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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
Degree of dehydration: - H/o losses - Minimal signs - Decreased frequency of urination
VERY MILD - 1% infant - 1% child
26
Degree of dehydration: - Poor skin turgor - Sunken fontanel and/or eyes - Lack of tears and/or saliva - Lethargy - Tachycardia
MILD - 5% infant - 3% child
27
Degree of dehydration: - Orthostatic Hypotension - Significant Tachycardia - Oliguria - Deepening lethargy
MODERATE - 10% infant - 6% child
28
Degree of dehydration: | - Shock
SEVERE - 15% infant - 9% child
29
Rate of volume repletion
50% deficit in first 8 hours | Remainder over next 16 hours
30
How do you estimate serum osmolality
2Na + 2K + Gluc/18 + BUN/3 ** biggest contribution to serum osmolality is sodium
31
- Thirst - Fever - Doughy skin
Hypernatremia
32
Lack of ADH
Central DI - Head trauma - Pituitary infarction - Pituitary/hypothalamic tumors (Histiocytosis X) - CNS infections
33
ADH in circulation, but kidneys not responding
Nephrogenic DI | - X-linked recessive loss of V2 receptor activity
34
Anorexia Muscle Cramps Neurologic symptoms
Hyponatremia
35
Rapid correction of hyponatremia
Central Pontine Myelinolysis
36
Rapid correction of hypernatremia
Cerebral edema
37
Most common cause of hyponatremia
SIADH - Na < 280 - Uosm > Posm - EUVOLEMIC - NORMAL RENAL FUNCTION
38
``` 6y/o w/ abd pain, v and confusion Na 125 Co2 7 Glu 900 SerumOSM 317 UrineOsm 600 ```
DM w/ factitious hyponatremia
39
``` 6y/o w/ abd pain, v and confusion Na 122 Co2 22 Glu 100 Serum osm 260 Urine osm 350 ```
SIADH
40
``` 3m/o with decreased alertness, irritability and doughy skin. H/o GBS meningitis. Na 165 CO2 24 Glu 100 Urine osm 200 ```
DI
41
``` 1y/o with polyuria and polydypsia Na 140 CO2 24 Glu 100 Urine osm 100 ```
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
- Weakness | - Peaked T waves
Hyperkalemia
43
Metabolic alkalosis Normotensive Low urine chloride
Normal renal response - outside kidneys - Pyloric stenosis - Cystic fibrosis
44
Metabolic alkalosis Normotensive High Urine Chloride
Kidney - Loop of Henle - Loop diuretics - Lasix - Barter Syndrome - polyhydramnios, hypercalciuria, hearing loss - Gittelman's - magnesium wasting
45
Metabolic alkalosis Hypertension High Urine Chloride
Liddle's syndrome - low renin/low aldo CAH (DOC acts like aldo) Renal artery stenosis Aldosterone excess
46
Normal anion gap
9-12
47
Anion gap calculation
Na - (Cl + HCO3)
48
Gap Acidosis
DKA, Lactic Acidosis
49
Non-gap acidosis
``` GI losses (Diarrhea, fistulas) RTA ```
50
Short stature Nephrocalcinosis RIckets
RTA
51
Hyperchloremia Hypokalemia Non-anion gap acidosis Alkaline urine
RTA
52
- Inability to acidify the urine appropriately with spontaneous or chemically induced metabolic acidosis - Hypokalemia - Hypercalciuria - SNHL - Rickets - Nephrocalcinosis
Distal/Type 1 RTA
53
- 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
Type II/Proximal RTA
54
- D/o of distal nephron - Hypoaldosteronism or pseudoaldosteronism and hyperkalmia - Inability to acidify the urine
Type IV distal RTA
55
IDM | Hematuria
Renal Vein/Artery Thrombosis
56
Child with illness and hemorrhagic cystitis
Adenovirus
57
Hematuria and chemotherapy
Cyclophosphamide
58
Indications for Renal Biopsy - hematuria
- Significant proteinuria - Persistent hypocomplementemia - CRI - F/h of nephritis with deafness - Alports - Recurrent gross hematuria not explained by a non-glomerular cause
59
Protieinuria - Indications for Renal Biopsy
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
Proteinuria > 40mg/m2/hr Hypoalbuminemia < 2.5g/dL Edema Hyperlipidemia
Nephrotic Syndrome
61
Most common cause of nephrotic syndrome in children
Minimal change disase
62
What is a common infectious complication of nephrotic syndrome
SBP - Strept pneumoniae
63
- Nephrotic syndrome - No changes on light microscopy - No immunofluorescent deposits - Epithelial foot process effacement on EM
MCNS
64
MCNS - response to Prednisone
93% responders 73% respond within 14 days 94% respond within 28 days

[Pediatric Board Review] (17 decks)

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