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CKPeds > Nephro > Flashcards

Nephro Flashcards

1
Q

positive urine culture without signs or symptoms; can become symptomatic if untreated; almost exclusive to girls

A

Asymptomatic bacteriuria

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2
Q

Urine culture considered postive for UTI

A

Positive if >50,000 colonies/mL (single pathogen) plus pyuria

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3
Q

Tx of UTI

A 
Lower-urinary tract infection (cystitis) with amoxicillin, trimethoprim-sulfamethoxazole,
or nitrofurantoin (if no fever)
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4
Q

Dxtics of UTI

A

Obtain voiding cystourethrogram (VCUG) in recurrent UTIs or UTIs with complications
or abnormal ultrasound findings

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5
Q

Etiology of VUR

A

Occurs when the submucosal tunnel between the mucosa and detrusor muscle is
short or absent

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6
Q

Grades of VUR

A

– Grade I: into nondilated ureter (common for anyone)
– Grade II: upper collecting system without dilatation
– Grade III: into dilated collecting system with calyceal blunting
– Grade IV: grossly dilated ureter and ballooning of calyces
– Grade V: massive; significant dilatation and tortuosity of ureter; intrarenal reflux
with blunting of renal pedicles

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7
Q

Dx of VUR

– ________for diagnosis and grading
–________ for renal size, scarring and function; if scarring, follow creatinine

A

VCUG

Renal scan

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8
Q

Palpable abdominal mass in newborn; most common cause is hydronephrosis

A

OBSTRUCTIVE UROPATHY

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9
Q

Obtain VCUG in all cases of congenital hydronephrosis and in any with ureteral
dilatation to rule out _______

A

posterior urethral valves

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10
Q

Otheir etiology for OBSTRUCTIVE UROPATHY

– __________—drains outside bladder; causes continual incontinence and UTIs

–______—cystic dilatation with obstruction from a pinpoint ureteral orifice; mostly in girls

– Posterior urethral valves

A

Ectopic ureter

Ureterocele

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11
Q

° Most common cause of severe obstructive uropathy; mostly in boys
° Can lead to end-stage renal disease

A

Posterior urethral valves:

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12
Q

OBSTRUCTIVE UROPATHY Dx

A

voiding cystourethrogram (VCUG)

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13
Q

OBSTRUCTIVE UROPATHY Tx

A

– Decompress bladder with catheter
– Antibiotics (intravenously)
– Transurethral ablation or vesicostomy

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14
Q

OBSTRUCTIVE UROPATHY

If lesion is severe, may present with _______

A

pulmonary hypoplasia (Potter sequence)

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15
Q

Acute Poststreptococcal Glomerulonephritis usually follows?

A

Follows infection with nephrogenic strains of group A beta-hemolytic streptococci
of the throat (mostly in cold weather) or skin (in warm weather)

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16
Q

Pathology of PSGN

A

Diffuse mesangial cell proliferation with an increase in mesangial matrix; lumpybumpy
deposits of immunoglobulin (Ig) and complement on glomerular basement
membrane and in mesangium

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17
Q

SSx of PSGN

1–2 weeks after _______ or 3–6 weeks after ______

A

strep pharyngitis

skin infection (impetigo)

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18
Q

Triad of PSGN

A

Edema, hypertension, hematuria (classic triad)

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19
Q

UA findings of PSGN

A

Urinalysis—RBCs, RBC casts, protein 1–2 +, polymorphonuclear cells

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20
Q

Complement levels low in PSGN

A

Low C3 (returns to normal in 6–8 weeks)

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21
Q

Dx of PSGN

A

Need positive throat culture or increasing antibody titer to streptococcal antigens;
best single test is the anti-DNase antigen

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22
Q

When to do biopsy in PSGN

A

Consider biopsy only in presence of acute renal failure, nephrotic syndrome, absence
of streptococcal or normal complement; or if present >2 months after onset

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23
Q

Most common chronic glomerular disease worldwide

A

IgA Nephropathy (Berger disease)

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24
Q

SSx of IgA Nephropathy (Berger disease)

A

– Most commonly presents with gross hematuria in association with upper respiratory infection or gastrointestinal infection
– Then mild proteinuria, mild to moderate hypertension

25
Q

Complement levels of IgA Nephropathy (Berger disease)

A

Normal C3

26
Q

Most important primary treatment for IgA Nephropathy (Berger disease) is ____

A

blood pressure control

27
Q
  • Hereditary nephritis (X-linked dominant); renal biopsy shows foam cells
  • Asymptomatic hematuria and intermittent gross hematuria 1–2 days after upper respiratory infection
A

Alport’s syndrone

28
Q

Association of Alport’s syndrome

A 
Hearing deficits (bilateral sensorineural, never congenital) females have subclinical
hearing loss

Ocular abnormalities

29
Q

Ocular abn associated with ALport

A

pathognomonic is extrusion of central part of lens into anterior chamber

30
Q
  • Small vessel vasculitis with good prognosis

* Present with purpurie rash, joint pain, abdominal pain

A

Henoch-Schönlein Purpura

31
Q

• Most common cause of acute renal failure in young children

A

Hemolytic Uremic Syndrome (HUS)

32
Q

Etiology of HUS

A

Most from E. coli O157:H7 (shiga toxin–producing)

33
Q

Pathophysiology of HUS

1
2
3

A

− Mechanical damage to RBCs as they pass through vessels
− Intrarenal platelet adhesion and damage (abnormal RBCs and platelets then
removed by liver and spleen)
− Prothrombotic state

34
Q

SSx of HUS

A

5–10 days after infection, sudden pallor, irritability, weakness, oliguria occur;
mild renal insufficiency to acute renal failure (ARF)

35
Q

Dx of HUS

A

Labs—

hemoglobin 5–9 mg/dL, helmet cells, burr cells, fragmented cells, moderate
reticulocytosis, white blood cells up to 30,000/mm3, Coombs negative, platelets usually 20,000–100,000/mm3, low-grade microscopic hematuria and proteinuria

36
Q

Plasmapheresis or fresh frozen plasma—may be beneficial in HUS not associated
with _______

A

diarrhea or with severe central nervous system involvement

37
Q

HUS

Prognosis:

A

—more than 90% survive acute stage; small number develop ESRD (end-stage renal disease

38
Q
  • Most common hereditary human kidney disease
  • Both kidneys enlarged with cortical and medullary cysts
  • Most present in fourth to fifth decade
A

ADPKD

39
Q

UTZ of ADPKD

A

Renal ultrasound shows bilateral macrocysts

40
Q

How to Dx ADPKD

A

Diagnosis—presence of enlarged kidneys with bilateral macrocysts with affected
first-degree relative

41
Q

_______ is the most common nephrotic syndrome seen in children

A

Steroid-sensitive minimal change disease

42
Q

SSx of MCD

A

− Proteinuria (>40 mg/m2/hour)
− Hypoalbuminemia (<2.5 g/dL)
− Edema
− Hyperlipidemia (reactive to loss of protein)

43
Q

preferred initial test for MCD

A

is a spot urine for protein/creatinine ratio >

44
Q

COmplement levels in MCD

A

N

45
Q

Tx of MCD

A

Start prednisone for 4–6 weeks, then taper 2–3 months without initial biopsy

46
Q

MCD

Consider biopsy with 
1
2
3
4
A

hematuria, hypertension, heart failure, or if no response after 8 weeks of prednisone (steroid resistant)

47
Q

MCD TX

Re-treat relapses (may become steroid-dependent or resistant);

may use alternate agents__________

renal biopsy with evidence of steroid dependency

A

(cyclophosphamide, cyclosporine, high-dose pulsed methylprednisolone);

48
Q

MCD

Infection is the major complication; make sure immunized against ________

A

Pneumococcus

and Varicella and check PPD

49
Q

Most frequent CX

A

Most frequent is spontaneous bacterial peritonitis (S. pneumoniae most common

50
Q

• Most common disorder of sexual differentiation in boys (more in preterm)

A

Undescended Testes

51
Q

Testes should be descended by ____ of age or will remain undescended

A

4 months

52
Q

Prognosis in terms of fertility of undescended testes

A

Treated: bilateral (50–65% remain fertile), unilateral (85% remain fertile

53
Q

Malignancy asstd with undescendes testes

A

Untreated or delay in treatment: increased risk for malignancy (seminoma most
common)

54
Q
  • Most common cause of testicular pain age >12 years

* Clinical presentation—acute pain and swelling; tenderness to palpitation

A

Testicular Torsion

55
Q

Testicular Torsion TX

A 
emergent surgery (scrotal orchiopexy); if within 6 hours and <360-degree
rotation, >90% of testes survive
56
Q

Most common cause of testicular pain age 2–11 years

− Gradual onset
− 3–5 mm, tender, inflamed mass at upper pole of testis
− Naturally resolves in 3–10 days (bed rest, analgesia)

A

Torsion of Appendix Testes

57
Q

Clinical sign of Torsion of Appendix Testes

A

Clinical—blue dot seen through scrotal skin

58
Q

• Ascending, retrograde urethral infection → acute scrotal pain and swelling (rare
before puberty)
• Main cause of acute painful scrotal swelling in a young, sexually active male

A

Epididymitis

59
Q

UA of Epididymitis

A

Urinalysis shows pyuria (can be N. gonorrhoeae [GC] or Chlamydia, but organisms mostly undetermined

CKPeds (20 decks)

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