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Pediatrics > Nephrology > Flashcards

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

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2
Q

What are the signs of Nephritic Syndrome

A
  1. Hypertension
  2. Oliguria
  3. Hematuria
  4. Azotemia

HOHA

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3
Q

What are the signs of nephrotic syndrome?

A
  1. Proteinuria (nephrotic range)
  2. Albumin low
  3. Lipid High
  4. edema

PALE

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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

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5
Q

What are the causes of false negative hematuria?

A
  1. Formalin

2. High urinary ascorbic acid

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6
Q

What are the causes of false positive hematuria?

A
  1. Alkaline urine (pH >8)

2 Hydrogen peroxide

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7
Q

[Hematuria]

The bleeding source if urine is grossly red without blood clots

A

Lower Urinary Tract

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8
Q

What crystals form in acidic urine?

A

Uric acid

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9
Q

What crystals form in alkaline urine?

A

Phosphate crystal

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10
Q

What is the normal value for specific gravity?

A

1.015-1.025

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11
Q

What contributes to falsely high specific gravity?

A
  1. Presence of glucose
  2. Abundant protein
  3. Iodine-containing contrast materials
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12
Q

[Sources of hematuria]

If the urine is color brown, cola,tea, burgundy

dysmorphic RBC,
proteinuria >100mg/dL

A

Glomerular

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13
Q

[Sources of hematuria]

presence of leukocytes of renal tubular cast

A

Tubular system

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14
Q

[Sources of hematuria]

gross hematuria, terminal hematuria, blood clots, normal morphology

Minimal proteinuria

A

Lower urinary tract

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15
Q

What is the most common cause of gross hematuria in pediatric population

A

PSGN

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16
Q

___ serologic marker to document prior strep throat infection

A

ASO

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17
Q

___ serologic marker to document prior strep infection of the skin

A

AntiDNAse B

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18
Q

[ASPGN]

How many weeks after a throat infection will a patient develop nephritic syndrome?

A

1-2 weeks

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19
Q

[ASPGN]

How many weeks after a skin infection will a patient develop nephritic syndrome?

A

3-6 weeks

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20
Q

[ASPGN: Resolution]

Acute phase

A

6-8 weeks

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21
Q

[ASPGN: Resolution]

Urinary protein excretion and hypertension

A

6 months

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22
Q

[ASPGN: Resolution]

microscopic hematuria

A

1-2 years

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23
Q

[ASPGN: Resolution]

C3 level

A

6-8 weeks

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24
Q

[ASPGN]

Why is there a predilection to glomerulus?

A
  1. Negatively charged capillary wall
  2. Mesangial trapping
  3. Hydrodynamic forces
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25
Q

[ASPGN]

Why does serum C3 decrease?

A

activation of classic and alternative pathway converging at C3 leading to lysis of membrane

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26
Q

What are the only causes of renal insufficiency that cause decreased C3

A
  1. PSGN
  2. MPGN
  3. Lupus nephritis
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27
Q

What are the indications for renal biopsy in ASPGN?

A
  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
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28
Q

[Diagnosis]

hematuria, hypertension, renal insufficiency

hemoptysis + severe respiratory distress

A

Goodpasture Syndrome

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29
Q

[Diagnosis]

hematuria, hypertension, renal insufficiency

History of SVI 3 weeks ago

Purpuric Rash in the buttocks, pain in the joints

A

HSP

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30
Q

[Diagnosis]

hematuria, hypertension, renal insufficiency

History of vomiting and bloody diarrhea after eating hamburger

dehydrated hepatosplenomegaly

A

HUS

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31
Q

[Diagnosis]

sudden onset of gross hematuria

patient febrile with LRTI or GIT infection

Normal C3 level

A

IgA nephropathy

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32
Q

[Diagnosis]

sudden onset of gross hematuria

History of strep throat

severely depressed C3

A

ASPGN

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33
Q

[Diagnosis]

asymptomatic microscopic hematuria

patient wearing very thick glasses and hearing aid, uncle has the same condition

normal labs

A

Alport Syndrome

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34
Q

[Diagnosis]

Bilateral sensoruneural hearing loss
anterior lenticonus
macular flecks
corneal erosions

family history

Hematuria

A

Alport Syndrome

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35
Q

What is the pathognomonic sign of Hereditary Nephritis

A

Anterior Lenticonys

36
Q

[Alports syndrome]

drug than can slow the rate of progression

A

ACEi

37
Q

[Diagnosis]

persistent microscopic hematuria, isolated thinning of GBM on E/M

A

Thin Basement membrane disease

38
Q

[Diagnosis]

Isolated hematuria in multiple family members without renal dysfunction

A

benign familial hematuria

monitor HPN, Progressive proteinuria, renal insiufficiency

39
Q

Treatment of Goodpasture Syndrome

A
  1. Plasma exchange
  2. Steroids
  3. Cyclophosphamide
40
Q

Treatment of Idiopathic Rapidly Progressive Glomerulonephritis

A

Steroid pulse therapy

41
Q

[Proteinuria: Urine Dipstick]

Trace means the alb is ___

A

10-39mg/dL

42
Q

[Proteinuria: Urine Dipstick]

1+ means

A

30mg/dL

43
Q

[Proteinuria: Urine Dipstick]

2+

A

100mg/dL

44
Q

[Proteinuria: Urine Dipstick]

3+

A

300 mg/dL

45
Q

[Proteinuria: Urine Dipstick]

4+

A

> 2g/dL

46
Q

What causes false positive urine dipstick?

A
  1. Very high urine pH >7
  2. Highly concentrated urine
  3. Contamination with blood
47
Q

What causes false negative urine dipstick?

A
  1. Dilute urine

2. Urine wherein the predominant protein is not albumin

48
Q

[Proteinuria: Urine Dipstick]

Is this positive or negative

> trace
SG <1.01

A

positive

49
Q

[Proteinuria: Urine Dipstick]

Is this positive or negative
+1

> /1.015

A

positive

50
Q

[24 hour urine protein]

Normal value

A

4mg/m2/hr

51
Q

[24 hour urine protein]

Abnormal value

A

4-40mg/m2/hr

52
Q

[24 hour urine protein]

Nephrotic range

A

> 40mg/m2/hr

53
Q

[Urine protein:creatinine ratio]

Normal value in <2y/o

A

<0.5

54
Q

[Urine protein:creatinine ratio]

Normal value in >2 years old

A

<0.2

55
Q

[Urine protein:creatinine ratio]

nephrotic range proteinuria

A

> 2

56
Q

What are the causes of transient proteinuria

A
  1. Fever
  2. Exercise
  3. Dehydration
  4. Cold exposure
  5. Congestive heart failure
  6. Seizure
  7. Stress
57
Q

What are the criteria for fixed proteinuria?

A
  1. Proteinuria >/ 1+ with SG > 1.015
  2. UPCR >/ 2

First morning void, 3 separate occasion

58
Q

Most common cause of nephrotic syndrome

A

Minimal Change Disease

59
Q

[Diagnose]

UA 3+ or 4+
UPCR >/2
Urine protein >40mg/m2/hr

serum alb <2.5g/dL
C3 and C4 norma

A

MCD

Tx: corticosteroids

Prednisone 60mg/BSA/ day or 2mg/kg/day

60
Q

Remission of MCD is attained within ____

A

4 weeks

61
Q

What are the criteria for MCD remission

A
  1. UPCR <2

2. <1+ urine dipstick for 3 consecutive days

62
Q

What is the major complication of nephrotic syndrome?

A

infection

63
Q

What is the most frequent type of infection ____

A

SBE

64
Q

Most common cause causing peritonitis

A

pneumococcus

65
Q

[Pathology crossover]

LN: Diffuse thickening of glomerular capillary walls
IF: granular IgG and C3
EM: Subepithelial deposits

A

membranous GN

66
Q

[Pathology crossover]

spike and dome appearance

A

Membranous GN

67
Q

[Pathology crossover]

LM: normal
EM: diffuse effacement of foot process, no deposit

A

Minimal Change Disease

Tx: steroids

68
Q

[Pathology crossover]

LM: large, hypercellular glomeruli, increased mesangial matrix

tram-track appearance

A

MPGN

69
Q

[Pathology crossover]

LM: focal segmental sclerosis, hyalinosis

EM: loss of foot processes, epithelial denudation

A

FSGS

70
Q

[UTI in children]

1st year of life

A

male predominance

71
Q

[UTI in children]

Beyond 1-2 years old

A

female predominance

72
Q

[UTI in children]

most common cause in girls

A
  1. E. coli
  2. Klebsiella
  3. Proteus
73
Q

[Diagnosis]

Abdomina, back, or flank pain

fever, malaise, nausea, vomiting, occasionally diarrhea

A

pyelonephritis

74
Q

[Diagnosis]

Dysuria, urgency, frequency, suprapubic pain, incontinence, malodorous urine

A

Cystuitis

75
Q

Most common cause of acute hemorrhagic cystitis

A

E. coli

76
Q

Risk factor for clinical pyelonephritis

A

VUR

77
Q

[UTI in children]

Criteria to diagnose UTI

A
  1. > 50,000 colonies of single pathogen from suprapubic tap or catheterized sample
  2. 10,000 colonies + symptoms
78
Q

[UTI in children]

Presumptive UTI is

A
  1. > 100,000, single organism
  2. Bag sample
  3. Positive UA
  4. Symptomatic
79
Q

[UTI in children]

Parameters in UA to look to diagnose UTI

A
  1. Leukocyte esterase
  2. Nitrite
  3. Microscopy
80
Q

[UTI in children]

Treatment of choice for acute cystitis

A
  1. TMP-SMX x 3-5 days
  2. Nitrofurantoin
  3. Ampicillin
81
Q

[UTI in children]

DOC for clinical pyelonephritis

A
  1. Broad spectrum 7-14 days
  2. Ceftriaxone or cefotaxime or ampicillin + gentamicin
  3. Oral cefiixme
  4. Ciprofloxacin or levofloxacin
82
Q

[UTI in children]

Risk factors for Febrile UTI in infants that warrants VCUG

A
  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
Q

What is the triad of HUS

A
  1. Microangiopathic hemolytic anemia
  2. Thrombocytopenia
  3. Renal insufficiency
84
Q

What is the most common cause of HUS from E. coli in western countries?

A
  1. Verotoxin-producing E. coli (VTE) O157:H7
85
Q

Difference of HUS and TTP

A

TTP has CNS involvement + fever

86
Q

What are the laboratory criteria to diagnose HUS

A
  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
Q

What are the long term complications of HUS

A
  1. Hypertension
  2. Chronic renal insufficiency
  3. Proteinuria

Pediatrics (15 decks)

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