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Pedia > Nephrology > Flashcards

Nephrology Flashcards

1
Q

At least 5 RBC/mcl of urine

A

Hematuria

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2
Q

Abnormal amount of protein in urine

>1 +

A

Proteinuria

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3
Q

<0.5 ml/kg/hr in children

<0.1 ml/kg/he in infants

A

Oliguria

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4
Q

> 5 ml/kg/hr, >2L/day

A

Polyuria

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5
Q

> 5 WBC/hpf

A

Pyuria

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6
Q

5 year old

2 day history of facial edema, bipedal edema
cola colored urine
multiple dried skin lesions

BP=150/90

A

PSGN

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7
Q

Most common glomerular cause of hematuria in children

A

Post Strep Glomerulonephritis

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8
Q

GABHS infection of throat or skin

Mediated by immune complex Type III on the glomeruli

Lumpy bumpy appearance

Complex leads to Inflammatory cascade and leads to hematuria

Sodium and water retention -> inc BP

A

Post Strep Glomerulonephritis

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9
Q

Acutr NEPHRITIC syndrome

Sudden onset gross or microscopic hematuria
Edema
HTN
Oliguria/renal insuffiency

A

PSGN

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10
Q

Onset of PSGN occurs 1-6 weeks after infection

comes from

marker

A

Strep throat infection

ASO titer

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11
Q

Onset of PSGN occurs 3-6 weeks after infection

Comes from

marker

A

Pyoderma

Anti-DNAse B:

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12
Q

Persistent microscopic hematuria in PSGN persists up to

A

1-2 years

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13
Q

Significantly reduces in acute phase PSGN

Normalizes after 6-8 weeks

A

C3 Complement

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14
Q

MRI of PSGN demonstrates

A

Posterior reversible encephalopathy syndrome (PRES)

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15
Q

If with acute renal insuffiency
nephrotic syndrome
negative strep infection

hematuria + proteinuria
diminished renal function
persistent hypocomplementenemia >2 months

perform

A

Renal biopsy

Also differentiates APSGN from HSP

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16
Q

PSGN Complications

A

Hypertensive encephalopathy (Posterior reversible encephalopathy syndrome)
Heart failure and pulmonary edema
Acute renal failure

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17
Q

PSGN Tx

A

Penicillin G 10d
Sodium restriction
Furosemide
HTN control (CCB, vasodilator)

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18
Q

PSGN Prognosis

A

Self limiting
Resolution in >95%?
CRD in <2%

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19
Q 
Adolescent
Edema and joint pains of 2 weeks
On and off fever of 1 month
Rashes of 2 weeks
Dec urine output 
BP= 160/100 
Pallor
Tachycardic 
Bilateral bipedal edema
Swollen ankles
A

SLE

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20
Q

Majority are adolescent females (connected with estrogen)

Immune complex mediated
Autoantibodies directed at Nuclear antigens

A

SLE

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21
Q

Most important cause of morbidity and mortality in SLE

A

Glomerulonephritis >80%

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22
Q

ACR SLE Clinical Criteria

A 
Acute cutaneous lupus (malar)
Chronic cutaneous lupus (discoid)
Oral or nasal ulcer 
Non scarring alopecia
Synovitis >/=2 joints 
Renal
Hemolytic anemia
Leukopenia or lymphonia
Thrombocytopenia
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23
Q

ACR SLE Immunologic Criteria

A 
ANA
Anti dsDNA
Anti-smith
APAS
Low complement
Direct coomb
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24
Q

SLE Diagnosis should fulfill

A

4/11 criteria +
one biopsy showing lupus

If renal biopsy + and only 2, still lupus

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25
Q

Classification of Lupus Nephritis

A

I - minimal mesangial (no renal findings)
II - mesangial proliferative (mild, minimal urinary sediment, active serology)
III - focal proliferative (proteinuria 25%; HTN)
a) active
a/c) active/chronic
c) chronic
IV - diffuse proliferative (most severe renal, nephrotic; dec GFR)
V - membranous LN GN (significant proteinuria; less active serology)
VI - advanced sclerosing LN (>90% glomerulosclerosis)

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26
Q

SLE Tx

A

Prednisone 1-2mkd 4-6weeks over 4-6 months
Monitor via C3, urinalysis, proteinuria

Others
Cyclophosphamide 6 months
Methylprednisone 6 months
Mycophenolate mofetil 
Rituximab

Hydroxychloroquine (Plaquenil) for extrarenal manifestatikns
ACEI/ARBs

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27
Q

SLE prognosis

A

10 year survival in 80%

Risk of infection, osteoporosis, poor growth from immunosupression

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28
Q

Most common cause of UTI in children for both sexes

A

E coli

Presence of bacterial pilli or fimbriae on bacterial surface

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29
Q

Cytitis with gross hematuria is usually caused by

A

Adenovirus

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30
Q

In children, incidence in <1 is higher in

A

Males bec of prepuce and hygiene but by 1-2, F predominance

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31
Q

Positive urine culture without any manifestation

Only alarming in pregnant

On UA, patients have leukocytes

Culture must still be done

A

Asymptomatic bacteriuria

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32
Q

UTI Confirmatory test

A

Urine CS > 50,000 single colony in suprapubic tap
Urine CS >10,000 cath sample with symptoms

Urine CS >100,000 single colony in bag

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33
Q

Patients <6 months with febrile UTI order

A

UTZ within 6 weeks of infection

VCUG if abnormal UTZ

Recurrent infections - CMSA scan

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34
Q

Patients >6 months

A

UTZ for atypical and recurrent UTI

UTZ dilatation etc - VCUG

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35
Q

Pyelonephritis Tx

A

Younger children:
Ceftriaxone IV
Cefotaxime IV
Ampicillin IV + Gentamycin IV

Without warning sign:
Cefixime PO

Adolescent >17
Fluoroquinolone

Acute febrile - 7-14 days

36
Q

Acute Cytitis Tx

A

TMP-SMZ (E coli) for 3-5 days
Amoxicillin

Initial but high resistance - Nitrofurantoin (Kleb, Enterobacter) 3-5 days

37
Q

2 episodes of UTI, within 6 months:

A

Vesico-ureteral reflux
UT obstruction
Neuropathic bladder
Urinary calculi

38
Q

Congenital and familial
Retrograde flow of urine from bladder to kidney

Reflux nephropathy -> CKD

A

Vesico-ureteral reflux

Classification:
Primary - congenital incompetence of the valvular mechanism of VUJ
Primary with malformation - ureteral duplication, ureterocoele, ureteral ectopia, paraureteral diverticula
Secondary to inc intravesical pressure - neuropathic bladder, BOO, non-neuropathic bladder
Secondary to inflamm - foreign bacterial cystitis, foreign bodies, vesical calculi, clinical cystitis
Secondary to surgical procedure - surgery

39
Q

Grading of VUR

A

Grade I - VUR into a non-dilated ureter
Grade II - VUR in upper collecting without dilation
Grade III - VUR into dilated ureter and/or blunting of calcyeal fornices
Grade IV - VUR into a grossly dilated ureter
Grade V - Massive VUR, significant ureteral dilation and tortuosity

40
Q

VUR Tx

A

Grade I and II - observation, modification

Grade III and IV - antimicrobial prophylaxis

Sx
Open ureteral reimplantation
Laparoscopic VUR

41
Q

8/M

Hematuria on UA
B Flank mass since infancy

UTZ: enlarged kidneys with bilateral MACROCYST
UTI

BP: 160/100

A

Polycystic Kidney Disease

fatal on neonatal period

42
Q

Most common hereditary human kidney disorder

Possible CYST formation in liver, pancreas, spleen, brain and cerebral aneurysm

CAUSED BY MUTATIONS ON

A

PCK

PKD1 Ch16 short arm
PKD2 Ch4 long arm

43
Q

PCK Tx

A

Control HTN using ACEI/ARB

44
Q

4/F

Cough of 5 days
Edema of 2 days

Facial edema, ascites, bipedial edema
UA: 3+ proteinuria

A

Idiopathic Nephrotic syndrome
Most common

Glomerular disease with isolated proteinuria

45
Q

Peaks in 2-6 years

Heavy proteinuria >3.5 g/24h 
Urine protein/creatinine ratio >2 
Hypoalbuminemia of =2.5 g/dL 
Edema
Hyperlipidemia >200 mg/dl
A

Nephrotic syndrome

46
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

47
Q

Children <2 years old
Edema
Proteinuria
Resistant to prednisone

A

Congenital Primary Nephrotic Syndrome

48
Q

Preceded by minor infection (insect bite, allergic reaction)

Foot process effacement

Increased permeability of glomerular capillary wall

Protein leakge in urine (hypoalbuminemia, proteinuria)

Hyperlipidemia (inc synthesis and, dec catabolism) from albumin production

A

Minimal change disease

49
Q

Patients with MCD have increased susceptibility to infection because

A

urinary losses of IgG and complement factors

impaired opsonization of microorganism

50
Q

Hemodynamic change in MCD

A

Hypercoagulability from vascular stasis, hemoconcentration, increased platelet number and aggregability and changes in coagulation factor

Increased Fibrinogen

Antithrombotic factors

Deep vein thrombosis

51
Q

MCD Tx

A 
Prednisone for 4-6 weeks
Sodium restriction <1500
Diuretics
Dyslipidemia (HMG CoA reductase)
3rd gen cephalosporin infection 
Heparin; LMW and warfarin for thromboembolism
52
Q

10/M

Weakness of both Lower extremities
Polyuria

Weight z score: -1 to -2
Mild signs of dehydration

A

Tubular disease
volume and electroylte abnormality

If acidotic Renal tubular acidosis

53
Q

Normal anion gap

Hyperchloremic metabolic acidosis

A

Renal Tubular Acidosis

54
Q

RTA Types

A

Proximal RTA - type II
Classic Distal RTA - type I
Hyperkalemic RTA - type IV
Combined proximal and distal RTA - type III

55
Q

Impaired bicarbonate reabsorption
Normal anion gap Hyperchloremic Metabolic Acidosis
Urine pH <5.5
Normal to low plasma K

Rickets

A

Proximal Type II
Defect at proximal tubule

Can acidify urine
Rickets because calcium is reabsorbed at proximal part. Because of defect, low electrolyte and calcium

56
Q

Failure to secrete acid secretion
Normal anion gap Hyperchloremic Metabolic Acidosis
Urine pH >5.5
Normal to low K

Hypercalciuria
Nephrocalcinosis on UTZ

A

Classic Distal Type I

Cannot acidify urine

57
Q

Impaired aldosterone production response
Normal anion gap Hyperchloremic Metabolic Acidosis
Urine pH <5.5
High plasma K

High urine Na
Low urine K

A

Hyperkalemic Type IV

58
Q

Anion gap formula

A

Na - (Cl + HCO3)

59
Q

Urine anion gap

A

(Urine Na + Urine K) - Urine Cl

60
Q

RTA Tx

A

Bicarbonate replacement
20 - Proximal Type II
2 - Distal Type I

Thiazide for hypercalciuria and nephrocalcinosis to decrease calcium excretion

61
Q

Failure to thrive
Polyuria
Recurrent episodes of Dehydration

Metabolic alkalosis
Hypercalciuria
Hypokalemia
Normal Magnesium
Salt wasting
A

Barter syndrome

62
Q

Mutation in transporters in the LOH

Hypokalemic
Metabolic alkalosis
Hypercalciuria
Salt wasting

A

Bartter syndrome

Type I, II, IV - antenatal
Classic - childhood

63
Q

Hypocalciuria
Hypomagnesemia
Hypokalemia
Metabolic alkalosis

SPASM and TETANY

A

Gitelmann Syndrome

Rare autosomal recessive

64
Q

Bartter Tx

Gitelmann Tx

A

Barter:
K supplement
Prevent dehy

Gitelmann:
K and Mg supplement

65
Q

6 year old
Vomiting and diarrhea of 3 days

Decreased activity and appetite

Last UO 8 hours PTA

A

Acute Kidney Injury

66
Q

Sudden deterioration of renal function
Inability of kidney to maintain fluid and electrolyte homeostasis

pRIFLE

A

Acute Kidney Injury

67
Q

AKI Risk criteria

A

<0.5 ml/kg/hr for 8 h

25% dec in CO

68
Q

AKI Injury

A

<0.5 ml/kg/h for 16 h

Dec 50% CO

69
Q

AKI Failure

A

<0.3 ml/kg/h for 24 h
Anuric for 12h
Dec by 75% CO
eCCl <35ml/min/1.73m2

70
Q

AKI Loss

A

Persistent failure >4 weeks

71
Q

AKI End stage

A

Persistent failure >3 months

72
Q

Pre Renal AKI

A 
Dehydration
Hemorrhage
Sepsis
Hypoalbuminemia
Cardiac failure
73
Q

Intrinsic Renal

A 
GN
Hemolytic Uremic Syndrome
Acute tubular necrosis
Cortical necrosis
Renal vein thrombosis
Rhabdomyolysis
Acute Interstitial Nephritis
Tumor infiltration
Tumor lysis syndrome
74
Q

Post Renal AKI

A 
Posterior urethral valve
Ureteropelvic junction obstruction
Ureterovesicular junction obstruction
Ureterocoele
Tumor
Urolithiasis
Hemorrhagic cystitis
Neurogenic bladder
75
Q

Biomarkers for AKI

A 
Plasma neutrophil gelatinase-associated lipocalin 
Cystatin C
Urinary NGAL
IL-18
Kidney injury molecule-1
76
Q

U Specific gravity >1.020
U osmolality >500
U Na <20
U Fractional excretion of Na (FENa) <1%

A

Prerenal AKI

Kidney able to compensate. Because dehydrated, osmolality is high and urine sodium low to retain water hence concentrated urine.

77
Q

U specific gravity <1.010
U osmolality <350
U Na >40
Fractional excretion of Na (FENa) >2%

A

Intrinsic AKI

No compensation

78
Q 
Hyperkalemia
Metabolic Acidosis
Hypervolemia
Hypertension
Anemia
A

Acute Kidney Injury

79
Q

AKI Tx

A

Diuretics - hypervolemia (edema)
Ca Gluconate, NaHCO3, Insulin + D50 - hyperkalemia
NaHCO3 - metabolic acidosis
salt-water restriction, Ca ch blocker - HTN
blood transfusion, iron or EPO - anemia

80
Q

Indications in AKI for dialysis

A

Anuria/oliguria
Volume overload with hypertension and/or pulmonary edema refractory to diuretic therapy
Persistent hyperkalemia
Severe metabolic acidosis unresponsive to medication
Uremia (encephalopathy, pericarditis, neuropathy)
BUN > 100-160 mg/dl
Ca:P imbalance with hypocalcemic tetany

81
Q

16/F
Pallor
Edema
Periorbital edema

BP: 120/90

Stunted
growth retarded

A

Chronic Kidney Disease

Clinical manifestations:
Edema
Hematuria
Headache
Anorexia
Hypertension
Proteinuria
Fatigue
Growth failure/Anorexia 
Elevated BUN/Crea
Hyperkalemia
Hyperphosphatemia
Hyponatremia
Acidosis 
Hypocalcemia
Elevated uric acid
82
Q

CKD Diagnosis

A

Kidney damage >/= 3 months (structural or functional abnormalities of kidney with or without decreased GFR)

GFR <60 mL for >/= 3 months
(with or without other signs of kidney damage)

83
Q

CKD stages

A 
Stage 1 - GFR >90 
Stage 2 - GFR 60-89, mild dec in GFR
Stage 3 - GFR 30-59, mod dec in GFR
Stage 4 - GFR 15-29, severe dec in GFR
Stage 5 - GFR <15, kidney failure
84
Q

CKD tx

A

Acidosis - NaHCO3
Growth - recombinant human growth hormone
Bone disease - CaCO3, Phosphate binder, Vit D analog
Anemia - Erythropoietin Stimulating Agents
HTN - diuretics, ACEI/Arb
Advise the patient for renal transplantation

85
Q

On the average, symptoms of uncomplicated PSGN resolve within

A

6-8 weeks

Urinary protein excretion and HTN - 4-6 weeks

Microscopic hematuria - persist 1-2 years

86
Q

disease with decreased serum complement c3

A 
SLE
Subacute bacterial endocarditis
Shunt nephritis
Essential mixed cryoglobulinemia
Visceral abscess
PSGN
Membranoproliferative GN Type I

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