Nephrology Flashcards
Newborn Cr 83. Is that mother’s Cr or baby’s?
Mother’s.
- 2nd half of gestation fetus + mom Cr equilibrate Thus birth Cr= mother - usually see drop by 1 wk - GFR estimated by serum Cr - Rise in > 20= RF - vs BUN affect hydration
What anomaly is most likely to be seen with single umb. artery:
- renal
- cardiac
- other
Renal anomaly
Increased risk of renal agenesis
Absent left kidney. Right small. Will this progress to ESRD?
YES - in Childhood
Chronic kidney disease and RF. Most likely category if < 5 y.o. RF or > 5 y.o.
< 5= congenital anomaly
- renal hypoplasia, dysplasia, obstructive anomaly, prune belly syn
> 5= acquired or inherited
- glomerulonephritis, SLE, alport syndrome, cystinosis
List 5 findings with kidney failure:
- HTN (vol + excess renin made)
- Neuro symptom (uremia)
- Growth retardation
- Acidosis
- Buildup nitrogenous waste
- HyperK
- Anemia
- Renal osteodystrophy (impaired vit D= bone pain, #)
What is true of multi cystic kidney disease:
- VUR chance
- inherited
- hematuria
- early HTN
Chance of VUR
NOT inherited \++++ cysts Most common abdo mass in newborn HTN rare No hematuria (PCKD more) Associated: Contralateral UPJ, hypoplasia F/U US and BP See kidney f'n and if bad kidney involute (usually by 3 y.o.) Small malignancy risk.
Versus PCKD:
- inherited
- hematuria, RF in early childhood
- HTN
- resp +/- liver complication
B/L palpable kidney + pulmonary hypoplasia + HTN. Dx?
Polycystic kidney dx
Big bright echogenic kidney on U/S.
Issue: pul hypoplasia
Neonate with multcystic kidney disease. Which is true:
- ipsilateral hydrometer
- posterior uretheral vale
- sensorineural hearing loss
- cataract
- risk of CA
Risk of Malignancy (Wilm’s even if cyst regress)
VUR
Contralateral hydronephrosis
No association with cataract or hearing.
6 y.o. incidental finding of 2cm renal cyst. What to do:
F/U only.
Observe +/- repeat US
T or F: multi cystic kidney disease is inherited.
False!
Polycystic Kidney Dx IS (AR or AD)
Most common cause of abdo mass in NEWBORN
Hydronephrosis
Or MCKD
Weak abdo muscle. Cryptorchidism. B/L Abdo mass. Likely:
- bilateral will
- PCKD
- MCKD
- hydronephrosis
Hydronephrosis
*usually pt= males
Prune Belly Triad:
- deficient abdo muscle
- b/l undescended testes
- GU (severe urethral obstruction; VUR, hydronephrosis)
What is the prune belly triad?
Deficient Abdo Muscle
Undescended testes B/L
GU (severe urethral obstruction, VUR, hydronephrosis)
False (+) for protein on dipstick.
High urine pH (>7)
Highly [urine specimen]
Contamination w/ urine blood
Most common reason for persistent routine proteinuria in healthy 16 y.o.. What tests do you order?
Postural Proteinuria (aka orthostatic proteinuria)
First morning urine
Urine Protein:Cr ratio x 3d
List reasons for false (-) on proteinuria on dipstick
Dilute urine
Lg vol. of U/O
T or F: orthostatic proteinuria can be associated with HTN, low alb, or hematuria.
False
List 5 reasons for proteinuria:
**Transient (fever, exercise, infection)
**Orthostatic (Postural)
Overload > **Rhabdo (myoglobinuria), Hemolysis (hemoglobinuria)
Glomerular
> **Nephrotic Syn (minimal change, focal segmental, glomerular sclerosis, membranopathy)
> **Nephritic Syn (post infectious, IgA, alport, SLE, HSP etc.)
Tubular > **Acute tubular necrosis > Tubulointerstitial nephritis > Cystinosis > Wilson Dx > Fanconi syndrome > Drugs (pen, lithium, NSAID) > Metal (gold, lead)
GAS 2 wk ago. Now anemia, low plt, rising Cr, BUN. Dx?
- HUS or HSP
HUS
- non immune microangiopathic hemolytic anemia
- thrombocytopenia
- acute renal injury
Usually E coli. O157:H7
Can be Strep pneumoniae etc.
Which Glomerulonephritis have LOW C3?
Primary
- *> Post infectious (post strep for ex.)
- *> Membranoproliferazive GN
Secondary **> AI (SLE) **> Subacute Bac Endocarditis > Abscess or shunt nephritis > Cryoglobinemia
Which glomerulonephritis have NORMAL C3?
Primary
**> IgA nephropathy
> Anti-GBM Dx
> Idiopathic rapid progressive GN
Secondary **> HSP **> Alport Syn **> HUS > polyarteritis nodosa > Granulomatosis with polyangiitis (Wegner)
Decreased C3 in:
- IgA
- HUS
- post strep GN
- nephrotic syndrome
Post strep glomerulonephritis
All are true about Alport except:
- progressive sensorineural hearing loss
- 15% have ESRD by 15 y.o.
- 2-3% of all end stage renal dx due to Alport
- F have worse prognosis
- gross hematuria= bad prognosis
MALE have worse prognosis in Alport Syn.
T or F: Kids with HSP have increased IgA.
True
IgA deposition of small vessel skin, joint, GI, kidney.