Nephrology

Question 1

Next step for microscopic hematuria

Answer 1

Repeat UA in few weeks

Question 2

Next step for persistent microscopic hematuria

Answer 2

Urine Ca/Cr ratio

If elevated, check 24hr total Ca excretion
If > 4 mg/kg/day — confirmed hypercalciuria

Question 3

Red/pink discoloration in diaper

Answer 3

Urate crystals

Not hematuria

Question 4

Myoglobinuria

Answer 4

Rhabdomyolysis

Question 5

Differential for gross hematuria (+ microscopy and red)

Answer 5

HSP and Hereditary nephritis
Benign familial hematuria
MPGN
Alport and IgA nephropathy
Trauma
UPJ obstruction
Renal stones and crystals
Infectious
Abnormal cells

Question 6

Most common renal stone in children

Answer 6

Calcium

Question 7

Most sensitive modality to confirm renal stone

Answer 7

Non contrast CT

Question 8

Predisposing factors of renal stones in IBD

Answer 8

Hyperoxaluria
Hypocitraturia

Question 9

Best way to decrease urinary calcium excretion and prevent stone formation in urine

Answer 9

Thiazide diuretic

Question 10

Mechanism of added calcium for renal stones

Answer 10

Decrease absorption of oxalate

Question 11

Renal stone
Distal RTA 1

Answer 11

Ca phosphate

Question 12

Orthostatic proteinuria

Answer 12

Proteinuria present during day but disappears when lying down

Question 13

Best test for orthostatic proteinuria

Answer 13

First void spot urine

If protein disappears when lying down, check sCr. If sCr normal, f/u 3 mo

If protein does not disappear, check Ur p/c ratio. > 0.2 means renal disease

Question 14

Renal failure
Persistent microscopic hematuria
Sensorineural hearing loss
Ocular defects
X-linked

Answer 14

Alport syndrome (familial nephritis)

Question 15

Most commonly palpated masses in infants

Answer 15

Hydronephrotic kidneys (from UPJ obstruction)

Multicystic dysplastic kidneys

Question 16

Diagnosing MCDK

Answer 16

Renal ultrasound

Question 17

Associated anomalies with MCDK

Answer 17

UPJ obstruction
Vesiclureteral reflex
Posterior urethral valves
Megaureter and duplication

Question 18

Bilateral flank mass
Oligohydramnios
Chronic portal HTN
Congenital hepatic fibrosis

Answer 18

Autosomal recessive polycystic kidney disease

Question 19

Renal disease
Cerebral aneurysms

Answer 19

Autosomal dominant polycystic kidney disease

Question 20

Most common pediatric kidney tumor

Answer 20

Wilms tumor

Question 21

Asymptomatic abdominal mass
HTN
gross hematuria
Aniridia
Hemihypertrophy
Does not calcify

Answer 21

Wilms tumor (nephroblastoma)

Question 22

Calcification on abdominal mass Xray

Answer 22

Neuroblastoma

Question 23

Complications of nephrotic syndrome

Answer 23

Edema
High LDL/HDL ratio
Hypercoagulability, thrombosis
Immunodeficiency, hypogammaglobulinema
Invasive pneumococcal disease
HypoCa, HypoNa
Functional hypothyroidism

Question 24

Hematuria
Oliguria
Proteinuria
HTN
Azotemia

Answer 24

Nephritic syndrome

Question 25

Recurrent painless hematuria URI < 1 week > 10 yo Normal complement

Answer 25

IgA nephropathy (Berger’s disease

Question 26

Correlates with worsening IgA nephrology

Answer 26

Persistent proteinuria

Question 27

African American HIV Heroin Sickle cell obesity Normal complement

Answer 27

Focal segmental glomerulosclerosis (FSGS)

Question 28

SLE Hep B, C Cryoglobulinemia SBE Low C3

Answer 28

Membranoproliferative glomerulonephritis (MPGN)

Question 29

Strep throat 1-3 weeks Impetigo 3-6 weeks Tea/coca-colored urine Transient low C3 Normal C4 Low serum albumin (hemodilution)

Answer 29

Post strep glomerulonephritis (PSGN)

Question 30

Hemolytic anemia Uremia Thrombocytopenia

Answer 30

Hemolytic uremic syndrome (HUS)

Question 31

FeNa

Answer 31

[(UrNa x sCr) / (UrCr x sNa)] x 100

Question 32

Indication for erythropoietin in CKD

Answer 32

Hgb < 8

Question 33

Secondary hyperparathyroidism

Answer 33

CKD Decrease production in 1,25 dihydroxy vitamin D3 (active vitamin D) Decrease Ca absorption Elevated PTH

Question 34

Effects of increased Phos in CKD

Answer 34

Suppress calcitriol production Additional Ca loss Increased PTH

Question 35

Age which GFR reaches adult value

Answer 35

2 yo

Question 36

Time it takes for creatinine to decrease to neonatal level from adult/maternal level

Answer 36

1-2 weeks

Question 37

Hypertension

Answer 37

BP > 95th percentile for age and sex Taken on 3 separate occasions

Question 38

Causes of pediatric HTN

Answer 38

Polycystic kidney disease 11 and 17 hydroxylase deficiencies Urinary reflux nephropathy Renal artery stenosis Neurofibromatosis Coarctation of aorta Pheochromoxytoma Lupus Hyperthyroidism Cushings

Question 39

Renin level in renal stenosis as a renal cause for HTN

Answer 39

Elevated