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Block 19 Module 3 > Glomerulonephritides in Kids > Flashcards

Glomerulonephritides in Kids Flashcards

1
Q

Edema of nephritic syndrome is typically most prominent on which part of the day?

A

Early in the morning (esp. on px dependent side)

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2
Q

T/F. Pregnancy is not an exacerbating factor for lupus nephritis

A

False (an exacerbating factor)

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3
Q

T/F. Acute nephrotic syndrome commonly affects adults

A

False (young children)

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4
Q

T/F. Typical prodrome of acute nephrotic syndrome in children

A

Gastroenteritis

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5
Q

Clinical criteria of acute nephritic syndrome

A

Edema, hypertension, hematuria, oliguria

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6
Q

Differentiate hpn of nephritic and nephrotic syndrome

A

Nephritic: HPN due to fluid retention VS Nephrotic: hypoalbuminuria → 3rd spacing → IV volume depletion

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7
Q

Most benign criteria in nephritic syndrome and also most common cause of consult

A

Hematuria

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8
Q

Hereditary nephritis

A

Alport syndrome

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9
Q

Most common cause of glomerulonephritis 2⁰ to isolated renal disease in our locality

A

Post infectious/strep GN

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10
Q

Most common cause of glomerulonephritis 2⁰ to isolated renal disease globally

A

IgA nephropathy

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11
Q

T/F. Membranous nephropathy is typically a disease of children

A

False (adults)

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12
Q

Commonly misdiagnosed as post strep GN

A

Membranoproliferative GN

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13
Q

Cause of GN with worst prognosis

A

Focal segmental glomerulosclerosis (FSGS)

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14
Q

T/F. Sickle cell glomerulopathy is common in Ph

A

False (seldom seen)

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15
Q

Typical picture of hemolytic uremic syndrome

A

GI symptoms prodrome then hematuria and abdominal pain

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16
Q

Difference of HUS from SLE

A

Type of rash and elevated BUN and creatinine

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17
Q

Most common glomerular cause of gross hematuria in children

A

Acute post streptococcal GN

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18
Q

Organisms associated with APSGN

A

Group A β-hemolytic streptococci

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19
Q

Immunofluorescent microscopy of APSGN

A

Lumpy bumpy deposits of Ig and complement in glomerular basement membrane

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20
Q

Reward given by doc to px after 6-12 weeks of management

A

McDonald’s

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21
Q

T/F. In a suspected APSGN px, confirm ddx if manifestations are triggered after 6-12 weeks of management

A

False (consider other ddx)

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22
Q

APSGN common in this age group

A

5-12 y.o.

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23
Q

Acute nephritic syndrome develops when post strep pharyngitis

A

1-2 weeks

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24
Q

Acute nephritic syndrome develops when after strep pyodermata

A

3-6 weeks

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25
Q

T/F. Px referred late for APSGN should not be dialyzed

A

False (undergo dialysis)

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26
Q

Management of rapidly progressing glomerulonephritis

A

Immediate prednisolone tx and a course peritoneal dialysis

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27
Q

Phases of APSGN

A

Oliguric, Diuretic, Convalescence

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28
Q

Why is there edema in APSGN?

A

Salt and water retention

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29
Q

Adequate urine output

A

≥1 cc/kg/hour

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30
Q

What to monitor in diuretic phase of APSGN

A

Dehydration and electrolytes (e.g. Na, K)

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31
Q

C3 levels in APSGN

A

Reduced because they get deposited in the glomerular basement membrane

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32
Q

C3 levels in rapidly progressing glomerulonephritis

A

Elevated

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33
Q

T/F. ASO titers are always elevated after strep skin infection

A

False (rarely only compared to throat infection; anti-DNase B level used to document cutaneous strep)

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34
Q

Which is more specific: Streptozyme test or ASO titers?

A

Streptozyme test but ASO is enough for ddx

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35
Q

C4 levels in APSGN

A

Often normal or only mildly depressed

36
Q

Neurologic involvement in APSGN

A

Posterior leukoencephalopathy in the parieto-occipital areas

37
Q

Most common complication of APSGN

A

HPN

38
Q

Drug of choice for APSGN

A

Penicillin for 10 days

39
Q

1st line drugs for HPN

A

Diuretics

40
Q

Safest anti-HPN in children

A

Calcium channel blockers

41
Q

T/F. ACE inhibitors and ARBs may worsen renal hypoperfusion

A

True, use w/ caution

42
Q

T/F. Skin infections are not risk for PSGN

A

False (risk)

43
Q

Clinical criteria for acute nephrotic syndrome

A

Edema, Normal BP, Proteinuria, Hypercholesterolemia

44
Q

Edema of nephrotic syndrome

A

Anasarca and 2⁰ to protein loss and drop in oncotic pressure

45
Q

Proteinuria in pedia

A

≥40 mg/m2

46
Q

Most common cause of nephrotic syndrome

A

Primary (idiopathic) nephrotic syndrome (INS)

47
Q

Nephrotic common in

A

Males; 2-6 y.o.

48
Q

Common cause of INS

A

Minimal change disease

49
Q

Pathology of minimal change disease

A

T cell dysfunction → alteration of cytokines → loss of negative charged glycoprotein in glomerular capillary

50
Q

Mutated podocyte proteins in FSGS

A

Podocin and alpha actinin

51
Q

Mutated podocyte proteins in steroid resistant nephrotic syndrome

A

NPHS2 (podocin) and WT1 genes

52
Q

Reason why FSGS still recur in transplanted kidneys

A

Plasma factor by lymphocutes causing permeability

53
Q

WT1 gene also expressed in what tumor?

A

Wilm’s tumor

54
Q

What to give in px with genital edema since it’s very painful

A

Albumin

55
Q

Proteinuria in INS

A

+3 or +4 proteinuria

56
Q

Serum creatinine, C3 and C4 in INS

A

Normal

57
Q

T/F. Children with uncomplicated nephrotic syndrome, 1-8 y.o. likely to be unresponsive to steroid

A

False (responsive)

58
Q

Gold standard drug for steroid resistant nephrotic syndrome

A

Prednisone, 60 mg/m2 for 6 weeks

59
Q

Alternative tx aside from steroid

A

Cyclophosphamide

60
Q

Steroid sparing agent

A

Cyclosporine

61
Q

Adjunct tx to reduce proteinuria

A

ACE inhibitors and angiotensin II blockers

62
Q

Most frequent type of infection in nephrotic syndrome

A

Spontaneous bacterial peritonitis by strep pneumonia

63
Q

Also known as Berger Nephropathy and may cross between nephritic and nephrotic and the most common chronic glomerular disease worldwide

A

IgA Nephropathy

64
Q

Part where IgA is deposited in IgA nephropathy

A

Mesangium of glomerulus

65
Q

C3 in IgAN

A

Normal vs post strep nga reduced

66
Q

T/F. Ddx of IgAN also does not require renal biopsy

A

False (requires)

67
Q

Closely related disease of IgAN

A

Henoch-Schonlein purpura

68
Q

What to suspect if px has gross hematuria 2-3 days after URTI

A

IgA Nephropathy

69
Q

Mainstay of tx in IgAN

A

ACEIs or ARBS (primary tx is proper bp control and reduce proteinuria)

70
Q

PSAGN vs IgAN

A

PSAGN: hematuria 2-3 weeks after infection
IgAN: within days of iinfection

71
Q

Form of hereditary nephritis with mutation in the COL4A5 gene encoding for the alpha chain of type IV collagen

A

Alport syndrome

72
Q

Extrarenal manifestations of alport syndrome

A

Hearing deficits and ocular abnormalities

73
Q

Presence of persistent microscopic hematuria and isolated thinning of the basement membrane on electron microscopy

A

Thin glomerular basement membrane disease

74
Q

Most common cause of nephrotic syndrome in adults, but an uncommon cause of hematuria in children

A

Membranous nephropathy

75
Q

Most common cause of Membranous nephropathy worldwide

A

Malaria

76
Q

Most common small vessel vasculitis in pedia

A

Henoch schonlein purpura

77
Q

Features of HSP

A

Purpuric rash and commonly accompanied by arthritis and abdominal pain

78
Q

T/F. The glomerular findings can be indistinguishable from those of IgA nephropathy

A

True

79
Q

T/F. Mild HSP nephritis requires treatment because it usually does not resolve spontaneously.

A

False (no tx because it resolves spontaneously)

80
Q

One of the most common causes of community acquired acute kidney failure in pedia (<1 y.o. with acute gastroenteritis)

A

Hemolytic uremic syndrome

81
Q

Triad of HUS

A

Acute renal failure, anemia, hx of AGE

82
Q

Typical agents in HUS

A

E. coli and STX producing shigella dysenteriae; Non STX assoc (atypical)

83
Q

Pathologic hallmark of HUS

A

Fibrin-platelet thrombi deposition in affected organs

84
Q

T/F. Biopsy needed in ddx of HUS

A

False

85
Q

Symptoms in HUS appear when post exposure

A

1-8 days ave 3 days

86
Q

T/F. The prognosis for HUS not associated with diarrhea is more severe

A

True

Block 19 Module 3 (9 decks)

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