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2023 RC Blue's Clues > Nephro > Flashcards

Nephro Flashcards

1
Q

IGA nephropathy vs post infectious GN

A

→ IgA nephropathy is hematuria during infection (vs. post infectious is weeks later)
→ IgA normal C3, PIGN low C3

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2
Q

nephrotic syndrome

A

hypoalbuminemia, increased edema, and presence of ascites due to the low oncotic pressure

Hyperlipidemia thought to be a result of the liver increasing production of lipoproteins to compensate for the low serum albumin, increased production of clotting factors, and increased risk of thrombosis

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3
Q

Low vs normal C3

A

Low C3
Post infectious GN
Membranoproliferative GN
C3 Glomerulopathy
Lupus
VP shunt nephritis
Subacute bacterial endocarditis

Normal C3
IgA nephropathy
anti-GBM disease
Anca vasculitis (typically normal but can be low)
Hereditary nephritis
IgA vasculitis (HSP)
GPA
Goodpastures
Alports

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4
Q

lax abdominal muscles, bilateral cryptorchidism, poor urine stream and bilateral abdominal masses

A

prune belly syndrome

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5
Q

SIADH

A

hyponatremic
euvolemic
low serum osmolality <280
high urine sodium, high urine osmolality
decreased urine output

Triggers: CNS, Resp, post-op

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6
Q

Dysnatremia correction rate

A

0.5mmol/hr
10mmol/24hr

Risks:
- hyponatremia central pontine myelinolysis
- hypernatremia cerebral edema

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7
Q

Distal RTA (Type 1)

A

metabolic acidosis
acid secretion problem at distal tubule (pee will be higher pH because we can’t secrete H+)

K low (hold onto H, pee out K)

Stones (ONE)
Hypercalciuria
Nephrocalcinosis

Etiology
- hereditary
- drugs
- nephrocalcinosis
- cirrhosis

Treatment
- bicarb, K citrate

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8
Q

Proximal RTA (Type 2)

A

Metabolic acidosis
Cant resorb bicarb in the proximal tubule

Urine phosphate high
Urine calcium normal
Proteinuria + glucosuria if Fanconi
Plasma Na low

Etiology
- hereditary
- fanconi
- cystinosis

Treatment
- bicarb

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9
Q

Type 4 RTA

A

Mild metabolic acidosis

Urine pH low

Plasma Na low (can’t reabsorb Na)
Plasma K high (inability to secrete K)
Plasma Cl high (due to inability to secrete K)

Etiology
- aldosterone resistance
- hypertension

Treatment
- Acei

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10
Q

Nephrotic range proteinuria

A

> 3.5 g / day

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11
Q

Nephrotic syndrome

A

Proteinuria
Hypoalbuminemia
Hypercholesterolemia
Edema

*usually no hematuria or AKI or HTN

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12
Q

Most common causes of nephrotic syndrome

A

Minimal change disease (80% for kids < 7 yrs) (should have normal C3)

Focal segmental glomerulosclerosis

Membranoproliferative GN (low C3)

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13
Q

Treatment for nephrotic

A

pred 2mg/kg/day
12 week course followed by taper

if no response consider biopsy

Supportive care
- salt restriction
- loop diuretics (esp if hyponatremic)
- careful albumin + lasix
- pneumococcal vaccines

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14
Q

nephrotic sx complications

A

infection
- lose immunoglobulins and complement in urine
- bacteremia or SBP
- esp encapsulated bugs (strep pneumo, e coli, klebsiella)
- give vaccine for pneumococcus

Thromboemolism
- lose anticoagulant proteins (antithrombin 3 and protein S)
- think of clot for headaches, leg swelling, chest pain, SOB

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15
Q

Child with arthralgia, abdo so pain, purpuric rash, BP was normal. Has protein 1g/L in the urine and 3-5 blood. What do you do next?

A

HSP

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16
Q

HSP (IgA vasculitis)

A

age 2-6
purpuric rash (must have), abdo pain, arthritis

Renal in 35% due to IgA deposition in glomeruli
–> GN or nephrotic syndrome
–> all will do it by 6 mo (so monitor urine for 6 mo)

Urinalysis
- microscopic hematuria
- usually no proteinuria
- check UA weekly while active disease, then monthly x 6mo

Refer to nephro if
- significant proteinuria
- hypertension
- Cr/Urea abnormal

normal complement

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17
Q

Prune belly syndrome

A
  • bilateral cryptorchidism
  • hydronephrosis
  • lax abdo muscles
  • can die early due to pulmonary hypoplasia d/t oligohydramnios
  • often ESRD
18
Q

Nephrotic syndrome + fever

A

paracentesis of ascites
ceftriaxone

strep pneumo is most common, then e coli (encapsulated)

19
Q

Hypertension

A

needs 3 separate high measurements in stage 1 range to diagnose

20
Q

Hypertension cut off

A

130/80s for age 13+

21
Q

Blood pressure measurement

A

width 40% of circumfurence
length 80-100% of circumference

22
Q

BP monitoring

A

annual over age 3
start sooner if risk factors (prem, umbilical caths, CHD, malignancy, drugs that raise BP)

Coarct patients should be checked at every visit

23
Q

most ommon cause of secondary hypertension

A

renal parenchymal or renalvascular

24
Q

Investigations for hypertension

A

urinalysis
Cr, Urea
lipids, HBA1C
renal doppler US
echo for everyone (canada) or before starting meds (AAP)
retinal exam (canada)

25
Q

Ambulatory BP monitoring

A

If elevated for 1 year or stage 1 x 3 visits
Consider if high risk conditions (coarct repair, CKD obese, diabetes) in order to rule out masked hypertension (might occur only overnight) or if suspected white coat hypertension

26
Q

Management hypertension

A
  • first line is non-pharm for all patients for 6 mo if stage 1

Meds if:
- symptomatic
- diabetes
- CKD
- stage 2 or higher

Meds
- thiazide first
- ACE or CCB 2nd
- dont do beta blockers

**use ACEi in diabetic pt with proteinuria)

27
Q

Antihypertensive med side effects

A

ACEi s/e: cough, headache, dizziness, asthenia, hyperkalemia, acute kidney injury, angioedema, fetal toxicity

ARB s/e: headaches, dizziness, hyperkalemia, acute kidney injury, fetal toxicity

Thiazide diuretic s/e: dizziness, hypokalemia, cardiac dysrhythmias, cholestatic jaundice, new onset diabetes mellitus, pancreatitis

CCB s/e: flushing, peripheral edema, dizziness, angioedema

28
Q

acute hypertension management for urgency

A

IV therapy
Tx goals to reduce MAP by 25% over the first 8-12hrs, then by another 25% over the next 8-12hrs and the final 50% in the 24hrs following

Labetalol (a and B blocker)
Nicardipine (CCB)
Na nitroprusside (vasodilator)
Hydralazine
Esmolol (best in cardiac cases)

29
Q

Hypertension cutoffs

A

age 1-13
Elevated: 90th - 95%
Stage 1: 95th - 95th+12
Stage 2: > 95th+12

Age 13+
Elevated: >120/80
Stage 1: >130/80
Stage 2: >140/90

30
Q

Post Strep GN

A

LOW C3, normal C4
ANA negative
ASO titer may be elevated (usually weeks into illness)

Symptoms
- hematuria and edema 5 days post cellulitis or 7-10 days post pharyngitis
- hypertension

Management
- supportive
- fluid management
- treat hypertension
-

31
Q

IgA Nephropathy

A

synpharngitic episodes of hematuria
recurrent
Normal C3, Normal C4
Dx biopsy (but usually not needed)

32
Q

AKI etiology

A

pre renal

Renal

Post renal

33
Q

ATN

A

urinalysis = granular casts

34
Q

ATN vs AIN

A

Tubular (ATN): hypoxemia, crystal obstruction, medications, toxins, tumor lysis syndrome
(brown urine with granular casts) * majority of renal AKI

Acute interstitial nephritis: allergic interstitial nephritis, pyelonephritis, sarcoidosis
(white cell casts)

35
Q

Neonate with midline mass + kidney injury

A

Posterior urethral valves.

Diagnosis =VCUG.

At risk pulmonary hypoplasia (oligohydramnios) and CKD

Keyhole sign on US

36
Q

most common long term complication Htn

A

left ventricular hypertrophy
do an echo

37
Q

Prophylaxis for UTI

A

Grade 4 or 5 VUR

reassess q3-6 mo

Use septra or nitrofurantoin

If the child is resistant to septra and macrobid, DONT use abx for prophyalxis

38
Q

Hypertensive urgency cut offs

A

Stage 2 HTN + symptoms

Stage 2:
- Age 1-12: >/= 95%ile + 12
- Age 13+: >/= 140/90

39
Q

fanconi syndrome

A

proximal tubule dysfxn
lose electrolytes in urine
hypokalemia, hypophosphatemia, glucosuria, acidosis

cystinosis is most common cause

40
Q

anterior lenticonus

A

pathognemonic eye finding in Alport syndrome

conical protrusion of the lens

2023 RC Blue's Clues (20 decks)

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