Nephrology Flashcards
A 5-year-old hospitalized and receiving penicillin IV for 10days, developed rash, eosinophilia, eosinophiluria, pyuria (sterile), hematuria, moderate proteinuria (usually
Antibiotic-induced allergic interstitial nephritis
A 4-year-old had throat infection 2weeks ago, teacolored urine, BP is slightly elevated, RBC casts in urine, low C3 and normal C4
Postinfectious glomerulonephritis
History of impetigo, tea-colored urine, hypertension, periorbital edema, C3 is low, normal C4, azotemia, normal ASO titer, positive anti-DNAse, oliguria, and RBC casts in urine
Postinfectious glomerulonephritis
Low C3 and cola-colored hematuria (RBC casts) 2–3weeks after upper respiratory tract infection
Postinfectious glomerulonephritis
Normal C3 and episodic gross hematuria (RBC casts) during acute upper respiratory tract infection
IgA nephropathy
The most common cause of gross hematuria in children
IgA nephropathy
Can antibiotics prevent acute postinfectious glomerulonephritis?
No
Can antibiotics prevent acute rheumatic fever?
Yes
After poststreptococcal glomerulonephritis (PSGN) does the C3 level normalize immediately after the illness?
No—at least 6weeks before C3 levels return to normal
Are steroids indicated in PSGN?
No—only supportive care measures and BP control as needed
Adolescent female with rapidly progressive glomerulonephritis, hypertension, and both C3 and C4 are decreased
Lupus nephritis
A healthy child with proteinuria, morning specimen is negative for proteinuria
Benign orthostatic proteinuria
A 3-year-old, swelling of the face and generalized edema, normal blood pressure, 4+ proteinuria, no hematuria, hyperlipidemia, hypoalbuminemia, normal C3 and C4, urine is negative for protein after 3weeks of steroid therapy
Nephrotic syndrome due to minimal change disease
Child with nephrotic syndrome not responding to treatment and progressing to chronic kidney disease
Focal segmental glomerulosclerosis
Adolescent with nephrotic syndrome, microscopic hematuria, and hypertension
Focal segmental glomerulosclerosis
Adolescent presents with proteinuria, hematuria, hypertension, persistent low C3, hyperlipidemia, renal failure
Membranoproliferative glomerulonephritis
Child presents with persistent proteinuria, history of hepatitis B virus infection
Membranous glomerulonephritis
Child develops acute kidney injury and within 4weeks progresses to end-stage renal disease, renal biopsy shows crescents formation in most glomeruli
Rapidly progressive (crescentic) glomerulonephritis
Which serologic marker can be positive in rapidly progressive glomerulonephritis?
P-ANCA
A 5-year-old has blood in urine, urine is positive for hematuria, RBC casts, renal function is normal, no hypertension, positive family history of hematuria with every generation affected
Familial thin basement membrane nephropathy (autosomal dominant)
Microhematuria, proteinuria, absent patella, dystrophic nails, dysplasia of elbows
Nail-patella syndrome (autosomal dominant)
A 7-year-old, failure to thrive, polyuria, polydipsia, anemia, ocular apraxia, retinitis pigmentosa, coloboma, nystagmus, aplasia of the cerebellar vermis, loss of differentiation between cortex and medulla on renal US
Juvenile nephronophthisis
Boy with a sensorineural hearing loss, proteinuria, mother’s brother died from renal failure
Alport syndrome (X-linked disease)
Upper respiratory infection a week ago, now with petechiae on the buttocks and lower extremities, abdominal pain, arthralgia, and hematuria
Henoch-Schönlein purpura
Bloody diarrhea, which resolves, but then the child becomes pale and tired and is found to have hemolytic anemia, thrombocytopenia, elevated BUN and creatinine. A stool culture is positive for Escherichia coli (E. coli) O157: H7
Hemolytic uremic syndrome
The most common causes of oliguric acute kidney injury requiring dialysis in children
Nephrotoxins and rhabdomyolysis
Child on amphotericin B developed kidney stones, and blood work showed non-anion gap metabolic acidosis. What is the most likely cause?
Renal tubular acidosis (RTA) type 1
Child with polyuria, polydipsia, dehydration, growth failure, non-anion gap metabolic acidosis, hypokalemia, hypophosphatemia, proteinuria, glucosuria
Fanconi syndrome
Type of renal tubular acidosis associated with Fanconi syndrome
RTA type 2
Type of renal tubular acidosis associated with hyperkalemia
RTA type 4
Hemoptysis, hematuria, proteinuria, positive antiglomerular basement membrane antibodies (anti-GBM)
Goodpasture syndrome
Child on Lasix, presents with oliguria, elevated creatinine; urine osmolality is >400mOsm/L, urine Na
Prerenal acute kidney injury
Child after a car accident and crush injury presents with high BUN/Cr, oliguria, urine osmolality 300mOsm/L.FeNa >1%, urine Na >20, large muddy brown granular cast
Acute tubular necrosis (intrarenal acute kidney injury)
A male infant with posterior urethral valves, born prematurely and is found to have high BUN/Cr, elevated FeNa, normal urine osmolality, elevated urine Na
Postrenal acute kidney injury
Status post-cardiac arrest, BUN and creatinine are elevated, hyperkalemia, hyponatremia, hyperphosphatemia, hypocalcemia, urine shows muddy brown, and granular casts
Acute tubular necrosis secondary to ischemia
Adolescent with severe muscle cramps, numbness, low blood pressure, fatigue, metabolic alkalosis, hypochloremia, hypokalemia, hyponatremia, hypomagnesemia, polyuria, low urine calcium, and high urinary chloride 70mEq/L.High aldosterone and renin levels
Gitelman syndrome (metabolic alkalosis and high urine chloride, low serum Mg, and low urine Ca)
An infant with failure to thrive, dehydration, low blood pressure, metabolic alkalosis, hypochloremia, hypokalemia, hyponatremia, normal serum magnesium level, polyuria, normal urine calcium, and high urinary chloride 70mEq/L.High aldosterone and renin levels. High urinary prostaglandin level
Bartter syndrome (metabolic alkalosis and high urine chloride, normal serum Mg, and normal or high urine Ca)
Child with a positive family history of hypertension (parents) presenting with headache, hypertension, hypokalemia, metabolic alkalosis, and high urinary chloride
Liddle syndrome (autosomal dominant)
Adolescent with mild glomerulonephritis, history of allergies/asthma with elevated eosinophil levels on CBC
Churg Strauss syndrome
An older child with a prolonged history of fever, weight loss, hematuria, and hemoptysis. Radiograph shows necrotizing granuloma and C-ANCA positive
Granulomatosis with polyangiitis (formerly Wegner granulomatosis)
A young child with palpable kidneys bilaterally, hypertension, and associated with a history of oligohydramnios
Autosomal recessive polycystic kidney disease
The predominant type of polycystic kidney disease seen in adults
Autosomal dominant polycystic kidney disease
How is hypertension defined in children?
BP >95th percentile for age, height, and gender on 3 different occasions or greater than 130/90mmHg in children aged 13years and older
How is elevated blood pressure defined in children?
BP ≥90th (≥13years BP >120/80mmHg matching new adult guideline)
Adolescent with severe muscle weakness after exercise, hypophosphatemia, hypokalemia and elevated CPK with myoglobinuria
Rhabdomyolysis—heme positive urine but no RBC
Child with nausea, severe flank pain, and hematuria
Renal stone
The most common type of stones in children
Calcium oxalate
Type of kidney stone associated with staghorn calculi and Proteus?
Struvite stones
Type of stone associated with an autosomal recessive pattern
Cystine stones
First-line therapy for children with primary monosymptomatic nocturnal enuresis
Bedwetting alarm and desmopressin (both)
Recommended lifestyle changes in all cases of monosymptomatic nocturnal enuresis
Adequate hydration during the day Limit fluids before bed (≤200mL) Void before bed Regular sleep and wake schedule
Diurnal enuresis after continence
Requires prompt evaluation
