Nephrology Flashcards
Most common chronic glomerular disease worldwide
More common in males
Predominance of IgA within mesangial deposits of the glomerulus
Normal C3 level
Gross/microscopic hematuria associated with URTI or GI infection 1-2days prior to its onset
IgA Nephropathy/Berger Disease
Treatment for IgA Nephropathy
ACE inhibitors and ARBs - proteinuria, proper BP control
X-linked disease due to mutation in the COL4A5 gene
All patients have asymptomatic microscopic hematuria
Bilateral sensorineural hearing loss
Anterior lenticonus
Alport Syndrome / Hereditary Nephritis
Presence of persistent microscopic hematuria and isolated thinning of the GBM on electron microscopy
Thin Basement Membrane Disease
Immune complex mediated reaction
It follows infection of the throat (1-2wks) or skin (3-6wks) by GABHS
Decrease in C3/hypocomplementemia
Gross hematuria, periorbital edema, hypertension and oliguria
Lumpy-bumpy pattern
Subepithelial humps
Acute Poststreptococcal Glomerulonephritis
Best single Ab titer to document skin infection
DNAse B antigen
DOC for acute PSGN
Penicillin (10 days)
(+) anti-GBM antibody
IF: linear IgG, C3
EM: no deposits
LM: focal to diffuse proliferation with crescents
Associated with pulmonary hemorrhage, iron deficiency anemia
Treatment: cyclophosphamide, plasma exchange, steroids
Goodpasture Syndrome
Hallmark: Crescents in the majority of glomeruli
Rapid and relentless progression to ESRD
Acute nephritis with concomitant proteinuria, often with nephrotic syndrome
Crescentic glomerulonephritis / Rapidly Progressive Glomerulonephritis
Microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency
Onset is preceded by gastroenteritis
Eating of undercooked meat and unpasteurized milk
Helmet cells, Burr cells, schistocytes on PBS
Hemolytic uremic syndrome
Most common form of Hemolytic uremic syndrome
Toxin-producing E. Coli
Microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency, CNS involvement, fever
Thrombotic Thrombocytopenic Purpura
Sudden onset of gross/microscopic hematuria and unilateral flank mass, flank pain, oliguria, hemolytic anemia, thrombocytopenia
Renal Vein Thrombosis
Bilateral palpable flank masses in an infant with pulmonary hypoplasia, oligohydramnios/Potter fascies, hypertension
Polycystic Kidney Disease
Most common cause of Urinary tract infection
E. Coli
Fever, flack pain, nausea and vomiting, malaise
Pyelonephritis
Gross hematuria and dysuria, urgency, frequency, incontinence, malodorous urine, suprapubic pain
Associated with Adenovirus
Cystitis
(+) urine culture without any manifestations of infection
Most common in girls
Asymptomatic bacteriuria
DOC for Acute Cystitis
Trimethoprim-Sulfamethoxazole (3-5 days)
Treatment for pyelonephritis
Oral: Cefixime
IV: Ceftriaxone 50-75mg/kg/day OR Cefotaxime 100mg/kg/day OR Ampicillin 100mg/kg/day plus Gentamicin 3-5mg/kg/day
Heavy proteinuria (40mg/m2/hr)
Hypoalbuminemia (<2.5mg/g/dl)
Hyperlipidemia
Edema
Nephrotic Syndrome
Most common idiopathic form of nephrotic syndrome
E/M: flattening of effacement of epithelial cell foot processes
Normal C3 level
Minimal Change Disease
Most common cause spontaneous bacterial peritonitis?
Streptococcus pneumoniae
Increased T3 and T4; low TSH; (+) TRSAb
Anxiety attacks with palpitations, feeling of restlessness
Marked proptosis and fine tremors with increasing frequency
Graves’ Disease
Low T4 & T3; elevated TSH
Prolonged physiologic jaundice
Birthweight and length are normal
Feeding difficulties, sluggishness, lack of interest, somnolence
Hypothyroidism
Most common cause of thyroid disease in children and adolescents
Thyroiditis
Stimulates osteoclasts to reabsorb calcium in the DCT
PTH
Inhibits osteoclast activity thus decreasing calcium reabsorption
Calcitonin
Most commonly due to a PTH-producing parathyroid adenoma that is not responsive to normal feedback regulation via an increased Ca concentration
Primary hyperparathyroidism
High PTH production due to decreased Ca and resulting in compensatory parathyroid gland hyperplasia
Secondary Hyperparathyroidism
Persistent parathyroid hyperfuction in spite of hypocalcemia correction and preexisting secondary hyperparathyroidism
Tertiary Hyperparathyroidism
Most consistent x-ray finding in hyperparathyroidism
Resorption of subperiosteal bone along the margins of the phalanges of the hands
Deficiency of 21-hydroxylase: increase serum 17-Hydroxyprogesterone
Congenita Adrenal Hyperplasia
Deficient production of cortisol or aldosterone due to congenital or acquired lesion of the hypothalamus, pituitary gland or adrenal cortex
Addison’s Disease
Gradual muscle weakness, general wasting, hypotension
increased skin pigmentation on face and hands, most intense around the genitals
Addison’s Disease
Obesity with associated hypertension which is the result of abnormally high blood levels of cortisol resulting from hyperfunction of the adrenal cortex
Cushing syndrome
Cathecholamine secreting tumor arising from the chromaffin cells
Pheochromocytoma
Most common sex chromosomal aneuploidy in males
Tall, slim, underweight, long legs, small testes and penis
Associated with leukemia and lymphoma
47, XXY / Klinefelter Syndrome
Cardinal finding in all girls with Turner Syndrome
Short stature
Most common skeletal abnormalities in Turner Syndrome
Shortening of the 4th metatarsal and metacapal bones
epiphyseal dysgenesis in the joints of the knees and elbows
Most common endocrine-metabolic disorder of childhood and adolescence
Diabetes Mellitus
Diagnostic criteria Diabetes Mellitus
Random plasma glucose >200 mg/dl
Fasting plasma glucose >126 mg/dl
PLUS polyuria, polydipsia, unexplained weight loss with glucosuria and ketonuria
Secondary nephrotic syndrome should be suspected in patients with
Proteinuria
Hypertension
The antihypertensive medication of choice in ALL children with proteinuric renal disease at chronic kidney disease
Enalapril
