Nephro/GU Flashcards
An 18 month old girl has periorbital swelling. Her albumin is 26. Her urine is negative for protein. What do you do for diagnosis?
a) Serum trypsin
b) Stool alpha anti-trypsin
c) Urine creatinine excretion
d) ECHO
b) Stool alpha anti-trypsin
Other potential causes of hypoalbuminemia include liver disease (reduced production) and inadequate protein intake. Very rarely hypoalbuminemia can result from an extensive skin disorder causing protein loss via the skin. Measurement of stool α1-antitrypsin is a useful screening test for protein-losing enteropathy.
What is important to know in order to determine if BP is within normal range?
a) Weight
b) Ethnicity
c) Height
d) Age
age, sex, and height percentile.
11 year old boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management?
a. Alarm
b. Imipramine
c. DDAVP
d. Oxybutynin
DDAVP
Synthetic analogue of ADH. Not curative. Desmopressin acetate’s greatest value may be for short-term treatment, in settings such as camp or sleepovers, rather than as an attempt at a cure
Alarm - Alarm therapy requires a commitment from parents and other siblings because the alarms are sufficiently loud that often all members of the household are wakened when the alarm goes off. Alarms are impractical for ‘sleepovers’ and camp.
A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it? Today 1 month 6 months 11 months
today
NON LIVE
Inactivated vaccines and toxoids can be administered to all immunocompromised patients in usual doses and schedules, although the response to these vaccines may be suboptimal.
16 year old girl comes to your office. Her BMI is 27 and she has stage 1 hypertension. No protein present on urinalysis. What is the next step in managing her high blood pressure?
1) Beta blocker
2) Calcium channel blocker
3) Lifestyle
4) ACEi
lifestyle
The mainstay of therapy for children with asymptomatic mild hypertension without evidence of target-organ damage is therapeutic lifestyle modification with dietary changes and regular exercise. Weight loss is the primary therapy in obesity-related hypertension.
Indications for pharmacologic therapy include symptomatic hypertension, secondary hypertension, hypertensive target organ damage, diabetes (types 1 and 2), and persistent hypertension and STAGE 2 HTN (>99th) -despite nonpharmacologic measures.
Which of the following is seen in distal RTA?
a. Hyperkalemia
b. Hyponatremia
c. Hypophosphatemia
d. Hypercalciuria
d. Hypercalciuria
can also get hypokalemia
Renal tubular acidosis is characterized by non-anion gap (hyperchloremic) metabolic acidosis in the setting of normal GFR. There are 4 types:
Type I - classic distal RTA- cant secrete H
Type II - proximal RTA - cant absorb bicarb
Type III - combined proximal and distal
Type IV - hyperkalemic RTA
Most common renal stone in children
a) Calcium oxalate
b) Cystine
c) Urate
d) Struvite
calc oxalate
4 year old girl with glomerulonephritis, hypertension, and vomiting x3 days. Most probable test to determine diagnosis
a) C3
b) Renal Biopsy
C3
GN with Low C3:
Systemic diseases: Lupus nephritis, subacute bacterial endocarditis, shunt nephritis, essential mixed cryoglobulinemia, visceral abscess
Renal disease: Acute post-infectious GN, membranoproliferative GN type I
GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)
15 yo with 3+ proteinuria.
a) Check Protein twice each am
check three times in a row
What is the result when you have a diagnosis of central DI post water deprivation test?
a) Decreased Urine osmolality
b) Increased urine osmolality
c) Decreaed Serum osmolality
d) Increased serum osmolality
increased serum osmolality
and urine will stay LOW as u keep spilling water
with ADH deficiency, high serum osmolality and low urine osmolality
this just diagnosis DI- next step give DDAVP to determine central vs peripheral
Boy with enuresis, what is a good non pharm way to treat it
a) Positive reinforcement
b) Bed Alarm
c) Ddavp
d) Bladder training
bed alarm
DO not reward them
Children with turners have which renal abnormality at rates higher than healthy population?
a -horseshoe kidney
b -MCDK
c -Vesicoureteral reflux
A horseshoe kidney
What glomerular disease is associated with a low C3?
a. Membranous nephropathy
b. Alports
c. IgA nephropathy
d. Membranoproliferative glomerulonephritis
MPGN
GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture, Alports (hematuria, sensorineural hearing loss)
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)
A child presents with hypertension, urine dip shows blood and protein, creatinine and urea are elevated, C3 and C4 are normal. What is the most likely diagnosis?
a. SLE
b. Membranoproliferative glomerulonephritis
c. Post-infectious glomerulonephritis
d. IgA nephropathy
d. IgA nephropathy
LOW C3- SLE, MPGN, Post infectios
4 year old child with nephrotic syndrome on steroids. Presents with a swollen and tender abdomen. Looks septic. What test would give you the diagnostic: a. Paracentesis b. CT scan c. MRI D. Laparotomy
parecentesis
Child with distal RTA who doesn’t take his meds. 2 months after last visit, presents with bilateral leg weakness and doesn’t want to walk. What does he have?
a. Chronic acidosis
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia
hypokalemia - gives bilat weakness
severe metabolic acidosis, urine pH cannot be reduced < 5.5, hyperchloremia (because of loss of HCO3-), hypokalemia (because of inability to secrete H+), hypercalciuria, hypocitraturia (chronic metabolic acidosis leads to impaired urinary citrate excretion, which worsens hypercalciuria)
7 y.o boy presents with left-sided night time flank pain. An US reveals left-sided hydronephrosis. what do you do next?
a. VCUG
b. Nuclear scan with lasix washout
c. DMSA scan
d. CT abdomen with contrast
nuclear scan with lasix washout
MAG-3 administered with lasix - looks at differential renal function to assess for obstruction
chool aged child with pH 7.15, HCO3 9, Na 138, Cl 121, PO4 0.7, K 3.0. Also has urine pH of 5 and glucose in urine. What do you check? Which test is most likely to reveal the diagnosis?
a. Leukocyte for cystine
b. Urine ca/cr ratio
leukocyte for cysteine
metabolic acidosis, non-aniongap
either RTA or diarrhea
distal RTA DO NOT have acidic urine.
RTA with pH <5.5, glucosuria = proximal RTA
Proximal RTA almost always = fanconi
Most common cause of fanconi = cystinosis
RTA proximal vs distal
proximal - acidic urine,
distal
pRTA presents with polyuria, dehydration, anorexia, vomiting, constipation, hypotonia and FTT in first year of life. Non-anion gap metabolic acidosis, normal urinalysis (except in Fanconi), urine pH < 5.5 because distal acidification mechanisms are intact, +/- renal failure.
severe metabolic acidosis, urine pH cannot be reduced < 5.5, hyperchloremia (because of loss of HCO3-), hypokalemia (because of inability to secrete H+), hypercalciuria, hypocitraturia (chronic metabolic acidosis leads to impaired urinary citrate excretion, which worsens hypercalciuria)
You are asked to assess a 10 day old baby with weak abdominal muscles and cryptorchidism. The baby is also found to have bilateral flank masses. What is the most likely association with this picture to explain the flank masses?
a. polycystic kidneys
b. multicytic dysplastic kidneys
c. hydronephrosis
d. bilateral wilms tumors
hydronephrosis
Shows picture of genitalia (looks labial adhesions) in an 18mo girl. What to do?
Estrogen cream to the affected area
b. Abdo US
c. Call CAS
d. Refer to urology
estrogen cream to affect area
6 yr American African girl presented with blood in underwear. She has some trouble urinating, no fever, no other symptoms. On exam there is a red mass coming out of vagina..
a. Urethral prolapse
b. Cancer
black + blood spotting
it is URETHRAL PROLAPSE
and give estrogen cream 2-3 times daily
Patient presents with edema, abdominal distension, and proteinuria. Patient also has fever and is found to have spontaneous bacterial peritonitis. What is the MOST likely pathogen causing the SBP.
a. Steptococcal pneumoniae
b. E. Coli
c. Enterococcus
d. Listeria
strep pneumo
e coli #2
Patient with history of sore throat. Urine shows microscopic hematuria. What is the natural course?
a. It will resolve over time
b. Progress to chronic renal disease
c. microscopic hematuria
d. proteinuria and hypertension
resolve over time
Progress to chronic renal disease - very rare
c. microscopic hematuria - can last up to a year
d. proteinuria and hypertension - in acute phase
Antenatal diagnosis of hydronephrosis. What to do before d/c?
a. VCUG
b. MAG scan
c. Ultrasound
ultrasound at 48 hours
if persistent then VCUG and nephro referal
A 14 year old boy presents with an acutely painful scrotum. You suspect testicular torsion. Which of the following is true?
a. absence of the cremasteric reflex is common
b. blue discoloration of the scrotum is pathognomonic
c. you have 36 hours to treat before losing the testes
absence of crem reflex ommon
non viable after 24 hours
he reason we do orchidopexy?
a. reduce the chance of testicular cancer
b. allow better testicular examination
c. increase fertility potential - JELD says best as per their lecture
ALL technically correct
increase fertility
A 10 month old boy comes to ER. Acute onset of scrotal swelling. Parents have noted on and off swelling in the past few days. Today a bit irritable. VSS stable. On exam, swollen scrotum, does not reduce; transilluminates well, testicle palpable separately. Likely diagnosis?
a. epididmytis
b. testicular torsion
c. acute hydrocele
d. incarcerated hernia
acute hydrocele
not super upset
Smooth, firm, tubular mass in scrotum that transilluminates, not febrile, irritable for a week. Discomfort with examination, testes palpable and are distinct from this mass. Not reducible, no vomiting.
a. incarcerated inguinal hernia
b. acute non-communicating hydrocoele
c. epididymitis
d. testicular torsion
acute non-communicating hydrocoele
as it transilluminates
3 mo baby boy with right inguinal mass. Anorexia and irritabiliy x 3days. Mass transilluminates, soft and separate from testes. Diagnosis:
a. acute non-communicating hydrocele
b. incarcerated inguinal hernia
c. Tumor
d. torsion of testes
INCARCERATED INGUINAL HERIA - could also be hydrocele
tunica vaginalis communicates, maybe they have hydrocele and inguinal hernia
Which of the following is important in measuring blood pressure:
a. height
b. weight
c. Tanner stage
height
BP varies with age, sex, and height in children
ABPM uses a portable automated device that records blood pressure (BP) over a specific time period (usually 24 hours).
Kid with hypertension confirmed by ambulatory blood pressure monitoring. Has BP 121/86. What do you do?
a. start him on captopril
b. observe and repeat an ambulatory blood pressure test
c. renal ultrasound
renal u/s
ABPM if positive over 24 hours that is diagnostic
if its by visits 3x
consider starting amlodipine
DONT do ace inhibitor/pril - with renal artery stenosis, causes hyperK, aki, and inc cr
Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do?
a. reassure
b. check for proteinuria
c. start antibiotics
check for proteinuria
tests for hypertension?
RENAL lytes and renal function
uurinalysis, renal ultrasound
HEART fasting glu and lipids
END ORGAN echo, acr, retinal exam
Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do?
a. reassure
b. check for proteinuria
c. start antibiotics
check proteinuria
Which of the following is a presentation of HUS?
a. Coombs + anemia
b. Thrombocytopenia
c. Myoglobinuria
thromboycypeona
Characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia and renal insufficiency.
2 major categories of disease:
Infection associated (E. coli O157:H7, Shigella dysenteriae type 1, HIV, neuraminidase producing Strep pneumo)
Genetic (atypical HUS)
Recurrent hematuria in a young male with a speech delay
a. IgA nephropathy (usu occurs within 2 days of getting ill)
b. Alport syndrome
c. PSGN
d. MPGN
alport
hematuria
often associated with sensorineural hearing loss and ocular abnormalities
C3 normal
xlinked
IF a GIRL - consider IgA nephropathy
6 y.o. girl with a history of bilateral VUR and recurrent UTIs, including two febrile illnesses. Has been off antibiotics and infection-free for two years. Repeat u/s and VCUG show normal kidneys, but grade 1-2 reflux bilaterally. What do you recommend:
a. consider operative repair
b. repeat cystogram every 2 years
c. restart prophylactic antibiotics
d. continue non-interventional observation
continue non-interventional observation
if put on abx, reasses 3-6 mo
12y old with diabetes Type I since the age of 5 with microalbuminuria despite optimum control of his diabetes. What should you start him on :
a. hydrochlorothiazide
b. nifidepine
c. enalapril
enalapril
Diabetic with microalbuminuria. What would you prescribe?
a. Enalapril
b. Hydrochlorothiazide
c. Nifedipine
d. Salt and water restriction
enalapril
14 year old boy in office for pre-camp physical, 3+ protein in urine x2, exam is normal, what is most likely cause?
a. exercise induced -
b. IgA nephropathy -
c. nephritic syndrome -
d. Orthostatic
a. exercise induced - also possible but less common
b. IgA nephropathy - persistent microscopic hematuria more common
c. nephritic syndrome - would have other symptoms
d. Orthostatic
Patient to ER with following labs: Na 135, K 2.3, Cl 116, Bicarb 9, pH 7.14, most likely cause?
a. RTA
b. DKA
c. lactic acidosis
d. Vomiting
RTA
Non- anion gap metabolic acidosis, hypokalemia, normal sodium, hyperchloremia
Anion gap = Na - HCO3 - Cl = 10 (normal)
RTA: RTA is a disease state characterized by a normal anion gap (hyperchloremic) metabolic acidosis
RTA 1
DISTAL
Impaired distal acid secretion
Severe metabolic acidosis with high urine pH (>5.5)
Loss of bicarb → hyperchloremia
Hypokalemia from inability to secrete H+
Hypercalciuria + nephrocalcinosis usually present
RTA 2
PROX
Impaired proximal bicarbonate reabsorption
Usually occurs as part of global proximal tubular dysfunction or Fanconi syndrome
Non-anion gap hyperchloremic metabolic acidosis
Urine pH <5.5 because distal H+ secretion intact
Glucosuria, aminoaciduria, phosphaturia
Hypophosphatemia (can cause rickets), hypokalemia
Patients can have FTT, polyuria, anorexia, vomiting, constipation
A child with recent Group A strep infection, normal C3, C4, slightly increased creatinine, Platelets and low hemoglobin, with blood in the urine
a. HSP -
b. HUS -
c. Post strep GN -
d. IgA nephropathy -
HUS
usu caused by strep pneumo
NOT GAS
a. HSP - need other sx to make diagnosis
b. HUS - if they meant both Plts and Hgb low, but no diarrhea?
c. Post strep GN - C3 would be low
d. IgA nephropathy - possible, but no anemia usually
Teenager found to have struvite stone. What would be next investigation?
a. Urine calcium/Po4
b. Urine culture
c. 24 hour urine ca
urine culture
klebsiella
ecoli and pseudomonas
- Asymptomatic renal cyst 2 cm
monitor
Distal RTA (type 1), what is the electrolyte abnormality?
a. Glycosuria -
b. Hypercalciuria
c. Increased anion gap
HYPERCALCURIA
a. Glycosuria - this is proximal RTA w/ Fanconi syndrome
b. Hypercalciuria
c. Increased anion gap acidosis - anion gap is normal
7 year old girl with BP 140/80 with sx of ?PSGN & no signs given in history of end-organ damage. Management?
a. IV labetolol
b. PO nifedipine
c. Salt/H2O restriction
salt h20 restrict
Which is a factor in determining what a child’s mean BP should be:
a. Height
b. Weight
c. Tanner stage
d. Ethnicity
height
age, sex and height.
6 yo female with prior history of recurrent UTI, 2 of them afebrile, known bilateral reflux. Last VCUG shows ongoing low grade reflux. She has been off antibiotics and infection free for 2 years. What to do next?
a. Restart antibiotics
b. Observe only
c. VCUG every 2 years
observe
15 yo female with 2+ protein on routine exam. What to do?
a. 24 hr urine protein
b. first morning urine analysis x 2
c. Renal function tests
FIRST MORRNING URINE X2
11 year old girl with gross hematuria. She has a history of 3 prior episodes, all associated with upper respiratory infections. Her gross hematuria resolves in one day, but she continues to dip positive for microscopic hematuria. What test would give you the diagnosis?
a. C3, C4
b. ASOT
c. Immunoglobulins
C3 AND C4
if normal then it would be IgA
6mm pelicalviceal dilatation noted on antenatal and postnatal u/s. What should be done next? start prophylactic antibiotics VCUG DMSA repeat U/S in 2 months
rpt in 2 mo
likely uou would do nothing
Description of testicular torsion. How can this diagnosis be confirmed?
a. testicular ultrasound
b. nuclear scan
testicular u/s
What is the most common etiology of hypertension in adolescents?
a. essential hypertension
b. renal artery stenosis
c. congenital renal disease
d. coarctation of the aorta
essential
5 day old infant in nursery has low urine output. Creatinine is 120. Renal ultrasound shows absent left kidney. The right kidney is at the low end of normal for size, and has consistent/uniform echodensity throughout. Which of the following is most likely?
a. Prognosis depends on liver and lung status
b. Likely will progress to end stage renal disease in childhood
c. Likely will progress to end stage renal disease in mid adulthood
d. He will have normal renal function
likely progress to ESRD
When one kidney absent/nonfunctioning, other should compensate by hypertrophy. The fact that this one is normal for size and already showing signs of renal failure (ie low U/O, high Cr) would think he will progress to ESRD -
3 month old boy with UTI and grade 2 VUR on Right side. Which is the most clinically relevant way to detect renal scarring.
a. IV pyelography
b. nuclear renal scan (MAG or DMSA)
c. Renal excretion scan (DTPA)
d. VCUG
MAG nuclear renal scan
All of the following about Alport’s are true except:
a. Girls have worse prognosis
b. Bad prognosis is with gross hematuria in childhood
c. Progressive sensorineural hearing loss in childhood
d. 15% have end stage renal disease before age 15
e. 2-3% of all end stage renal disease is due to Alport’s
girls have worst prognosis
7 year old with microscopic hematuria most likely dx?
a. IgA nephropathy
b. alports
c. idiopathic
idiopathic
Child with HUS following E coli enteritis, admitted in renal failure. How do you treat/screen her two siblings who are having bloody diarrhea?
a. admit them, do CBC, BUN/Cr, start antibiotics
b. do CBC, BUN/Cr, follow them clinically
c. do CBC, BUN/Cr, start antibiotics
d. do nothing unless they develop signs or symptoms of HUS
b. do CBC, BUN/Cr, follow them clinically
abx not recommended
What is true about primary nephrogenic DI
a. female predominance
b. mental retardation
c. growth deficiency
growth def are cause of DI defect in receptors for ADH - so resistant to ADH - AVPR2 gene gene for receptors is X linked - so more likely in males present with: massive polyuria (very wet diapers) volume depletion hyperNatremia hyperthermia irritability crying constipation poor weight gain multiple episodes of hypernatremic dehydration causes developmental delay and mental retardation
A child with multicystic dysplastic kidney. What is the likely association?
a. severe hypertension
b. vesico-uretero reflux
c. cataracts
d. brain aneurysm
VUR
Contralateral hydronephrosis is present in 5-10% and 15% have contralateral VUR, of patients with MCDK
Previously well 10yo boy presents with microscopic hematuria. Renal ultrasound reveals 1 cm stone in pelvic basin. Likely:
a. oxaluria
b. idiopathic hypercalciuria
c. aminoaciduria
d. cystinuria
idiopathic hypercalciuria is most common cause of stones
most common metabolic urine abnormality found in kids:
Hypercalciuria, 50 %
Hyperoxaluria, 10 to 20 %
Hyperuricosuria, 2 to 8 %
Cystinuria, 5 %
Hypocitraturia, 10 %
Most urinary calculi are either calcium oxalate and/or calcium phosphate.
What is the management of 10 yo male with nocturnal enuresis (normal u/a)?
a. conditioning alarm
b. DDAVP
c. TCA
d. diapers
conditioning alarm
In SIADH you DO NOT have:
a. serum hypouricemia
b. urine hyperkalemia
c. high urine sodium excretion
d. urine/serum osm ratio >1.5
urine hyperkalemia
urine/serum osm ratio >1.5 - expect really low serum osm with high ADH
Patient with HSP. What would you monitor
a. urinalysis
b. IgA
c. stool for O/P
d. AXR
urinalysis
What condition is not associated with low complement levels?
a. MPGN
b. HSP
c. Shunt nephritis
d. Lupus nephritis
e. Post strep GN
HSP -
shunt and lupus causes secondary MPGN
Low complement GN:
Systemic: SLE, endocarditis, cryoglobulinemia, shunt nephritis
Isolated renal: post-infectious GN, MPGN
Normal complement GN:
Systemic: HSP, ANCA-associted (Wegener’s, PAN), Goodpasture’s syndrome, hypersensitivity vasculitis
Isolated renal: IgA nephropathy, anti-GBM disease, RPGN
51/2 boy with recent URTI, now has respiratory distress and BP150/110, most likely
a. anxiety
b. pneumonia
c. Henoch-schonlein purpura
d. post strep GN
post strep GN
11y old presents with a 4 day hx of tea colored urine. He had an upper respiratory tract infection 10 days ago. There is no hx of urgency or dysuria. Normal PE. Blood pressure 110/75 (not hypertensive). Urine analysis: red blood cells, 0-2 WBC and 1+ protein.
a. cystitis
b. Hypercalcuria
c. IGA nephropathy
d. Post infectious GN
post infectious GN
nephritis proteinrua Hemuatira Azotemia Renal inusff Oliguria HTN
ystitis - ?could they mean hemorrhagic cystitis, could be secondary to adenovirus, should present with LUTS.
b. Hypercalcuria - idiopathic hypercalciuria can cause gross hematuria, should have pain, LUTS, diagnosed by 24 hour urine calcium excretion > 4mg/kg, spot calcium/creatinine ratio.
c. IGA nephropathy - shorter latency period, should be 1-2 days after URTI, M>F
d. Post infectious GN - would be helpful to distinguish from IgA nephropathy if C3 levels were given. Low C3 in post infectious GN and normal C4 in IgA nephropathy.
A 17 y adolescent male complains of several weeks of swelling above his left testicle. He does not have any pain in the area. He is sexually active and states that he uses condoms. On PE: he has a mass along the spermatic cord that feels like a bag of worms. Which of the following is the most effective management?
a. ceftriaxone and doxycyclin po
b. Doppler flow studies of testis
c. Radionucleide scan of testis
d. reassurance and education only at that time
reassurance and education only at that time
ultrasound - only if R side to r/o abdo mass
During the first year of infant’s life, which of the following remains essentially unchanged?
a. GFR
b. nephron number
c. renal blood flow
d. Ability to concentrate urine
nephron #
5 yo male with fever and rhinorrhea presents with gross hematuria one day later. He has had a previous similar episode 3 months ago. What is the most likely diagnosis?
a. chronic glomerulonephritis
b. post-Strep GN
c. postinfectious GN
d. IgA nephropathy
e. nephrotic syndrome
IgA nephropty
14 mos male with FTT and vomiting, labs pH 7.31, bicarb 17, K3.5, Na 140, Cl 118, and urine pH 6.3.
a. distal RTA
b. Bartter’s syndrome
c. organic acidopathy
d. nutritional deprivation
distal RTA
Renal tubular acidosis = non-anion gap hyperchloremic metabolic acidosis
if urine pH >5.5 + potassium is NOT high = type 1 RTA; distal RTA
Bartter syndrome = hypochloremic metabolic alkalosis
Organic acidopathy = anion-gap metabolic acidosis
A newborn infant has a left sided abdominal mass. A renal ultrasound demonstrates multicystic kidney disease. Which of following would this be associated with:
a. ipsilateral hydroureter
b. posterior urethral valves
c. sensorineural hearing loss
d. cataracts
e. risk of malignancy
risk of malignancy for life
The risk of associated hypertension is 0.2-1.2%, and the risk of Wilms tumor arising from an MCDK is approximately 1 in 1,200. Because neoplasms arise from the stromal rather than the cystic component, even if the cysts regress completely, the likelihood that the kidney could develop a neoplasm is not altered.
you get CONTRAlateral hydroureter
Which of the following is associated with a low C3:
a. Alport’s syndrome
b. nephrotic syndrome
c. post-streptococcal glomerulonephritis
d. hemolytic uremic syndrome
e. Henoch-Schonlein purpura -
post strep glomerulopehritis
An 8-year-old boy has recurrent episodes of asymptomatic gross hematuria triggered by intercurrent illnesses. Between illnesses, dipstick shows microscopic hematuria. Best test to determine etiology: ***Q
a. immunoglobulins (as per Consensus)
b. C3 and C4 levels (as per Nelson’s)
c. 24-hour urine protein
d. abdominal ultrasound
e. DMSA scan
c3 c4
6-year-old girl with incidental finding of a 2 cm renal cyst. Appropriate management:
a. observe
b. CT abdomen
c. ultrasound liver
d. urology consult
e. full nephrologic workup
observe
Isolated renal cysts are commonly observed within the general population, and the prevalence rises with increasing age.
For both affected adults and children, the principle clinical concern is accurately distinguishing simple renal cysts from complex renal cysts that are associated with malignancy.
if complex CT
A 6-year-old child has hypertension and persistent hypokalemia. Most likely diagnosis:
a. hyperaldosteronism
b. Bartter syndrome
c. Addison’s disease
d. renal vein thrombosis
e. aortic coarctation
hyperaldosterosnims
Primary hyperaldosteronism:
excessive aldosterone secretion causes hypertension, hypokalemia. Also high Na, low Cl, low Mg. Urine is neutral or alkaline. High urine potassium
Aortic coarctation = hypertension, without hypokalemia
Addison’s disease = hypocortisolism, hypoaldosteronism = hyperkalemia, hypotension
Renal vein thrombosis = hypertension, without hypokalemia
Bartter syndrome = hypotension, metabolic alkalosis, hypokalemia
Child presents with failure to thrive, polydipsia, polyuria, and hypokalemic metabolic alkalosis.
a. hyperaldosteronism
b. Bartter syndrome
c. cystinosis
d. renal tubular acidosis
e. congenital adrenal hyperplasia
Bartter syndrome - like being on lasix all the time
hypokalemic hypochloremic metabolic akalosis with hypercalciuria, salt wasting
can manifest antenatally, perinatally, in infancy, or in childhood with FTT and history of recurrent dehydration
type4 is HYPOaldosteronisn
5½-year-old child with a recent upper respiratory tract infection, now has respiratory distress and BP 150/110. Most likely:
a. anxiety
b. pneumonia
c. myocarditis
d. Henoch-Schonlein purpura
e. post-streptococcal glomerulonephriti
post strep glomeuerlonephritis
pulm edema cause resp distress
The following are shared by cystinosis and renal tubular acidosis (distal) EXCEPT:
a. hypokalemia
b. nephrolithiasis
c. concentrating defect
d. aminoaciduria
e. hyperchloremic metabolic acidosis
b. aminoaciduria
-The main cause of fanconi syndrome is cystinosis
-Clinical features of proximal renal tubular acidosis (Type 2) include Polyuria, polydipsia and dehydration, Growth failure
Hyperchloremic metabolic acidosis
Hypokalemia
Fanconi syndrome (other features)
Glycosuria
Proteinuria/aminoaciduria
Hyperuricosuria
Infant post cardiac surgery with poor urine output. BUN 25, Cr 177, urine (low Na, concentrated)
a. ATN
b. prerenal failure
c. anaesthetic injury to kidney
d. obstructive uropathy
e. renal vein thrombosis
pre renal
Urine Na <20 = prerenal
Urine Na >20 = renal
In a newborn found to have a multicystic-dysplastic kidney, the following is likely:
a. hematuria
b. hypertension
c. ureteropelvic reflux
ureteropelvic reflux
Child with nephrotic syndrome admitted with edema. Na=125. Best fluids:
a. D5W/0.2% saline
b. D5W/0.45% saline
c. normal saline
d. 3% saline
e. Nothing
Treatment of Nephrotic Syndrome:
· sodium restriction <1500mg daily
· water/fluid restriction
An 8 year old female presents with microscopic hematuria. She has no symptoms. The most likely diagnosis is:
a. Alport’s
b. Wilms’ tumour
c. IgA nephropathy
d. nephrocalcinosis
e. post streptococcal glomerulonephritis
IgA neprhopathy
A child is brought to the emergency department after an MVA. There has been a period with prolonged hypotension/hypovolemia. His urine output is now 0.3 ml/kg/hr. His mother states that he was evaluated for hematuria and proteinuria 1 year ago and was told that the child may have renal disease. What is the best way to detect parenchymal kidney disease:
a. Increased tubular reabsorption of urea
b. Decreased urinary creatinine
c. Urinary sodium <10 mmol/L
d. Fractional excretion of Na <3%
e. IVP
urinary sodium <10mmol/L
You are assessing a 3 week old infant. The weight is 4 kg, the birth weight was 3.6 kg, the blood pressure is 90/55 (high). The mother states that the infant is feeding well. The labs show:
Na 142 (Normal), K 3.6 (low), Cl 113 (high), Cr normal, pH 7.25 (acidotic), urine pH 5.0. What is the most likely etiology
a. hyperaldosteronism
b. RTA, proximal
c. CF
d. Psychosocial failure to thrive
RTA
a. Hyperaldosteronism - should have hypokalemia, hypertension, high urine potassium, metabolic alkalosis due to H excretion (when K leaves too)
b. RTA, proximal - urine with pH < 5.5, non metabolic gap metabolic acidosis + hyperchloremic
c. CF - should have hypochloremic, hyponatremic metabolic alkalosis
d. Psychosocial failure to thrive - gained ~ 20g/day
Photograph of Prune Belly Syndrome. Which of the following is a consistent association:
a. Posterior urethral valves
b. Progression to renal failure
c. Sex-linked inheritance
d. Polyhydramnios
progression to renal failure
in 50% and ESRD 30%
more common in males
usu oligohydramnios
A 14 year old boy has hypertension. He is at the 99th percentile for height and weight. What are the THREE investigations you need to do to assess for effects of his hypertension, and what would you be testing for? (3 points)
ECHO - looking for LVH
Fundoscopy - looking for papilledema, retinal changes
ACR (albumin to Cr - renal function
A boy with family history of renal stones, presents with 24-48h right flank pain. Passed a 5 mm stone determined to be calcium oxalate. Name 4 dietary interventions you would recommend to decrease the risk of further stones.
hydration
low Na diet
Low fat diet
limiting animal diet
nephrotic syndrome
what vaccine they should get
Because children with nephrotic syndrome are at increased risk for serious complications and potentially death from pneumococcal infection, they should receive 23-valent polysaccharide (PPSV23) pneumococcal vaccine if not previously immunized. Pneumococcal vaccine is effective even in children receiving high doses of steroids and it is not associated with an increased risk of relapse
What are four other possible causes of his testicular pain?
Epididymitis
Incarcerated inguinal hernia
Scrotal trauma
Orchitis
What are 3 reasons to refer to a nephrologist?
Failure to respond to steroids Gross hematuria Hypertension Renal insufficiency <1 year >12 years
Child with hemolytic uremic syndrome (you are told it is HUS)
What are the 3 characteristic laboratory features of HUS?
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal insufficiency
5yo nausea and confuse, then seizue 12 hours post tonsillectomy
labs Na 121
serum osm 260
a) urine osm higher than serum osm
SIADH
child sick with vomitting and diarrhea
feeding sugar water
Na 108
Cr 95 urea 13
correct to 118/120 over 24 hours
3% correct over 4-6 hours
fluid restric
correct to 135-140 in 24 hurs
correct to 118/120 over 24 hours
4 mo with FTT
gas 7.24, co2 30, HCO3 16
BW- Na 138, Cl 111, K5, P04 2.1, glu 4
RTA
Fanconi causes low p04 (its normal here)
Distal RTA
a. hypercalcuria
b. hypokalemia
hpyercalcuria
child with unilat gr 4 VUR, and has had resistance with 2 abx, what to do next
stop prophylaxis
7yo M left sided night time flank pain, u/s L sided hydro whats next a-vcug b-nuc scan with lasix washout c-dmsa scan d- CT with contrast
nuc scan with lasix as this diagnosis obstrcution
four intervention decrease stones
low salt
high urine
more citrate - lemonade
more pho4 and magneisum
14yo recurrent, painless hematuria, best test
a) IgA level
b) C3
c) renal us
d) hearing test
IGA level
no pain so not ultrasuond for stone
C3- recurrent so not PIGN
hearing test= males alport
12 yo with 2 w fever, artharglia an dmaalgia
well but pale
blood and proitein urine
ESR 50 WBC 5, normal platelet
acute rheumatic fever
SLE
wegeners granulmatosis
JRA
SLE
12 yo with 2 w fever, artharglia an dmaalgia
well but pale
blood and proitein urine
ESR 50 WBC 5, normal platelet
acute rheumatic fever
SLE
wegeners granulmatosis
JRA
SLE
usu pancytopenic
3 ft of HUS
MAHA
thrombocytpenoa
renal abn
NO abx in HUS, do CBC BUN cr and follow clinically
most common cause of htn in newborn
renovascular
