Nephro Flashcards
production of Angiotensin II when
there is fall in intravascular volume
Renin
Eyes widely separated with epicanthal folds
o Ears low set
o Nose broad and compressed flat due to
oligohydramnios
o Chin receding
o Limb anomalies
Potter facies
Increased in those with SINGLE UMBILICAL
ARTERY
Unilateral renal agenesis
Associated with ipsilateral vaginal agenesis in
Mayer-Rokitansky-Kuster-Hauser Syndrome
Unilateral renal agenesis
Most common cause of abdominal mass in newborn
• Contralateral Hydronephrosis present in 5-10%
• Confirm diagnosis with Renal Scan
MULTICYSTIC DYSPLASTIC KIDNEY (MCDK)
Autosomal dominant inheritance
advise screening first-degree relatives of
individuals identified with Renal Agenesis or Dysplasia
FAMILIAL RENAL ADYSPLASIA
Seen in 7% of patients with Turner Syndrome • Wilms’ Tumor development is 4x more common • Increased incidence of MCDK
HORSESHOE KIDNEYS
MOST COMMON FUNCTIONAL ANOMALY OF THE KIDNEYS
PRIMARY VESICOURETERAL REFLUX (VUR)
MOST COMMON FUNCTIONAL ANOMALY OF THE KIDNEYS
PRIMARY VESICOURETERAL REFLUX (VUR)
accounts
for 5-10% of children and adults
with End-Stage Renal Failure
Reflux nephropathy
Most common cause of severe obstructive uropathy in
children
POSTERIOR URETHRAL VALVES (PUV)
MOST SENSITIVE AND ACCURATE study for demonstrating Renal Scarring,
DMSA - renal cortical scintigraphy
Treatment for Acute Cystitis
Trimethoprim-Sulfamethoxazole
Trimethoprim-Sulfamethoxazole (8-
10 MG TMP/kg/24 hr in 2 divided doses), 3-5 day course, effective against most E. coli
Treatment for Acute Cystitis
Nitrofurantoin
(5-7 mg/kg/24 hr in 3-4
divided doses) effective even for Klebsiella-Enterobacter organism
Treatment for Acute Pyelonephritis
Parenteral Antibiotic Treatment:
a. Ceftriaxone
Drug of choice for oral therapy
50-75 mg/kg/24 hr not to
exceed 2 gm)
Treatment for Acute Pyelonephritis
Parenteral Antibiotic Treatment:
Ampicillin
100 mg/kg/24 hr)
Parenteral antibiotic Treatment
+ aminoglycoside
Gentamicin : 3-5 mg/kg/24 hr in 1-3 divided doses)
alternative for resistant organisms
especially Pseudomonas in >17 years
Oral Fluoroquinolone Ciprofloxacin
What is Acute Lobar Nephronia or Nephritis?
Localized renal bacterial infection involving >1 lobe either a complication of Pyelonephritis or Early Renal Abscess
Manifestations identical to Pyelonephritis
What is a Renal Abscess?
Following Pyelonephritis or secondary to Primary Bacteremia (Staph. Aureus)
WBC markedly elevated to >20,000-25,000/mm3
What is a Perinephric Abscess?
Secondary to contiguous infection such as in Vertebral Osteomyelitis or Psoas Abscess or Pyelonephritis
Dissected Renal Capsule
What is Acute Hemorrhagic Cystitis?
Often by E. coli but also Adenovirus types 11 and 21
Adenovirus more common in males
Self-limiting with hematuria lasting about 4 days
What is Interstitial Cystitis?
Irritating voiding symptoms (urgency, frequency, dysuria and bladder/pelvic pain) relieved by voiding with (-) urine culture
Idiopathic, most likely in adolescent girls
Diagnosis by cystoscopic observation of mucosal ulcers with bladder distention
Treatments include bladder hydrodistension and laser ablation of ulcers
What is Eosinophilic Cystitis?
Rare, in children exposed to an allergen
Cystitis with hematuria, ureteral dilatation, occasional hydronephrosis and filling defects in bladder caused by masses of inflammatory infiltrates with eosinophils
Bladder biopsy often necessary to rule out neoplasm
Treatment: Antihistamines and NSAIDs, in some, Intravesical Dimethyl Sulfoxide instillation necessary
What is Recurrent UTI?
Beneficial to identify predisposing factors like voiding dysfunction or severe constipation
Counseling may help
MOST COMMON Chronic Glomerular
Disease worldwide
• More often seen in males than females, 2:1
IgA NEPHROPATHY (BERGER’S DISEASE)
Characteristic presence of vacuolated “FOAM CELLS” in
Glomeruli in light microscopy
ALPORT SYNDROME (HEREDITARY NEPHRITIS WITH DEAFNESS)
Most common cause of Chronic GN in older
children and young adults
MEMBRANOPROLIFERATIVE GN (MPGN)
Hallmark: persistently low C3, >6-8 weeks
MEMBRANOPROLIFERATIVE GN (MPGN)
name comes from thickened
capillary walls due to comb-like deposits of IgG and C3 called “SPIKES”
MEMBRANOUS NEPHROPATHY (MGN)
Gold Standard for Diagnosis of renovascular hypertension
CONVENTIONAL and
INTRAARTERIAL
DIGITAL
SUBTRACTION
ANGIOGRAPHY (Selective Renal Arteriogram)
MOST
COMMON malignant renal neoplasm in
children and adolescents
Wilm’s tumor
most common malignant abdominal
tumor in childhood
2 - Wilm’s tumor
Neuroblastoma
Where are the kidneys located in the human body?
Posterior wall of the abdomen in the retroperitoneal space, at waist level.
What is the functional unit of the kidney?
The nephron.
What percentage of blood pumped by the heart is received by the kidneys?
0.2
Which structures supply and drain blood to and from the kidneys?
Supplied by the abdominal aorta and drained by the inferior vena cava.
What hormone is released by the kidneys to increase blood pressure during decreased intravascular volume?
Renin.
What are the main endocrine functions of the kidneys?
Production of renin, erythropoietin, vitamin D (1,25-dihydroxycalciferol), and regulation of blood pressure.
What is the normal weight of a full-term newborn kidney?
Each kidney weighs 13–44 grams.
What condition results from bilateral renal agenesis?
Potter syndrome, which is incompatible with life.
Which congenital condition is the most common cause of an abdominal mass in newborns?
Multicystic dysplastic kidney (MCDK).
What is the gold standard diagnostic test for acute pyelonephritis and renal scarring?
Renal cortical scintigraphy (DMSA).
What is the most common cause of nephrotic syndrome in children?
Minimal change disease.
Which genetic syndrome is associated with horseshoe kidneys?
Turner syndrome.
What is the triad of hemolytic uremic syndrome (HUS)?
Microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure.
What urinary finding is characteristic of acute poststreptococcal glomerulonephritis?
Tea-colored urine due to hematuria.
What is the most common bacteria causing urinary tract infections in children?
Escherichia coli.
What is the hallmark finding in membranoproliferative glomerulonephritis (MPGN)?
Persistently low C3 levels.
What type of inheritance is associated with Alport syndrome?
X-linked dominant inheritance.
What renal abnormality is commonly seen in Mayer-Rokitansky-Küster-Hauser syndrome?
Ipsilateral vaginal agenesis with renal abnormalities.
What is the first imaging study done for suspected urinary tract obstruction in children?
Ultrasound.
What are podocytes, and what is their function?
Podocytes are visceral epithelial cells that regulate the glomerular filtration rate (GFR).
What is the most common cause of chronic kidney disease in children under 5 years old?
Congenital abnormalities such as renal hypoplasia or dysplasia.
What is the target protein intake for children with chronic kidney disease?
0.5-1 g/kg/day.
What are the complications of nephrotic syndrome?
Infections (e.g., spontaneous bacterial peritonitis), thromboembolic events, and hyperlipidemia.
What condition is characterized by a kidney weighing less than 35 grams with deep grooves on its surface?
Segmental hypoplasia (Ask-Upmark kidney).
What defines oliguria in children?
Urine output less than 0.5 mL/kg/hour.
What is the most common presenting symptom of Henoch-Schönlein purpura nephritis?
Purpuric rash followed by hematuria.
What is the treatment of choice for hypertension in children with acute kidney injury?
Calcium channel blockers or beta-blockers.
What is the normal glomerular filtration rate (GFR) range in children?
90–120 mL/min/1.73 m².
Which nephrotic syndrome histological type responds best to corticosteroids?
Minimal change disease (MCD).
What imaging study is used to detect vesicoureteral reflux (VUR)?
Voiding cystourethrogram (VCUG).
What is the most common genetic mutation in autosomal dominant polycystic kidney disease?
Mutations in the PKD1 or PKD2 gene.
What complication should be monitored in children with multicystic dysplastic kidney?
Hypertension and Wilms’ tumor.
What are the features of Potter facies?
Low-set ears, broad nose, receding chin, and widely spaced eyes.
What is the preferred diuretic in cases of nephrotic syndrome with severe edema?
Furosemide.
What antibiotic is commonly used for UTI prophylaxis in children with vesicoureteral reflux?
Trimethoprim-sulfamethoxazole.
What defines chronic kidney disease (CKD)?
An irreversible reduction in functioning renal tissue causing decreased GFR.
What are the primary metabolic disturbances in acute kidney injury?
Hyperkalemia, hyponatremia, acidosis, and hypocalcemia.
What is the most common cause of acute glomerulonephritis in children?
Poststreptococcal glomerulonephritis (PSGN).
What is a hallmark of rapidly progressive glomerulonephritis (RPGN)?
Crescents in the majority of glomeruli on biopsy.
What is the mainstay treatment for Henoch-Schönlein purpura nephritis with significant proteinuria?
High-dose corticosteroids and cytotoxic therapy (e.g., cyclophosphamide).
What is the treatment goal in managing hyperkalemia in acute kidney injury?
Stabilize myocardial membranes and shift potassium intracellularly.
Where are the kidneys located in the human body?
Posterior wall of the abdomen in the retroperitoneal space, at waist level.
What is the functional unit of the kidney?
The nephron.
What percentage of blood pumped by the heart is received by the kidneys?
0.2
Which structures supply and drain blood to and from the kidneys?
Supplied by the abdominal aorta and drained by the inferior vena cava.
What hormone is released by the kidneys to increase blood pressure during decreased intravascular volume?
Renin.
What are the main endocrine functions of the kidneys?
Production of renin, erythropoietin, vitamin D (1,25-dihydroxycalciferol), and regulation of blood pressure.
What is the normal weight of a full-term newborn kidney?
Each kidney weighs 13–44 grams.
What condition results from bilateral renal agenesis?
Potter syndrome, which is incompatible with life.
Which congenital condition is the most common cause of an abdominal mass in newborns?
Multicystic dysplastic kidney (MCDK).
What is the gold standard diagnostic test for acute pyelonephritis and renal scarring?
Renal cortical scintigraphy (DMSA).
What is the most common cause of nephrotic syndrome in children?
Minimal change disease.
Which genetic syndrome is associated with horseshoe kidneys?
Turner syndrome.
What is the triad of hemolytic uremic syndrome (HUS)?
Microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure.
What urinary finding is characteristic of acute poststreptococcal glomerulonephritis?
Tea-colored urine due to hematuria.
What is the most common bacteria causing urinary tract infections in children?
Escherichia coli.
What is the hallmark finding in membranoproliferative glomerulonephritis (MPGN)?
Persistently low C3 levels.
What type of inheritance is associated with Alport syndrome?
X-linked dominant inheritance.
What renal abnormality is commonly seen in Mayer-Rokitansky-Küster-Hauser syndrome?
Ipsilateral vaginal agenesis with renal abnormalities.
What is the first imaging study done for suspected urinary tract obstruction in children?
Ultrasound.
What are podocytes, and what is their function?
Podocytes are visceral epithelial cells that regulate the glomerular filtration rate (GFR).
What is the most common cause of chronic kidney disease in children under 5 years old?
Congenital abnormalities such as renal hypoplasia or dysplasia.
What is the target protein intake for children with chronic kidney disease?
0.5-1 g/kg/day.
What are the complications of nephrotic syndrome?
Infections (e.g., spontaneous bacterial peritonitis), thromboembolic events, and hyperlipidemia.
What condition is characterized by a kidney weighing less than 35 grams with deep grooves on its surface?
Segmental hypoplasia (Ask-Upmark kidney).
What defines oliguria in children?
Urine output less than 0.5 mL/kg/hour.
What is the most common presenting symptom of Henoch-Schönlein purpura nephritis?
Purpuric rash followed by hematuria.
What is the treatment of choice for hypertension in children with acute kidney injury?
Calcium channel blockers or beta-blockers.
What is the normal glomerular filtration rate (GFR) range in children?
90–120 mL/min/1.73 m².
Which nephrotic syndrome histological type responds best to corticosteroids?
Minimal change disease (MCD).
What imaging study is used to detect vesicoureteral reflux (VUR)?
Voiding cystourethrogram (VCUG).
What is the most common genetic mutation in autosomal dominant polycystic kidney disease?
Mutations in the PKD1 or PKD2 gene.
What complication should be monitored in children with multicystic dysplastic kidney?
Hypertension and Wilms’ tumor.
What are the features of Potter facies?
Low-set ears, broad nose, receding chin, and widely spaced eyes.
What is the preferred diuretic in cases of nephrotic syndrome with severe edema?
Furosemide.
What antibiotic is commonly used for UTI prophylaxis in children with vesicoureteral reflux?
Trimethoprim-sulfamethoxazole.
What defines chronic kidney disease (CKD)?
An irreversible reduction in functioning renal tissue causing decreased GFR.
What are the primary metabolic disturbances in acute kidney injury?
Hyperkalemia, hyponatremia, acidosis, and hypocalcemia.
What is the most common cause of acute glomerulonephritis in children?
Poststreptococcal glomerulonephritis (PSGN).
What is a hallmark of rapidly progressive glomerulonephritis (RPGN)?
Crescents in the majority of glomeruli on biopsy.
What is the mainstay treatment for Henoch-Schönlein purpura nephritis with significant proteinuria?
High-dose corticosteroids and cytotoxic therapy (e.g., cyclophosphamide).
What is the treatment goal in managing hyperkalemia in acute kidney injury?
Stabilize myocardial membranes and shift potassium intracellularly.
