Nephro

Question 1

def. HTN

Answer 1

SBP or DBP >95% for age, sex and height

- prehypertension is 90%

Question 2

DDx for HTN by age

Answer 2

infants

• renal art. thrombosis
• congenital renal
• coarctation of aorta

Question 3

risk factors of HTN

Answer 3

• abdo trauma
• Hx of renal disease
• premature
• fam Hx

Question 4

Hx for HTN

Answer 4

• H/A
• FTT, fatigue
• blurred vision
• resp. distress
• epistaxis

Question 5

Phx findings

Answer 5

BP- according to sex height age

• full neuro
• checkedema
• HSM
• thyroid exam

Question 6

invest for HTN

Answer 6

• urine dip and catecholamines
• renal funct. tests
• imaging: ECHO, abdo US,
• renin and aldosterone levels
• ocular exam

Question 7

mgmt of HTN

Answer 7

• treat cause

- if severe: nifedipine, hydralizine, labetalol

Question 8

def. nephrotic syndrome

Answer 8

group of diseases caused by alterations of the glom cap. wall

Question 9

clincal and lab manifestations of nephrotic

Answer 9

HELP
Hypoalbumenmia
Edema - dependent area
Lipids high - LDL and total chol
Proteinuria

Question 10

eval. of nephrotic

Answer 10

• urinalysis
• first morning urin
• serum lytes
• chol. levels
• serum albumen
• C3, C4, ANA
• Hep if at risk
• renal Bx

Question 11

4 main types of nephrotic syndromes

Answer 11

1. minimal change
   - most common
   - idiopathic with good prognosis
2. focal segmental glomerulosclerosis
   - glom. sclerosis and tubular atrophy
   - often pregresses to dialysis and transplant
3. membranous glomerulonephrisits
   - thickening of cap. walls
   - primary or other causes
4. membranoproliferative
   - more commonly nephritic syndrome

Question 12

mgmt of nephrotic

Answer 12

pred and then taper for 4-6 wks

Question 13

def. of hematuria

Answer 13

> 5RBC per HPF on 3 samples

Question 14

2 basic sources of RBCs and signs of each

Answer 14

1. glomerular - upper tract
   - cola urine
   - no clots
   - protein
   - RBC casts
2. extra-glom - lower tract
   - pink or red urin
   - clots
   - no protein
   - no casts

Question 15

DDx for hematuria

Answer 15

1. glomerulonepridities
   - post strep - 10 days post strep
   - IgA nephropathies - after viral infection
   - SLE
   - HSP
   - stones
2. excercise induced
3. meds
4. familial
   - alport syndrome
   - SCD
   - benign familial
   - polycystic
5. infectious
   - UTI
   - viral cystitis
6. idiopathic

Question 16

def. of nephritic syndrome

Answer 16

PHAROH
Proteinuria
Hematuria
Acute Kidney injury
RBC casts
Oliguria
Hypertension

Question 17

nepritic vs nephrotic

Answer 17

p. 202

Question 18

triad of HUS

Answer 18

1. microangiopathic hemolytic anemia
2. thrombocytopenia
3. acute renal failure
   - most common cause of renal failure in children

Question 19

2 main types of HUS and etiology

Answer 19

1. Typical - D+
   - shiga producing E.Coli
   - abdo pain and bloody diarhhea
   - HUS 2-14 days after poos
2. Atrypical - D-
   - heterogenous group of non-diarrheal forms of HUS
   - multiple etiologies, including strep
   - less common and with worse outcomes

Question 20

lab findings for HUS

Answer 20

• anemia - normocytic
• hemolysis - bili, low hapto, high LDH
• negative DAT
• thrombocytopenia
• BUN and creat up
• hematuria and proteinuria

Question 21

mgmt of HUS

Answer 21

• supportive
• dyalisis if sever BUN, fluid overload or lyte disturbance
• possible transfusion
• no use for ABx