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Pediatric Board Review > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Serum sodium indicates ___

A

water balance

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2
Q

Voiding dysfunction + spinal dysraphism

A

myelomeningocele

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3
Q

Voiding dysfunction + weak stream

A

PUV

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4
Q

Daytime continence is achieved at ?

A

4yrs

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5
Q

Nightime continence is acheived at ?

A

5-7yrs

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6
Q

Abnormal bladder contraction and filling

Vincent’s Curtsy

A

Overactive bladder

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7
Q

Inability to relax sphincter and pelvic floor during voiding

A

Neurogenic vs. non-neurogenic (can be pathological)

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8
Q

What treatment has the highest rate of success for nocturesis

A

Enuresis alarm

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9
Q

What is the most appropriate follow-up for an infant with a unilateral multicystic dysplastic kidney?

A

VCUG to rule out reflux in contra-lateral kidney

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10
Q

DDx for bilateral polycystic kidneys

A
  • ARPKD and ADPKD
  • von Hippel-Lindau disease
  • Tuberous sclerosis
  • Acquired
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11
Q
  • Microcysts limited to COLLECTING TUBULES
  • Enlarged echogenic kidneys
  • Can become massive –> pulmonary problems
  • LIVER INVOLVED - congenital hepatic fibrosis, periportal fibrosis
  • HTN is common and can be presenting symptom
  • 99% cases of bilateral polycystic kidneys in neonates
A

ARPCKD

- With neonatal survival, 80% survival at 10 years with renal survival of 75% and liver fibrosis 44%

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12
Q
  • Later presentation
  • ONLY KIDNEY INVOLVEMENT
  • MACROCYSTS in all segments of nephron
  • Kidneys are enlarged with large cysts
  • Present as abd masses, flank pain, hematuria
  • HTN common
  • Gene is sitting next to tuberous sclerosis gene
  • Cerebral aneurysms
  • Hepatic cysts later in life
  • 75% with family history
A

ADPKD

- PKD1 and PKD2

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13
Q
  • Oligohydramnios
  • Pulmonary hypoplasia
  • Limb deformities
  • Flattened facies
A

POTTER SEQUENCE

- associated with bilateral renal agenesis

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14
Q
  • Vertebral
  • Cardiac
  • TE fistula
  • Renal
  • Limb
A

VACTERL

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15
Q
  • Renal agenesis

- Absence of upper vagina and uterus

A

Mayer-Rokitansky-Kuster-Hauser

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16
Q

Most common cause of antenatal hydronephrosis

A

UPJ Obstruction

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17
Q

2nd most common cause of antenatal hydronephrosis

A

Congenital megaureter

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18
Q

Most common cause of congenital kidney disease 2/2 obstruction

A

PUV

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19
Q

Best imaging for suspected renal trauma

A

CT with and without contrast

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20
Q
  • Pelvic fracture
  • Free fluid in cul-de-sac
  • Gross hematuria
A
  • Renal trauma

- Get CT scan

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21
Q
  • Perineal/penile hematoma
  • Blood at meatus
  • Inability to void
A
  • Urethral injuries

- Dx via retrograde urethrography in males, cystoscopy in females

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22
Q

What is the single best test for a 9y/o M with a FHx of nephrolithiasis who presents with flank pain

A

CT scan of abdomen without contrast - want to see stone

CT>US>Plain film

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23
Q

A 10y/o M is found to have HTN at a sports physical and has cafe-au-laits on exam. The next best test is…

A

Renal US with doppler - RAS/neurofibromatosis

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24
Q

Volume follows _____.

A

Sodium
TBW ~ Total body salt
*Serum sodium indicates water balance

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25
Q

Degree of dehydration:

  • H/o losses
  • Minimal signs
  • Decreased frequency of urination
A

VERY MILD

  • 1% infant
  • 1% child
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26
Q

Degree of dehydration:

  • Poor skin turgor
  • Sunken fontanel and/or eyes
  • Lack of tears and/or saliva
  • Lethargy
  • Tachycardia
A

MILD

  • 5% infant
  • 3% child
27
Q

Degree of dehydration:

  • Orthostatic Hypotension
  • Significant Tachycardia
  • Oliguria
  • Deepening lethargy
A

MODERATE

  • 10% infant
  • 6% child
28
Q

Degree of dehydration:

- Shock

A

SEVERE

  • 15% infant
  • 9% child
29
Q

Rate of volume repletion

A

50% deficit in first 8 hours

Remainder over next 16 hours

30
Q

How do you estimate serum osmolality

A

2Na + 2K + Gluc/18 + BUN/3

** biggest contribution to serum osmolality is sodium

31
Q
  • Thirst
  • Fever
  • Doughy skin
A

Hypernatremia

32
Q

Lack of ADH

A

Central DI

  • Head trauma
  • Pituitary infarction
  • Pituitary/hypothalamic tumors (Histiocytosis X)
  • CNS infections
33
Q

ADH in circulation, but kidneys not responding

A

Nephrogenic DI

- X-linked recessive loss of V2 receptor activity

34
Q

Anorexia
Muscle Cramps
Neurologic symptoms

A

Hyponatremia

35
Q

Rapid correction of hyponatremia

A

Central Pontine Myelinolysis

36
Q

Rapid correction of hypernatremia

A

Cerebral edema

37
Q

Most common cause of hyponatremia

A

SIADH

  • Na < 280
  • Uosm > Posm
  • EUVOLEMIC
  • NORMAL RENAL FUNCTION
38
Q 
6y/o w/ abd pain, v and confusion
Na 125
Co2 7
Glu 900
SerumOSM 317
UrineOsm 600
A

DM w/ factitious hyponatremia

39
Q 
6y/o w/ abd pain, v and confusion
Na 122
Co2 22
Glu 100
Serum osm 260
Urine osm 350
A

SIADH

40
Q 
3m/o with decreased alertness, irritability and doughy skin. H/o GBS meningitis.
Na 165
CO2 24
Glu 100
Urine osm 200
A

DI

41
Q 
1y/o with polyuria and polydypsia
Na 140
CO2 24
Glu 100
Urine osm 100
A

Perform water deprivation test

No change in Na with an increase in urine ism to 400 = psychogenic polydipsia

Serum sodium increases to 146, urine osm maxes out at 250 = DI (central or nephrogenic)

42
Q
  • Weakness

- Peaked T waves

A

Hyperkalemia

43
Q

Metabolic alkalosis
Normotensive
Low urine chloride

A

Normal renal response - outside kidneys

  • Pyloric stenosis
  • Cystic fibrosis
44
Q

Metabolic alkalosis
Normotensive
High Urine Chloride

A

Kidney - Loop of Henle

  • Loop diuretics
  • Lasix
  • Barter Syndrome - polyhydramnios, hypercalciuria, hearing loss
  • Gittelman’s - magnesium wasting
45
Q

Metabolic alkalosis
Hypertension
High Urine Chloride

A

Liddle’s syndrome - low renin/low aldo
CAH (DOC acts like aldo)
Renal artery stenosis
Aldosterone excess

46
Q

Normal anion gap

A

9-12

47
Q

Anion gap calculation

A

Na - (Cl + HCO3)

48
Q

Gap Acidosis

A

DKA, Lactic Acidosis

49
Q

Non-gap acidosis

A 
GI losses (Diarrhea, fistulas)
RTA
50
Q

Short stature
Nephrocalcinosis
RIckets

A

RTA

51
Q

Hyperchloremia
Hypokalemia
Non-anion gap acidosis
Alkaline urine

A

RTA

52
Q
  • Inability to acidify the urine appropriately with spontaneous or chemically induced metabolic acidosis
  • Hypokalemia
  • Hypercalciuria
  • SNHL
  • Rickets
  • Nephrocalcinosis
A

Distal/Type 1 RTA

53
Q
  • Defect in Na/H exchange mechanism leading to a defect in proximal tubular bicarbonate resorption
  • Distal nephron acidifies urine appropriately
  • Hypokalemia
  • Acidic urine during acidosis
  • Fanconi’s anemia - renal wasting of phosphate, amino acids, bicarbonate, irate and glucose
  • Rickets
A

Type II/Proximal RTA

54
Q
  • D/o of distal nephron
  • Hypoaldosteronism or pseudoaldosteronism and hyperkalmia
  • Inability to acidify the urine
A

Type IV distal RTA

55
Q

IDM

Hematuria

A

Renal Vein/Artery Thrombosis

56
Q

Child with illness and hemorrhagic cystitis

A

Adenovirus

57
Q

Hematuria and chemotherapy

A

Cyclophosphamide

58
Q

Indications for Renal Biopsy - hematuria

A
  • Significant proteinuria
  • Persistent hypocomplementemia
  • CRI
  • F/h of nephritis with deafness - Alports
  • Recurrent gross hematuria not explained by a non-glomerular cause
59
Q

Protieinuria - Indications for Renal Biopsy

A

Proteinuria + FHx renal failure
Proteinuria + persistent hematuria
Steroid resistant nephrotic syndrome
Proteinuria and persistent hypocomplementemia
Proteinuria and HTN
Proteinuria associated with systemic disease
Persistent non-orthostatic proteinuria (>1-2yrs)

60
Q

Proteinuria > 40mg/m2/hr
Hypoalbuminemia < 2.5g/dL
Edema
Hyperlipidemia

A

Nephrotic Syndrome

61
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disase

62
Q

What is a common infectious complication of nephrotic syndrome

A

SBP - Strept pneumoniae

63
Q
  • Nephrotic syndrome
  • No changes on light microscopy
  • No immunofluorescent deposits
  • Epithelial foot process effacement on EM
A

MCNS

64
Q

MCNS - response to Prednisone

A

93% responders
73% respond within 14 days
94% respond within 28 days

Pediatric Board Review (17 decks)

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