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Peds-Final > nephrology > Flashcards

nephrology Flashcards

1
Q

avg. newborn systolic BP

A

70-75

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2
Q

avg 1 yr old systolic BP

A

90

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3
Q

avg 5 yr old systolic BP

A

95

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4
Q

avg 12 yr old systolic BP

A

100-105

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5
Q

HTN is BP > than 95th percentile for what?

A

age
gender
ht

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6
Q

HTN is more often_________than_________in CH

A

secondary than primary (“essential”)

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7
Q

HTN in CH, consider what types of dz first

A

renal dz

endocrine dz

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8
Q

early HTN in CH is a precursor to what?

A

serious adult HTN

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9
Q

HTN in CH DDx

A 
renal dz
endocrine
neurologic
psychologic causes
vascular causes
drugs
other
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10
Q

renal dz that may cause HTN in CH

A 
pyelonephritis
renal parenchymal dz
congenital anomalies
reflux nephropathy
acute glomerulonephritis
Henoch-Schonlein purpura
renal trauma
hydronephrosis
hemolytic-uremic syndrome
renal stones
nephrotic syndrome
Wilms tumor
hypoplastic kidney
polycystic kidney dz
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11
Q

endocrine dz that may cause HTN in CH

A 
hyperthyroidism
congenital adrenal hyperplasia
Cushing syndrome
primary aldosteronism
primary hyperparathyroidism
DM
hypercalcemia
pheochromocytoma
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12
Q

neurologic dz that may cause HTN in CH

A

increased ICP

Guillain-Barre syndrome

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13
Q

psychologic causes in HTN in CH

A

mental stress

anxiety

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14
Q

vascular causes of HTN in CH

A 
renal artery abnormalities
renal vein thrombosis
coarctation of the aorta
patent ductus arteriosus
arteriovenous fistula
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15
Q

some drugs that may cause HTN in CH

A

anabolic steroids
corticosteroids, OCPs
PCP, cocaine

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16
Q

other causes of HTN in CH

A

pain
collagen vascular dz
neurofibromatosis

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17
Q

Henoch-Schonlein purpura pneumonic

NAPA

A

Nephritis
Abdominal pain
Purpura-non blanching rash over buttocks & calves/ankles
Arthralgias

test urine initially weekly, then monthly to monitor for kidney failure

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18
Q

Hx taking in eval of HTN in CH

A 
CNS- HA, seizures
hearing impairment
CV- palpitations
renal- edema, UTI, urine output
meds
neonatal hx- hx of central cath
early CV dz
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19
Q

eval of HTN cause

A 
intracranial HTN
Alport syndrome
catecholamine
nephropathy (HUS, SLE, GN, tumor, ADPKD, etc)
OCPs
renal artery or aortic stenosis
obesity, essential HTN
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20
Q

Labs for evaluation of HTN in CH

A

BP measurements w/ approp. cuff size
electrolytes, BUN, cretinine, UA, urine cx
consider: CBC, uric acid, C3 level, FBG, lipid levels, urine catecholamines, renal ULS, echocardiogram & EKG

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21
Q

HTN tx in CH

A

treatable causes must 1st be r/o- much more common to have a treatable cause in CH than adults
exercise
diet changes to address obesity & co-morbidities
medical therapy- diuretics, ACEi, B-blockers, CCB

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22
Q

Hematuria DDx in CH

DOGSHIT

A 
Drugs
Oncologic
Glomerulonephritis
Stones
Hematologic
Infection
Trauma
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23
Q

Fever in a neonate

A

blood
CSF
urine

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24
Q

UTI labs in kids <2yo in addition to basics, like CBC

A

renal ULS- visualizes upper UT

VCUG (voiding cystourethrogram)- visualizes lower UT

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25
Q

what clinches the dx of kidney stones in CH

A

UA w/ micro to get WBC & RBC count (elevated)

the clincher is….CT w/o contrast

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26
Q

what are some of the causes of red urine w/o urinalysis evidence of blood

A

red dye
food
meds
chemicals excreted in urine

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27
Q

causes of red urine w/ urinalysis evidence of blood but no RBC on microscopy

A

free Hgb- hemolysis, DIC

free myoglobin-crush injury, burns, myositis, asphyxia

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28
Q

red urine w/ urinalysis & microscopy evidence of blood but no RBC casts

A

bleeding from urinary tract distal to renal tubules

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29
Q

red urine w/ blood & casts in urine

A

glomerular dz

  • immunologic dz (e.g. post-streptococcal glomerulonephritis)
  • inherited dz (e.g. Alport syndrome)
  • vascular injury (e.g. ATN, cortical necrosis)
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30
Q

hematuria work up

A

hx & PE
confirm true hematuria
-if microscopic w/ benign H&P=>recheck
-if repeatedly + or +H&P=>workup

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31
Q

hematuria DDx

A 
UTI/cystitis/urethritis
hypercalcemia
urolithiasis
trauma
post-streptococcal glomerulonephritis
IgA nephropathy
Henoch Schonlein purpura (HSP)
SLE
nephrotic syndrome 
membranoproliferative glomerulonephritis
Alport syndrome- sensorineural deafness, progressive renal failure
sickle cell trait/dz
structural abnormality
renal/urinary tract tumor
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32
Q

hematuria benign DDx

A

benign familial hematuria

post exercise

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33
Q

phase I workup for hematuria

A 
UA w/ microscopic exam
CBC
urine cx
chem 8 (including BUN, Cr)
24 hr urine collection for Cr, protein, Ca2+
serum C3 level
renal ULS
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34
Q

phase II workup for hematuria

A 
ANA titer
throat culture for Step pyogenes
ASO titer or DNAse B titer or streptozyme
urine erythrocyte morphology
coagulation studies
sickle cell screen
VCUG (voiding cystourethrogram)
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35
Q

hematuria & when a renal bx is indicated

A

persistent high grade microscopic hematuria;

microscopic hematuria & diminished renal function, proteinuria exceeding 150 mg/ 24 hrs, 2nd episode of gross hematuria

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36
Q

post streptococcal glomerulonephritis clinical presentation

A 
5-21 days (avg 10) post streptococcal infxn
gross hematuria (65% of cases)
edema (75% of cases)
HTN (HA, visual changes) 50% of cases
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37
Q

post streptococcal glomerulonephritis labs

A

elevated ASO titer
group A B-hemolytic streptococcal infxn
decreased C3 level

38
Q

tx of post-streptococcal glomerulonephritis

A 
Abx for streptococcus pyogenes
supportive care for renal function
-reduce salt intake
-tx w/ diuretics
-anti-HTN drugs
39
Q

IgA Nephropathy pathogenesis

A

glomerulonephritis w/ IgA immunoglobulin in mesangial deposits
absence of systemic dz

40
Q

IgA nephropathy clinical manifestations

A

episode of gross hematuria 1-2 days after a viral upper respiratory infxn
may be picked up by UA showing microscopic hematuria

41
Q

IgA nephropathy tx

A

usually resolves w/ minimal intervention in CH. some progress to have HTN, diminshed renal function, proteinuria. 25% of adults progress to end-stage renal dz

42
Q

clinical manifestations of SLE

A 
malar rash
discoid rash
photosensitivity
oral ulcers
arthritis
serositis
renal d/o-variable: minimal to end-stage
neurologic d/o
hematologic d/o
immunologic
\+ANA
43
Q

proteinuria

A

nml CH exretion <4 mg/m2/hr

proteinuria is a urinary protein loss of 50 mg/kg per 24 hrs

44
Q

proteinuria may be the result of normal activity such as

A

exercise
febrile illness
upright posture

45
Q

some non-renal causes of proteinuria

A

Fanconi syndrome
drug & heavy metal intoxication
processes that increase glomerular filtration such as physical damage, abnormal hemodynamics

46
Q

Clinical diagnostic criteria for nephrotic syndrome

A

generalized edema
hypoproteinemia ( 1g/m2/24 hrs
hypercholesterolemia (>250 mg/dL)

47
Q

pathophysiology of nephrotic syndrome

A

loss of basement membrane sialoproteins (loss of nml neg. charge)
allows glomerular permeability to proteins
protein loss in urine

48
Q

complications of protein loss in urine

A

hypoalbuminemia
loss of plasma oncotic pressure- fluid shifts from vascular to interstitial compartment
increases risk of thromboembolism
hepatic lipoprotein synthesis stimulated by hypoproteinemia

49
Q

most common presentation of nephrotic syndrome

A

sudden onset of pitting edema, wt gain or ascites

onset < 6 yo

50
Q

DDx of nephrotic syndrome

A 
transient proteinuria
postural (orthostatic) proteinuria
glomerular proteinuria
glomerular proteinuria
minimal change dz (typical nephrotic syndrome)
congenital nephrotic syndrome
focal segmental glomerulosclerosis
meangial nephropathy
membranous nephropathy
51
Q

transient proteinuria (w/ fever, dehydration, etc.)

A

protein to creatinine ratio reveals mild proteinuria, ratio <1

52
Q

postural (orthostatic) proteinuria

A

benign condition of moderate proteinuria while upright

rationale for 1st morning samples

53
Q

glomerular proteinuria

A

associated w/ acute illnesses involving kidney

54
Q

clinical findings of nephrotic syndrome

A

edema
periorbital swelling
oliguria
fluid shifts- ascites, pleural effusion, scrotal/ labial edema

55
Q

labs in nephrotic syndrome

A

low albumin
UA (proteinuria)- 1+ proteinuria on 2+ random specimens warrants quantitative measure or proteinuria (1st a.m. void spot protein/Cr ratio, ratio>0.5 prompts lab & radiographic workup)
C3 level
renal bx

56
Q

C3 level in nephrotic syndrome

A

a low C3 level is the most sensitive & specific test to imply a presence OTHER than minimal change dz

57
Q

renal bx in nephrotic syndrome

A

generally unremarkable

foot processes of glomerular basement membrane fused

58
Q

nephrotic syndrome tx

A

corticosteroids (80% of pts respond)
low Na+ diet to prevent massive fluid shifts
can try immunosuppressive agents
renal bx if no response to either above (this would typically preced steroids if C3 level was low- implying dz other than minimal change dz)

59
Q

complications of nephrotic syndrome

A

infection (peritonitis, bacteremia/sepsis- S. pneumoniae, E. coli), cellulitis
hypercoagulability
pleural effusion
renal insufficiency- BP instability

60
Q

what accounts for renal cysts as well as tuberous sclerosis

A

ADPKD (1:1000)
ARPKD (1:10k-40k)
ADPKD can present in infancy & CH

61
Q

urinary tract obstructions that can lead to nephropathy

A 
ureteropelvic junction (UPJ) obstruction
posterior urethral valves
62
Q

clinical manifestations of posterior urethral valves

A

poor urine stream
urethra dilates, VUR may develop, kidneys swell & become dysplastic
rupture of the renal pelvis may cause urinary ascites
hopefully caught on fetal ULS (as obstruction)

63
Q

what is the MCC of newborn ascites

A

rupture of the renal pelvis d/t posterior urethral valves

64
Q

hypospadias

A

ventral malposition of urethral meatus

10% have undescended testes

65
Q

severe cases of hypospadias prompt suspicion of what?

A

congenital adrenal hyperplasia & masculinization of female genotype

66
Q

hypospadias is often associated w/ what?

A

chordee (ventral curve in penile shaft)

67
Q

phimosis

A

unretractable foreskin
90% can retract by 16 yo
tx w/ serial stretching/ steroid cream
circumcision in severe cases

68
Q

paraphimosis

A

trapped retracted foreskin in coronal sulcus
foreskin becomes swollen, red, painful
reduce manually w/ lubrication & plenty of analgesia
rarely proceeds to circumcision

69
Q

testicular torsion

A

torsion of the testis twists the spermatic cord, causing vascular compromise of involved testicle

70
Q

S&S of testicular torsion

A 
acute onset of severe scrotal & testicular pain
n/v
swelling & color change of scrotum
transverse lie to testicle
vascular flow absent in scrotal ULS
71
Q

tx of testicular torsion

A

address in 1st 6 hrs of symptoms & 90% of testes will survive
surgical- detorsion, orchiopexy

72
Q

torsion of the appendix testis

A

appendix of the epididymis may torse & undergo vascular compromise

73
Q

S&S of torsion of the appendix testis

A

insidious onset of pain
n/v
“blue dot” sign- pain at upper pole of testicle w/ appearance of blue dot
point tenderness at epididymis
minimal swelling
torsion of testis needs to be r/o if pain is moderate or severe

74
Q

epididymitis

A

inflammation of the epididymis usually 2/2 infxn or inciting agent- STI, UTI/structural anomaly, trauma, chemical inflammation, often w/ antecedent sexual activity or UTI

75
Q

clinical presentation of epididymitis

A

pain & swelling of the epididymis
frequency, dysuria, urethral d/c
fever

76
Q

PE of epididymitis

A

normal vertical lie of testis
normal cremasteric reflex
scrotal edema, redness

77
Q

labs for epididymitis

A

UA, urine cx
urine nucleic acids for N. gonorrhoeae, C. trachomatis
gram stain & cx of urethral d/c
consider screening for other UTIs in high risk pts

78
Q

tx of epididymitis

A

Abx to address UTI/STI

further work up if age or circumstances suggest a structural anomaly- scrotal or renal ULS, VCUG

79
Q

hydrocele

A

trapped fluid around the testis located in the tunica vaginalis

80
Q

what are the 2 types of hydrocele

A

communicating- precursor to inguinal hernia

non-communicating

81
Q

tx of hydrocele

A

observation 1st 2 years of life

earlier if underlying problem (adj. testis becomes inflamed), not resolving, compromise to the testicle

82
Q

varicocele

A

tortuous collection of veins around the spermatic cord

83
Q

clinical sx’s of varicocele

A

fullness
may be asymptomatic
“bag of worms”

84
Q

tx of varicocele

A

tx to preserve function of testes
observation- testicular vol., LH, FSH levels
surgical intervention- embolization, ligation

85
Q

spermatocele

A

sperm-containing cyst distinct from the testis. may arise from epididymis, rete testis, or ductulis efferentes

86
Q

dx of spermatocele

A

transilluminates

ULS

87
Q

tx of spermatocele

A

surgical excision for comfort

88
Q

undescended testes

A

more common in premies
present in 3.4% of newborns, remains in 0.7% at 1 yo
if no descent by 1 yo, testes are located (if present) & surgically corrected/removed

89
Q

retractile testes

A

retract from scrotum when cold

present in scrotum by parent’s report

90
Q

testes retained in the abdomen are at higher risk for what

A

progression to testicular cancer. rates higher for infertility & torsion

Peds-Final (10 decks)

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