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Pediatrics- Noelle > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Post strep GN

  • what age
  • after what infection, time frame
A

age 5-15
after Group A beta hemolytic streptococcus
cellulitis- 5 days after if co-infection with staph aureus otherwise 3 weeks post infection
pharyngitis- 7-10 days after

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2
Q

what is the classical presentation of post strep GN

A

Hypertension- 50 to 90%

Gross hematuria and edema- 30 to 60%

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3
Q

what happens to C3 and C4 with post strep GN
ANA?
ASO titer?
urine?

A 
low C3 (90% will be low at presentation)
C4 normal
ANA negative
ASO titer may be elevated
red cells, red cell casts, positive for leukocytes
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4
Q

when do ASO titers peak?

A

4 to 6 weeks after strep infection but may remain detectable for several months after the strep infection has resolved

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5
Q

when should your C3 normalize after post-strep GN

A

8 weeks
if it doesn’t normalize then think membranoproliferazive glomerulonephritis
microscopic hematuria persists for up to a year

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6
Q

List 4 diagnoses that can cause a low C3

A 
post strep GN
Lupus
membranoproliferative glomerulonephritis
subacute bacterial endocarditis
shunt nephritis
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7
Q

what is the treatment for post strep GN

A 
supportive
fluid and salt restriction
Furosemide (1-2mg/kg/day)
treat hypertension- resolves by 2 weeks
Short-acting or long-acting antihypertensive medications: Nifedipine/Hydralazine or Amlodipine

C3 level should return to normal by 6-8 weeks
proteinuria may last for 4 months
microscopic hematuria may last for 2 years though most cases resolved by 3-6 months

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8
Q

how is IgA nephropathy diagnosed?

A

renal biopsy

most common in adolescents

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9
Q

when do you see gross hematuria with IgA nephropathy?

A

Gross hematuria often occurs within 1-2 days of onset of an upper respiratory or gastrointestinal infection, in contrast with the longer latency period observed in acute postinfectious glomerulonephritis

gross hematuria gets better as they get better (typically only lasts 3-4 days)

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10
Q

what happens to C3 and C4 with IgA nephropathy

A

normal!!

Normal serum levels of C3 in IgA nephropathy help to distinguish this disorder from postinfectious glomerulonephritis.

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11
Q

what are the treatment options for IgA nephropathy

A

ACE, fish oil, corticosteroids

The primary treatment of IgA nephropathy is appropriate blood pressure control and management of significant proteinuria.
ACE inhibitors and angiotensin II receptor antagonists are effective in reducing proteinuria and retarding the rate of disease progression when used individually or in combination.
Fish oil, which contains antiinflammatory omega-3 polyunsaturated fatty acids, may decrease the rate of disease progression in adults
If a renin-angiotensin system (RAS) blockade proves ineffective and significant proteinuria persists, then addition of immunosuppressive therapy with corticosteroids is recommended.

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12
Q

what is alport syndrome

A 
Alport syndrome (AS), or hereditary nephritis, is caused by mutations in type IV collagen, a major component of basement membranes.
85% are x-linked
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13
Q

what are the clinical features of alport syndrome

A

all patients have asymptomatic microscopic hematuria
hypertension
proteinuria (commonly progressive by 2nd decade of life)
renal failure
bilateral sensorineural hearing loss

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14
Q

what is seen on electron microscopy for alport syndrome? when do they need renal replacement therapy?

A

thin basement membrane

renal replacement therapy by 20-30 years of age

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15
Q

why do you refer alport syndrome to an ophthalmologist?

A

Ocular abnormalities, which occur in 30–40% of patients with X-linked AS, include ANTERIOR LENTICONUS, macular flecks, and corneal erosions.

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16
Q

Anterior lenticonus is pathognomonic for what?

A

Alport syndrome

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17
Q

what are 4 clinical features of Alport syndrome

A 
AS is highly likely in the patient who has hematuria and at least two of the following characteristic clinical features: 
macular flecks
recurrent corneal erosions
GBM thickening and thinning
sensorineural deafness.
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18
Q

what are the features of anti-GBM disease (Goodpasture disease)

A

autoimmune disease characterized by

  • pulmonary hemorrhage
  • rapidly progressive glomerulonephritis
  • elevated anti–glomerular basement membrane antibody titers
  • rare in children
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19
Q

what parts of the body are attacked by anti-GBM disease? good pasture syndrome

A

The disease results from an attack on these organs by antibodies directed against certain epitopes of type IV collagen, located within the alveolar basement membrane in the LUNG and glomerular basement membrane (GBM) in the KIDNEY

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20
Q

how do children present with anti-GBM disease

A

hemoptysis from pulmonary hemorrhage that can be life-threatening
usually systemic symptoms (malaise, fever, weight loss, arthralgia) are ABSENT

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21
Q

What is the treatment for anti-GBM disease?

A

plasmapheresis** to remove the antibody
high-dose intravenous methylprednisolone
cyclophosphamide

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22
Q

what is the most important cause of morbidity and mortality in SLE.

A

lupus nephritis (diagnosed by renal biopsy)

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23
Q

Diagnostic criteria for Lupus

A 
SOAP BRAIN MD
need 4/11 criteria
Serositis – Pleuritis, pericarditis
Oral ulcers
Arthritis (2 or more joints)
Photosensitivity

Blood disorders- hemolytic anemia, leukopenia <4 or lymphopenia <1.5 or platelets <100 000
Renal involvement- nephritis
Antinuclear antibodies- ANA
Immunologic markers (dsDNA, anti-Sm, anti-ro)
Neurologic disorder- seizures, psychosis

Malar rash
Discoid rash

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24
Q

what is the most common cause of a midline mass of the abdomen in a newborn

A

mesenteric cyst

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25
Q

you are asked to see a newborn in the nursery for an abdominal mass. what is the most likely origin of this mass? what is the likely diagnosis?

A

renal mass
hydronephrosis
multi cystic dysplastic kidney

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26
Q

what are the top 3 causes of renal masses

A

hydronephrosis
multi cystic dysplastic kidney
renal vein thrombosis

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27
Q

what would be your first line modality to evaluate the renal mass?

A

ultrasound

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28
Q

NS is _____meq/L of Na

A

154 mEq/L Na

154 mEq/L Cl

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29
Q

how do you calculate body surface area

A

√height (cm) x weight (kg) ÷ 3600

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30
Q

what is the equation for insensible losses

A

400mL/m2

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31
Q

what is your minimum glucose requirement

A

4-6mg/kg/min

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32
Q

what are 2 conditions that present with normal anion gap metabolic acidosis

A
  1. RTA

2. Gastroenteritis (diarrhea)

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33
Q

where are most things absorbed in the kidney

A

65% of anything that goes through your body is predominantly absorbed in the proximal tubule

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34
Q

Proximal RTA

A 
pH <7
acidosis- HCO3 15
often hypoNa
can have hypoPhos
Glucosuria
Mild tubular proteinuria or generalized aminoaciduria
Fanconi's syndrome
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35
Q

Distal RTA

A 
urine pH >7
acidosis- HCO3 can go below 10
sodium usually normal
nephrocalcinosis may be present**
Hypokalemia
Hypercalciuria
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36
Q

what is the most common cause of proximal RTA

A

cystinosis

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37
Q

how do you treat distal RTA

A

potassium citrate

giving them bicarbonate

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38
Q

how do you treat proximal RTA

A

sodium citrate (because they are losing sodium through proximal tubule)

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39
Q

what are the 2 main causes of type 4 RTA

A

aldosterone deficiency

aldosterone resistance

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40
Q

what is the most common cause of distal RTA

A

idiopathic

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41
Q

what constitutes the single most important risk factor for future loss of kidney function

A

proteinuria

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42
Q

what is the most common cause of proteinuria in pediatrics?

A

transient proteinuria

  • exercise
  • fever
  • infection
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43
Q

what is the definition of persistent proteinuria

A

proteinuria on 2 or 3 separate samples taken 1-2 weeks apart

  • if you have a kid with proteinuria you have to repeat the sample 2-3x
    <1% have persistent proteinuria
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44
Q

how do we measure urine protein

A

on urine dipstick
or urine protein/creatinine ratio
- don’t do 24h urine collection

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45
Q

what is a normal protein/creatinine ratio for infants <2 years of age

A

upc <50mg/mmol

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46
Q

what is a normal protein/creatinine ratio for children >2 years of age

A

upc <20mg/mmol

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47
Q

what are 3 causes of false positive protein on urine dipstick

A

semen
menstrual blood
vaginal discharge

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48
Q

what is orthostatic proteinuria

A

normal, persistant proteinuria
seen in adolescents
assess with two separate night and daytime samples
if am sample upc <20mg/mmol then the diagnosis can be made
Prognosis: No treatment is required; benign disease

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49
Q

what is the average age for idiopathic nephrotic syndrome

A

2-10 years

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50
Q

what are causes of idiopathic nephrotic syndrome

A 
minimal change disease
mesangial proliferation
focal segmental glomerulosclerosis
membranous nephropathy
membranoproliferative glomerulonephritis

Approximately 90% of children with nephrotic syndrome have idiopathic nephrotic syndrome.

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51
Q

what is the initial treatment for nephrotic syndrome

A

prednisone
2mg/kg/day for 6 weeks
then 1.5mg/kg/ day for alternate days for 6 weeks and then stop
most children respond within 5-10 days of starting steroids
95% with steroid sensitive nephrotic syndrome are in remission by 4 weeks

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52
Q

what is the definition of remission

A

urine protein/creatinine ratio <20 or urine dipstick negative - trace for 3 days

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53
Q

what is the definition of relapse

A

after remission, increase in proteinuria of 20g/l for 3 days

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54
Q

what is the definition of frequently relapsing

A

2 or more relapses within 6 months or >/= 4 in any 12 month period
Cyclophosphamide prolongs the duration of remission and reduces the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome.

55
Q

how do you manage a patient with nephrotic syndrome

A

fluid and salt restriction
steroids
lasix/albumin

56
Q

what is the definition of steroid dependent

A

relapse during taper or within 2 weeks of discontinuation of steroids

57
Q

what is the definition of steroid resistant

A

inability to induce remission within 4 weeks of daily steroid therapy
2nd line agent- cyclosporine or tacrolimus

Children with steroid-resistant nephrotic syndrome require further evaluation, including a diagnostic kidney biopsy, evaluation of kidney function, and quantitation of urine protein excretion (in addition to urine dipstick testing). Steroid-resistant nephrotic syndrome is usually caused by FSGS (80%)

58
Q

what is the main cause of steroid resistant nephrotic syndrome

A

FSGS
50% will require dialysis/ transplant within 5 years
in pediatrics it is the most common cause of acquired end stage renal disease

59
Q

what is the most common cause of chronic kidney disease in pediatrics

A

congenital

60
Q

what are the four main features of nephrotic syndrome

A
  1. heavy proteinuria
    protein: creatinine ratio >20mg/mmol
  2. generalized edema
  3. hypoalbuminemia (<25g/l)
  4. hypercholesterolemia
61
Q

what are the initial investigations for nephrotic syndrome

A 
urine dipstick analysis
early morning urine for protein:creatinine ratio
urine microscopy and C&amp;S
electrolytes, albumin, urea, creatinine
CBC
VZV status
HepB and C serology, HIV
C3, C4
\+/- ASOT, ANA, ds-DNA
62
Q

what are features of an atypical presentation of nephrotic syndrome?

A 
age <12 months or >10 years
persistent hypertension
impaired renal function
hematuria (can be present in 10%)
low C3
positive hep B or C serology
63
Q

what are 3 complications of nephrotic syndrome

A 
1. increased risk for infection
especially cellulitis, spontaneous bacterial peritonitis, and bacteremia
- s pneumonia
- other streptococci
- ecoli
- enterobacteriaceae
- h influenza
  • spontaneous bacterial peritonitis must be considered inane child with NS who has severe abdominal pain, fever
  1. hyper coagulable state (risk of thrombosis)
    - decreased antithrombin III
    - decreased protein C and S
  2. hyperlipidemia
    - kids that are resistant or have FSGS with increased lipids are at increased risk of cardiovascular disease in the future
64
Q

what vaccinations are required for children with nephrotic syndrome

A

all routine vaccinations
live vaccinations >3 months off prednisone or cyclosporine
or > 6 mo after cyclophosphamide
annual flu vaccine

65
Q

how does glomerulonephritis typically present

A

with gross hematuria

66
Q

what are some causes of gross hematuria

A 
foods: beets, blueberries, plums, cherries, food colouring
hemoglobinuria- intravascular hemolysis
myoglobinuria- rhabdo
urate crystals
drugs- rifampin
porphyria
munchausen by proxy
67
Q

what is the most common cause of microscopic hematuria?

gross hematuria?

A 
microscopic= idiopathic hypercalciuria
gross= cystitis
68
Q

what is the most common presenting symptom of nephrotic syndrome

A

Edema is the most common presenting symptom of children with nephrotic syndrome

69
Q

how does spontaneous bacterial peritonitis present?

A

Spontaneous bacterial peritonitis presents with fever, abdominal pain, and peritoneal signs. Although Pneumococcus is the most frequent cause of peritonitis

70
Q

what is seen on electron microscopy for minimal change disease

A

85% of total cases of nephrotic syndrome in children
the glomeruli appear normal
electron microscopy simply reveals effacement of the epithelial cell foot processes.
More than 95% of children with minimal change disease respond to corticosteroid therapy.

71
Q

Barrter Syndrome

A

Present with hypokalemia, alkalosis, hyperaldosteronism, polyuria, polydipsia, hypercalciuria and salt wasting

Presents early with polyhydramnios
** like giving someone too much Lasix!!! (hypoK, met alkalosis, increased Ca in urine, polyuria)

72
Q

how does someone with type 4 RTA present

A

Hyperkalemic non-anion gap MA
Either impaired aldosterone production or impaired renal responsiveness to aldosterone
no aldosterone= high potassium

73
Q

Teenager found to have struvite stone. What would be next investigation?

A

urine culture

74
Q

how do you diagnose hypercalciuria

A

Hypercalciuria is diagnosed by a 24-hr urinary calcium excretion > 4 mg/kg

75
Q

what are the treatment options for hypercalciuria

A

thiazide diuretics

Sodium restriction is important because urinary calcium excretion parallels sodium excretion.
Importantly, dietary calcium restriction is not recommended

76
Q

what happens if you correct hyponatremia too quickly. What should you aim to increase your sodium by per day?

A

Na <120
Correcting too quickly can lead to osmotic demyelination
(central pontine myelinolysis)
Overall aim for slow correction < 0.5mmol/l/hr or =10- 12mmol/day

77
Q

what is multi cystic dysplastic kidney?

what are some associations with multicystic dysplastic kidney

A

MCDK- congenital condition in which the kidney is replaced by cysts and does not function
unilateral and not inherited (different from polycystic kidney disease)

MCDK is the most common cause of an abdominal mass in the newborn, but the vast majority are nonpalpable at birth

Contralateral hydronephrosis is present in 5–10% of patients.
Contralateral VUR
hypertension
Wilm’s tumor

78
Q

what is the equation for plasma osmolality

A

2Na + Glucose + BUN

-Affected by water content

79
Q

how does SIADH present

A

low serum osm
increased ADH-inappropriate elevated Urine osm (> 100)
urine sodium >20meq/l
low serum uric acid and high urine excretion of uric acid

Treat with Fluid Restriction and Remove offending agent

80
Q

How do you calculate anion gap? what’s a normal anion gap?

A

AG = Na – (Cl +HCo3)

Normal AG < 12mmol/l

81
Q

Causes of high anion gap metabolic acidosis

MUDPILES

A 
M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Paracetamol, Propylene glycol
I — Infection, Iron, Isoniazid (which can cause lactic acidosis in overdose), Inborn errors of metabolism (an especially important consideration in pediatric patients)
L — Lactic acidosis
E — Ethylene glycol
S — Salicylates
82
Q

Causes of nonanion gap metabolic acidosis

A 
USEDCRAP
U- ureteric diversion
S- Sigmoid fistula
E- Excessive saline
D- Diarrhea
C- carbonic anhydrase inhibitors
R- RTA
A- Addisons
P- Pancreatic fistula
83
Q

What is cystinosis

A

Cystinosis

            - autosomal recessive
            - lysosomal storage disease
            - accumulation of cysteine in various organs 
             - measurement of cysteine levels in leucocytes 				can confirm  diagnosis
84
Q 
Which of the following is seen in distal RTA
Hyperkalemia
Hyponatremia
Hypophosphatemia
Hypercalciuria
A

hypercalciuria

85
Q

Febrile UTI > 2ms < 2years. when should they get an ultrasound?

A

During or within 2 weeks of presentation

86
Q

what prophylaxis is recommended for grade IV/V VUR

A

TMP/SMX and Nitrofurantoin recommended unless resistant

If resistant to both consider d/c. Broader spectrum leads to more resistance

87
Q

what followup is recommended for a solitary kidney

A

No VCUG if ultrasound is otherwise normal
No antibiotics
Follow by ultrasound to be sure it grows appropriately
Yearly urinalysis, BP
Contact sports – no longer advise against it

88
Q

Most common renal stone in children

A

Calcium oxalate

89
Q

Treatment recommendations to prevents calcium oxalate stone

A

Increase fluids
Low salt diet to decrease calciuria
Increase citrate in diet as natural inhibitor
Do not restrict calcium in diet unless hypercalcemia
Minimize use of furosemide/steroids/excess vit D
Consider thiazide diuretic to decrease calciuria or potassium citrate to augment stone inhibition

90
Q

what are some indications for dialysis

AEIOU

A

A-acidosis
E- electrolyte abnormalities – hyperkalemia, hyponatremia, hyperphosphatemia
I- intoxication/poisoning – ethylene glycol, ASA, lithium
O- overload – fluid
U- uremia - mental status change, pericarditis

91
Q

14y old boy in your office for pre-camp physical; 3+ protein in urine x2; exam is normal; what is most likely cause?

a) exercise induced
b) IgA nephropathy
c) nephrotic syndrome
d) orthostatic proteinuria

A

orthostatic proteinuria

92
Q

What is the most common cause of proteinuria in an otherwise well teen? How would you test for this? Two causes of false +ve proteinuria on dipstick.

A

Answer: Orthostatic proteinuria
Diagnostic test: 3 consecutive first morning urines with negative protein
False +ve: Concentrated urine (SG>1.010), gross hematuria, fever, exercise

93
Q

Diabetic patient with microalbuminuria. What drug to start?

a) hydrochlorothiazide
b) nifedipine
c) enalapril
d) salt and water restriction

A

enalapril

94
Q

Diabetic nephropathy, how do you diagnose it? what is the treatment?

A

Diagnosis: First morning urine showing albumin:creatinine ratio (ACR) >2.5mg/mmol on two occasions
Treatment: ACE inhibitors
Inhibit the renin-angiotensin system (RAAS) which results in decreased urinary protein excretion

95
Q

Patient presents with edema, abdominal distention, and proteinuria. Patient also has fever and is found to have spontaneous bacterial peritonitis. What is the MOST likely pathogen causing the SBP?

a) Streptococcal pneumoniae
b) E Coli
c) Enterococcus
d) Listeria

A

Streptococcal pneumoniae

96
Q

what are some complications of steroids

A 
Obesity
Labile mood
Hirsutism
Gastritis
Hypertension
Infection
Hyperlipidemia
Osteopenia
Diabetes
Avascular necrosis
Cataracts
Adrenal suppression
97
Q

what is the diagnostic criteria for nephritic syndrome

A

Gross hematuria
Hypertension (due to salt and water overload)
RBC or granular casts

98
Q

Renal-limited causes of low C3

A

Post-infectious GN**
MPGN (type 1 & II)
C3 Glomerulopathy

99
Q

systemic causes of low C3

A

SLE **
VP Shunt Nephritis
Subacute bacterial endocarditis

100
Q

renal causes of normal C3

A

IgA Nephropathy **
anti-GBM disease
ANCA-associated vasculitis (renal ltd)
Hereditary Nephritis

101
Q

systemic causes of normal C3

A

HSP **
Granulomatosis with polyangiitis
Goodpasture’s
Alport’s **

102
Q

5y old child with recent upper respiratory tract infection, now has respiratory distress and BP 150/110. Most likely diagnosis:

a) anxiety
b) pneumonia
c) myocarditis
d) Henoch-Schonlein purpura
e) post-infectious glomerulonephritis

A

post-infectious glomerulonephritis

103
Q

Decreased C3 is a feature of which of the following:

a) IgA nephropathy
b) HUS
c) Post-streptococcal glomerulonephritis
d) Nephrotic syndrome

A

Post-streptococcal glomerulonephritis

104
Q

what is the most common cause of acute nephritis in children around the world

A

post-streptococcal glomerulonephritis

105
Q

14y old girl with recurrent painless hematuria, best test?

a) C3
b) IgA level
c) Renal ultrasound
d) Hearing test

A 
IgA level (elevated in 35-50% IgA nephropathy)
although best test for IgA nephropathy is biopsy

If it was a boy, get the hearing test (Alport’s)

106
Q

Classic presentation of IgA

age?

A

First episode usually occurs between 15 -30y of age
Recurrent episodes of gross hematuria concomitant with infection (synpharyngitic)
Gross hematuria lasts <3 days
Microscopic hematuria and/or proteinuria may be the only signs
Not often associated with complete nephritic syndrome

Importantly, high IgA levels are only found in 35-50% of patients

107
Q

5y old M with intermittent abdominal pain and purpuric rash on thighs. He has joint pains and hematuria. Which of the following lab abnormalities would likely be present?

a) Thrombocytopenia
b) Schistocytes
c) Elevated IgA

A

Elevated IgA

108
Q

HSP

A

Common childhood vasculitis; Peak incidence age 5-7y
Immune complex-mediated vasculitis associated to IgA deposits
Clinical syndrome and multi-system disorder affecting predominantly skin, joints, GI tract, and kidney
Preceded by URTI (30-50%)
*Normal C3

109
Q

12y old female presents with a 2 week history of fevers, arthralgias, and myalgias. She is pale but otherwise looks well. She has blood and protein in her urine. ESR 50, WBC 3. Platelets normal.

a) Acute rheumatic fever
b) Wegener’s granulomatosis
c) Systemic lupus erythematosus
d) Juvenile rheumatoid arthritis

A

Systemic lupus erythematosus

110
Q

what happens to C3/C4 with lupus nephritis

A

Lupus nephritis: occurs in 80% of childhood-onset SLE; major determinant of prognosis

*Low C3/C4

111
Q

The most common manifestation of lupus nephritis is? 2nd most common?

A

The most common manifestation of lupus nephritis is microscopic hematuria (79%)
nephrotic syndrome- 55%

112
Q

What are the 3 core features of hemolytic uremic syndrome?

A

Thrombocytopenia
Microangiopathic hemolytic anemia (schistocytes)
Renal failure

113
Q

Which is important for measuring blood pressure?

a) Weight
b) Height
c) Tanner staging

A

height

*BP tables are dependent on age, sex, and height.

114
Q

What is the most common cause of hypertension in the newborn?

a) Renovascular
b) Coarctation
c) Hydronephrosis

A

Renovascular

*Most commonly renal artery thrombosis or stenosis

115
Q

11y old girl with hypertension confirmed by ambulatory monitoring, next step?

a) 24h urine catecholamines
b) Renal ultrasound
c) Start enalapril
d) Repeat monitoring

A

Renal ultrasound

116
Q

how should you measure blood pressure

A

Patient at rest for minimum 3 mins, sitting, right arm supported, cubital fossa at heart level
Cuff width at least 2/3 the width of the arm
If cuff too small, BP recordings are falsely high

117
Q

Most common causes of paediatric hypertension by age group
<1 month
>1 month- 6 years

A 
<1 month
Renal artery thrombosis
Coarctation of the aorta
Congenital renal disease
Bronchopulmonary dysplasia

> 1 month - 6 years
Renal parenchymal disease
Coarctation of the aorta
Renovascular disease

118
Q

Most common causes of paediatric hypertension by age group
>6-10
>10-18

A

> 6-10 years
Renal parenchymal disease
Renovascular disease
Essential hypertension

> 10-18 years
Essential hypertension
Renal parenchymal disease
Renovascular disease

119
Q

Initial HTN workup

A

Blood: CBC, electrolytes (including TCO2, extended), Cr/BUN, (fasting) lipids, optional: LFTs, TSH, renin, aldosterone, catecholamines, Hb A1C, drug screen
Urine: Urinalysis + microscopy, ACR, +/- urine metanephrines
Imaging: Renal US (+ Doppler), CXR
Functional tests: ECG, 24h ambulatory BP monitoring, +/- sleep study

120
Q

What are the 4 organ systems that should be checked for end-organ damage in a hypertensive paediatric patient?

A
  1. Kidney
  2. Heart
  3. Eye
  4. CNS
121
Q

Initial investigations for end organ damage

A

Kidney:
Urinalysis/microscopy
Urine protein-creatinine ratio
Renal US (+Doppler)

Heart:
ECG
Chest x-ray
Echocardiography (?LVH)

Eyes:
Fundoscopy (retinal changes, papilledema)

CNS:
History?
Imaging?
School performance?

122
Q

Treatment options for HTN

A

Lifestyle:
DASH (Dietary Approaches to Stop Hypertension) diet
Moderate - vigorous physical exercise 3-5d/wk for 30-60mins
Stress Reduction

Pharmacologic Management: Start with ACEi, ARB, long-acting calcium channel blocker (Amlodipine), or thiazide

123
Q

Normal BP for 1-13y?
Stage I HTN?
Stage 2 HTN?

A

Children Aged 1-13y
Normal BP: <90th percentile

Elevated BP: ≥90th percentile to <95th percentile OR 120/80mmHg to <95th percentile (whichever is lower)

Stage I HTN: ≥95th percentile to <95th percentile + 12mmHg, or 130/80 to 139/89mmHg (whichever is lower)

Stage II HTN: ≥95th percentile + 12mmHg, or ≥140/90mmHg (whichever is lower)

124
Q

Normal BP Children >13 ?
Stage I HTN?
Stage II HTN?

A

Children Aged >13y

Normal BP: <120/80mmHg

Elevated BP: 120/<80 to 129/<80mmHg

Stage I HTN: 130/80 to 139/89mmHg

Stage II HTN: ≥140/90mmHg

125
Q

what are 3 treatment options for hypertensive crisis

A

IV Labetalol
IV Nicardipine
IV Hydralazine

126
Q

what is nephrotic range proteinuria

A

Nephrotic-range proteinuria is defined as proteinuria > 3.5 g/24 hr or a urine protein:creatinine ratio > 2.
The triad of clinical findings associated with nephrotic syndrome arising from the large urinary losses of protein are hypoalbuminemia (≤2.5 g/dL), edema, and hyperlipidemia (cholesterol > 200 mg/dL).

127
Q

lab results with SIADH

A

hyponatremia
an inappropriately concentrated urine (>100 mOsm/kg), normal or slightly elevated plasma volume
normal-to-high urine sodium
low serum uric acid.

128
Q

how is cerebral salt wasting different from SIADH

A

Hyponatremia
elevated urinary sodium excretion (often >150 mEq/L), excessive urine output **
hypovolemia **
normal or high uric acid **
suppressed vasopressin
elevated atrial natriuretic peptide concentrations (>20 pmol/L).

129
Q

what is the treatment for SIADH

A

Chronic SIADH is best treated by oral fluid restriction.

130
Q

what are 4 urine tests you would do for evaluation of nephrolithiasis

A 
urinalysis
urine culture
calcium:creatinine ratio
spot test for cystinuria
24h urine collection for: creatinine clearance, calcium, phosphate, oxalate, uric acid
131
Q

Ddx SIADH (euvolemic)

A

hypothyroidism

glucocorticoid deficiency

132
Q

what is prune belly syndrome (whats the triad)

A

deficient abdominal muscles
undescended testes
urinary tract abnormalities probably results from severe urethral obstruction in fetal life

Oligohydramnios and pulmonary hypoplasia are common

Urinary tract abnormalities include massive dilation of the ureters and upper tracts and a very large bladder

Most patients have vesicoureteral reflux.

133
Q

what lab abnormalities are associated with ATN

A

The hallmark of ATN is a progressive increase in the serum creatinine and BUN.

sodium (UNa > 40 mEq/L)
fractional excretion of sodium > 2% (>10% in neonates)

134
Q

What are two causes of Fanconi syndrome

A
  1. cystinosis
  2. galactosemia
  3. glycogen storage disease

Pediatrics- Noelle (28 decks)

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