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PRCE > Nephrology q-bank > Flashcards

Nephrology q-bank Flashcards

1
Q

What is the definition of hypertension?

A

A systolic +/- diastolic blood pressure that is >/= 95% for age, sex and height on >3 occasions.

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2
Q

Difference between primary and secondary hypertension? Causes?

A

Primary- no known cause, most adults.
Secondary- secondary to other issue, in kids 90% is secondary to renovascular hypertension and renal issues (chronic GN, reflux or obstructive nephropathy, HUS, polycystic or dysplastic renal disease)

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3
Q

Explain the evaluation for a child with hypertension

A

History and physical :)
*sleep, FamHx, RFs (diet, habits)

urinanalysis, urine culture
BUN, creat, electrolytes
CBC
renal ultrasound

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4
Q

Other investigations to perform if confirmed hypertension?

as per Nelson’s

A 
Echocardiogram (evaluate for LVH etc..)
Retinal exam (retinal vascular changes)
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5
Q

What kind of stones should you think of associated with a gram negative rod UTI?

A

Struvite stones

magnesium ammonium PO4

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6
Q

What is the most common palpable abdominal mass in a newborn?

A

A hydronephrotic kidney is most common,

then a multicystic kidney

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7
Q

What is the best test to evaluate vesicoureteral reflux in kids with hydronephrosis?

A

VCUG

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8
Q

What is the best test to evaluate if renal scarring in present in a kid with posterior urethral valves?

A

DMSA

nuclear renal scan

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9
Q

What should you suspect with a flank mass, hematuria and thrombocytopenia?

A

Renal vein thrombosis

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10
Q

What are risk factors for renal vein thrombosis?

neonates (7)
older kids (4)
A 
polycythemia (IDM)
perinatal asphyxia
prematurity
shock
dehydration
cyanotic heart disease
sepsis

nephrotic syndrome
burns
SLE
renal transplant

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11
Q

Hyperchloremia, hypokalemia, chronic non-AG metabolic acidosis and hypercalciuria are features of what?

A

Distal Renal Tubular Acidosis (type 1)

  • impaired hydrogen ion secretion distally
  • urine pH >5.5 (N 6.5-8) + urine AG
  • non-anion gap metabolic acidosis
  • FTT
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12
Q

Chronic non-AG metabolic acidosis, acidic urine and hypokalemia are features of what?

A

Proximal Renal Tubular Acidosis (type 2)

  • impaired bicarbonate reabsorption proximally
  • urine pH >5.5 initially then <5.5 + urine AG
  • hypokalemia
  • FTT
  • usually a part of Fanconi syndrome (proteinuria, glucosuria, phosphaturia & prox RTA)
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13
Q

Hyperkalemia, non-AG metabolic acidosis are features of what?

A

Renal tubular Acidosis type 4, aldosterone deficiency or resistance

  • urine pH <5.5 + urine AG
  • hyperkalemia
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14
Q

Urine anion gap suggests what?

A

Renal tubular acidosis!

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15
Q

Urine pH >5.5 suggests what?

A

RTA 1

or RTA2 early on

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16
Q

What is the best single antibody titer to document previous streptococcal infection?

A

anti-DNAse B level

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17
Q

Indications for renal biopsy in post-streptococcal GN?

A
  • if hematuria, proteinuria, low C3 or diminished renal function persist for >2 months
  • acute renal failure
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18
Q

Management of post-streptococcal GN?

A

treating acute effects and preventing spread

  • 10 days antibiotics
  • sodium restriction
  • diuresis, initially furosemide
  • hypertension txt with CCB, ACE-i, vasodilators
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19
Q

What types of glomerulonephritis present with low C3?

A

Post-streptococcal (+antiDNAseB Ab)
Membranoproliferative GN
Lupus (+anti-DNA Ab)
Cryoglobulinemic (cryoglobulins)

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20
Q

What types of glomerulonephritis present with anti-GBM autoantibodies?

A

Goodpastures’s syndrome (lung hemorrhage)

Anti-GBM nephritis

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21
Q

What types of glomerulonephritis present with anti-neutrophil cytoplasmic antibodies? (ANCA)

A 
Eosinophilic polyangiitis (asthma, allergies)
Microscopic polyangiitis (systemic necrotizing arteritis)
Wegener's Granulomatosis with polyangiitis (cANCA +anti-PR3)
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22
Q

What test can help you distinguish between acute kidney disease and chronic kidney disease?

A

Renal ultrasound!
large in acute
small in chronic

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23
Q

What conditions are associate with Fanconi syndrome?

A 
Cystinosis
Galactosemia
Glycogen storage disease type 1
Wilson's disease
Fructosemia
Tyrosinemia 1
Mitochondrial disorders
Dent's, Lowe, GRACILE, Fanconi-Bickel...
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24
Q

What does hypokalemia, alkalosis, hyperaldosteronism, hypercalciuria, salt wasting fit with?

A

Excessive Lasix ingestion or Barter’s!

presents early in life, polyhydramnios

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25
Q

What does hypokalemia, alkalosis, hypomagnesemia, hypocalciuria, salt wasting look like?

What disease?

A

Excessive Hydrochlorothiazide ingestion or Gitelman’s!

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26
Q

What is the triad of HUS?

Name an infectious and genetic etiology.

A

MAHA, thrombocytopenia, renal insufficiency

E. coli 0157H7
ADAMTS13

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27
Q

A boy with a hearing impairment and microscopic hematuria exacerbated within 1-2 days of URTI (or proteinuria or nephrotic syndrome) most likely has what?

A

Alport Syndrome
type IV collagen gene mutation
X-linked
they also have anterior lenticonus

28
Q

Name two severe complications of PSGN

A

encephalopathy secondary to uncontrolled hypertension

heart failure secondary to hypertension and hypervolemia

29
Q

Approach to asymptomatic microscopic hematuria?

A 
Repeat u/a weekly x2, no exercise before
If persists, urine culture
If persists, then urine spot calcium:creatinine ratio + Hgb electrophoresis if black
IF hx &amp; p/e remain normal, can follow for 1 year before:
-test parent's urine
-Doppler US
-serum creatinine and electrolytes
-refer to Nephrologist
30
Q

What is the management of simple renal cysts?

Complex renal cysts?

A

Follow up simple renal cysts.

Complex renal cysts need additional work-up because of their higher likelihood of malignancy. CT or MRI, then consider surgery.

31
Q

What is the earliest that you should perform an US to evaluate antenatal VUR?`

A

DOL 2-3

fluid shifts occurring postnatally may artificially underestimate the degree of VUR

32
Q

How do you manage a post-natal confirmation of bilateral VUR grade 4-5?

A

Order VCUG with antibiotic prophylaxis until testing.
IF confirmed VUR IV-V (or positive reflux acc to Nelson’s), continue abx prophylaxis and order functional renal scan.
IF VUR 1-III, no abx and F/up US q3months

33
Q

What antibiotics are recommended for prophylaxis in VUR?

A

Amoxil for first month of life (Hamilton)
Septra or Nitrofurantoin thereafter
1/3-1/4 of normal daily dose
Aim for only 3-6 months

34
Q

What are dynamic radionuclear scans and what are they used for?

A

MAG-3 or DTPA

used to evaluate renal function and to diagnose urinary tract obstruction in infants with hydronephrosis

35
Q

What is seen in nephrotic syndrome?

A

Proteinuria (>3.5g/day), edema, hypoalbuminemia
Hyperlipidemia, lipiduria
Increased susceptibility to infections
Increased coagulability

*note urine loss of Ig’s and complement make more susceptible to infection, loss of coagulation factors

36
Q

Recurrent hematuria around URTIs and within 1-2 days of symptom onset is suggestive of what?

A

IgA nephropathy

37
Q

What is the most common chronic glomerular disease?
How to diagnose?
What is seen?

A
  • IgA nephropathy
  • diagnose with biopsy
  • predominance of IgA immunoglobulin with mesangial glomerular deposits in the absence of systemic disease
38
Q

Name 5 common causes of gross hematuria

A 
Hypercalciuria
UTI
Meatal stenosis
Trauma
Perineal inflammation
Coagulopathy
Tumour
Glomerular disease
39
Q

What measurement distinguishes mild to moderate hydronephrosis from severe?

A

15mm

40
Q

What tests can be used to distinguish between pre-renal and intrinsic acute kidney injury?

Explain.

A

Fractional excretion of sodium:
(UNa/SeNa) / (UCr/SeCr) = %
FeNa <1%= prerenal, almost all filtered sodium is reabsorbed, which is a natural response to decreased perfusion
FeNa > 2%= ATN, kidneys are failing to handle properly

BUN/Cr ratio:
>20 = prerenal AKI , BUN avidly reabsorbed in PT but this test isn’t reliable because of known alternative causes that elevate BUN like TPN, catabolism, GI bleeding

41
Q

How do you calculate an anion gap?

What is the normal value?

A

Na - (Cl + HCO3)

12 +/-4 meq/L

42
Q

What organ systems are affected in Cystinosis?

A

kidney
liver
eye
brain

43
Q

Describe the findings in infantile cystinosis?

A

aka Nephropathic cystinosis

  • present in first 2 yrs with severe tubular dysfxn and growth failure
  • ESRD by end of 1st decade of life
  • Fanconi syndrome with polyuria, polydipsia, FTT, rickets
  • fair skinned and blond
  • can also develop hypotTh, HSM, delayed sexual maturation
44
Q

How to diagnose cystinosis?

Treatment?

A

Cystine crystals in the cornea
Measurement of increased leukocyte cystine content
Prenatal testing available

Treatment with cysteamine, converts to cysteine facilitating lysosomal transport and decreasing tissue concentrations

45
Q

What is the triad associated with Prune Belly Syndrome?

A

Abdominal muscle deficiency
Severe urinary tract abnormalities
Bilateral cryptorchidism in males

30% of survivors develop ESRD

46
Q

What electrolyte concentrations are suggested for ORT solutions?

A

Na -Cl: 45-60mmol/L
K: 20mmol/L
Carbs: 25-30g/L
Osm: 250mOsm/L

47
Q

What % of dehydration is associated with mild, moderate and severe? What is the recommended volume of ORT?

A

Mild: <5% ; 50mL/kg over 4 hrs
Moderate: 5-10%; 100mL/kg over 4 hrs
Severe: >10%; IV 20-40mL/kg NS or RL over 1hr

Always replace ongoing losses, age appropriate diet after rehydration.

48
Q

What lab anormalities are associated with hypernatremia?

What is the maximum rate of correction for hypernatremia?

A
  • hyperglycemia, hypocalcemia

- max 12meq/L in 24hrs, unless symptomatic

49
Q

Prerenal or AKI?
UNa <20
UOsm >400
FeNa <1

A

Hypovolemia

50
Q

ATN or hypovolemia?
UNa >30
UOsm <350
FeNa >1

A

ATN

51
Q

When to refer an undescended testes?

A

It won’t spontaneously descend after 4 months, surgery should be performed no later than 15 months.

52
Q

What are consequences of cryptorchidism?

A 
infertility
testicular malignancy - pathologic changes by 6-12mo!
associated hernia
torsion of the high testis
psychological effects of empty scrotum
53
Q

Does the risk of germ cell malignancy go down after orchidopexy?

A

The jury is out!
While riding high the risk is 2-4x higher than the general population (1/80 with unilat, 1/40-50 with bilat)
Early descent is associated with better outcomes (<2yo)

54
Q

Which primary kidney disorders are classically associated with hypertension?

A

Autosomal recessive polycystic kidney disease (ARPKD)

Autosomal dominant PKD (ADPKD)

55
Q

List causes of elevated anion gap metabolic acidosis

A

MUDPILES

Methanol, Uremia, DKA, Paraldehyde/Propylene glycol, Iron/INH, Lactate, Ethanol, Salicylates

56
Q

A seizing hyponatremic patient, how to manage?

A

Hypertonic saline 3% 4-6mL/kg

57
Q

Describe hypernatremic dehydration approach to IVF

A

1) Maintenance fluids (4-2-1 rule)
2) Free water deficit correction = .6 x kg x ((SeNa/140)-1)
which can be given with 0.45NS (ie: NS=N, D5W not good to infuse, meet halfway with 0.45NS so giving 1/2 free water, therefore need 2x as much)
3) replace ongoing losses 1:1

Follow electrolytes closely, min q6hrs

58
Q

How to diagnose hypercalciuria?

A

Best: 24hr urine calcium excretion >4mg/kg

Screening test: random urine calcium to creatinine ratio, >0.2 suggests hypercalciuria in an older child

59
Q

How to diagnose nephrolithiasis?

A

Plain x-ray and ultrasound to start

Weigh risks and benefits of CT (the gold standard) but ++ radiation

60
Q

What can cause transient proteinuria?

A 
Fever
Exercise
Dehydration
Cold exposure
Heart failure
Seizures
Stress
61
Q

What is the most common cause of persistent proteinuria in school-aged children and adolescents?

How to confirm?

A

Orthostatic proteinuria

First morning urine sample x3
If no protein seen or UrineProtein:UrineCreatinine ration <0.2, diagnosis is confirmed.

62
Q

When should inguinal hernias be repaired in the following groups?
<1yr
NICU
>1yr

A

<1yr: repair quickly! High likelihood of incarceration before 11 months (70%!)
NICU: before discharge from unit
>1yr: promptly

63
Q

What is your differential diagnosis for a neonate with hyponatremia and hyperkalemia?

A

CAH
Defects in aldosterone production or function
Adrenal damage or dysfxn (hemorrhage, absence, infection, insufficiency)
Type IV RTA
Defects in cholesterol biochemistry
Pseudohypoaldosteronism

64
Q

What urine specific gravity do you see in dehydration? In a fluid replete individual?

A

Urine >1.03 is concentrated

Urine <1.01 is dilute

65
Q

Give an example of a calcium channel blocker & its side effect

A

Nicardipine

reflex tachycardia

66
Q

Give an example of a beta blocker & its side effect

A

Esmolol
very short acting so constant infusion preferred,
may cause bradycardia

67
Q

Give an example of a direct vasodilator

A

Hydralazine

Sodium Nitroprusside

PRCE (8 decks)

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