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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
Classification of Lupus Nephritis
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)
26
SLE Tx
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
27
SLE prognosis
10 year survival in 80% | Risk of infection, osteoporosis, poor growth from immunosupression
28
Most common cause of UTI in children for both sexes
E coli Presence of bacterial pilli or fimbriae on bacterial surface
29
Cytitis with gross hematuria is usually caused by
Adenovirus
30
In children, incidence in <1 is higher in
Males bec of prepuce and hygiene but by 1-2, F predominance
31
Positive urine culture without any manifestation Only alarming in pregnant On UA, patients have leukocytes Culture must still be done
Asymptomatic bacteriuria
32
UTI Confirmatory test
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
33
Patients <6 months with febrile UTI order
UTZ within 6 weeks of infection VCUG if abnormal UTZ Recurrent infections - CMSA scan
34
Patients >6 months
UTZ for atypical and recurrent UTI | UTZ dilatation etc - VCUG
35
Pyelonephritis Tx
Younger children: Ceftriaxone IV Cefotaxime IV Ampicillin IV + Gentamycin IV Without warning sign: Cefixime PO Adolescent >17 Fluoroquinolone Acute febrile - 7-14 days
36
Acute Cytitis Tx
TMP-SMZ (E coli) for 3-5 days Amoxicillin Initial but high resistance - Nitrofurantoin (Kleb, Enterobacter) 3-5 days
37
2 episodes of UTI, within 6 months:
Vesico-ureteral reflux UT obstruction Neuropathic bladder Urinary calculi
38
Congenital and familial Retrograde flow of urine from bladder to kidney Reflux nephropathy -> CKD
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
Grading of VUR
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
VUR Tx
Grade I and II - observation, modification Grade III and IV - antimicrobial prophylaxis Sx Open ureteral reimplantation Laparoscopic VUR
41
8/M Hematuria on UA B Flank mass since infancy UTZ: enlarged kidneys with bilateral MACROCYST UTI BP: 160/100
Polycystic Kidney Disease fatal on neonatal period
42
Most common hereditary human kidney disorder Possible CYST formation in liver, pancreas, spleen, brain and cerebral aneurysm CAUSED BY MUTATIONS ON
PCK PKD1 Ch16 short arm PKD2 Ch4 long arm
43
PCK Tx
Control HTN using ACEI/ARB
44
4/F Cough of 5 days Edema of 2 days Facial edema, ascites, bipedial edema UA: 3+ proteinuria
Idiopathic Nephrotic syndrome Most common Glomerular disease with isolated proteinuria
45
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 ```
Nephrotic syndrome
46
Most common cause of nephrotic syndrome in children
Minimal change disease
47
Children <2 years old Edema Proteinuria Resistant to prednisone
Congenital Primary Nephrotic Syndrome
48
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
Minimal change disease
49
Patients with MCD have increased susceptibility to infection because
urinary losses of IgG and complement factors impaired opsonization of microorganism
50
Hemodynamic change in MCD
Hypercoagulability from vascular stasis, hemoconcentration, increased platelet number and aggregability and changes in coagulation factor Increased Fibrinogen Antithrombotic factors Deep vein thrombosis
51
MCD Tx
``` Prednisone for 4-6 weeks Sodium restriction <1500 Diuretics Dyslipidemia (HMG CoA reductase) 3rd gen cephalosporin infection Heparin; LMW and warfarin for thromboembolism ```
52
10/M Weakness of both Lower extremities Polyuria Weight z score: -1 to -2 Mild signs of dehydration
Tubular disease volume and electroylte abnormality If acidotic Renal tubular acidosis
53
Normal anion gap | Hyperchloremic metabolic acidosis
Renal Tubular Acidosis
54
RTA Types
Proximal RTA - type II Classic Distal RTA - type I Hyperkalemic RTA - type IV Combined proximal and distal RTA - type III
55
Impaired bicarbonate reabsorption Normal anion gap Hyperchloremic Metabolic Acidosis Urine pH <5.5 Normal to low plasma K Rickets
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
Failure to secrete acid secretion Normal anion gap Hyperchloremic Metabolic Acidosis Urine pH >5.5 Normal to low K Hypercalciuria Nephrocalcinosis on UTZ
Classic Distal Type I Cannot acidify urine
57
Impaired aldosterone production response Normal anion gap Hyperchloremic Metabolic Acidosis Urine pH <5.5 High plasma K High urine Na Low urine K
Hyperkalemic Type IV
58
Anion gap formula
Na - (Cl + HCO3)
59
Urine anion gap
(Urine Na + Urine K) - Urine Cl
60
RTA Tx
Bicarbonate replacement 20 - Proximal Type II 2 - Distal Type I Thiazide for hypercalciuria and nephrocalcinosis to decrease calcium excretion
61
Failure to thrive Polyuria Recurrent episodes of Dehydration ``` Metabolic alkalosis Hypercalciuria Hypokalemia Normal Magnesium Salt wasting ```
Barter syndrome
62
Mutation in transporters in the LOH Hypokalemic Metabolic alkalosis Hypercalciuria Salt wasting
Bartter syndrome Type I, II, IV - antenatal Classic - childhood
63
Hypocalciuria Hypomagnesemia Hypokalemia Metabolic alkalosis SPASM and TETANY
Gitelmann Syndrome Rare autosomal recessive
64
Bartter Tx Gitelmann Tx
Barter: K supplement Prevent dehy Gitelmann: K and Mg supplement
65
6 year old Vomiting and diarrhea of 3 days Decreased activity and appetite Last UO 8 hours PTA
Acute Kidney Injury
66
Sudden deterioration of renal function Inability of kidney to maintain fluid and electrolyte homeostasis pRIFLE
Acute Kidney Injury
67
AKI Risk criteria
<0.5 ml/kg/hr for 8 h | 25% dec in CO
68
AKI Injury
<0.5 ml/kg/h for 16 h | Dec 50% CO
69
AKI Failure
<0.3 ml/kg/h for 24 h Anuric for 12h Dec by 75% CO eCCl <35ml/min/1.73m2
70
AKI Loss
Persistent failure >4 weeks
71
AKI End stage
Persistent failure >3 months
72
Pre Renal AKI
``` Dehydration Hemorrhage Sepsis Hypoalbuminemia Cardiac failure ```
73
Intrinsic Renal
``` GN Hemolytic Uremic Syndrome Acute tubular necrosis Cortical necrosis Renal vein thrombosis Rhabdomyolysis Acute Interstitial Nephritis Tumor infiltration Tumor lysis syndrome ```
74
Post Renal AKI
``` Posterior urethral valve Ureteropelvic junction obstruction Ureterovesicular junction obstruction Ureterocoele Tumor Urolithiasis Hemorrhagic cystitis Neurogenic bladder ```
75
Biomarkers for AKI
``` Plasma neutrophil gelatinase-associated lipocalin Cystatin C Urinary NGAL IL-18 Kidney injury molecule-1 ```
76
U Specific gravity >1.020 U osmolality >500 U Na <20 U Fractional excretion of Na (FENa) <1%
Prerenal AKI Kidney able to compensate. Because dehydrated, osmolality is high and urine sodium low to retain water hence concentrated urine.
77
U specific gravity <1.010 U osmolality <350 U Na >40 Fractional excretion of Na (FENa) >2%
Intrinsic AKI | No compensation
78
``` Hyperkalemia Metabolic Acidosis Hypervolemia Hypertension Anemia ```
Acute Kidney Injury
79
AKI Tx
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
Indications in AKI for dialysis
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
16/F Pallor Edema Periorbital edema BP: 120/90 Stunted growth retarded
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
CKD Diagnosis
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
CKD stages
``` 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
CKD tx
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
On the average, symptoms of uncomplicated PSGN resolve within
6-8 weeks Urinary protein excretion and HTN - 4-6 weeks Microscopic hematuria - persist 1-2 years
86
disease with decreased serum complement c3
``` SLE Subacute bacterial endocarditis Shunt nephritis Essential mixed cryoglobulinemia Visceral abscess PSGN Membranoproliferative GN Type I ```

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