Nephrology/Urology Flashcards
Electrolyte requirements
Na - 1 mEq/kg
K - 2 mEq/kg
Cl - 3 mEq/kg
Volume of distribution
0.6 x wt x 1L/kg
Osmolarity calculation
2NA + BUN/2.6 + glucose/18
Electrolyte disturbances in hypernatremic dehydration
Hyperglycemia, hypocalcemia
FENa calculation
(Una x Pcr)/(Ucr x Pna)
FENa in prerenal AKI
< 1%
RAS stimulation
decreased renal perfusion
Angiotensin II effects
vasoconstriction, renal effects (efferent vasoconstriction, Na reabsorption, aldosterone secretion), ADH secretion
Aldosterone effects
Na reabsorption, K secretion
ANP effects
vasodilation, renal effects (dilates afferent/constricts efferent, decrease Na reabsorption, decrease RAS)
Diagnosis of nephrotic syndrome
Proteinuria (> 40 mg/mg2/hr)
Edema
Elevated cholesterol
False positive for protein on UA
pH > 7.5
FSGS diagnosis
Nephrotic syndrome NOT responsive to steroids
FSGS prognosis
50-70% progress to CKD (30% relapse in transplant)
Nephrotic syndrome causes
Primary (90%) - MCD»_space;> FSGS > MPGN
Secondary (10%) - HSP, SLE, HUS
Renal disease with decreased C3
PSGN, MPGN, SLE nephritis
Congenital nephrotic syndrome genetics
AR
Congenital nephrotic syndrome findings
Oligohydramnios, large placenta, presentation < 1 yo, death by E. coli sepsis
MCD age group
preschool
Complications of MCD
peritonitis (s. pneumo, e. coli), thrombosis
Treatment of refractory MCD
cyclophosphamide, cyclosporine
Most common vasculitis in children
HSP
HSP pathogenesis
IgA deposition
HSP findings
Palpable purpura, abdominal pain (intussusception), arthralgia/arthritis, renal dz
HSP diagnosis
clinical (biopsy reserved for atypical cases)
Indications for glucocorticoids in HSP
abdominal pain (NOT indicated for renal dz)
Recurrence rate of HSP
up to 1/3 (screen with UA every 6 mo)
HUS findings
microangiopathic hemolytic anemia, AKI, thrombocytopenia
HUS prognosis
5% mortality, 5% complictions
Risk factors for development of HUS
antimobility agents, vomiting (if < 5.5 yo), WBC > 13 K
ARPKD presentation
Infant - enlarged kidney, pulmonary hypoplasia, highest mortality
Children - liver fibrosis, less renal dz
Most common cause of congenital hydronephrosis
UPJ obstruction
Prophylactic antibiotics in VUR
For patients 2-24 mo
Prune belly syndrome eponym
Eagle-Barrett syndrome
Prune belly syndrome findings
lack of abd. muscles, cryptorchidism, GU abnormalities
RTA type 1
Distal - inability to secrete H+ causes severe acidosis
RTA type 2
Proximal - inability to reabsorb HCO3
RTA type 4
Deficiency or resistance to aldosterone (decreased K+, mild acidosis
Alport genetics
X-linked
Alport defect
type IV collagen
Alport findings
Glomerulonephritis, hearing loss, ocular abnormalities
Cystinosis genetics
AR
Cystinosis defect
defect in lysosomal transport
Liddle syndrome genetics
AD
Liddle syndrome defect
“gain on function” of aldosterone sensitive Na channels –> HTN, hypokalemia, alkalosis
Membranous glomerulonephritis association
HBV
Diagnosis of metabolic syndrome
3/5 of obesity, HTN, insulin resistance, hyperlipidemia, hyperglycemia
Most common cause of severe HTN in childhood
renal artery stenosis
Lethal side effect of metformin
lactic acidosis
Causes of anion gap acidosis
Methanol, Uremia, DKA, Paraldehyde, Inborn EM, Lactic acidosis, Ethylene glycol, Salicylate
Ammonium chloride (acid load) test
Expect acidification (pH < 5.5) of urine (does NOT happen in RTA type 1)
Diagnosis of RTA type 2
24-hour urine collection (?Fanconi syndrome)
Unilateral cystic kidney
Multicystic dysplastic kidney
Multiscystic dysplastic kidney association
VUR (40%)
PSGN treatment
symptomatic - ie diuretic if HTN
Hypokalemia metabolic acidosis
Bartter syndrome, Gitelman syndrome
Bartter syndrome
Hypercalciuria, nephrocalcinosis, polyhydramnios
Gitelman syndrome
Hypocalcemia, hypomagnesemia, salt-wasting
Most common cause of abdominal mass in a newborn
multicystic dysplastic kidney
Management of UPJ obstruction
surgical intervention if decreased ipsilateral function on renal scan
2nd most common cause of prenatal hydronephrosis
megaureter
Management of hypospadias and unilateral undescended testicle
karyotype - possible mixed gonadal dysgenesis (45 XO, 46 XY)
Radiographic evaluation of undescended testicle
unnecessary
Age of orchidopexy
6-12 months
Rate of foreskin retraction
1 yr - 50%, 5 yr - 90%
Balanoposthitis
inflammation of prepuce and glans
Paraphimosis
foreskin stuck in retracted position
Most common complication of circumcision
meatitis leading to meatal stenosis
Hypospadias location
ventral side (underside)
Medical management of bladder instability
oxybutynin (SE: dry mouth, facial flushing, constipation)
Management of enuresis
bedwetting alarm, desmopressin, imipramine
Indication for management of varicocele
ipsilateral testicular hypotrophy
Management of torsion of appendix testis
NSAIDs
Age range for testicular torsion and torsion of appendix testis
appendix testis - pre-pubertal
testicular torsion - pubertal boys
