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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
Q

Atypical HUS is associated with what

A

complement destruction

Factor H deficiency

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26
Q

a low C3 level in GN could be what?

A

PSGN, MPGN, SBE, HIV, HepB

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27
Q

normal C3 in GN could be what

A

IgA nephropathy
Alports
thin basement membrane
idiopathic, progressive GN

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28
Q

what are renal causes on nonglomerular hematuria

A 
acute interstitial nephritis
sickle cell trait
PCKD
tumors
renal vein thrombosis
A/V malformation
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29
Q

What are non glomerular causes of hematuria in urinary tract

A

cystisis, stones, hyperCa, vW disease

30
Q

for acute post strep GN what is plan in PE

A

ask about Hx of strep and if got treated

abdominal exam, GU, HEENT(past strep)

31
Q

acute post strep GN presents with what unique finding in kids

A

HA due to HTN most likely caused by GN

32
Q

What titers would you pull on suspected post-strep GN

A

ASO

33
Q

how do you differentiate post strep GN and IgA nephropathy if not so clear

A

IgA nephropathy comes and goes

have you had hematuria before?

34
Q

What lab or imaging would you do to confirm post strep GN

A 
UA- RBC
Hb
WBC 
total protein and albumin
ASO titer
complement level!!!
35
Q

what is Tx for post strep GN

A

water and electrolyte

36
Q 
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?
A

barium swallow CT

shows something displacing esophagus

37
Q

Where does Wilms Tumor metastasize to almost always

A

lungs

38
Q

What imaging helps Dx wilms tumor

A

ultrasound, enlarged kidneys

39
Q

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?

A

surgical repair

could do wishful waiting, could do antibiotic prophylaxis

40
Q

What is grade I VUR

A

reflux just in ureter

41
Q

what is grade II VUR

A

reflux reaches pelvis

42
Q

what is grade III VUR

A

dilation of ureter and reached pelvis

43
Q

what is grade IV VUR

A

dilation of ureters and pelvic calyces

44
Q

what is grade V VUR

A

severe dilation ureter and calyceal system

45
Q

DMSA contrast will light up what areas of kidney

A

the viable areas of kidneys, dark areas are renal scars

46
Q

persistent VUR is caused by what

A

immune mediated from infection, like E coli

47
Q

how does chronic renal disease affect childhood growth

A

stunt growth

low heigh and weight percentiles

48
Q

what is pre term baby?

post term?

A

pre is 42 weeks

49
Q

what is perinatal death

A

death occurring before 28th week of gestations and 28th day of life

50
Q

what is APGAR scoring

A

0, 1, 2 for HR, RR, muscle tone, reflex irratability, skin color

51
Q

if apgar is <5

A

BE CONCERNED

52
Q

during first week of life infants lose weight why?

A

lose 10% birth weigh from water loss

53
Q

What is fractional Na excretion in infants

A

same as adults <1%

54
Q

in preterm infants what is Na loss propertional to

A

inverse to gestational age

55
Q

What is hyper/hypo natremia

A

hyper >150 mmol/L

hypo <130 mmol/L

56
Q

what are signs of excessive water loss in newborn

A 
excessive weight loss
dray oral mucosa
sunken anterior fontanelle
capillary refill >3 sec
decreased BP
metabolic acidosis
57
Q

what is normal urine output for newborn

A

1-3 ml/kg/hr

58
Q

10 day old male with lethargy, poor feeding and decreased urine output
Ddx?

A 
septic until proven otherwise (infections etc)
metabolic defect
intracranial bleed
hypoxic/ischemic encephalopathy
feeding difficulties/dehydration
renal malformations
renal vein thrombosis
59
Q

if there is meconium staining of amniotic fluid what is that indicative of

A

stress in-utero

60
Q

what does dry skin in infant mean you should be thinking about

A

water loss

61
Q

definition ARF in infant

A

rapid elevation of [ ] blood of BUN, creatinine and other waste products from diminshed GFR

62
Q

why can you not measure creatinine in newborn

A

reflect mothers

63
Q

what do you rely on for ARF indicator in newborn

A

urine output

less than 0.5 ml/kg/hr

64
Q

what are prerenal causes ARF in newborn

A

sepsis, hypovolemia, hemorrhage, hypoxia ischemia, cardiac failure, hypotension, hyperviscosity

65
Q

what are the intrinsic causes of ARF in neonate

A 
ATN
drugs
ACEI
vascular
congenital
maternal drugs
transient ARC in newborn
66
Q

what are the psot renal causes of ARF in newborns

A

congenital obstruction: ureteral, urethral, bladder, pelvic mass
calculi

67
Q

What is opisthotonic posturing

A

arched back

68
Q

What do ammonia levels tell you in newborn

A

urea cycle defects
acidosis
neurologic–> NH4 mess with glutamine glutamate–> cerebral edema

69
Q

escitalopram (lexapro) use in pregnancy as been assoc with what

A

feeding difficulties and increased Na content in breast milk

70
Q

when must you follow up with mother after discharge of newborn

A

1-2 days

71
Q

how do you correct hypernatremia

A

slowly!!! don’t want to force water into intracell

72
Q

dehydration in infant can lead tow hat

A

coagulopathy which can lead to hemorrhage and thrombosis

Year2 Renal (20 decks)

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