Nephrology/Genitourinary

Question 1

Urosepsis

Answer 1

Presents as febrile illness or nosocomial infection in the ICU.

Requires immediate evaluation and therapy, fluid resuscitation and management of other shock symptoms.

Question 2

Pyelonephritis

Answer 2

Bacterial infection of the upper urinary tract.

S/S: High fever, lethargy, ill appearance, poor feeding, pain, vomiting, irritability, and jaundice. Can result in renal scarring.

Dx: UA, UCx, CBC, CRP, ESR, basic chemistry, renal panel.
- Imaging: Renal ultrasound, VCUG

Tx: Inpatient or outpatient based on symptoms and severity, hydration status.

Question 3

Renal Tubular Acidosis

Answer 3

Uncommon in children!

Defect in renal tubules resulting in metabolic acidosis with normal anion gap.

Three Types:
1. Decrease in acid excretion.

2. Failure of bicarbonate to reabsorb.
3. Aldosterone deficiency or impairment.

Question 4

Renal Failure

Answer 4

Acute, complex process with high risk for mortality.

- Occurring when the kidney function ceases to secrete water, regulate electrolyte and acid-base balance.

Question 5

Pre-Renal Failure

Answer 5

Most common form in children.

Usually caused by decreased blood flow to kidney through acute disease causing hypovolemia and some medications, such as ACE inhibitors.

Question 6

Intrinsic Renal Failure

Answer 6

Caused by HUS, pyelonephritis, vasculitis, high levels of calcium, phosphorus, and uric acid.

Question 7

Post-Renal Failure

Answer 7

Usually caused by structural defects.

• Posterior urethral valves.
• Neurogenic bladder.
• Trauma.

Question 8

Nephrotic Syndrome

Answer 8

Kidney filtration disorder with protein filtered out.

S/S: Hypoalbuminemia, hyperlipidemia, hyperproteinuria.

Question 9

Indications for Dialysis

Answer 9

Hypervolemia, electrolyte abnormalities (especially increased potassium), acidosis, hypocalcemia, azotemia, uremia with confusion, bradycardia, platelet dysfunction and tamponade, removal of toxic substances, malnutrition.

Question 10

Testicular Torsion

Answer 10

Acute twisting of the spermatic cord, which cuts of the blood supply to the testicle and surrounding structures within the scrotum.

S/S: Sudden onset of severe pain in one testicle, with or without a previous predisposing event.

Tx: Emergent surgical referral is appropriate management!