Nephrology Flashcards
1
Q
[Diagnosis]
10/M
Swelling, history of skin infection,
130/90
(+) bipedal edema,
UA: RBC 25 to 30, Protein +1, bact +1 EC +1
A
PSGN
2
Q
What are the signs of Nephritic Syndrome
A
- Hypertension
- Oliguria
- Hematuria
- Azotemia
HOHA
3
Q
What are the signs of nephrotic syndrome?
A
- Proteinuria (nephrotic range)
- Albumin low
- Lipid High
- edema
PALE
4
Q
Cut off RBC value for hematuria
A
> 5 RBC/hpf (centrifuged)
Presence of RBC is suggested by >10 RBC/uL or +1 dipstick in a freshly voided urine
5
Q
What are the causes of false negative hematuria?
A
- Formalin
2. High urinary ascorbic acid
6
Q
What are the causes of false positive hematuria?
A
- Alkaline urine (pH >8)
2 Hydrogen peroxide
7
Q
[Hematuria]
The bleeding source if urine is grossly red without blood clots
A
Lower Urinary Tract
8
Q
What crystals form in acidic urine?
A
Uric acid
9
Q
What crystals form in alkaline urine?
A
Phosphate crystal
10
Q
What is the normal value for specific gravity?
A
1.015-1.025
11
Q
What contributes to falsely high specific gravity?
A
- Presence of glucose
- Abundant protein
- Iodine-containing contrast materials
12
Q
[Sources of hematuria]
If the urine is color brown, cola,tea, burgundy
dysmorphic RBC,
proteinuria >100mg/dL
A
Glomerular
13
Q
[Sources of hematuria]
presence of leukocytes of renal tubular cast
A
Tubular system
14
Q
[Sources of hematuria]
gross hematuria, terminal hematuria, blood clots, normal morphology
Minimal proteinuria
A
Lower urinary tract
15
Q
What is the most common cause of gross hematuria in pediatric population
A
PSGN
16
Q
___ serologic marker to document prior strep throat infection
A
ASO
17
Q
___ serologic marker to document prior strep infection of the skin
A
AntiDNAse B
18
Q
[ASPGN]
How many weeks after a throat infection will a patient develop nephritic syndrome?
A
1-2 weeks
19
Q
[ASPGN]
How many weeks after a skin infection will a patient develop nephritic syndrome?
A
3-6 weeks
20
Q
[ASPGN: Resolution]
Acute phase
A
6-8 weeks
21
Q
[ASPGN: Resolution]
Urinary protein excretion and hypertension
A
6 months
22
Q
[ASPGN: Resolution]
microscopic hematuria
A
1-2 years
23
Q
[ASPGN: Resolution]
C3 level
A
6-8 weeks
24
Q
[ASPGN]
Why is there a predilection to glomerulus?
A
- Negatively charged capillary wall
- Mesangial trapping
- Hydrodynamic forces
25
[ASPGN]
Why does serum C3 decrease?
activation of classic and alternative pathway converging at C3 leading to lysis of membrane
26
What are the only causes of renal insufficiency that cause decreased C3
1. PSGN
2. MPGN
3. Lupus nephritis
27
What are the indications for renal biopsy in ASPGN?
1. ARF
2. Nephrotic syndrome
3. Absence of evidence of strep
4. Normal complement level
5. Hematuria and proteinuria
6. Low C3 that persists more than 2 months
28
[Diagnosis]
hematuria, hypertension, renal insufficiency
hemoptysis + severe respiratory distress
Goodpasture Syndrome
29
[Diagnosis]
hematuria, hypertension, renal insufficiency
History of SVI 3 weeks ago
Purpuric Rash in the buttocks, pain in the joints
HSP
30
[Diagnosis]
hematuria, hypertension, renal insufficiency
History of vomiting and bloody diarrhea after eating hamburger
dehydrated hepatosplenomegaly
HUS
31
[Diagnosis]
sudden onset of gross hematuria
patient febrile with LRTI or GIT infection
Normal C3 level
IgA nephropathy
32
[Diagnosis]
sudden onset of gross hematuria
History of strep throat
severely depressed C3
ASPGN
33
[Diagnosis]
asymptomatic microscopic hematuria
patient wearing very thick glasses and hearing aid, uncle has the same condition
normal labs
Alport Syndrome
34
[Diagnosis]
Bilateral sensoruneural hearing loss
anterior lenticonus
macular flecks
corneal erosions
family history
Hematuria
Alport Syndrome
35
What is the pathognomonic sign of Hereditary Nephritis
Anterior Lenticonys
36
[Alports syndrome]
drug than can slow the rate of progression
ACEi
37
[Diagnosis]
persistent microscopic hematuria, isolated thinning of GBM on E/M
Thin Basement membrane disease
38
[Diagnosis]
Isolated hematuria in multiple family members without renal dysfunction
benign familial hematuria
monitor HPN, Progressive proteinuria, renal insiufficiency
39
Treatment of Goodpasture Syndrome
1. Plasma exchange
2. Steroids
3. Cyclophosphamide
40
Treatment of Idiopathic Rapidly Progressive Glomerulonephritis
Steroid pulse therapy
41
[Proteinuria: Urine Dipstick]
Trace means the alb is ___
10-39mg/dL
42
[Proteinuria: Urine Dipstick]
1+ means
30mg/dL
43
[Proteinuria: Urine Dipstick]
2+
100mg/dL
44
[Proteinuria: Urine Dipstick]
3+
300 mg/dL
45
[Proteinuria: Urine Dipstick]
4+
>2g/dL
46
What causes false positive urine dipstick?
1. Very high urine pH >7
2. Highly concentrated urine
3. Contamination with blood
47
What causes false negative urine dipstick?
1. Dilute urine
| 2. Urine wherein the predominant protein is not albumin
48
[Proteinuria: Urine Dipstick]
Is this positive or negative
>trace
SG <1.01
positive
49
[Proteinuria: Urine Dipstick]
Is this positive or negative
+1
>/1.015
positive
50
[24 hour urine protein]
Normal value
4mg/m2/hr
51
[24 hour urine protein]
Abnormal value
4-40mg/m2/hr
52
[24 hour urine protein]
Nephrotic range
>40mg/m2/hr
53
[Urine protein:creatinine ratio]
Normal value in <2y/o
<0.5
54
[Urine protein:creatinine ratio]
Normal value in >2 years old
<0.2
55
[Urine protein:creatinine ratio]
nephrotic range proteinuria
>2
56
What are the causes of transient proteinuria
1. Fever
2. Exercise
3. Dehydration
4. Cold exposure
5. Congestive heart failure
6. Seizure
6. Stress
57
What are the criteria for fixed proteinuria?
1. Proteinuria >/ 1+ with SG > 1.015
2. UPCR >/ 2
First morning void, 3 separate occasion
58
Most common cause of nephrotic syndrome
Minimal Change Disease
59
[Diagnose]
UA 3+ or 4+
UPCR >/2
Urine protein >40mg/m2/hr
serum alb <2.5g/dL
C3 and C4 norma
MCD
Tx: corticosteroids
Prednisone 60mg/BSA/ day or 2mg/kg/day
60
Remission of MCD is attained within ____
4 weeks
61
What are the criteria for MCD remission
1. UPCR <2
| 2. <1+ urine dipstick for 3 consecutive days
62
What is the major complication of nephrotic syndrome?
infection
63
What is the most frequent type of infection ____
SBE
64
Most common cause causing peritonitis
pneumococcus
65
[Pathology crossover]
LN: Diffuse thickening of glomerular capillary walls
IF: granular IgG and C3
EM: Subepithelial deposits
membranous GN
66
[Pathology crossover]
spike and dome appearance
Membranous GN
67
[Pathology crossover]
LM: normal
EM: diffuse effacement of foot process, no deposit
Minimal Change Disease
Tx: steroids
68
[Pathology crossover]
LM: large, hypercellular glomeruli, increased mesangial matrix
tram-track appearance
MPGN
69
[Pathology crossover]
LM: focal segmental sclerosis, hyalinosis
EM: loss of foot processes, epithelial denudation
FSGS
70
[UTI in children]
1st year of life
male predominance
71
[UTI in children]
Beyond 1-2 years old
female predominance
72
[UTI in children]
most common cause in girls
1. E. coli
2. Klebsiella
3. Proteus
73
[Diagnosis]
Abdomina, back, or flank pain
fever, malaise, nausea, vomiting, occasionally diarrhea
pyelonephritis
74
[Diagnosis]
Dysuria, urgency, frequency, suprapubic pain, incontinence, malodorous urine
Cystuitis
75
Most common cause of acute hemorrhagic cystitis
E. coli
76
Risk factor for clinical pyelonephritis
VUR
77
[UTI in children]
Criteria to diagnose UTI
1. >50,000 colonies of single pathogen from suprapubic tap or catheterized sample
2. 10,000 colonies + symptoms
78
[UTI in children]
Presumptive UTI is
1. >100,000, single organism
2. Bag sample
3. Positive UA
4. Symptomatic
79
[UTI in children]
Parameters in UA to look to diagnose UTI
1. Leukocyte esterase
2. Nitrite
3. Microscopy
80
[UTI in children]
Treatment of choice for acute cystitis
1. TMP-SMX x 3-5 days
2. Nitrofurantoin
3. Ampicillin
81
[UTI in children]
DOC for clinical pyelonephritis
1. Broad spectrum 7-14 days
2. Ceftriaxone or cefotaxime or ampicillin + gentamicin
3. Oral cefiixme
4. Ciprofloxacin or levofloxacin
82
[UTI in children]
Risk factors for Febrile UTI in infants that warrants VCUG
1. Abnormal antenatal UTZ of fetal urinary tract
2. Family history of reflux
3. Septicemia
4. Renal failure
5. Age younger htan 6 months in a male infant
6. No clinical response to appropriate Abx within 72 hours
7. Infection with organism other than UTI
83
What is the triad of HUS
1. Microangiopathic hemolytic anemia
2. Thrombocytopenia
3. Renal insufficiency
84
What is the most common cause of HUS from E. coli in western countries?
1. Verotoxin-producing E. coli (VTE) O157:H7
85
Difference of HUS and TTP
TTP has CNS involvement + fever
86
What are the laboratory criteria to diagnose HUS
1. Anemia with microngiopathic changes
2. Renal injury - hematuria, proteinura, elevated crea (>1mg/dL in <13 y/o or >1/5mg/dL in >13 y/o or >50% increase over baseline)
87
What are the long term complications of HUS
1. Hypertension
2. Chronic renal insufficiency
3. Proteinuria
