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2019 RC Specialties > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Newborn Cr 83. Is that mother’s Cr or baby’s?

A

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
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2
Q

What anomaly is most likely to be seen with single umb. artery:

  • renal
  • cardiac
  • other
A

Renal anomaly

Increased risk of renal agenesis

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3
Q

Absent left kidney. Right small. Will this progress to ESRD?

A

YES - in Childhood

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4
Q

Chronic kidney disease and RF. Most likely category if < 5 y.o. RF or > 5 y.o.

A

< 5= congenital anomaly
- renal hypoplasia, dysplasia, obstructive anomaly, prune belly syn

> 5= acquired or inherited
- glomerulonephritis, SLE, alport syndrome, cystinosis

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5
Q

List 5 findings with kidney failure:

A
  • HTN (vol + excess renin made)
  • Neuro symptom (uremia)
  • Growth retardation
  • Acidosis
  • Buildup nitrogenous waste
  • HyperK
  • Anemia
  • Renal osteodystrophy (impaired vit D= bone pain, #)
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6
Q

What is true of multi cystic kidney disease:

  • VUR chance
  • inherited
  • hematuria
  • early HTN
A

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
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7
Q

B/L palpable kidney + pulmonary hypoplasia + HTN. Dx?

A

Polycystic kidney dx

Big bright echogenic kidney on U/S.
Issue: pul hypoplasia

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8
Q

Neonate with multcystic kidney disease. Which is true:

  • ipsilateral hydrometer
  • posterior uretheral vale
  • sensorineural hearing loss
  • cataract
  • risk of CA
A

Risk of Malignancy (Wilm’s even if cyst regress)

VUR
Contralateral hydronephrosis
No association with cataract or hearing.

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9
Q

6 y.o. incidental finding of 2cm renal cyst. What to do:

A

F/U only.

Observe +/- repeat US

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10
Q

T or F: multi cystic kidney disease is inherited.

A

False!

Polycystic Kidney Dx IS (AR or AD)

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11
Q

Most common cause of abdo mass in NEWBORN

A

Hydronephrosis

Or MCKD

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12
Q

Weak abdo muscle. Cryptorchidism. B/L Abdo mass. Likely:

  • bilateral will
  • PCKD
  • MCKD
  • hydronephrosis
A

Hydronephrosis

*usually pt= males

Prune Belly Triad:

  • deficient abdo muscle
  • b/l undescended testes
  • GU (severe urethral obstruction; VUR, hydronephrosis)
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13
Q

What is the prune belly triad?

A

Deficient Abdo Muscle

Undescended testes B/L

GU (severe urethral obstruction, VUR, hydronephrosis)

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14
Q

False (+) for protein on dipstick.

A

High urine pH (>7)
Highly [urine specimen]
Contamination w/ urine blood

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15
Q

Most common reason for persistent routine proteinuria in healthy 16 y.o.. What tests do you order?

A

Postural Proteinuria (aka orthostatic proteinuria)

First morning urine
Urine Protein:Cr ratio x 3d

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16
Q

List reasons for false (-) on proteinuria on dipstick

A

Dilute urine

Lg vol. of U/O

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17
Q

T or F: orthostatic proteinuria can be associated with HTN, low alb, or hematuria.

A

False

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18
Q

List 5 reasons for proteinuria:

A

**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)
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19
Q

GAS 2 wk ago. Now anemia, low plt, rising Cr, BUN. Dx?

- HUS or HSP

A

HUS

  1. non immune microangiopathic hemolytic anemia
  2. thrombocytopenia
  3. acute renal injury

Usually E coli. O157:H7
Can be Strep pneumoniae etc.

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20
Q

Which Glomerulonephritis have LOW C3?

A

Primary

  • *> Post infectious (post strep for ex.)
  • *> Membranoproliferazive GN
Secondary
**> AI (SLE)
**> Subacute Bac Endocarditis
> Abscess or shunt nephritis
> Cryoglobinemia
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21
Q

Which glomerulonephritis have NORMAL C3?

A

Primary
**> IgA nephropathy
> Anti-GBM Dx
> Idiopathic rapid progressive GN

Secondary
**> HSP 
**> Alport Syn
**> HUS
> polyarteritis nodosa
> Granulomatosis with polyangiitis (Wegner)
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22
Q

Decreased C3 in:

  • IgA
  • HUS
  • post strep GN
  • nephrotic syndrome
A

Post strep glomerulonephritis

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23
Q

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
A

MALE have worse prognosis in Alport Syn.

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24
Q

T or F: Kids with HSP have increased IgA.

A

True

IgA deposition of small vessel skin, joint, GI, kidney.

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25
Q

What is the most common vasculitis of childhood

A

HSP

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26
Q

What is the HSP triad

A
  1. Arthritis (large joint)
  2. Abdominal Pain (V/D, intussusception)
  3. Purpuric Rash (limb, buttocks)

+ Renal (IgA nephropathy, hematuria, proteinuria, HTN)

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27
Q

How do you dx HSP?

A

Petechiae/purpura
+ 1 of (joint, GI, renal, histology)

Resolve within 1 month.
1/3 Recur

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28
Q

What do you monitor if HSP?

A

HTN + U/A (wkly x 4 wk then q2wk till 3 month then monthly) x 6 month

Note: almost anyone who will have renal complication do by 6 month but most by 6 weeks!

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29
Q

Child present w/ bloody diarrhea, abdo pain, petechiae rash. UTI one week ago. Dx?

A

HSP

Note bowel angina= abdo pain or bloody diarrhea

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30
Q

What two lab test to her confirm dx of post strep glomerulonephritis?

A

ASOT

Low C3

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31
Q

Most common presenting symptom for nephrotic syn?

A

Edema

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32
Q

Weaned off steroids for nephrotic syndrome. Now relapse. Name 3 specific therapies?

A
  1. Repeat prednisone
  2. Cyclophosphamide
  3. Cyclosporine

+/- loop diuretic for extravasation and edema

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33
Q

What is the nephrotic syndrome Clinical triad?

A 
Edema +
Hypoalbuminemia (<25 g/L)
\+ Hypercholesterolemia
\+ Heavy proteinuria
Pr:Cr > 250 or > 40 mg/m2/hr
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34
Q

Proteinuria suggestive of nephrotic syn?

A

Proteinuria > 3.5 g/ 24h

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35
Q

What is the most common type of nephrotic syndrome?

A

Primary

** Minimal Change Dx

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36
Q

What type of nephrotic syn?

A

Primary

  • Minimal Change Dx
  • Focal Segmental Glomerulosclerosis
  • Memb Nephropathy

Secondary

  • Infection (Hep B, C, HIV, Malaria)
  • Drugs (Lithium, NSAID, Pen, Gold)
  • CA (lymphoma, leuk)
  • Other (SLE, amyloidosis, IgA)
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37
Q

Which vaccine contraindicated for child w/ nephrotic syn on steroids?

  • Pneumococcal 13
  • Hep B
  • Flu
  • Varicella Zoster
A

Varicella Zoster

= Live Vaccine!

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38
Q

Define FTT

A

wt < 3rd % tile
OR crossing 2 major %tile
OR < 80% for ideal wt for ht and age

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39
Q

List DDX for normal AG Metabolic Acidosis

A

Bicarb loss matched by serum ++ Cl

> Extra CL= IVF
GI Bicarb loss= diarrhea, ureterosigmoidostomy, NG loss, intestinal fistula
Renal Bicarb= RTA, early uremic acidosis, hyperparathyroid, low aldosterone etc.
Lose Renal H+ = RTA 1 and 4

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40
Q

T or F: renal tubular acidosis has anion gap metabolic acidosis.

A

FALSE

NORMAL AG
Met Acidosis

> Less H+ out
Less Bicarb Absorbed

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41
Q

FTT. Polyuria. Constipation (low K). BW non AG metabolic acidosis. Likely Dx?

A

Renal Tubular Acidosis

K low as H move into cell as K move out
Low K= GI muscle wkness= constipation

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42
Q

Describe Type 1 RTA

A

Type 1= One Letter
**Less H+ out
“i” sooner in distal
= Distal Tubule Issue

> Congenital
Secondary (Obstructive uropathy, Genetic like ethler-danlos, Sickle, SLE, Toxin like lithium)

**CC: stones
> Ca2+ in kidney
> Rickets, Osteomalacia

**Bicarb Low (<15)
**Urine pH > 5.5
Stones

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43
Q

Describe Type 2 RTA

A

Not 1.
= Less Bicarb reabsorbed
= In proximal tubule

> Isolated RTA (primary, carbonic anhydrase deficiency)
> Generalized = Fanconi
- primary
- IEM (**cystinosis)
- vit D deficiency
- Sjogren
- Toxin (lead)

CC: **glucosuria, a. acuduria, low P, K, Na

  • *Plasma Bicarb > 15
  • *Urine pH < 5.5

No stones but Rickets from low P and Vit D

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44
Q

Describe Type 4 RTA

A

= Hypoaldosterone (which usually promote acidifying urine)
= Less H+ out

> Congenital (CAH)
Acquired (Addison, Post B/L adrenlectomy, SLE)

** High K +++
Plasma Bicarb >15
No stones

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45
Q

3 wk old FTT. BP okay. Na 142, K 3.6. Metabolic acidosis. Urine pH 5. Likely:

  • HIGH aldosterone
  • Proximal RTA
  • CF
  • Psychosocial FTT.
A

Proximal RTA (Type 2)

Met acidosis +
Urine acidic (not RTA 1 or 4)

Vs.
High aldosterone= K out and Na in.
CF and Psychosocial not met acidosis.

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46
Q

Distal RTA.

  • Glycosuria
  • Hypercalcuria
  • Met Alkalosis
A

Hypercalciuria

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47
Q

Polyuria. Polydipsia. Hypokalemic. Metabolic alkalosis. Dx?

A

Bartter Syndrome.

= defect in loop of Henle (lose Na, Cl= vol contract= aldosterone so K out)

= Low K
+ Met ALKALOSIS
+ Hypercalciuria
+ Salt wasting.

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48
Q

14 mo. FTT. Met Acidosis. Bicarb 14. Urine pH 6.3

  • Distal RTA
  • Proximal RTA
  • Bartter
A

DISTAL

urine alkalotic

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49
Q

Tell me about Cystinosis.

A

= cysteine accumulate in renal tubular cell

  • French Canadian
  • Fair, Blond hair
  • Corneal bodies by 1
  • Rickets
  • Primary etiology of RTA 2
  • Glycosuria
  • Aminoaciduria
  • Phosphate/Na/K wasting
  • Tubular proteinuria

**WBC cysteine level dx

Tx:
Cystagon
Fanconi: water, lytes
Feeds: NG, GT
Indomethacin slow salt loss
Rickets (phosphate, vit D)
Etc. (thyroid, GH etc.
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50
Q

What do you get from infantile cystinosis?

  • Cataracts
  • ESRD
  • Nephrocalcinosis
A

ESRD

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51
Q

Post cardiac Sx. Poor U/O. BUN 25. Cr 177. Concentrated Urine.

  • ATN
  • Pre-Renal
  • Anaesthetic injury to kidney
  • Obstructive uropathy
  • Renal vein thrombosis
A

Pre-Renal

Urine Sp. Gravity high (> 1.020)

Low Urine Na

FeNa < 1%

Urine osmolality high (> 500 most/kg)

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52
Q

What are parameters suggestive of intrinsic AKI?

A

Urine Sp. gravity < 1.01 (Normal/ Dilute)

Urine Osmolality Low (< 350)

High urine Na (>40)

Fractional Excretion > 2%

ATN: brown granular cast
AIN: WBC, eosinophil, cellular cast

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53
Q

What does an obstructive post-renal cause parameter look like?

A

Urine na low if acute.
Urine osmol Low
FeNa low if acute process

Versus Intrinsic usually FeNa > 1%

54
Q

Describe three examples of AKI:

  • Prerenal
  • Intra-renal
  • Post renal
A

Pre renal

  1. Dehydration
  2. Hemorrhage
  3. Cardiac failure
  4. Sepsis
  5. Third space (low albumin)

Intra-renal

  1. Vascular (HUS)
  2. GN
  3. Acute interstitial nephritis (NSAID, pen, TB, Sjogren)
  4. Acute tubular necrosis secondary to ischemia (volume loss like hemorrhage, low intravascular volume like HF, rhabdo cause renal artery obstruction, Vasculitis, HUS)
  5. Tumour lysis Syn

Post-Renal

  1. PUV
  2. Ureteropelvic junction obstruction
  3. Ureterovesicular junction obstruction
  4. Hemorrhagic cystitis
  5. Tumour
55
Q

List three complications of acute kidney injury:

A
  1. ++ K
  2. Fluid status (pulmonary edema)
  3. HTN
  4. Neuro (from HTN and lytes - h/a, sz, confusion)
  5. Uremic Pericarditis
56
Q

List three indications for Dialysis:

A

“AEIOU”

> Acidosis
- severe intractable acid

> Electrolytes
- persistent ++ K

> Ingestion

  • ASA/ salicylate
  • Lithium
  • Na Valproate
  • Carbamazepine

> Overload or Not enough

  • Oliguria/ Anuria
  • Pul Edema refractory to diuretics

> Uremia
- encephalopathy, pericarditis, bleeding, neuropathy

57
Q

15 y.o. post trauma. Next day orange urine. Oliguria. High Cr. No improvement w/ fluid.

  • Rhabdo
  • Renal vein thrombosis
  • Pre renal failure
A

Rhabdomyolysis

58
Q

15 y.o. w/ rhabdo. Given lots of fluid but Cr still rises. Next step:

  • epi infusion
  • norepi infusion
  • mannitol infusion
A

Mannitol

*Theoretical benefit by pulling fluid into vasculature

59
Q

10 y.o. Post MCV. # and low BP. Lots of fluid. Over 48h get polyuria and Cr rise. Likely Dx?

  • Fat embolus
  • ATN
  • DM
A

ATN

Necrosis secondary to ischemia (volume deplete, myoglobinuria like rhabdo, HF etc.)

60
Q

Child with RF has anemia. Describe 4 mechanisms?

A
  1. EPO= Decreased erythropoietin production
  2. Fe deficiency from chronic blood loss (frequent BW, dialysis)
  3. Anemia of chronic dx
  4. B12 or folate deficiency
  5. Hyper parathyroidism
61
Q

Toddler w/ gastro. Moderate dehydration. Most appropriate:

  • IV fluid
  • IVF if vomiting
  • PO w/ Na
  • Stop BF and lytes
  • Hold refeeding
A

PO solution

Na 75
K 20
Cl 65
Glucose 75 (2%)
Osm 245
62
Q

T or F: ORT as effective than IV for mild-mod dehydration.

A

True

63
Q

T or F: glucose in ORT help enhance cotransport of Na which help Na/K ATP pump draw water in.

A

True

64
Q

List contraindications to PO feed in ORT if mild-mod dehydration:

A
  1. Protracted vomit despite small f feed
  2. Severe dehydration
  3. Paralytic ileus
  4. Monosacc malabsorption
65
Q

T or F: You should give plain water for dehydration.

A

False.

66
Q

T or F: you should not refeed if dehydrated.

A

False

Continue BF throughout if tolerated

67
Q

Best ORT for gastro and dehydration

  • Na 20; K 20; Glucose 10%
  • Na 75; K 20; Glucose 2%
  • Na 75; K 0; Glucose 8%
  • Gingerly
  • Apple Juice
A

Na 75
K 20
Glucose 2%

68
Q

Which accompanies hypernatremic dehydration:

  • Low BG; High Ca
  • High BG; Low Ca
  • High BG; High Ca
  • Low BG; Low Ca
A

HIGH BG

Low Ca2+

69
Q

List three etiology for Hypernatremia:

A
  1. Intake= **Excess Na in (PO, IV), **poor mix formula, ++ aldosterone
  2. Loss (Fluid loss> Na loss)
    - Pure water out= **DI, prem phototherapy
    - Water > Na out= GI (V/D), skin (burn, sweat), Renal (osmotic diuretic like mannitol)
  3. Other
    - Pharm: Lithium, Cyclophosphamide, Cisplastin
70
Q

How do you manage Hypernatremia:

A

Text: 0.45NS + D5
x 1.5 maintenance w/ monitoring

AHD:
1. +/- Bouls (20cc/kg NS over 20 minute)

  1. Calc Fluid Deficit= X
    wt x 10 x % (5-10-15 if < 10kg or 3-6-9 if > 10 kg)
  2. Total deficit = X- bolus = Y
  3. Replace Y over 48 h
    + Maintenance

Start w/ D5W 0.45 naCl w/ 20 KCL

  1. Serum Na monitoring q 2-4 hour

Do not lower by > 12 mEq/L/day (or 0.5 per hour)

71
Q

6 y.o. 10 minute GTC. HTN. Na 115. Urine Na 30. Euvolemic. Initial Tx? List two possible Dx?

A

Sz= 3% NS 3-5cc/kg IV push

Euvolemic Low Na:

  • *- SAIDH
  • *- Glucocorticoid deficiency
  • Hypothyroidism
  • Water intoxication
72
Q

Nephrotic syndrome w/ edema. Na 125. Best fluids?

A

Nothing (usually water + Na restrict and if need resus albumin + diuretics)

73
Q

List ddx for hyponatremia based on fluid status.

A

Hypovolemic
- ** CSW
- ** Adrenal insuff
- ** Renal (Addison, Diuretic, excessive loop diuretic)
Extra renal: GI (V/D), Burn, third space sepsis

= Restore vol w/ isotonic fluid

Euvolemic

  • ** SIADH (urine osmol < serum)
  • **Glucocorticoid deficiency
  • Low thyroid

= Eliminate excess water

Hypervolemic

  • **Nephrotic Syn
  • **CHF
  • Cirrhosis
  • Low Alb FPIES

= Water + Na restrict +/- diuretic (after alb)

74
Q

List three symptoms of hyponatremia:

A

N/V
H/A
Muscle Cramp

If < 120= sz, coma, resp arrest

75
Q

3 wk old infant w/ lethargy. Na 118. K 8. Most important next test?

A

17 OHP

76
Q

What is hyperkalemia?

A

> 5.5

77
Q

List 3 etiology for hyperK

A

high IN:
- KCL tab, IV

redistribute

  • metab acidosis
  • tissue breakdown like rhabdo

Less renal OUT

  • RF
  • Spironolactone (K+ sparing diuretic)
  • Aldosterone deficiency (Addison, CAH)
78
Q

list three ECG findings of hyperK

A

Peaked T wave

Long PR

Wide QRS

79
Q

List three tx options for high K

A
  1. Stop all K in
    If > 6.5= ECG
    Ca2+ gluconate
  2. ** Inhaled ventolin
  3. **Insulin (0.1U/kg IV over 30 min x 1) + Glucose (D10 10cc/kg over 30 min x 1)
  4. **Lasix
  5. Ion exchange resin (**kayexelate or enema)
  6. Na bicarb if acid
    * *8. Hemolysis
80
Q

List the table for DI versus SIADH versus CSW:

  • Clinical
  • Na
  • U/O
  • Urine Na
  • Osmolality
A 
DI:
= ADH (don't make enough= CNS or doesn't respond= Renal)
- dehydrated
**- Na ++
- Serum osm HIGH
**- U/O ++
- Urine Na low
- Tx: DDAVP, Vasopressin

SIADH:
= too much ADH (neuro Sx, trauma, brain bleed, med)

  • euvolemic
  • *- Na LO
  • urine osm HI
  • *- U/O low
  • Urine Na hI
  • TX: free water restrict (insensible + 1/2 U/O replace only)
CSW:
= high atrial natriuretic peptide (= diuresis; secondary to brain injury, neuro Sx)
- hypovolemic
**- Na LO
- osmolality variable
**- U/O HI
- urine Na HIGH
- Tx: underlying Dx, Na/Fluid repletion
81
Q

How do you treat HYPO-Na dehydration?

A
  1. Bolus
  2. Fluid deficit

wt x 10 x %

  1. Deficit- Bolus= X
  2. Replace first 1/2 over 8 hour and next 1/2 over 16 hour
    + Maintenance

Start w/ D5 NS and monitor.

82
Q

5 y.o. asthma. Lots of ventolin. Nausea + weakness. Which lyte to check?

A

K

Low K

  • alkalemia
  • insulin
  • ventolin
  • refeeding
  • GI loss (V/D)
  • Renal (RTA, Bartter etc.)

CC: weakness, GI ileus, low DTR, arrhythmia

83
Q

What rate of ORS do you provide for diff level of hydration?

A

Think of BB dehydration (5-10-5) and multiply by 10
= cc/kg over 4 hour

i.e. Moderate
= 10cc/kg over 4 hour
30 kg kid….
= 300 cc over 4 hour

84
Q

List 3 causes of antenatal pelviectasis:

A
  1. Transient
  2. UPJ= Urteropelvic junction obstruction
  3. VUR= Vesiculoureteral reflux
  4. MCKD, PUV
85
Q

When do you want to repeat a US for antenatal pelviectasis?

A

after DOL #3

86
Q

What do you do w/ F/U US that still sees prenatal US?

A

Grade 1-2= Observe; repeat

Grade 3-4= VCUG +/- MAG 3

87
Q

Newborn w/ antenatal US show 6mm dilatation post-natal. What do you do?

A

U/S repeat in 1-3 months.

When isolated hydronephrosis < 10mm monitor conservatively and repeat in 3-4 months.

88
Q

Mod-severe hydro seen on mod-severe hydronephrosis. BW show normal renal f’n and normal U/O. What to do?

A

Outpatient VCUG

89
Q

List AP diameter for antenatal hydronehprosis?

A

Mild: 7-9
Mod: 9-15
Severe > 15

90
Q

Teen male with struvite stone. What do you look for?

A

Infection

Urine Cx

91
Q

Most common kidney stone in peds?

  • Ca oxalate
  • Struvite
  • Cysteine
  • Uric acid
A

Ca oxalate

92
Q

Renal stone child. Prior prem. Which med in neo stage likely contribute to this?

A

Lasix

93
Q

Most common GN in kids

A

Post streptococcal GN

94
Q

List 3 causes of gross hematuria

A
  1. Trauma.

GU Tract:

  1. Hypercalciuria
  2. Glomerular (PSGN, HSP nephritis, IgA, Alport, SLE)
  3. Renal vein thrombosis (seen in neonate)

Bladder:

  1. UTI
  2. Hemorrhagic cystitis

Lower:

  1. Meatal Stenosis
  2. Perineal irritation

Other:

  1. P/E
  2. Coagulopathy or Sickle Cell or Plt low
  3. Tumour
95
Q

Most common cause of gross hematuria

A

UTI

2nd= idiopathic hypercalciuria

96
Q

List other causes of red urine aside from blood

A
  • **hemogloburia (intravascular hemolysis)
  • **myoglobin (rhabdomyolysis)
  • drugs (chloroquine, ibuprofen, flagyl, nitrofurantoin, **rifampin)
  • **food (beet, blackberry, rhubarb)
  • Other (melanin, **porphyrin)
97
Q

Describe post-streptococcal GN

A

5-12 y.o.
Gross hematuria 1-3wk after infection

Edema
HTN
Proteinuria

Hematuria can recur with febrile illness

C3 Low

ABX does not prevent PSGN
Supportive Tx
Most recover completely.

98
Q

8 y.o. recurrent episode of asymptomatic gross hematuria triggered w/ intercurrent illness. Dipstick (+) even between illness. Best test for etiology

  • immunoglobulin
  • C3, C4
  • 24h urine protein
  • abdo US
  • DMSA scan
A

Immunoglobulin

15% of kids with igA have high IgA

99
Q

List three glomerular dx causes of recurrent hematuria

A

IgA nephropathy
Alport Syn
Thin GBM Disease

100
Q

How can you tell IgA nephropathy from PSGN?

A

hematuria 1-2 d after viral onset.

Normal C3

Progressive in 1/3 versus rare in PSGN

101
Q

T or F: Alport Syndrome is AR inherited?

A

False.

X linked.
CC: hematuria, HTN, proteinuria, RF, hearing loss.

102
Q

Which test differentiate post-infectious glomerulonephritis versus IgA?

A

C3

103
Q

Child w/ hematuria as incidental finding. What do you do?

A

Repeat UA + microscopy in few day to see if resolution.

Asymptomatic child with (+) micro blood on 3 dips in 2 wk period= investigate!

  • Urine Cx
  • Urine Ca:Cr
  • Sickle Screen
  • U/A in FHX
  • Renal or Bladder US etc.
104
Q

Most common cause of HTN in teen:

A

Primary (essential)

105
Q

How do you check BP?

A

Sit quiet x 5 min.
Cuff size cover 2/3 upper arm and 80-100% circumference
Auscultate

106
Q

T or F: to dx HTN you have to measure BP min. 2 occasion.

A

False.

Min. 3 occasion.

107
Q

Definition HTN

A

HTN= 95% tile for age, gender, ht

NEW DEFINITION:
Norm= 1-13 y.o.: < 90th %tile
Stage 1: 90 to 95+12
Stage 2: 95 + 12
Or use kids > 13 guideline (whichever is lower)

Norm min. 13: < 120/80
Stage 1: 130-139 sys
Stage 2: min. 140

OLD DEFINITION:
Pre-HTN:
- 90-94% tile OR > 120/80 starting 12 y.o.
Stage 1= 95 to 99+5 mmHg
Stage 2= > 99 + 5 mmHg (usually secondary cause)

** HTN urgency
> acute severe
NO end organ damage

** HTN crisis/Emergency:
> symptomatic
+ end organ damage (brain, eye, heart, kidney)

108
Q

What are common cause of HTN in young and teen?

A

Young: (Renal, Coarc)

  • **Prem= **umbilical a. cauterization, renal a. thrombosis
  • Neo= **renal thrombosis, **coarc, pheo, cushing
  • < 6 y.o.= **renal parenchymal dx, coarc, pheo, cushing, meds
  • school age= renal parenchymal, vascular, **pheo, **cushing

Teen= **Essential

109
Q

List secondary causes of HTN head to toe:

A

**Head: ICP, OSA

Vascular: **Coarc, aortic valve dx, renal artery dx, umbilical a. cath with thrombosis, NF, vasculitis, atherosclerosis

Renal: **renal a. or vein thrombosis, RF, renal tumour, **parenchymal (GN, PCKD, RF)

Endo: **pheo (5% of NF pt), neuroblastoma, hyper-aldosteronism, **CAH, **cushing, **hyper thyroid, hyper parathyroid, GH

Drugs: **OCP, alcohol, nasal decongestant, **steroid, **stimulant
Other: white coat

110
Q

Approach to HTN

A
  1. confirm
  2. BP R/O coarc
  3. U/A - renal
  4. W/U: BUN, Cr, lytes, CBC, renal US w/ doppler
  5. Screen end organ if > 95% tile= ECG, Echo, retinal exam
  6. Asymptomatic and no end organ find= lifestyle, reduce wt, diet, exercise, less salt, no smoking
If persist x 4-6 month or
 End-organ, symptomatic=  
- **ACEI/ARB, CCB, beta blocker
8. HTN Crisis= ABC, 2 IV, lower BP max 25% over first 8h
- Labetalol
- Hydralazine
111
Q

6 y.o. child with HTN and persistent hypokalemia. Likely dx?

  • Hyperaldosterone
  • Bartter syn
  • Addison
  • Renal vein thrombosis
  • Coarc
A

Hyperaldosteronism

VS.
Bartter= Low K, met alkalosis but not usually HTN

Addison= not enough adrenal hormone= poor steroid= low BP, high K and low Na

112
Q

Hyperaldosteronism Classic PPT

A

HTN + Hypokalemia

- excess aldosterone
= dump K but keep Na= HTN
- etiology:
> aldosterone producing adenoma
> b/l idiopathic hyperaldosteronism
> unnatural adrenal hyperplasia
> familial hyperaldosteronism

Plasma renin low
Plasma aldosterone: renin (HIGH= good screen)

Tx underlying cause.

113
Q

7 y.o. acute hematuria. Well. HTN. Initial Med to treat HTN:

  • IV nitroprusside
  • Salt and water restriction
  • SL Nifedipine
A

S/L Nifedipine

114
Q

Name 3 drugs and route to treat HTN emergency. List one AE for each.

A
  1. IV labetolol
    Or IV esmolol
    > *Bradycardia, Blurry vision
  2. IV Hydralazine
    > palpitation, *SOB
  3. IV Sodium Nitroprusside
    > *CP, palpitation
  4. IV nicardipine
    > *tachycardia, palpitation

NOTE: you can put palpitation for any of these except beta blocker.

115
Q

Renal vein thrombosis. Etiology:

  • UVC
  • IDM with polycythemia and dehydration.
A

IDM w/ polycythemia + dehydration.

Causes of renal vein thrombosis:
1. Newborn:
> dehydration
> shock
> maternal diabetes
2. Older: 
> nephrotic syn
> cyanotic heart dx
> hypercoag. state
> sepsis

PPT:

  • sudden hematuria
  • +/- flank mass
  • HTN
  • oliguria
116
Q

THINK of something other than nephrotic syndrome IF:

A
  • < 1.5 y.o. or > 10 y.o.
  • chronic dx
  • HTN
  • ARF
  • extra-renal manifestation
  • (+) FHX
117
Q

Initial W/U and Tx for Nephrotic Syn

A
  • CBC
  • Lytes
  • BUN
  • Cr
  • albumin
  • glucose
  • cholesterol
  • ANA (if < 2 or > 10)
  • Uri (dip and Pro:Cr ratio)
  • Thinking ahead: VZV status, Hep B, Hep C serology, HIV, C3, C4

Tx: Steroids x 6 weeks

Edema= Albumin/Lasix, Fluid + salt restrict

118
Q

If steroid dependent or steroid resistant nephrotic syndrome. What do we do?

A
  • Prednisone
  • Cyclophosphamide
  • Consider MMF or Cyclosporine
  • Bx
119
Q

Most common cause of microscopic hematuria?

A

Idiopathic hypercalciuria and for gross= UTI #1.

120
Q

How can you tell different GN apart that have systemic involvement?

A

> Multi- Sys= Lupus, ANCA vasculitides

> Only Pul= Granulomatosis with polyangitis, Anti-GBM dx, Lupus, HSP, IE, Pul edema

121
Q

When should your C3 normalize after PSGN?

A

8 weeks

F/U BW then…

122
Q

How do you treat PSGN?

A
  • supportive
  • fluid
  • HTN (tx; resolves by 2wk)

Expectation:

  • C3 back to N in 8 wk
  • Proteinuria proteinuria usually gone by 4 month
123
Q

T or F: 1% of all pt with HSP go on to develop ESRD.

A

True

124
Q

T or F: ANCA dx have multi system ppt?

A

True

i.e. granulomatous w/ polyangiitis, microscopic, renal limited vasculitis etc.

  • fever, migratory, arthralgia, wt loss
  • skin, ENT, pul etc.
125
Q

For HTN you need all BUT:

  • ht
  • sex
  • age
  • wt
A

Weight

126
Q

Most common cause of HTN > 6 y.o.

A

Primary HTN

RF: fhx, obesity.

127
Q

Most common cause of secondary HTN

A

Renal: parenchymal or renovascular.

128
Q

Post solid transplant. What infections do they get?

A

Kidney transplant= high risk of UTI

Think Viral:

  • CMV, VZV
  • EBV

Think Opportunistic:
- Pneumocystis jiroveci

Think: Normal infections

129
Q

How often should you follow simple kidney cyst?

A

Annual

Simple
= well defined, < 1 cm, < 3 total, unilateral, slow growth

CT if Ca2+, thick wall

130
Q

Prenatal signs of PUV:

A
  • severe b/l hydronephrosis
  • echogenic kidney cysts
  • large bladder: keyhole sign
  • oligohydraminos (if severe obstruction)
131
Q

Note: polycystic kidney disease require screening for cerebral aneurysms?

A

True

MRA every 2-3 yr.

2019 RC Specialties (31 decks)

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