MedU Clipp 31 Flashcards
(5) DDx of Periorbital Swelling?
- Seasonal / Pernnial Allergic Conjunctivitis
- URI
- Sinusitis (Ethmoid, Frontal, or Maxillary)
- Acute allergic Reactin
- Cellulitis
An S3 gallop and Edema is a sign of what?
Heart Failure
Signs of Nephrotic Syndrome?
- Edema is most prominant
- Periorbital edema that improves when upright
- Generalized Edema
- Pitting Edema, Ascites
- Weight Gain
- A/w interstitial fluid accumulation rather than intravascular fluid overload (as in acute glomerulonephritis)
- Severe cases –> Hypotensive
Most common cause of Nephrotic Syndrome in Children?
Minimal Change Disease ( 90% cases under 10 y.o.)
- Characteristic finding is:
- Fusion and Diffuse effacement of the epithelial cell foot processes on electron microscopy
- Nephron appears relatively normal on Light Microscopy
Benign Causes of Proteinuria?
- Children may excrete 1+ to 2+ ( 30 - 100 mg/dL) of protein during a Fever or after Significant Exertion
- Clears after Resolution of the Fever or on Cessation of exertion
-
Orthostatic Proteinuria - frequent finding in adolescents and does not signify Renal disease
- As much as 1500 mg/1.73 m2 may be excreted in a 24 hour collection, but protein occurs while standing, not recumbent
- First morning uring should be negative
(3) Causes of Proteinuria in Nephrotic Syndrome?
- Loss of the Polyanion Charge - loss of negative charge due to Proteoglycans such as Heparin Sulfate
- -> leak large negatively charged proteins
- Shift in the Capillary Wall Pore Size - toward permitting increased leaking of Large molecules
- Change in the Hemodynamic Characteristic of Capillary Flow - greater filtration of larger molecules
What is seen on Urinalysis w/ Pyelonephritis?
- WBC and WBC casts would be seen w/ Urinary Tract Infection
- -> cause a Positive Leukocyte Esterase Test on dipstick
What is in the Urine of Poststreptococcal Glomerulonepthritis?
- Varying degrees of Proteinuria
- RBCs and RBC casts
- Postive Heme Test
- -> Acute Glomerulonephritis
What is seen in the Urine of Interstitial Nephritis?
What causes it?
- RBC and WBC casts
- Rare in Children
- Methicillin (ABX)
- NSAIDs
- Penicillins
- Cephalosporins
- Rifampin
- Sulfonamids
- Infection
Hypo____ and Hyper____ are a/w Nephrotic Syndrome?
- Hypoalbuminemia - major loss of albuin in urine
- -> decreased protein sysnthesis in Liver
- Hyperlipidemia - rxn to decreased Albumin, Liver makes Lipoproteins as well as Albumin
- -> decreased Lipid Clearance from the Circulation
What does Proteinuria result in?
- Lowered Osmotic Pressure
–> Fluid moves into interstitial space - Intravascular Hypovolemia –> activates sensors and extrarenal neurohumoral and hemodynamic mechanisms that signal the Kidney
- Kidney retains Salt and Water through increased
Renin-angiotensin-aldosterone catecholamines, ADH, and Depressed Natriuretic factor - Retention of Salt and Water Leads to Edema
(5) Risk Factors Predisposing to Venous Thrombosis?
- Urinary Loss of Proteins that inhibit Coagulation
(Antithrombin III) - Increased Fibrinolysis
- Destabilization of Platelets by Hyperlipidemia
- Increased Fibrinogen levels
- Increased Blood Viscosity due to rise in Hematocrit
(use of diuretics are used without Albumin replacement) - Increasd / Prolonged use of Corticosteroids
–> risk of Thrombosis for pts. w/ Nephrotic Syndrome
(3) Groups of pts. classified w/ Nephrotic Syndrome?
- 95%
- Steroid Responsive
- Relapsing / Steroid-dependent
- 5%
- Steroid Resistant
Where is Generalized-Edema seen best
in a Male and Female?
- Males –> Scrotal Region
- Females –> Labia
(6) DDx of
Fatigue, Periorbital Edema, Abdominal Distention?
- Nephrotic Syndrome
- Allergic Rxn
- Acute Glomerulonephritis
- Congestive Heart Failure
- Sinusitis
- Hepatic Failure
