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Year2 Renal > Exam 3- Brandau > Flashcards

Exam 3- Brandau Flashcards

1
Q

what is classification for microscopic hematuria

A

> 5 RBCs/HPF on more than 2 occasions

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2
Q

What is Ddx for gross hematuria

A

kidney stones, trauma, AV malformation, renal vein thrombosis, ATN, IgA nephropathy, Alport, Glomerular nephritis

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3
Q

clinical presentation of renal vein thrombosis

A

abdominal mass, tenderness, hematuria, oliguria and thrombocytopenia
sonography shows enlarged kidneys with hyperechogenicity

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4
Q

renal vein thrombosis occurs in what childhood stage

A

neonates

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5
Q

Clinical presentation of renal AV malformations

A

gross hematuria and decreasing renal function

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6
Q

what are predisposing factors to renal vein thrombosis

A

hemoconcentration(hypercoaguable states), reduced renal blood flow

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7
Q

are renal AV malformations congenital or acquired

A

could be either

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8
Q

what is high Hct for neonate

A

> 60s

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9
Q

describe general presentation of ATN in child

A

occurs most often in critically ill child who suffered nephrotoxic or ischemic insults

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10
Q

what process is acute tubular necrosis

A

tubular cell necrosis

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11
Q

What medications are known to cause ATN

A

aminoglycosides, cyclosporine, oncologic drugs, heavy metals

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12
Q

What is most common chronic glomerular disease world wide

A

IgA nephropathy

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13
Q

clinical presentation IgA nephropathy

A

gross hematuria associated with URI
subnephrotic proteinuria
normal C3 levels

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14
Q

Describe micro of IgA

A

predominance IgA in mesangial deposis of glomerulus in absent of systemic disease like lupus of HSP

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15
Q

What causes alport syndrome

A

mutations in genes for type IV collagen

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16
Q

findings of alport syndrome

A

proteinuria, hematuria
ocular abnormalities, hearing loss,
leiomyomatosis of esophagus and trachea and female genitals

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17
Q

clinical presentation acute post strep glomerulonephritis

A

sudden onset gross hematuria, edema, HTN, renal insufficiency
hemturia
follow infection

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18
Q

What is age group post strep glomerulonephritis

A

age 5-12 uncommon before age 3

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19
Q

why to post strep GN have hypocomplementemia

A

using C3 up

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20
Q

What i first step of hematuria CC

A

UA to look for Hb

if still red but no RBC elements–> myoglobin

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21
Q

RBC casts suggest what as cause of hematuria

A

glomerulus

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22
Q

for multisystem diseases with hematuria and patient has low C3
what is top of Ddx

A

SLE

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23
Q

multisystem disease with hematuria and patient has normal C3

Ddx

A 
HSP
HUS
Wegeners
Goodpastures
Polyarteritis
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24
Q

Typical HUS is associated with what

A

E. coli

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25
Atypical HUS is associated with what
complement destruction | Factor H deficiency
26
a low C3 level in GN could be what?
PSGN, MPGN, SBE, HIV, HepB
27
normal C3 in GN could be what
IgA nephropathy Alports thin basement membrane idiopathic, progressive GN
28
what are renal causes on nonglomerular hematuria
``` acute interstitial nephritis sickle cell trait PCKD tumors renal vein thrombosis A/V malformation ```
29
What are non glomerular causes of hematuria in urinary tract
cystisis, stones, hyperCa, vW disease
30
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)
31
acute post strep GN presents with what unique finding in kids
HA due to HTN most likely caused by GN
32
What titers would you pull on suspected post-strep GN
ASO
33
how do you differentiate post strep GN and IgA nephropathy if not so clear
IgA nephropathy comes and goes | have you had hematuria before?
34
What lab or imaging would you do to confirm post strep GN
``` UA- RBC Hb WBC total protein and albumin ASO titer complement level!!! ```
35
what is Tx for post strep GN
water and electrolyte
36
``` 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
37
Where does Wilms Tumor metastasize to almost always
lungs
38
What imaging helps Dx wilms tumor
ultrasound, enlarged kidneys
39
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
40
What is grade I VUR
reflux just in ureter
41
what is grade II VUR
reflux reaches pelvis
42
what is grade III VUR
dilation of ureter and reached pelvis
43
what is grade IV VUR
dilation of ureters and pelvic calyces
44
what is grade V VUR
severe dilation ureter and calyceal system
45
DMSA contrast will light up what areas of kidney
the viable areas of kidneys, dark areas are renal scars
46
persistent VUR is caused by what
immune mediated from infection, like E coli
47
how does chronic renal disease affect childhood growth
stunt growth | low heigh and weight percentiles
48
what is pre term baby? | post term?
pre is 42 weeks
49
what is perinatal death
death occurring before 28th week of gestations and 28th day of life
50
what is APGAR scoring
0, 1, 2 for HR, RR, muscle tone, reflex irratability, skin color
51
if apgar is <5
BE CONCERNED
52
during first week of life infants lose weight why?
lose 10% birth weigh from water loss
53
What is fractional Na excretion in infants
same as adults <1%
54
in preterm infants what is Na loss propertional to
inverse to gestational age
55
What is hyper/hypo natremia
hyper >150 mmol/L | hypo <130 mmol/L
56
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 ```
57
what is normal urine output for newborn
1-3 ml/kg/hr
58
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 ```
59
if there is meconium staining of amniotic fluid what is that indicative of
stress in-utero
60
what does dry skin in infant mean you should be thinking about
water loss
61
definition ARF in infant
rapid elevation of [ ] blood of BUN, creatinine and other waste products from diminshed GFR
62
why can you not measure creatinine in newborn
reflect mothers
63
what do you rely on for ARF indicator in newborn
urine output | less than 0.5 ml/kg/hr
64
what are prerenal causes ARF in newborn
sepsis, hypovolemia, hemorrhage, hypoxia ischemia, cardiac failure, hypotension, hyperviscosity
65
what are the intrinsic causes of ARF in neonate
``` ATN drugs ACEI vascular congenital maternal drugs transient ARC in newborn ```
66
what are the psot renal causes of ARF in newborns
congenital obstruction: ureteral, urethral, bladder, pelvic mass calculi
67
What is opisthotonic posturing
arched back
68
What do ammonia levels tell you in newborn
urea cycle defects acidosis neurologic--> NH4 mess with glutamine glutamate--> cerebral edema
69
escitalopram (lexapro) use in pregnancy as been assoc with what
feeding difficulties and increased Na content in breast milk
70
when must you follow up with mother after discharge of newborn
1-2 days
71
how do you correct hypernatremia
slowly!!! don't want to force water into intracell
72
dehydration in infant can lead tow hat
coagulopathy which can lead to hemorrhage and thrombosis

Year2 Renal (20 decks)

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