Nephro Flashcards
Describe the presentation of a young patient with hypertension, tea-colored urine, massive proteinuria, and edema, who had a history of upper respiratory tract infection 1-2 weeks ago. Diagnosis:
Poststreptococcal glomerulonephritis (PSGN).
What is the most important step in the treatment of PSGN?
Initiating anti-hypertensive drugs and fluid restriction.
How should the diet be modified in a patient with PSGN?
Increase carbohydrates and decrease protein intake.
Define the fate of patients with PSGN.
Complete recovery in over 95% of patients.
Describe the diagnosis of a young patient presenting with hypertension, tea-colored urine, massive proteinuria, and edema, with a history of upper respiratory tract infection 1-2 days ago. Diagnosis:
IgA nephropathy.
What is the most common cause of renal failure in pediatric patients?
IgA nephropathy.
What is the most common type of glomerulonephritis?
IgA nephropathy.
Explain the association between upper respiratory tract infection and glomerulonephritis in IgA nephropathy.
Both conditions can occur simultaneously.
Explain the association between upper respiratory tract infection and glomerulonephritis in PSGN.
URTI preceding GN by 1-2 weeks is characteristic of PSGN.
Describe the presentation of a child with blood in urine, normal blood pressure, normal renal function tests, and no proteinuria. Diagnosis:
Basement membrane nephropathy (benign hematuria).
What is the treatment approach for basement membrane nephropathy?
Reassurance.
Describe the diagnosis of a patient presenting with recurrent painless hematuria and deafness. Diagnosis:
Alport syndrome.
In a child who develops renal failure a few weeks after an attack of bloody diarrhea, what is the likely diagnosis?
Hemolytic uremic syndrome (HUS).
Explain the features of HUS.
Renal failure, anemia, thrombocytopenia, and schistocytes following an E. coli O157:H7 infection.
What is the treatment for HUS?
Plasmapheresis.
Describe the scenario in an adult with renal failure, fever, neurological manifestations, and the likely diagnosis.
Thrombotic thrombocytopenic purpura (TTP).
What is the treatment for TTP?
Plasmapheresis.
Describe the diagnosis of a child with a history of recent viral upper respiratory tract infection who develops hematuria, rash in buttocks, abdominal pain, and joint pain. Diagnosis:
Henoch-Schönlein purpura (HSP).
What is the most important complication of HSP?
Intussusception.
Explain the diagnosis of a child who presents with proteinuria after a fall, with a normal physical exam and normal lab results. Diagnosis:
Orthostatic proteinuria.
What is the management approach for a child with orthostatic proteinuria?
Repeat the test; if still positive, perform a 24-hour urine collection.
Describe the presentation of a child with marked proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema.
The child likely has nephrotic syndrome.
What is the treatment for nephrotic syndrome in children?
Treatment includes cortisone( prednisone) and dietary adjustments such as increasing protein intake.
What is the investigation of choice for vesico-ureteric reflux (VUR) in children?
Voiding cystourethrogram (VCUG) is the preferred investigation.
How can renal scarring from recurrent UTIs be assessed?
Renal scarring can be evaluated using a DMSA scan.
Define the treatment of choice for renal scarring due to recurrent UTIs.
Continuous prophylactic antibiotics like TMP-SMX are the preferred treatment.
Do children with the first attack of UTI require a specific investigation?
Yes, children with the first UTI should undergo an ultrasound (US).
Describe the diagnosis and investigation for a child with recurrent attacks of abdominal pain, fever, and a renal mass on examination.
The child likely has uretero-pelvic junction obstruction, and the investigation of choice is VCUG.
What is the accidental discovery diagnosis of a renal mass in a child?
Wilms tumor is the likely diagnosis.
How can cholesterol embolization present in a patient who underwent cardiac catheterization?
It can present with livedo reticularis and blue or purple lesions in fingers and toes.
Describe the diagnosis of a patient with hematuria and pulmonary manifestations like hemoptysis, dyspnea, or cough.
The patient likely has Goodpasture syndrome.
What is the diagnosis for a patient who develops edema and increased creatinine after a radiological procedure with contrast?
Contrast-induced nephropathy is the likely diagnosis.
How can contrast-induced nephropathy be prevented?
Hydration is key in preventing contrast-induced nephropathy.
Describe the screening test for kidney biopsy
Anti-basement membrane antibodies.
What is the treatment for Wegner granulomatosis?
Plasmapheresis, immunosuppressive, and cortisone.
What type of anemia is common in End-Stage Renal Disease (ESRD)?
Iron deficiency anemia.
How is iron deficiency anemia in ESRD treated?
Erythropoietin followed by iron supplementation.
What is a common risk for patients with ESRD related to bone health?
Osteoporosis.
How is osteoporosis in ESRD managed?
Calcium and vitamin D supplementation.
What risk does ESRD pose for patients in terms of bleeding?
Platelet dysfunction.
How is hyperphosphatemia managed in ESRD?
Dietary phosphate restriction and oral phosphate binders.
Describe the diagnosis and treatment of uremic pericarditis in a patient with ESRD.
Diagnosis: Uremic pericarditis. Treatment: Immediate dialysis.
What is the diagnosis of a patient with ESRD showing tall T-waves on EKG?
Hyperkalemia.
What is the first step in treating hyperkalemia in ESRD patients?
Immediate calcium gluconate administration.
What is the definitive treatment for ESRD?
Renal transplantation.
What is the most common complication during dialysis?
Hypotension due to over-removal of fluid.
What is the most common type of rejection after renal transplant?
Acute rejection.
Describe the pathology and treatment of acute rejection after renal transplant.
Pathology: Acute Tubular Necrosis. Treatment: IV steroids.
What is the term for rejection occurring during a renal transplant surgery?
Hyperacute rejection.
How is a patient with renal failure best assessed?
By monitoring body weight.
What is considered the best treatment for ESRD?
Renal transplantation, preferably from a living related donor.
What is the most common cause of death in End-Stage Renal Disease (ESRD)?
Cardiovascular disease.
What anti-hypertensive medication is contraindicated in patients with ESRD?
ACE Inhibitors.
What is the most common cause of hypertension in young adults?
Renal artery stenosis.
What is the investigation of choice for renal artery stenosis?
Angiography.
What is the treatment of choice for renal artery stenosis?
Angioplasty & stent placement.
What is the treatment of hypertension in unilateral renal artery stenosis cases?
ACE Inhibitors (may still need stent placement).
What is contraindicated in patients with bilateral renal artery stenosis?
ACE Inhibitors.
What important laboratory finding is seen in renal artery stenosis?
Increased renin (due to activation of the RAAS).
What does a urinalysis showing pus but no organism suggest?
Sterile pyuria.
What is the most common cause of sterile pyuria?
Tuberculosis (TB).
What is the most common cause of fluid overload in patients with ESRD?
Missed dialysis session.
What is the most common symptom of fluid overload in patients with ESRD?
Dyspnea.
What is the most important investigation for fluid overload in patients with ESRD?
Arterial blood gas (ABG).
What is the next step if a patient with ESRD develops dyspnea and ABG shows acidosis?
Urgent dialysis.
Describe a rash that occurs after an Upper Respiratory Tract Infection (URTI) following antibiotic use.
Raised above the surface and non-blanching, suggestive of vasculitis.
Describe a rash that presents with raised lesions, joint pain, abdominal pain, and hematuria.
Henoch-Schönlein Purpura (HSP).
Describe a maculopapular rash that occurs after taking ampicillin.
Likely due to Epstein-Barr Virus (EBV) infection.
Describe a rash accompanied by wheezy chest, vomiting, hypotension.
Likely indicative of anaphylaxis.
How can fluid input and output be most accurately assessed in patients with renal failure and cardiac issues?
By monitoring weight followed by a 24-hour urine collection.
What is the recommended imaging modality for an HIV patient on antiretroviral drugs presenting with painful hematuria and renal colic?
CT scan without contrast (to evaluate for renal stones).
What is the most nephrotoxic antibiotic combination?
Gentamicin and cephalexin.
