Nephrology Flashcards
What is the definition of microscopic hematuria?
Greater than five RBCs per HPF
What is the first step of evaluation of microscopic hematuria?
Urine calcium and urine creatinine.
- Calcium:creatinine > 0.25 -> hypercalciuria w/u
- Calcium:creatinine < 0.25 -> renal ultrasound to look for structural anomalies
OR
Imaging, serum BUN, serum creatinine, coagulation studies, platelet count, ANA, ds-DNA, ESR, complement levels depending on the clinical picture
What is the work up for hypercalciuria?
Urine calcium to creatinine ratio.
- > 0.25 = hypercalciuria (idiopathic, Loop diuretics) -> repeat ratio from a 24 hour urine collection -> if greater than 4.0, get a renal ultrasound to look for a stone
What is the evaluation for proteinuria?
- 1+: repeat in 2 weeks
- 2+: get an AM void
- No protein: transient due to orthostasis
- Get a creatinine to check renal fxn - +: random protein-to-creatinine ratio
- >0.2: renal dz -> get renal bx
- No protein: transient due to orthostasis
What is the evaluation of UPJ obstruction?
- suggested on ultrasound by dilated renal calyces, pelvis, or frank hydronephrosis
- May be born with signs of oligohydramnios
- Confirm with postnatal ultrasound
- Get a VCUG to rule out other anomalies, look for reflux, and PUV
- Once ruled out, get a MAG3 furosemide renal scan to look for slow flow of urine from the renal pelvis into the ureter
What is the most common cause of urinary retention in girls?
Ureterocele
Symptoms are similar to those with UTI
Get IV pyelogram to look for a filling defect
What are the clinical features of post streptococcal glomerulonephritis?
- Proteinuria + hematuria +- edema +- HTN
- Labs: low C3, normal C4 +- renal impairment
- Follow C3 until back to normal
- If C3 still abnormal after six weeks, consider a different diagnosis
What are the clinical features of hemolytic uremic syndrome?
- Diarrhea caused by EHEC
- fever
- hemolytic anemia (Coombs negative)
- thrombocytopenia
- renal failure
- neurologic changes
- normal complement levels
What are the findings in glomerulonephritis?
Hematuria, elevated BUN, proteinuria, oliguria, hypertension
What are the findings of IGA nephropathy?
- Most common cause of primary glomerulonephritis
- Recurrent episodes of hematuria
- May be worse after a URI or G.I. illness
- Urinalysis shows rbc casts
- Diagnosed with renal biopsy, which will show IgA and IgG mesangial deposits
- Complement is normal
What are the findings in membranoproliferative glomerulonephritis?
- Hematuria
- Proteinuria
- High blood pressure
- Low C3 and C4
- Dx: biopsy showing TRAM TRACK LESIONS
What are the findings in nephrotic syndrome?
“They swell up like that big O in nephrotic syndrome.”
- Classic triad: Edema + Proteinuria + Hypoalbuminemia
- Albumin lost in urine
- Low urine sodium
- Low FeNa
- Etiologies: minimal change disease, focal segmental glomerular nephritis, membranous nephropathy, congenital nephrotic syndrome, membranoproliferative glomerulonephritis
What are the findings in a minimal change nephrotic syndrome?
- Common in toddlers or elementary school age children
- Most common etiology of nephrotic syndrome
- Abdominal pain, diarrhea, decreased urine output, normal creatinine
- Bx: loss of FOOT PROCESSES
What are the findings in focal segmental glomerulonephrosis?
Bx: segments of some glomeruli that have scarring
What are the findings in membranous nephropathy?
“Adolescent boys play with their thick loops (balls) and thick membranes until they get nephropathy- thickened capillary loops.”
- Adolescent with nephrotic syndrome
- Bx: diffusely thickened capillary loops
