hypo <130 mmol/L
what are signs of excessive water loss in newborn
excessive weight loss dray oral mucosa sunken anterior fontanelle capillary refill >3 sec decreased BP metabolic acidosis
what is normal urine output for newborn
1-3 ml/kg/hr
10 day old male with lethargy, poor feeding and decreased urine output
Ddx?
septic until proven otherwise (infections etc) metabolic defect intracranial bleed hypoxic/ischemic encephalopathy feeding difficulties/dehydration renal malformations renal vein thrombosis
if there is meconium staining of amniotic fluid what is that indicative of
stress in-utero
what does dry skin in infant mean you should be thinking about
water loss
definition ARF in infant
rapid elevation of [ ] blood of BUN, creatinine and other waste products from diminshed GFR
why can you not measure creatinine in newborn
reflect mothers
what do you rely on for ARF indicator in newborn
urine output
less than 0.5 ml/kg/hr
what are prerenal causes ARF in newborn
sepsis, hypovolemia, hemorrhage, hypoxia ischemia, cardiac failure, hypotension, hyperviscosity
what are the intrinsic causes of ARF in neonate
ATN drugs ACEI vascular congenital maternal drugs transient ARC in newborn
what are the psot renal causes of ARF in newborns
congenital obstruction: ureteral, urethral, bladder, pelvic mass
calculi
What is opisthotonic posturing
arched back
What do ammonia levels tell you in newborn
urea cycle defects
acidosis
neurologic–> NH4 mess with glutamine glutamate–> cerebral edema
escitalopram (lexapro) use in pregnancy as been assoc with what
feeding difficulties and increased Na content in breast milk
when must you follow up with mother after discharge of newborn
1-2 days
how do you correct hypernatremia
slowly!!! don’t want to force water into intracell
dehydration in infant can lead tow hat
coagulopathy which can lead to hemorrhage and thrombosis
