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Paediatrics > Nephrology & Urology > Flashcards

Nephrology & Urology Flashcards

1
Q

Ddx for periorbital edema

A 
URTI
allergic rhinitis/conjunctivitis
acute allergic rxn
periorbital cellulitis
heart failure (uncommon to have edema in paeds)
hepatic failure
nephrotic syndrome
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2
Q

nephrotic syndrome presentation

A 
hypoalbuminemia
edema, pleural effusions
lipids elevated
proteinuria
anorexia, diarrhea

M>F, 2-6 years

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3
Q

work-up for nephrotic syndrome

A

U/A, ACR, lytes (low Na, Ca, high K), BUN, Cr, glucose

PTT (low)

lipids

serum albumin

C3 + C4, ANA

Hep B, Hep C, HIV

TB skin test, varicella, streptozyme

kidney biopsy if >10 years old /w hematuria, HTN, renal insuf, or low complement

or if not responding to treatment

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4
Q

types of nephrotic syndrome

A

minimal change disease (most common)

focal segmental glomerulosclerosis

membranous glomerulonephritis

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5
Q

treatment of nephrotic syndrome

A

prednisone 4-6wks then taper. Na restrict while edematous. Lasix + albumin only if edema causing issues.

If no response or ++ relapses: cyclophosphamide or mycophenolate mofetil

after treatment give pneumococcal, varicella, influenza vaccines

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6
Q

complications of nephrotic syndrome

A

renal failure, thromboembolic events, bacterial infections (peritonitis - do cultures + tap)

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7
Q

hematuria diagnosis

A

> 5 RBCs per hpf x3 consecutive samples

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8
Q

hints that hematuria is glomerular source

A
  • cola coloured urine (vs pink/red)
  • no clots
  • proteinuria (2+)
  • dysmorphic RBCs
  • RBC casts
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9
Q

evaluation for hematuria

A

exam:

  • CVS exam
  • edema, ascites, flank pain, CVA tenderness, subrapubic pain
  • joint pain, purpura

lytes, Cr, BUN, albumin, CBC + diff

nephritic labs: C3/4, ANA, anti-dsDNA, ANCA, anti-strepsolysin

UA, microscopy, urine culture

imaging: bladder + renal US, +/- doppler, +/-cystoscopy, +/-CT if trauma

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10
Q

Paediatric hematuria DDx

A

glomerulonephritis

exercise induced

medications (cyclophosphamide)

familial - alport syndrome, sickle cell, benign fam hematuria, PCKD

infections - UTI, pyelonephritis, viral cystitis (adeno, CMV, BK - have pyuria + sterile cultures)

Nephrolithiasis

idiopathic hypercalcuria

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11
Q

Glomerulonephritis types

A

post strep (10 days after) - low C3, high ASO

IgA nephropathy - painless hematuria post virus (can have nephritic syndrome, rapid progression), dx /w renal bx

lupus nephritis

HSP nephritis

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12
Q

nephritic syndrome presentation /labs

A 
proteinuria (mild-mod)
hematuria
AKI
RBC casts
Oliguria (& mild edema, pulm edema)
hypertension
headache

+/-dyspnea, arthralgias, rash

older kids (5-15 years)

high: urea, Cr, K, P
low: Ca
acidosis (not excreting H+)
mild anemia
+/-mild hypoalbumin

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13
Q

Hemolytic Uremic Syndrome Presentation

A

abdo pain + bloody diarrhea prior (can also have e coli without this)

can cause acute renal failure

suspect if: decreased urine output, edema

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14
Q

labs in HUS

A
  • anemia, high retics
  • low plt
  • high tot bili, low haptoglobin, high LDH, schistocytes
  • negative DAT
  • high BUN and Cr
  • urine: protein, blood
  • d-dimer, fibrinogen, INR, PTT = normal
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15
Q

management of HUS

A

treat HTN, correct lytes, fluids PRN

dialysis if fluid overload + lytes not correctable or high BUN

RBC + plt transfusion PRN

plasmapheresis if non-e coli

antibiotics CONTRAINDICATED (increase shiga toxins)

annual follow-up for Cr, Bp, urinalysis

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16
Q

hydronephrosis ddx

A 
UPJ or UVJ obstruction
posterior urethral valves (males)
utereocele (ureter balloons into bladder)
ectopic ureter (into urethra or vagina)
17
Q

work-up for hydronephrosis

A

serial US in preg
if >10mm pelviectasis in 3rd trim do post-natal US

renal bladder US

consider: VCUG (can see reflux), anterograde or retrograde pyelography

18
Q

management of hydronephrosis

A

antenatal: intervene only if oligohydramnios

often resolves during 1st year of life

consider antitbiotic prophylaxis if high grade reflux

surgical: if progressing, recurrent UTIs

19
Q

posterior urethral valves description

A

mucosal folds in distal prostatic urethra –> obstruction

20
Q

posterior urethral valves presentation

A

variable, age dependent

  • renal dysplasia, reflux
  • antenatal: bladder distension, HN, oligohydramnios
  • birth: abdo mass (bladder/HN), drippling urine, resp distress, urinary ascites
  • later: dehydration, lytes, urosepsis, FTT
  • toddler: UTI, difficulty voiding, incontinence
21
Q

diagnosing PUV

A

U/S, +/- VCUG

22
Q

management of PUV

A

cystoscopic resection, vesicostomy if cant resect

post-op: monitor for CKD, bladder disfunction, reflux

Paediatrics (23 decks)

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