Nephrology 2 Flashcards
Extrarenal findings in adult polycystic kidney disease?
Cerebral aneurysms
Autosomal recessive polycystic kidney disease – extrarenal involvement? Management?
Liver involvement (cirrhosis with portal hypertension)
Renal transplantation
Symptoms of medullary sponge kidney?
Hematuria, UTI, nephrolithiasis
Hereditary renal diseases?
- Alport’s
- Multicystic renal dysplasia
- Infantile PKD
- Adult PKD
- Medullary sponge kidney
- Nephronophthisis-Medullary Cystic Disease Complex
Significant versus severe versus malignant hypertension?
Above 95th percentile
Above 99th percentile
End organ damage
Specific acid/base disorder in RTA?
Non gap hyperchloremic acidosis
Distal RTA – characteristic feature? Causes? Clinical presentation? Treatment?
Inability to excrete acid
Inherited, drugs (amphotericin)
Vomiting, growth failure, nephrolithiasis, nephrocalcinosis
Small doses of oral alkaline
Proximal RTA – characteristic feature? Causes? Clinical presentation? Treatment?
Impaired bicarbonate reabsorption
Heavy-metal, gentamicin, Fanconi syndrome
Vomiting, growth failure, muscle weakness
Large doses of oral alkali
Type III RTA? Treatment?
Variant of type 1 with bicarbonate wasting
Large doses of oral alkali
Type IV RTA – characteristic feature? Causes? Clinical presentation? Treatment
Transient acidosis in infants with hyperkalemia
Obstructive neuropathy, aldosterone deficiency
Failure to thrive
Furosemide to lower potassium, oral alkali
Oliguria in children?
Insensible water losses in children?
Urine output <1 mL/kg/hr
300 mL/m²/hr
General treatment for patient with renal failure?
- Restore intravascular volume first
- Maintain electrolytes
- Restrict protein intake
- Dialysis when conservative management fails
Medical management of renal failure?
- Nutritional – avoid phosphorus sodium, potassium. Take phosphate binders and vitamin D analogues
- Blood-pressure management
- Anemia – give EPO
- Growth – give growth hormone
- Electrolyte management
Lab findings in preanal azotemia? Intrarenal failure?
The BUN/creatinine > 20, FEna under 20 specific gravity >1.030, urine osmolality >500,
Decreased urinary B2-Microglobulin, FEna >1%
Child with real failure – when to dyalyse? Preferred method of dialysis in children?
GFR is 5-10% of normal; peritoneal dialysis
Causes of
- ureteropelvic junction obstruction?
- Ureterovesical Junction obstruction?
- Bladder outlet obstruction?
- Kinks, fibrous bands, Abarrant blood vessels
- Megaureter, ureterocele, abnormal insertion of ureter
- Posterior urethral valves (males), prune belly syndrome
Prune belly syndrome?
- Absence of rectus muscles
- Bladder outlet obstruction
- Undescended testicles/Cryptorchidism in males
Causes of renal agenesis?
- Failure of mesonephric duct
2. Failure of metanephric blastema
Vesicoureteral reflux - defect? Inheritance? Predisposes to? Outcome in most children? Outcome if severe VUR? Diagnosis? Management?
Urine influxing from bladder into ureters
Autosomal dominant
Pyelonephritis; most have spontaneous resolution
Reflux uropathy which may lead to ESRB
Voiding cystourethrogram
- Low-dose prophylactic antibiotics
- Consideration of surgical reimplantation of ureters
Grading for vesicoureteral reflux?
Grade 1 – reflux into distal ureter
Grade 2 – reflux into renal pelvis and calyces without dilation
Grade 3 – Reflux into calyces with dilation
Grade 4 – dilation causes clubbed calyces
Grade 5 – gross dilation of entire collecting system
Most common kidney stones in children? Conditions associated with urolithiasis?
Calcium salts, uric acid, cysteine, struvite
- Hypercalcemia
- hyperoxaluria (Due to Malabsorption)
- Hyperuricosuria Lesch-Nyhan, gout, leukemia
- Sistine urea
- UTI – especially Proteus
UTI – epidemiology children?
Critical features in neonates? Older infants? Young children?
Urine sample in neonates/infants versus children?
Diagnostic test?
younger than six months – uncircumcised boys
Older than six months – girls
Neonates – fever, irritability, jaundice
Older infants – fever, vomiting, irritability
Young children – nocturnal enuresis, daytime wetting
- Neonates/infants – sterile catheterization
- Older children – clean catch
Gold standard – urine culture
All children with pyelonephritis, recurrent UTI, all males, all girls younger than four with cystitis
Urine culture for UTI – significant colony counts if collected by suprapubic aspiration? Sterile urethral catheterization? Clean catch?
Any group
> 10,000
50,000-100,000
UTI treatment in symptomatic patients? Neonates? Toxic appearing children?
Duration of treatment for cystitis? Pyelonephritis? Pyelonephritis in infants?
- Empiric Bactrim if symptomatic
- If neonates – admit for IV ampicillin/gentamicin
- If toxic appearing – admitted for IV antibiotic and hydration
7-10 days
14 days
Low-dose prophylactic antibiotics for three months to prevent renal scarring
