Nephrology and Urology Flashcards
2 phases of parenteral rehydration
- Emergency phase
2. Repletion phase
what is given during emergency phase
normal saline (20) lactated Ringers
Hypernatremic dehydration
done over 48 hours to minimize risk of cerebral edema
hyponatremic or isonatremid redehydration
over 24 hours
how does oral dehydration work
absorption of electrolytes is enhanced by active absorption of glucose
what can cause a false-negative result urinary dipstick
ascorbic acid ( vitamin C)
what does urinary dipstick detect
RBC, protein in urine
Most accurate method of detecting proteinuria? but in children….
24 hours urinary protein collection
- random spot urine total protein-to-creatine ration
orthostatic protienuria
protein excretion upright but not supine
- benign
what in the urine will indicate tubular proteinuria
- beta2-microglobulin
2. glucosuria and aminoaciduria
signs of acute nephritic syndrome
- gross hematuria
- hypertension
- fluid overload from renal insufficiency
Less common causes of postinfectious glomerulonephritis are
HIV
Hep B and C
Low serum levels of what is found in post streptococcal glomerulonephritis
complement
renal biopsy for post streptococcal glomerulonephritis shows
mesangial cell proliferation
increased mesangial matrix
antibiotic use of Strep throat reduces the risk of what
rheumatic fever not kidney problem
most common chronic glomerulonephritis worldwide
IgA nephropathy
what ethnic groups get IgA nephropathy
Asia
Australia
Native Americans
clinical feature of IgA nephropathy
gross hematuria
respiratory infections
Management of IgA nephropathy
supportive
Henoch-Schonlein purpura
IgA-mediated vasculitis
- palpable purpura on buttocks/ thigh
- abdominal pain
- arthritis
- hematuria
Membranoproliferative glomerulonephritis
lobular mesangial hypercellularity
thickening of glomerular basement membrane
Membranoproliferative glomerulonephritis management
no definitive treatment
most common cause of primary nephrotic syndrome
minimal change disease
clinical feature of nephrotic proteinuria
edema followed by upper respiratory infection
nephrotic proteinuria increase their risk for what type of infection
- encapsulated organisms
- predisposed to infection
what values must be ruled out to diagnose nephrotic proteinuria
C3
ANA
antistreptococcal
antibodies
drug of choice for minimal change disease
steroids
children who have nephrotic proteinuria and are sensitive to steroids can develop what
focal sclerosing glomerulosclerosis
do you give antibiotics to HUS caused by e. coli
no
prognosis for HUS by e. coli
good
bad signs: high WBC and prolonged oliguria
complication: toxic megacolon
Alport syndrome
progressive hereditary nephritis
defect in type IV collagen
how is Alport syndrome inherited
X-linked dominant
clinical manifestations of Alport syndrome
hematuria
Hearing loss
ocular: lens and retina
treatment of Alport syndrome
treat hypertension with ACE inhibitor
most common cause of renal mass in newborn
multicystic renal dysplasia
clinical feature of autosomal recessive polycystic kidney disease
- oligohydramnios
- pulmonary hypoplasia
- enlarged kidneys
- servere hypertension
prognosis for autosomal recessive polycystic kidney disease
eventually need transplant
when does autosomal dominant polycystic kidney disease
adulthood
most hypertension in childhood is what type
secondary hypertension
too small of a cuff will give
elevated blood pressure
PE for hypertension
four limb blood pressure
funduscopic examination
goal of chronic hypertension
maintain BP level below 90th percentile
Renal tubular acidosis
inability of kidney to maintain normal acid-base balance
- defects in bicarbonate conservation
- defects in excretion of hydrogen ions
classic electrolyte presentation for RTA
hyperchloremic
metabolic acidosis
normal anion gap
positive urine anion gap is seen in what RTA
distal RTA
Management for renal failure
- intravascular volume restored first
- total fluid intake should be restricted to insensible loses and ouput replacement
what diet should be restricted in renal failure
protein intake
what type of dialysis is preferred for infants and children
Peritoneal dialysis
Preferred treatment for children with end stage renal disease
kidney transplant
2 causes of bladder outlet obstruction
- posterior urethral valves in males
2. prune belly syndrome
Vesicoureteral reflux
urine refluxing from urinary bladder into ureters and renal collecting system
what causes Vesicoureteral reflux
ureterovescial junction abnormality
how is Vesicoureteral reflux inherited
autosmal dominant
diagnose Vesicoureteral reflux
voiding cystourethrogram
management for Vesicoureteral reflux
lost dose prophylactic antibiotics
what should you think when a child has urolithiasis
metabolic disorders
when should VCUG and renal ultrasound be done for a UTI
- pyelonephritis
- recurrent UTI in all males, and all girls younger than 4 cystitis
gold standard diagnosis for UTI
urine culture
pyelonephritis
upper tract infection
cystitis
lower tract infection
how do you get urine from neonates and infants
- suprapubic aspiration of urinary bladder
- sterile urethral catherterization
how do you get urine from older children
clean catch urine sample
