Lecture 6: Pediatric Renal Flashcards
For children age 1-13 yo, normal BP is < what percentile?
<90th percentile
Which percentile range and BP elevation is considered stage 1 HTN in a child aged 1-13 yo?
≥95th percentile to <95th percentile + 12 mmHg
Which percentile range and BP elevation is considered stage 2 HTN in a child aged 1-13 yo?
≥95th percentile + 12 mmHg
A healthcare professional can make a diagnosis of HTN in a child or adolescent if what criteria are met?
Ausculatory confirmed BP readings ≥95th percentile at 3 different visits
In some children, the 4th Karotkoff sound never goes away and the “muffled” sounds can be heard all the way to zero, how should this be interpreted?
4th sound is used for DBP
In older, school age children, prevalence of primary HTN has increased hand-in-hand with what?
Obestity epidemic
The most prominent evidence of mild, chronic, untreated HTN in a child is the presence of what?
How is it detected?
- Left-ventricular hypertrophy (LVH)
- Echocardiography
How does a BP cuff that is too small vs. too big affect the measure BP?
- Cuff too small = artificial elevation of BP
- Cuff too big = artifical depression of BP
How many RBC’s/hpf in 3 consecutive fresh, centrifuged specimens obtained over a span of weeks is indicative of hematuria?
5+ RBC’s/hpf in 3 consecutive tests
What are 4 drugs that can color the urine?
- Rifampin
- Nitrofurantoin
- Pyridium
- Sulfa drugs
A newborn presents with brick red color in the diaper, this is most likely due to?
Uric acid crystals due to dehydration
If you collect a UA from a child and there seems to be blood in the specimen, what must you do next?
Confirm that the color is actually blood by doing microscopy
What is the RBC morphology associated with glomerular hematuria?
Dysmorphic RBC’s
What is the color of the urine associated with glomerular hematuria?
May be red or brown
What is an ominous finding in conjunction w/ hematuria?
Hematuria + proteinuria
What are 5 common causes of gross hematuria in a child?
- UTIs
- Trauma
- Bleeding disorders
- Renal stones
- Cystitis –> viral (adenovirus) = hemorrhagic cystitis
What is the prognostic indicator of long term renal damage in children w/ Henoch-Schonlein Purpura?
Development of PROTEINURIA along w/ hematuria
How long will a child with Henoch-Schönlein Purpura feel sick?
Will feel sick for a long time
In a child w/ asymptomatic (isolated) hematuria, why is it important to ask about family hx?
There is entitiy known as benign familial hematuria (thin basement membrane disorder)
Increased urine levels of which ion may be a cause of asymptomatic microscopic hematuria in a child?
HYPERcalcuria
Children with asymptomatic (isolated) hematuria should be regularly monitored for?
Regularly monitored for proteinuria and HTN
Urine Ca-to-Creatinine ratio of >_____ is indicative of excess calcium excretion and could be cause of asymptomatic hematuria.
>0.2
What is march hematuria?
May be seen in a child presenting after what?
- After vigorous exercise, it is not unusual to see some RBC’s in the urine
- May be seen in young person who comes in for PE after sport’s practice
If a child can void on command, how may a urine sample be collected for suspected UTI?
Clean-catch urine
If a child is not able to void on command what 2 ways may you collect a urine sample that can be used for culture in suspected UTI?
- Catheterization
- Suprapubic aspiration (SPA)
What is the recommendation for collecting a urine sample for child that can be culutured if you are going to start on Abx?
Collect the urine sample BEFORE starting meds
What type of urine samples are NOT appropriate for culuture?
Bag urine samples
If urine is collected by clean catch method, what criteria must be met for diagnosis of UTI?
Presence of both pyruia AND at least 50,000 colonies/mL of a single uropathogenic organism
If urine is collected by cathether what is the criteria that must be met for diagnosis of UTI?
- Pyruria and colony count of 50,000 CPM
or
- 10,000-50,000 CPM confirmed by repeat
If urine sample is obtained by suprapubic aspiration, what criteria need to be met for diagnosis of UTI?
Pyuria and ANY growth on culture
Leukocyte esterase is a test looking for what?
Tells you what?
- WBC’s
- Inflammation/infection in kidney or urinary tract
Urine Nitrate testing detects what?
Used in screening of?
- Detects presence of certain types of bacteria
- Screening for presence of UTI
E. coli in the urine can be detected with what screening test?
Urine nitrate testing
What is the recommended length for Abx treatment of a child with UTI who is febrile (pyelonephritis)?
10-14 days
When does a UTI prompt imaging of a boy vs. girls urinay tract?
- After the first UTI in boys
- After second (or 3rd) in girls
What type of imaging is done in boys after the 1st UTI?
- Renal and bladder ultrasound
- VCUG
*DO THEM BOTH!
What are the indications for performing VUCG in girl following a UTI?
- Any anomalies detected on RBUS
- Combo of temp >39 °C + pathogen other than E. coli
- Poor growth and HTN is part of clinical presentation
Which grades of VUR in child should prompt referral to a specialist?
Grades III-V
List 6 indications in a pediatric pt w/ UTI that would prompt a referral to a specialist
- Presence of VUR (grades III-V)
- Obstructive uropathy present
- Renal abnormalities identified
- Kidney function is impaired
- Patient is hypertensive
- Bowel and bladder dysfunction is refractory to primary care measures
1st line Abx choice in pediatric pt with UTI that is not acutely ill and tolerating (po)?
Cephalosporins like cefixime or cefdinir
If pediatric pt w/ UTI is acutely ill or not tolerating PO, which Abx should be given and via which route?
3rd gen. cephalosporin (ceftriaxone) via parenteral route
