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Peds > nephrology > Flashcards

nephrology Flashcards

1
Q

RBC cast

A

diagnostic of glomerular bleeding. in acute or active glomerulonephritis

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2
Q

RBC morphology

A

blebs- gomerulus

biconcave- lower urinary tract

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3
Q

large # RBC

A

acute hemorrhage cystitis. bacterial/viral infection or chemo

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4
Q

hematuria

A

1) infection: UTI, hemorrhagic cystitis -adenovirus
2) trauma
3) hematologic: SCD, thrombocytopenia, thrombosis
4) metabolic: hypercalcemia
5) structural: tumor, obstruction, stone,
6) glomerular: berger’s, henoch schonlein purpura, post strep glomerulonephritis, alport’s sydnrome

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5
Q

proteinuria

A

> 100/d.
false pos if urine is very concentrated or on meds
TP/Cr is 2yo

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6
Q

urinary beta2 microglobulin

A

elevated in tubular proteinuria. freely filtered in glomerulus. usually completely reabsorbed at tubular epi. so if in urine, tubular injury

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7
Q

glomerulonephritis

A

inflm at glomeruli. usually immune mediated injury. primary- limited to kidney. secondary- part of a systemic disease (SLE)
P: variable. acute nephrite syndrome, nephrotic syndrme or asx
labs: urinalysis, urinary TP/Cr, blood chem, serm complemetn components, ab testing, IgA lvl.
types: poststrep GN, IgA nephropathy, Henoch schonlein purpura nephritis, membranoproliferative GN, SLE

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8
Q

acute nephrite syndrome

A

gross hematuria, HTN, signs of fluid overload from renal infuse

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9
Q

nephrotic syndrome

A

proteinuria, hyperchiilesteremia, edema

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10
Q

microalbumin

A

elevated in glomerular proteinuria. incr permeability

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11
Q

post streptococcal GN

A

dev 8-14d post infection of skin or pharynx or nephritogenic strain of GAS.
P: hematuria (gross), proteinuria, HTN+ fluid overload sx, low serum complement 3.
dx: ASO titer pos in 90% after pharyngitis. ABD titer pos after respiratory or skin infection with strep
tx: supportive. diet, ant-htn

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12
Q

IgA nephropathy

A

= merger’s disease. most common type of chronic GN.
etio: abn clearance of IgA complexes
P: repeat bouts of gross hematuria associated with respiratory infection. microscopic hematuria btw bouts
dx: renal bx-mesangial prolif and incr mesangial matrix
tx: supportive, ACEi, steroids
prog-variable

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13
Q

Henoch schonlein purpura nephritis

A

IgA mediated vascliits, nonthrombocytopenic palpable purpura on buttocks and thighs, abd pain, arthritis or arthralgia, gross or microscopic hematuria

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14
Q

membranoproliferative GN (MPGN)

A

lobular mesangial hypercellularity and thickening of glomerular GM.
nephritis or nephrotic syndrome + micro/gross hematuria, HTN, low serum complement, most pt dev end stage renal disease
tx: none, try corticosteroid, ace

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15
Q

nephrotic syndrome (NS)define and types

A

heavy proteinuria >50, hypoalbuminemia, hypercholesterolemia, edema
2/3 bf 5yo
3 categories
1) primary NS: 90% of all childhood cases. most common is minimal change disease (MCD)
2) NS from other primary glomerular disease like IgA nephropathy, MPGN, PSGN
3) NS from systemic disease like SLE

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16
Q

NS presentation

A

edema, follows URI. predispose to thrombosis 2/2 hypercoag –> renal vein thrombosis, DVT
incr rist for infection with encapsulated organism like strep pneumonia. present with spontaneous bacterial peritonitis, pneumonia or sepsis

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17
Q

NS dx

A

urinalysis 3+/4+ protien. CBC show elevated hct due to hsmoconc form hypoproteinemia. metabolic acidosis from renal tubular acidosis, hypoalbuuminemia elevated hl. C3, ANA antistrep ab to r/o other causes of NS. renal US-enlarge kidney. renal bx-rare

18
Q

NS tx

A

dep on cause. supportive
hospitalized for initial tx
if widespread edema- IV infusion of 25% albumin
low salt diet, corticosteroid for MCD pt. empiric ab if febrile bc risk of pneumococcal infection
5% mortality from infection or thrombosis. response to steroid = less likely to dev ESRD

19
Q

hemolytic uremic syndrome (HUS)

A

acute renal failure in presence of microangiopathic hemolytic anemia and thrombocytopenia
2 types: shiga toxin associated HUS and atypical HS

20
Q

shiga toxin associated HUS (Stx HUS)

A

most common type in kids
e coli toxin
vascular endo injury by shiga toxin to end cells - plt thrombi formation and real ischemia
P: diarrheal prodrome (often bloody) then onset of hemolytic anemia, thrombocytopenia, acute renal failure
tx: supportive, no antibiotics. antibiotics for tx of coli in hemorrhagic colitis incr risk of HUS
prog- favorable, C- toxic megacolon

21
Q

atypical HUS

A

drugs or inherited. P ~ Stx HUS although no diarrhea. supportive tx, stop meds, relapsing course. more become ESRD than sty HUS

22
Q

hereditary renal disease

A

alport’s , multicystic renal dysplasia= most common cause of renal mass in newborn, ARPKD, ADPKD, medullary sponge kidney,

23
Q

alport’s syndrome

A

progressive herediatary nephritis 2/2 side chain of type IV collagen in glomerular BM. x-linked dom.
HTN, hematuria, ESRD sometimes
hearing loss progressive, ocular abn in lens and retina
tx: tx HN with ACEi, renal transplant

24
Q

ARPKD

A

uncommon. oligohydramnios, pul hypoplasia
greatly enlarge dcysic kidney. severe HTN, lier involved- cirrhosis, portal HTN
progressive - all need renal transplant

25
Q

ADPKD

A

present 20-40yo. flank mass, UTI, hematuria, HTN, renal isuf. cerebral aneurysem.
need transplant

26
Q

HTN et by age

A

neonates- most common cause- renal artery embolus after umbilical artery catheter placement, coarctation of aorta, congenital renal disease, renal stenosis
1-10yo: renal disease and coarctation
adolescents: renal disease and essential HTN

27
Q

HTN features

A

infant: nonspecific. irritable, V, FTT, sz, CHF
kids: if acute malig HTN- HA, sz, stroke
kids with chronic HTN- growth retardation, poor school performance

28
Q

renal tubular acidosis (RTA) define and types

A

inability of kidney to maintain normal acid base balance bc defect in bicarb conservation or excretion of H ions.
etio
1) congenital: mut in transporter of proximal or distal tubular cells
2) acquired: nephrotoxic drugs -amphotericin

29
Q

RTA P by age

A

infant- growth failure and V
older kids- recurrent calculi, M weakness bone pain, myalgias
nephrocalcinosis-polyuria
hyperchloremic metabolic acids with normal serum anion gap!!

30
Q

RTA eval

A

suspect in pt with non-anion gap hyperchloremic metabolic acidosis. confirm by venous blood gas.
calc urine anion gap= positive (Na+K-Cl).
eval for fanconi syndrome

31
Q

acute renal failure

A

abrupt decr in ability to excrete nitrogenous wastes
P: lethargy, N/V, respiratory distress, HTN, sz, oliguria-nonoliguric
dx: lab: serum electrolyte, BUN, cr, UA, US, nuclar renal scan
tx: fluids. electrolyte, restrict protein intake, dialysis

32
Q

chronic renal isuf and ESRD

A

most commonly glomerular disease.

33
Q

prerenal failure

A 
reversible decr in renal perfusion that leads to decr GFR. 
dehydration, hemorrhage, CHF, shock.
incr bun/Cr>20. 
incr urine SG>1.03
osmolarlity>500
urine Na
34
Q

renal parenchymal failure

A

damage to glomerulus (lupus, HUS,)- hematuria, proteinuria
damage to tubules (ischemic)- urinary Be micro globulin
interstitium (drugs)- eosinophilia, eosinophiluria, incr micro globulin

35
Q

post renal failure

A

obstruction of urine flow by stones, tumor, ureterocele, trauma. dilation of renal collecting system on US

36
Q

Vascular renal failure

A

decr perfusion of kidney due to renal artery embolus, renal vein thrombosis. decr blood on nuclear scan

37
Q

dialysis

A

initiated if GFR is 5-10% of normal. peritoneal dialysis is preferred

38
Q

multicystic dysplastic kidney

A

most common abd mass in newborn. associated with atrocity ureter

39
Q

VUR

A

low dose prophylactic antibody to decr risk of UTI until outgrow VUR

40
Q

urolithiasis

A

calcium salt. unusual in kid so look for predisposing metabolic D- hypercalciuria (idiopathic, fuosemid euse, familial hyeprcalciuria), hyperoxaluria (IBD), distal RTA, hyperuricouria, cystinuria, UTI, hyperPTH
labs: electrolyte, UA, BMP, PTH, uric acid lvl, venous blood gas to r/o RTA. urine testing, imaging-xray, stone fragment analysis

41
Q

UTI

A

may present as enuresis in previously toleit trained
dx
1) neonate and infant: collect urine by suprapubic aspiration of bladder via sterile urethral catherization
2) leukocytes on microscopy>5-10. pos nitrite or luekocyte esterase
3) culture is gold standard
4) US and VCUG for all peel, recurrent UTI girls with cystitis

Peds (21 decks)

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