Nephrology Flashcards
Maintenance sodium? Maintenance potassium?
3 mEq/kg/day
2 mEq/kg/day
Maintenance fluid requirement?
100 mL per kilogram for first 10 kg
50 mL per kilogram or second 10 kg
20 mL per kilogram for subsequent kilos
Phases of parenteral rehydration?
- Emergency phase – 20 mL/Kg bolus of saline/LR
2. Repletion phase – over 24 hours (if acute hyponatremia) or over 48 hours (if hyperNa)
Definition of microscopic hematuria?
> 6 RBCs per high-powered field on 3+ attempts
False-negative urine dipstick for hematuria if?
Ascorbic acid ingestion
UA – meaning of RBC morphology?
Dysmorphic – from glomerulus
Normal – lower urinary tract
Definition of pathologic proteinuria?
> 100 mg/m²/Day
False positive urinary dipstick for proteinuria if?
- Urine concentrated – specific gravity >1.025
- Alkaline – pH over 7
- ?
Most accurate method of measuring proteinuria? Most used method? Interpretation?
24-hour urinary protein collection
Random spot urine total protein: creatinine ratio
TP/CR normally under .5 until two years; under .2 over two years
Diagnose orthostatic proteinuria with?
Normal total protein to creatinine ratio in the morning but elevated ratio in the afternoon
Causes of tubular proteinuria? Characteristic lab funding?
Interstitial nephritis, acute tubular process, nephrotoxic drugs
Urinary levels of urinary B2-Microglobulin, aminoaciduria
Poststreptococcal GN – when to do a biopsy? Typical biopsy findings?
Indication: significant impairment/nephrotic syndrome or complement fails to normalize within 8 weeks
Mesangial proliferation and increasing mesangial matrix
Most of chronic GN worldwide? Clinical features? Biopsy shows? Management? Can progress to?
IGA nephropathy (burger disease)
Recurrent gross hematuria and respiratory infections
- Real biopsy shows mesangial proliferation and increasing mesangial matrix
- Immunofluorescent microscopy shows IgA
Supportive; ACE, steroids used in patients with renal insufficiency
End stage renal disease
Henoch- Schonlein purpura - classification? characteristic features? Prognosis?
IgA-mediated vasculitis
- Non-thrombocytopenic palpable purpura on butt/thighs
- Gross hematuria
- Arthritis
- Abdominal pain
Recovery within three months
MPGN – biopsy findings? Treatment?
Lobar mesangial hypercellularity and thickening of glomerular basement
No definitive treatment. May respond to corticosteroids
Definition of nephrotic syndrome in children?
More than 50 mg/kg/day proteinuria
Three basic categories of nephrotic syndrome?
- Primary – not a consequence of systemic disease. 90% of all cases. (Includes MCD)
- Results from other primary glomerular disease (IgA nephropathy, MPGN, PSGN)
- Results from systemic disease – SLE, HSP
Consequences of nephrotic syndrome?
- Hypoproteinemia leading to hypercholesterolemia/edema (Losing albumin in urine)
- Hypercoagulability (losing anti-thrombin in urine)
- Increased risk for infection/sepsis (losing immunoglobulins in urine)
Patients with steroid resistant/steroid dependent nephrotic syndrome eventually develop?
End-stage renal disease
HUS – clinical features? Treatment? Poor prognostic signs? Causes of mortality?
- Diarrheal prodrome
- Triad - Hemolytic anemia, thrombocytopenia, acute renal failure
Do not give antibiotics for HUS (antibiotics for E. coli colitis increases chance of HUS)
High WBC count, prolonged oliguria
Toxic megacolon or cerebral infarcts
Atypical HUS? Causes? Prognosis versus regular HUS?
HUS with absent diarrheal phase and more prominent proteinuria/hypertension
Drugs or inherited
Higher risk of progression to ESRD
Drugs that can cause atypical HUS?
OCP
Cyclosporine
Tacrolimus
OKT3
Alport’s syndrome – inheritance? Defect? Clinical features? Management?
X-linked dominant
Defects in of type IV collagen in the glomerular basement membrane leads to progressive hereditary nephritis
- Renal – hypertension and hematuria
- Hearing loss in childhood
- Ocular abnormalities involving rent and retina
ACE inhibitors, renal transportation
Newborn with unilateral flank mass – most common cause? Associated with?
Multicystic renal dysplasia; atretic ureter
Most common form of GN in children? Clinical features? Diagnosis? Tx?
Poststreptococcal GN
- 8-14 days after pharynx infection/3+ weeks after impetigo
- Hematuria, proteinuria, hypertension
- Low C3 that normalizes in 8 weeks
- ASO titer (mostly after pharyngitis)
- ADB titer (more reliable)
Supportive
