GU

Question 1

No. of RBCs in urinalysis that warrants emergent imaging due to possible trauma to the kidney

Answer 1

> 20-50 RBC/hpf

Question 2

Formula for Crea clearance in children

Answer 2

(mL/min/1.73m2) = k x height (cm)

K
1 mo-2 y: 40
3-12y: 49
>12y: 62

Question 3

Flank pain radiating to the groin

Answer 3

Renal colic

Question 4

Ideal imaging study for UTI, renal scarring, hydroureter and pyelocaliectasis

Answer 4

Voiding cystourethrogram

Question 5

Conditions that warrant a renal biopsy

Answer 5

Persistent microscopic hematuria ( 3 positive UA/ 1 mo)

Recurrent gross hematuria w/ dec renal fx, proteinuria or hypertension

Question 6

I/F: IgA within mesangial deposits

L/M: focal & segmental mesangial proliferation

Answer 6

IgA nephropathy

Question 7

E/M: diffuse thickening, thinning, SPLITTING, and layering of the glonerular & tubular BM

Answer 7

Alport syndrome (hereditary nephritis)

Question 8

E/M: isolated thinning of GBM

Answer 8

Thin glomerular basement membrane disease

Question 9

Crescents in the glomeruli

Answer 9

Rapidly progressive glomerulonephritis

Question 10

PERIORBITAL EDEMA, gross hematuria, oliguria, hypertension

Answer 10

Post-infectious glomerulonephritis

Question 11

hematuria assoc. w/ URTI or GI infection 1-2 days prior its onset
normal C3

Answer 11

IgA nephropathy

Question 12

Usually follows GAHBS infection

Low C3

Answer 12

Post-infectious glomerulonephritis

Question 13

What type of hypersensitivity reaction is seen in PSGN?

Answer 13

Type 3: Immune-complex

Question 14

Benign familial hematuria

Answer 14

Thin membrane disease

Question 15

X-linked disease with asymptomatic microscopic hematuria

w/ pathognomonic anterior lenticonus

Answer 15

Alport syndrome

Question 16

Latency period of PSGN after pyoderma

Answer 16

3-6 weeks

Question 17

Treatment of PSGN

Answer 17

Na restriction
Penicillin for 10 days
Furosemide 1 mk/dose IV
ACE inhibitors/ CCBs/ vasodilators

Question 18

Ring-formed RBCs with one or more protrusions of different shapes and sizes

Answer 18

Acanthocytes/ dysmorphic RBCs

Question 19

Primary renal diseases that manifest as ACUTE glomerulonephritis

Answer 19

Post strep GN
IgA nephropathy
Goodpasture syndrome
Idiopathic RPGN

Question 20

GN that is common in the 2nd decade of life; assoc w/ chronic infx; C3 levels low; histo: lobular pattern, capillary walls are thick

Answer 20

Membranoproliferative GN

Question 21

GN that mostly affects HSP, SLE patients; hallmark: crescents in majority of GN; S/Sx: acute nephritis w/ proteinuria

Answer 21

Rapidly progressive GN

Question 22

Triad of HSP

Answer 22

Hematuria
Purpura on dependent areas
Arthritis of large joints

Question 23

Microangiopathic hemolytic anemia
+ thrombocytopenia
+ renal insufficiency

Answer 23

Hemolytic uremic syndrome (HUS)

Question 24

Ety of most common form of HUS

Answer 24

toxin-producing E. coli (worldwide)
Shiga toxin (Asians)

Question 25

Difference of HUS from TTP

Answer 25

TTP has same triad but w/ CNS involvement and fever, more gradual onset

Question 26

Lab criteria for HUS

Answer 26

Anemia w/ microangiopathic changes in PBS (Schistocytes, burr cells, helmet cells) Acute renal injury (hematuria, proteinuria or elev crea)

Question 27

Confirmed case of HUS

Answer 27

Both criteria met and began w/in 3 wks after onset of bloody diarrhea

Question 28

Characteristic histo of HUS

Answer 28

Microvascular injury with endothelial cell damage

Question 29

Sudden onset of pallor in HUS occurs usually at...

Answer 29

5-10 days after initial AGE or resp illness

Question 30

Sudden onset of gross/ microscopic hematuria, unilat/bilat flank masses

Answer 30

Renal vein thrombosis

Question 31

Confirmatory test for RVT

Answer 31

Doppler studies of IVC and renal vein

Question 32

Infantile autosomal recessive disease w/ bilat flank masses; assoc w/ potter facies or oligohydramnios complex

Answer 32

Polycystic kidney disease

Question 33

Complication of polycystic disease seen in over 50% of children in the 1st decade of life

Answer 33

ESRD

Question 34

``` Abdominal, flank, or back pain Fever Malaise N/V Diarrhea (occasional) ```

Answer 34

Pyelonephritis

Question 35

Gross hematuria and dysuria Suprapubic pain Urgency, frequency resolves within 1 week

Answer 35

Cystitis

Question 36

Most common cause of hemorrhagic cystitis

Answer 36

Adenovirus 11 and 21

Question 37

At what age does the child be able to undergo bladder training and master it?

Answer 37

2 y/o and 3 y/o respectively

Question 38

At what age does the child be able to undergo bowel training and master it?

Answer 38

3 y/o and 4 y/o respectively

Question 39

DOC for UTI

Answer 39

Coamoxiclav | or Cefuroxime

Question 40

Diagnosis of UTI based on 2011 AAP guidelines

Answer 40

``` Positive UA Positive culture (>50k cfu/mL) ```

Question 41

Upper limit of (N) CHON excretion in healthy children

Answer 41

150 mg/day | UAbCHON 3+ significant

Question 42

Non-pathologic cause of proteinuria

Answer 42

Febrile Exercise (resolves after 2 days) Postural (orthostic)

Question 43

``` Heavy proteinuria (40 mg/m2/hr) Hypoalbuminemia ( ```

Answer 43

Nephrotic syndrome

Question 44

2nd most common cause of nephrotic syndrome

Answer 44

Minimal change disease (85%) | Most common: idiopathic

Question 45

E/M: flattening/effacement of epith cell foot processes

Answer 45

Nephrotic syndrome

Question 46

Mainstay tx of nephrotic syndrome

Answer 46

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)

Question 47

When do you say that a child is steroid-resistant?

Answer 47

Proteinuria after 8 weeks | Consider biopsy, usual form: focal segmental glomerulonephritis