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CPR Exam 3 > Lecture 6: Pediatric Renal > Flashcards

Lecture 6: Pediatric Renal Flashcards

1
Q

For children age 1-13 yo, normal BP is < what percentile?

A

<90th percentile

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2
Q

Which percentile range and BP elevation is considered stage 1 HTN in a child aged 1-13 yo?

A

≥95th percentile to <95th percentile + 12 mmHg

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3
Q

Which percentile range and BP elevation is considered stage 2 HTN in a child aged 1-13 yo?

A

≥95th percentile + 12 mmHg

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4
Q

A healthcare professional can make a diagnosis of HTN in a child or adolescent if what criteria are met?

A

Ausculatory confirmed BP readings ≥95th percentile at 3 different visits

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5
Q

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?

A

4th sound is used for DBP

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6
Q

In older, school age children, prevalence of primary HTN has increased hand-in-hand with what?

A

Obestity epidemic

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7
Q

The most prominent evidence of mild, chronic, untreated HTN in a child is the presence of what?

How is it detected?

A
  • Left-ventricular hypertrophy (LVH)
  • Echocardiography
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8
Q

How does a BP cuff that is too small vs. too big affect the measure BP?

A
  • Cuff too small = artificial elevation of BP
  • Cuff too big = artifical depression of BP
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9
Q

How many RBC’s/hpf in 3 consecutive fresh, centrifuged specimens obtained over a span of weeks is indicative of hematuria?

A

5+ RBC’s/hpf in 3 consecutive tests

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10
Q

What are 4 drugs that can color the urine?

A
  • Rifampin
  • Nitrofurantoin
  • Pyridium
  • Sulfa drugs
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11
Q

A newborn presents with brick red color in the diaper, this is most likely due to?

A

Uric acid crystals due to dehydration

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12
Q

If you collect a UA from a child and there seems to be blood in the specimen, what must you do next?

A

Confirm that the color is actually blood by doing microscopy

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13
Q

What is the RBC morphology associated with glomerular hematuria?

A

Dysmorphic RBC’s

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14
Q

What is the color of the urine associated with glomerular hematuria?

A

May be red or brown

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15
Q

What is an ominous finding in conjunction w/ hematuria?

A

Hematuria + proteinuria

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16
Q

What are 5 common causes of gross hematuria in a child?

A
  • UTIs
  • Trauma
  • Bleeding disorders
  • Renal stones
  • Cystitis –> viral (adenovirus) = hemorrhagic cystitis
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17
Q

What is the prognostic indicator of long term renal damage in children w/ Henoch-Schonlein Purpura?

A

Development of PROTEINURIA along w/ hematuria

18
Q

How long will a child with Henoch-Schönlein Purpura feel sick?

A

Will feel sick for a long time

19
Q

In a child w/ asymptomatic (isolated) hematuria, why is it important to ask about family hx?

A

There is entitiy known as benign familial hematuria (thin basement membrane disorder)

20
Q

Increased urine levels of which ion may be a cause of asymptomatic microscopic hematuria in a child?

A

HYPERcalcuria

21
Q

Children with asymptomatic (isolated) hematuria should be regularly monitored for?

A

Regularly monitored for proteinuria and HTN

22
Q

Urine Ca-to-Creatinine ratio of >_____ is indicative of excess calcium excretion and could be cause of asymptomatic hematuria.

A

>0.2

23
Q

What is march hematuria?

May be seen in a child presenting after what?

A
  • 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
24
Q

If a child can void on command, how may a urine sample be collected for suspected UTI?

A

Clean-catch urine

25
Q

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?

A
  • Catheterization
  • Suprapubic aspiration (SPA)
26
Q

What is the recommendation for collecting a urine sample for child that can be culutured if you are going to start on Abx?

A

Collect the urine sample BEFORE starting meds

27
Q

What type of urine samples are NOT appropriate for culuture?

A

Bag urine samples

28
Q

If urine is collected by clean catch method, what criteria must be met for diagnosis of UTI?

A

Presence of both pyruia AND at least 50,000 colonies/mL of a single uropathogenic organism

29
Q

If urine is collected by cathether what is the criteria that must be met for diagnosis of UTI?

A
  • Pyruria and colony count of 50,000 CPM

or

  • 10,000-50,000 CPM confirmed by repeat
30
Q

If urine sample is obtained by suprapubic aspiration, what criteria need to be met for diagnosis of UTI?

A

Pyuria and ANY growth on culture

31
Q

Leukocyte esterase is a test looking for what?

Tells you what?

A
  • WBC’s
  • Inflammation/infection in kidney or urinary tract
32
Q

Urine Nitrate testing detects what?

Used in screening of?

A
  • Detects presence of certain types of bacteria
  • Screening for presence of UTI
33
Q

E. coli in the urine can be detected with what screening test?

A

Urine nitrate testing

34
Q

What is the recommended length for Abx treatment of a child with UTI who is febrile (pyelonephritis)?

A

10-14 days

35
Q

When does a UTI prompt imaging of a boy vs. girls urinay tract?

A
  • After the first UTI in boys
  • After second (or 3rd) in girls
36
Q

What type of imaging is done in boys after the 1st UTI?

A
  • Renal and bladder ultrasound
  • VCUG

*DO THEM BOTH!

37
Q

What are the indications for performing VUCG in girl following a UTI?

A
  • Any anomalies detected on RBUS
  • Combo of temp >39 °C + pathogen other than E. coli
  • Poor growth and HTN is part of clinical presentation
38
Q

Which grades of VUR in child should prompt referral to a specialist?

A

Grades III-V

39
Q

List 6 indications in a pediatric pt w/ UTI that would prompt a referral to a specialist

A
  • 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
40
Q

1st line Abx choice in pediatric pt with UTI that is not acutely ill and tolerating (po)?

A

Cephalosporins like cefixime or cefdinir

41
Q

If pediatric pt w/ UTI is acutely ill or not tolerating PO, which Abx should be given and via which route?

A

3rd gen. cephalosporin (ceftriaxone) via parenteral route

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