GU Flashcards
No. of RBCs in urinalysis that warrants emergent imaging due to possible trauma to the kidney
> 20-50 RBC/hpf
Formula for Crea clearance in children
(mL/min/1.73m2) = k x height (cm)
K
1 mo-2 y: 40
3-12y: 49
>12y: 62
Flank pain radiating to the groin
Renal colic
Ideal imaging study for UTI, renal scarring, hydroureter and pyelocaliectasis
Voiding cystourethrogram
Conditions that warrant a renal biopsy
Persistent microscopic hematuria ( 3 positive UA/ 1 mo)
Recurrent gross hematuria w/ dec renal fx, proteinuria or hypertension
I/F: IgA within mesangial deposits
L/M: focal & segmental mesangial proliferation
IgA nephropathy
E/M: diffuse thickening, thinning, SPLITTING, and layering of the glonerular & tubular BM
Alport syndrome (hereditary nephritis)
E/M: isolated thinning of GBM
Thin glomerular basement membrane disease
Crescents in the glomeruli
Rapidly progressive glomerulonephritis
PERIORBITAL EDEMA, gross hematuria, oliguria, hypertension
Post-infectious glomerulonephritis
hematuria assoc. w/ URTI or GI infection 1-2 days prior its onset
normal C3
IgA nephropathy
Usually follows GAHBS infection
Low C3
Post-infectious glomerulonephritis
What type of hypersensitivity reaction is seen in PSGN?
Type 3: Immune-complex
Benign familial hematuria
Thin membrane disease
X-linked disease with asymptomatic microscopic hematuria
w/ pathognomonic anterior lenticonus
Alport syndrome
Latency period of PSGN after pyoderma
3-6 weeks
Treatment of PSGN
Na restriction
Penicillin for 10 days
Furosemide 1 mk/dose IV
ACE inhibitors/ CCBs/ vasodilators
Ring-formed RBCs with one or more protrusions of different shapes and sizes
Acanthocytes/ dysmorphic RBCs
Primary renal diseases that manifest as ACUTE glomerulonephritis
Post strep GN
IgA nephropathy
Goodpasture syndrome
Idiopathic RPGN
GN that is common in the 2nd decade of life; assoc w/ chronic infx; C3 levels low; histo: lobular pattern, capillary walls are thick
Membranoproliferative GN
GN that mostly affects HSP, SLE patients; hallmark: crescents in majority of GN; S/Sx: acute nephritis w/ proteinuria
Rapidly progressive GN
Triad of HSP
Hematuria
Purpura on dependent areas
Arthritis of large joints
Microangiopathic hemolytic anemia
+ thrombocytopenia
+ renal insufficiency
Hemolytic uremic syndrome (HUS)
Ety of most common form of HUS
toxin-producing E. coli (worldwide) Shiga toxin (Asians)
Difference of HUS from TTP
TTP has same triad but w/ CNS involvement and fever, more gradual onset
Lab criteria for HUS
Anemia w/ microangiopathic changes in PBS (Schistocytes, burr cells, helmet cells)
Acute renal injury (hematuria, proteinuria or elev crea)
Confirmed case of HUS
Both criteria met and began w/in 3 wks after onset of bloody diarrhea
Characteristic histo of HUS
Microvascular injury with endothelial cell damage
Sudden onset of pallor in HUS occurs usually at…
5-10 days after initial AGE or resp illness
Sudden onset of gross/ microscopic hematuria, unilat/bilat flank masses
Renal vein thrombosis
Confirmatory test for RVT
Doppler studies of IVC and renal vein
Infantile autosomal recessive disease w/ bilat flank masses; assoc w/ potter facies or oligohydramnios complex
Polycystic kidney disease
Complication of polycystic disease seen in over 50% of children in the 1st decade of life
ESRD
Abdominal, flank, or back pain Fever Malaise N/V Diarrhea (occasional)
Pyelonephritis
Gross hematuria and dysuria
Suprapubic pain
Urgency, frequency
resolves within 1 week
Cystitis
Most common cause of hemorrhagic cystitis
Adenovirus 11 and 21
At what age does the child be able to undergo bladder training and master it?
2 y/o and 3 y/o respectively
At what age does the child be able to undergo bowel training and master it?
3 y/o and 4 y/o respectively
DOC for UTI
Coamoxiclav
or Cefuroxime
Diagnosis of UTI based on 2011 AAP guidelines
Positive UA Positive culture (>50k cfu/mL)
Upper limit of (N) CHON excretion in healthy children
150 mg/day
UAbCHON 3+ significant
Non-pathologic cause of proteinuria
Febrile
Exercise (resolves after 2 days)
Postural (orthostic)
Heavy proteinuria (40 mg/m2/hr) Hypoalbuminemia (
Nephrotic syndrome
2nd most common cause of nephrotic syndrome
Minimal change disease (85%)
Most common: idiopathic
E/M: flattening/effacement of epith cell foot processes
Nephrotic syndrome
Mainstay tx of nephrotic syndrome
Steroids
(Prednisone 60mg/m2/day, 2-3 doses for at least 4 wks)
(Pulse therapy: methylprednisolone 30mg/kg bolus w/ 1st 6 doses given every other day then tapered up to 18 mos)
When do you say that a child is steroid-resistant?
Proteinuria after 8 weeks
Consider biopsy, usual form: focal segmental glomerulonephritis
