Nephro Flashcards
positive urine culture without signs or symptoms; can become symptomatic if untreated; almost exclusive to girls
Asymptomatic bacteriuria
Urine culture considered postive for UTI
Positive if >50,000 colonies/mL (single pathogen) plus pyuria
Tx of UTI
Lower-urinary tract infection (cystitis) with amoxicillin, trimethoprim-sulfamethoxazole, or nitrofurantoin (if no fever)
Dxtics of UTI
Obtain voiding cystourethrogram (VCUG) in recurrent UTIs or UTIs with complications
or abnormal ultrasound findings
Etiology of VUR
Occurs when the submucosal tunnel between the mucosa and detrusor muscle is
short or absent
Grades of VUR
– 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
Dx of VUR
– ________for diagnosis and grading
–________ for renal size, scarring and function; if scarring, follow creatinine
VCUG
Renal scan
Palpable abdominal mass in newborn; most common cause is hydronephrosis
OBSTRUCTIVE UROPATHY
Obtain VCUG in all cases of congenital hydronephrosis and in any with ureteral
dilatation to rule out _______
posterior urethral valves
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
Ectopic ureter
Ureterocele
° Most common cause of severe obstructive uropathy; mostly in boys
° Can lead to end-stage renal disease
Posterior urethral valves:
OBSTRUCTIVE UROPATHY Dx
voiding cystourethrogram (VCUG)
OBSTRUCTIVE UROPATHY Tx
– Decompress bladder with catheter
– Antibiotics (intravenously)
– Transurethral ablation or vesicostomy
OBSTRUCTIVE UROPATHY
If lesion is severe, may present with _______
pulmonary hypoplasia (Potter sequence)
Acute Poststreptococcal Glomerulonephritis usually follows?
Follows infection with nephrogenic strains of group A beta-hemolytic streptococci
of the throat (mostly in cold weather) or skin (in warm weather)
Pathology of PSGN
Diffuse mesangial cell proliferation with an increase in mesangial matrix; lumpybumpy
deposits of immunoglobulin (Ig) and complement on glomerular basement
membrane and in mesangium
SSx of PSGN
1–2 weeks after _______ or 3–6 weeks after ______
strep pharyngitis
skin infection (impetigo)
Triad of PSGN
Edema, hypertension, hematuria (classic triad)
UA findings of PSGN
Urinalysis—RBCs, RBC casts, protein 1–2 +, polymorphonuclear cells
Complement levels low in PSGN
Low C3 (returns to normal in 6–8 weeks)
Dx of PSGN
Need positive throat culture or increasing antibody titer to streptococcal antigens;
best single test is the anti-DNase antigen
When to do biopsy in PSGN
Consider biopsy only in presence of acute renal failure, nephrotic syndrome, absence
of streptococcal or normal complement; or if present >2 months after onset
Most common chronic glomerular disease worldwide
IgA Nephropathy (Berger disease)
SSx of IgA Nephropathy (Berger disease)
– Most commonly presents with gross hematuria in association with upper respiratory infection or gastrointestinal infection
– Then mild proteinuria, mild to moderate hypertension
Complement levels of IgA Nephropathy (Berger disease)
Normal C3
Most important primary treatment for IgA Nephropathy (Berger disease) is ____
blood pressure control
- Hereditary nephritis (X-linked dominant); renal biopsy shows foam cells
- Asymptomatic hematuria and intermittent gross hematuria 1–2 days after upper respiratory infection
Alport’s syndrone
Association of Alport’s syndrome
Hearing deficits (bilateral sensorineural, never congenital) females have subclinical hearing loss
Ocular abnormalities
Ocular abn associated with ALport
pathognomonic is extrusion of central part of lens into anterior chamber
- Small vessel vasculitis with good prognosis
* Present with purpurie rash, joint pain, abdominal pain
Henoch-Schönlein Purpura
• Most common cause of acute renal failure in young children
Hemolytic Uremic Syndrome (HUS)
Etiology of HUS
Most from E. coli O157:H7 (shiga toxin–producing)
Pathophysiology of HUS
1
2
3
− 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
SSx of HUS
5–10 days after infection, sudden pallor, irritability, weakness, oliguria occur;
mild renal insufficiency to acute renal failure (ARF)
Dx of HUS
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
Plasmapheresis or fresh frozen plasma—may be beneficial in HUS not associated
with _______
diarrhea or with severe central nervous system involvement
HUS
Prognosis:
—more than 90% survive acute stage; small number develop ESRD (end-stage renal disease
- Most common hereditary human kidney disease
- Both kidneys enlarged with cortical and medullary cysts
- Most present in fourth to fifth decade
ADPKD
UTZ of ADPKD
Renal ultrasound shows bilateral macrocysts
How to Dx ADPKD
Diagnosis—presence of enlarged kidneys with bilateral macrocysts with affected
first-degree relative
_______ is the most common nephrotic syndrome seen in children
Steroid-sensitive minimal change disease
SSx of MCD
− Proteinuria (>40 mg/m2/hour)
− Hypoalbuminemia (<2.5 g/dL)
− Edema
− Hyperlipidemia (reactive to loss of protein)
preferred initial test for MCD
is a spot urine for protein/creatinine ratio >
COmplement levels in MCD
N
Tx of MCD
Start prednisone for 4–6 weeks, then taper 2–3 months without initial biopsy
MCD
Consider biopsy with 1 2 3 4
hematuria, hypertension, heart failure, or if no response after 8 weeks of prednisone (steroid resistant)
MCD TX
Re-treat relapses (may become steroid-dependent or resistant);
may use alternate agents__________
renal biopsy with evidence of steroid dependency
(cyclophosphamide, cyclosporine, high-dose pulsed methylprednisolone);
MCD
Infection is the major complication; make sure immunized against ________
Pneumococcus
and Varicella and check PPD
Most frequent CX
Most frequent is spontaneous bacterial peritonitis (S. pneumoniae most common
• Most common disorder of sexual differentiation in boys (more in preterm)
Undescended Testes
Testes should be descended by ____ of age or will remain undescended
4 months
Prognosis in terms of fertility of undescended testes
Treated: bilateral (50–65% remain fertile), unilateral (85% remain fertile
Malignancy asstd with undescendes testes
Untreated or delay in treatment: increased risk for malignancy (seminoma most
common)
- Most common cause of testicular pain age >12 years
* Clinical presentation—acute pain and swelling; tenderness to palpitation
Testicular Torsion
Testicular Torsion TX
emergent surgery (scrotal orchiopexy); if within 6 hours and <360-degree rotation, >90% of testes survive
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)
Torsion of Appendix Testes
Clinical sign of Torsion of Appendix Testes
Clinical—blue dot seen through scrotal skin
• 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
Epididymitis
UA of Epididymitis
Urinalysis shows pyuria (can be N. gonorrhoeae [GC] or Chlamydia, but organisms mostly undetermined
