Nephrology/Urology Flashcards

Question 1

Q

What is the main indication for orchidopexy?

When should a child be referred for orchidopexy?

When should the orchidopexy be performed?

Answer

A

Risk of infertility

Referral between 6-9 months

Between 6-18 months

Question 2

Q

What are the criteria for the TWIST score? (SHARE)

What management is indicated based on the scoring?

When should a testicular torsion be repaired by?

Answer

A

Swelling of testicles - 2
Hard testes - 2
Absent cremasteric reflex - 1
Riding high testicle - 1
Emesis/nausea - 1

Indications

0-2 LOW risk → no ultrasound or consult required
3-4 INTERMEDIATE risk → ultrasound warranged
≥5 HIGH risk → ultrasound not required, urgent urological consultation and surgery required

Repair - ideally within 6h of onset of pain, if not available, manual detorsion can be attempted

Question 3

Q

What is the best test to confirm pelvic urethral valves?

Question 4

Q

What is an indication for a nuclear cystogram?

What is a disadvantage of a nuclear cystogram for assessment of first presentation UTI?

Answer

A

Initial assessment for VUR in females only.

Follow-up of VUR in males and females

Unable to detect presence of posterior urethral valves in males.

Question 5

Q

Which nuclear diagnostic test is able to assess renal scarring?

Which nuclear diagnostic test is best able to asess obstruction?

Why are renal scans performed?

Answer

A

DMSA

MAG3 diuretic

Provide information on differential renal function

Question 6

Q

What are the 2 most common forms of DSD?

When should DSD investigations be initiated in an infant with hypospadias?

Answer

A

CAH, mixed gonadal dysgenesis

Bilateral cryptorchidism

Question 7

Q

Why shouldn’t RBUS be done within the first 2 days of life?

What are the recommendations for postnatal imaging in antenatal diagnosis of hydronephrosis?

What is the management recommendations with postnatal imaging results?

Answer

A

Can underestimate the severity of hydronephrosis.

In 3rd trimester, APD 7-10 = Low grade, >15 = High grade
- Low grade (“minimal or mild”, calyces are not dilated)→ RBUS within first 1-3 months of life, may benefit from antibiotic prophylaxis
- High grade (“moderately severe”, dilated calyces, parenchymal thinning) → RBUS within first 2 weeks of life

Management

If normal, counsel on signs and symptoms of UTI/UPJO and discharge
If APD <10 - repeat RBUS in 6 months, then annually. No antibiotic prophylaxis
If >15 - refer to pediatric urology for further investigations

Question 8

Q

List 4 of the most common causes of high grade or “significant” congenital hydronephrosis

Answer

A

UPJO: Ureteropelvic junction obstruction
high-grade VUR: High-grade Vesicoureteral reflux
UVJO: Ureterovesical junction obstruction
PUV: Posterior urethral valves

Question 9

Q

What diagnosis is suspected when significant hydronephrosis is observed WITHOUT hydroureter?

Answer

A

UPJO - ureteropelvic junction obstruction

Question 10

Q

List 3 signs of PUV from antenatal ultrasounds?

What management would you recommend upon delivery of an infant with suspected PUV?

Answer

A

Male sex suspected
Distended, thick walled bladder
Bilateral hydronephrosis
Keyhole sign
Oligohydramnios

Postnatal management

Urgent postnatal RBUS
Bladder decompression if needed
Confirmatory VCUG
Serial creatinine levels
Consult urology
Consider nephrology consult for acid-base, electrolyte management if needed

Question 11

Q

What is the most common cause of acquired hydronephrosis?

Answer

A

UPJO - ureteropelvic junction

Question 12

Q

What is the most common non-infectious cause of daytime incontinence?

What 2 diagnoses do you need to rule out before you can diagnose someone with OAB?

What are common associated diagnoses with OAB?

Answer

A

Idiopathic overactive bladder

Bacterial cystitis/Bladder outlet obstruction

Constipation, Nocturnal enuresis, recurrent cystitis

Question 13

Q

Provide 4 recommendations for the management of Idopathic Overactive Bladder

Answer

A

Treat constipation if present
Treat UTI if present
Timed voiding (q1.5-2h)
Observation if not bothersome to child
Anticholinergics (oxybutynin)
- decrease frequency and intensity of involuntary contractions, resulting in increased bladder capacity
- Can worsen constipation → aggravate OAB

Question 14

Q

Which CAKUT anomaly is associated with:

Increased risk UVJO + VUR

Increased risk UPJO

Answer

A

Complete duplication

Horseshoe kidney

Question 15

Q

What is the best investigation to most reliably identify a non-obstructing stone in the distal ureter?

List 2 management strategies in the ER for renal stones

When is urology referral indicated for kidney stones?

Answer

A

CT KUB (2nd line though, shoudl get US first) - indicated when US identifies hydroephrosis/hydroureter but no stone identified

Analgesic (NSAIDS +/- opioids)
Alpha-adrenergic blockers (tamsulosin) to hasten passage of small ureteric stones

Referral

Too large to pass (>5mm)
Unremitting pain
Persistent, severe obstruction
Solitary kidney
Infected, obstructed kidney

Question 16

Q

What is the most common type of renal stone?

List 5 dietary recommendations for kidney stones

What type of investigations should you complete for a renal stone?

Answer

A

Calcium oxalate

Increase hydration to 2-2.5L/day
Ensure maintaining RDA intake for calcium
Low sodium diet (associated with obligatory calcium excretion)
Add citrus juice to water (contains citrate → urinary inhibitor of stone formation)
Low protein diet

Investigations

Initial
- Lytes, BUN, Creatinine
- Urinalysis with stone evaluation
  - pH <6 → uric acid stones
  - pH >7 → calcium phosphate and struvite stones
Additional
- Renal stone analysis (if retrieved)
- Urine Ca:Cr ratio
- 24-hour urine sample to assess for risk factors of stone development (cystinuria, hyperuricosuria, hypocitraturia, hyperoxaluria, hypercalciuria)

Question 17

Q

What is the most common metabolic abnormality associated with stone formation?

List 4 risk factors for calcium stone development

What bacterial cystitis is associated with struvite stones?

What amino acids are increased with cystine stones?

Answer

A

Hypercalciuria

Risk factors

Hypercalciuria
Hypercalcemia
Immobilization
Loop diuretics
Ketogenic diet
Renal diseases (distal RTA [RTA1], medullary sponge kidney)
Intestinal malabsorption (IBD, CF, celiac disease [oxalate])

Proteus mirabilis

Question 18

Q

What type of hernia is at risk of developing with a communicating hydrocele?

When should you refer for hydrocele?

What are reasons for a persisting non-communicating hydrocele?

Answer

A

Indirect hernia

If not resolved by 12 months

Reactive (infection, inflammation, trauma, tumour)

Question 19

Q

In regards to circumcision:

What is the most common long-term complication + how can it be prevented?

List 2 acute complications

List 2 medical indications

List 2 contraindications

List 3 possible benefits

Answer

A

Meatal stenosis
Apply petroleum jelly to the glans for up to 6mo following circumcision

Acute complications:

Minor bleeding
Local infection
Unsatisfactory cosmetic result

Medical indications

Scarred phimosis (pathological phimosis)
Recurrent balanoposthitis
Genital lichen sclerosis (balanitis xerotica obliterans)
Recurrent UTIs in high-risk patients as an adjunct or alternative to prophylactic antibiotics
Untreatable paraphimosis

Contraindications

Known bleeding disorder
Hypospadias

Benefits

↓incidence UTI in young boys
↓risk of penile cancer
↓risk of trichomonas, BV and cervical cancer in female partners
↓risk of acquiring STI (HSV, HIV, HPV)

Question 20

Q

What percentage of males will have retractile foreskins by 6yo + 17yo?

What is the difference between paraphimosis and phimosis?

What is the treatment of phimosis?

Answer

A

50% + 95%

Phimosis = scarred, thickened foreskin preventing retraction
Paraphimosis = foreskin entrapped behind the glans

Treatment

Topical steroid BID to foreskin, accompanied with gentle traction
- Betamethasone 0.05%
- Triamcinolone 0.1%
- Mometasone furoate 0.1%

Question 21

Q

When does the CPS recommend antibiotic prophylaxis be considered?

What is the length of time prophylaxis should be considered?

What are 2 usual choices for prophylaxis?

When should prophylaxis be stopped or changed?

Answer

A

Grade IV-V VUR
Significant urological anomaly

Consider managing constipation appropriate to decrease UTI recurrences.

Length of time: No more than 3-6 months

Usual choices - 1/4-1/3 of treatment dose daily

Nitrofurantoin - no longer commercially available as suspension; can crush, mix with yogourt or apple sauce
TMP/SMX

Antibiotic resistance identified (even when believed to be contaminated). If resistance present to both Nitrofurantoin + TMP/SMX, consider discontinuing prophylaxis.

Question 22

Q

What is secondary nocturnal enuresis?

When should a child be considered enuric?

How common is bedwetting in 5yo, 8yo and 15yo?

What sleep disorder is associated with nocturnal enuresis?

What treatment options are available?

Answer

A

Bladder control attained for ≥6 months, then incontinence reoccurs

If wetting >2/week when >5yo

5yo - 10-15%
8yo - 6-8%
15yo - 1-2%

Sleep terrors

Management

Minimize emotional impact on the child
- Reassurance, support and avoidance of punishment and humiliation → maintain self-esteem + minimize parental frustrations
Non-pharmacological:
- Avoid caffeine-containing foods
- Avoid excessive fluids before bedtime
- Take child out of diapers
- Include child in morning cleanup in nonpunitive manner
- Ensure access to toilet
Behavioural therapy
- “Dry bed training” may be more effective in combination with alarm therapy
- Ensure to empty bladder before bed
- Avoid drinking fluids after supper, if able
- Encourage the child to participate in cleaning up in morning
If “significant problem for child”
- Alarm devices - most efficacious
- DDAVP/desmopressin acetate for camp/sleepovers or if alarm system impratical
  - Avoid fluids 1h before + 8h after taking
- Imipramine
  - Short-term treatment
  - Refractory cases with distressed, older children
  - Parents are reliable + counselled about safe storage (danger of overdose)

Question 23

Q

Provide counselling to a family who is considering use of bed alarms for primary nocturnal enuresis.

Answer

A

Success depends on motivation of child and willingness of child/parents/siblings to be awakened
Most effective ≥7-8yo
Cure rate is just under 50%
Recommend a trial period of 3-4 months. It can take 1-2mo to see any effect
- Usually first improvement is less urine than totally dry
Discontinue once 14 days consecutively dry
- Can consider “overlearning” at this point - where you encourage child to drink 2 glasses water before bed, then discontinue once 7 days dry in a row
May be repeated if a relapse occurs

Question 24

Q

When should UA/UCx be obtained from children <3yo?

What is the most common cause of a positive urine culture in afebrile young children?

List 4 symptoms of UTI in children ≥3yo

What 5 features can be used to rule out UTI in girls <24 months? How is it used?

Answer

A

Fever >39˚C with no apparent source

Contamination

Symptoms

Increased Urinary frequency
Dysuria
Hematuria
Abdominal pain
Back pain
New daytime incontinence

Predictive tool (females <2yo)

If ≤1 present, risk for UTI is <1%

Age <12mo
Fever >39˚C
White race
Fever for >2 days
Absence of another source of infection

Question 25

Q

What can cause a nitrite test to be falsely negative?

What is considered pyuria?

Who requires a catheterized or SPA collection for urine culture to be considered reliable?

What are 4 of the most common causes of UTI in previously well children who have not been on antibiotics?

Which bacteria is seen with adolescent females with UTI?

Answer

A

If bladder is emptied frequently
Infection 2˚ organism that does not metabolize nitrate (all gram positive organisms)

Pyuria = >5 WBC/hpf

Children not toilet trained

Common causes

Escherichia coli
Klebsiella pneumoniae
Enterobacter species
Citrobacter species
Serratia species

Adolescent females: Staphylococcus saphrophyticus

Question 26

Q

What is the minimum colony count indicative of UTI for clean catch and catheter urines?

When should blood cultures be performed in a child with UTI?

When should renal function be monitored?

List 2 features of a complicated UTI

What route of antibiotic is recommended?

Answer

A

Clean catch: ≥10^5 CFU/mL or ≥10^8 CFU/L
Catheter: ≥5 x 10^4 CFU/mL or ≥5x10^7 CFU/L

Blood cultures: HD unstable

Renal function: >48h aminoglycosides or complicated UTI

Complicated UTI (get RBUS to r/o abscess or obstruction)

Hemodynamically unstable
No clinical improvement within 24h or fever not trending downward within 48h of appropriate antibiotics
Bladder or abdominal mass
Elevated serum creatinine (at any time)
Poor urine flow

Route of antibiotic:

Uncomplicated Febrile UTI:
- PO if can RECEIVE and TOLERATE every dose
- 2-3mo old: PO w/close follow-up arranged (others feel IV needed)
Complicated UTI: IV

Question 27

Q

What is the duration of treatment recommended for:

Uncomplicated UTI?
Cystitis (dysuria/urinary frequency + NO FEVER)
Complicated UTI

What should be done if multiresistant drug isolated?

What imaging studies should be performed, why and when?

What counselling should you provide to families?

Answer

A

Uncomplicated UTI: 7-10 days
Cystitis: 2-4 days
Complicated UTI:

Multiresistant organism isolated:

Asymptomatic: Repeat UA/UCx and change therapy only if results are suggestive of persistent UTI
Symptomatic: Repeat UA/UCx and modify antimicrobial based on results

Imaging studies

RBUS
- Who: First febrile UTI AND <2yo
- When: within 2 weeks of acute illness
- Why:
  - Identify if severe VUR or structural anomalies present
  - Confirm child had pyelonephritis
- Results:
  - If significantly abnormal or VUR IV-V → consult paediatric urology or nephrology to determine whether urgent need for consult is needed and make plan for further investigation/management
VCUG: consider for males <2yo + 2nd well-documented UTI
Nuclear cystogram: consider for females <2yo + 2nd well-documented UTI

Counselling

Advise parents their child needs to be assessed for possibility of recurrent UTI early in the course of any unexplained fever

Question 28

Q

What is the most common “solid” renal mass diagnosed at the following times?:

Antenatal/Infant

>1 year old

List 2 syndromes associated with Wilms tumour.

Answer

A

Antenatal/Infant
- Congenital Mesoblastic Nephroma
  - treated with complete surgical excision
>1 year
- Wilms tumour
  - renal biopsy not done = “spillage” which upstages the tumour

Wilms tumour syndromes:

WAGR Syndrome
Denys Drash syndrome

Question 29

Q

List 5 causes of painless scrotal swelling.

List 5 causes of painful scrotal swelling.

Answer

A

PAINLESS

Testicular tumour
Hydrocele
Varicocele
Large epididymal cyst
Inguinal hernia

PAINFUL

Orchitis
Testicular torsion
Incarcerated inguinal hernia
Infectious epididymitis
Torsion of the appendix testis
Testicular tumour

Question 30

Q

How do you calculate insensible losses?

Answer

A

400mL/m^2/24h

Question 31

Q

What tests would you require in order to evaluate the cause of severe hyponatremia (sodium 120)?

Answer

A

Urine sodium
Serum osmolality
Urine osmolality

Question 32

Q

List 4 causes of non-anion gap metabolic acidosis

Answer

A

USED CARP

Ureteric diversion
Sigmoid fistula
Excess saline
Diarrhea (or resolving DKA)
Carbonic anhydrase inhibitors
Addison’s
Renal tubular acidosis
Pancreatic fistula

Question 33

Q

List 4 causes of metabolic acidosis with an elevated anion-gap

Answer

A

MUDPILES

Methanol toxicity
Uremia
Diabetic ketoacidosis
Paraldehyde
Isopropyl alcohol
Lactic acidosis
Ethylene glycol toxicity
Salicylate toxicity

Question 34

Q

How do you find an RTA using urine electrolytes?

Answer

A

Urinary anion gap = Na+K-Cl

Cannot be interpreted if UNa <25.

if Na+K > Cl = Ammonia excretion

If Na+K < Cl = Normal (No RTA)

Question 35

Q

What are the different types of RTA, their locations and features?

Answer

A

Proximal (Type 2) + Fanconi syndrome

impaired resorption of bicarb/glucose/protein/etc
proximal tubule
acidic urine
Tx: PO4 supp and vit D

Type 4

aldosterone deficiency/insensitivity (can’t excrete K)
collecting duct
Hyperkalemia
Tx: kayexelate

Distal (Type 1)

impaired excretion of acid (H+)
distal tubule
basic urine + hypokalemia + hypercalcuria
Tx: thiazides

Question 36

Q

List 4 causes of Fanconi syndrome.

What are 4 expected features of laboratory investigations associated with Fanconi syndrome.

Answer

A

Cystinosis
Wilsons disease
Galactosemia
Tyrosinemia
Herediatary fructose intolerance
Lowe syndrome
Mitochondrial disease

Lab features

Non-anion gap metabolic acidosis
Hypokalemia
Hypophosphatemia
Glucosuria
Hyperphosphaturia

Question 37

Q

List 3 risk factors for hypertension

What is the criteria for diagnosis of HTN in children?

List 2 non-pharmalogical recommendations for HTN management.

List 3 indications for initiation of pharmacologic therapy.

Answer

A

Risk factors for HTN

History of coarctation of the aorta or aortic arch obstruction
Diabetes mellitus
Renal disease
Obesity

Criteria for HTN Diagnosis

if sBP or dBP ≥95th on ≥3 occasions (AAP says then ABPM if Stage 1 over 3 visits or elevated BP for ≥1y)
- If stage 1: ≥2 occasions within 1 month
- If stage 2: prompt referral for evaluation and therapy

Non-pharmacological management

Dietary education (DASH diet)
Increased physical activity

Pharmacologic therapy indications

Symptomatic
Target organ damage
Stage 1 hypertension persisting ≥ 6 months, despite trial of non-pharmacologic therapy
Stage 2 hypertension
T1DM/T2DM, CKD or heart failure AND BP ≥90th

Question 38

Q

What are the stages of hypertension as per AAP?

What investigations should be performed after HTN has been diagnosed as per CHEP?

What additional investigations are recommended by AAP?

Answer

A

Normal <90th
Elevated BP ≥90 or 120/<80-129/<80
Stage 1 HTN ≥95 or 130/80-139/89 (whichever is lower)
Stage 2 HTN ≥95th +12mmHg or ≥140/90 (whichever is lower)

Investigations (CHEP)

Screening
- Electrolytes, BUN/Creatinine, total CO2
- Renal ultrasound with dopplers
- Urinalysis
Cardiovascular risk screen
- Fasting blood glucose
- Lipid profile
End-organ damage assessment
- Retinal examination
- Echocardiogram
- Albumin-to-creatinine ratio (1st morning)

AAP Investigations

Renal ultrasound if <6yo or abnormal UA/renal function tests
If obese
- HbA1C
- AST/ALT - fatty liver disease screen
Depending on history/physical + initial testing
- CBC - growth delay or abnormal renal function
- Sleep study - if OSA risk factors
- Drug screen
- TSH

Question 39

Q

Which antihypertensives can you start as first line?

When do you refer to pediatric nephrology?

What are the target BPs for management?

Answer

A

1st line:

ACEi (not in black patients)
ARB
long-acting dihydropyridine CCB

Referral to nephro: ≥6mo standard-dose monotherapy without improvement

Target BPs:

No RFs <95th
RFs or target organ damage <90th

Question 40

Q

When should competitive sport participation be restricted in HTN?

In severe symptomatic hypertension

list 3 medications you can use and their routes
What principle do you need to follow when lowering the BP?

Answer

A

Sport restriction for:

Stage 2 HTN (lower below threshold before participating)
Presence of LVH or concomitant heart disease

Acute Severe HTN

Life threatening
- Esmolol - IV infusion
- Hydralazine - IV/IM
- Labetalol - IV infusion or bolus
- Nicardipine - IV infusion or bolus
- Sodium Nitroprusside - IV infusion
Less significant symptoms
- Clonidine - PO
- Hydralazine - PO

Principle: reduce by no more than 25% over first 8h

Question 41

Q

What are the 2 most common causes of proteinuria?

List 2 etiologies of false positive proteinuria on urinalysis

How would you recommend testing a child who has elevated protein on initial assessment?

Answer

A

Orthostatic proteinuria, Transient proteinuria

False positive

Alkaline urine
Concentrated urine, gross hematuria
Chlorhexidine contamination
Radioconstrast agent (iodine)

Investigations (if 24h urine, protein <1g/24h)

1st morning urine x 2 at least 1 week apart
- Urinalysis with microscopy
- Urine protein/creatinine ratio
  - If <0.2, no further testing needed
  - If >0.2 → Refer to nephrology
    - CBC, lytes, BUN/Cr, lipid profile, C3, C4 +/- ANA (esp. if FMHx)
    - Consider RBUS

Question 42

Q

Regarding nephrotic syndrome:

What is the most common cause? What is its prognosis?

List 3 features that it is defined by.

List 4 management strategies.

List 2 complications associated with it

Answer

A

Minimal change nephrotic syndrome (MCNS) - 95% respond to prednisone, most attain long-term remission

Nephrotic Syndrome: (>3.5g/24h)

Hyperlipidemia
Hypoalbuminemia
Edema
Proteinuria

Management

1st line: Glucocorticoids
Low-salt diet
Furosemide +/- albumin (if severe edema)
If relapsing/steroid-dependent:
- Cyclophosphamide
- Cyclosporine or tacrolimus

Complications

Infections - risk for pneumococcal infections
- Spontaneous bacterial peritonitis
- Cellulitis
Venous thrombosis
- DVT
- Cerebral venous thrombosis

Question 43

Q

Regarding glomerulonephritis:

What is the most common cause?

List 2 diagnoses associated with normal C3.

List 2 diagnoses with decreased C3 and C4.

If PSGN was caused by a skin infection, what is the best test to confirm systemic effect?

Answer

A

Poststreptococcal glomerulonephritis (PSGN)

Normal C3

Alport syndrome
IgA nephropathy
ANCA vasculitides
HSP nephritis

Low C3/Low C4

Membranoproliferative glomerulonephritis (MPGN)
Lupus nephritis
Postinfectious glomerulonephritis
Shunt nephritis

DNAse B (elevated with PSGN skin/throat) but ASOT will be normal in skin infections.

Question 44

Q

List 3 management strategies for management of nephritis.

What is the expected prognosis for PSGN?

Answer

A

Fluid restriction
Sodium restriction
Treat hyperkalemia (if present) with low-potassium diet and kayexalate
Close monitoring of fluid balance, daily weights, blood pressure
If hypertensive without improvement following restriction:
- 1st line: Diuretics - HCTZ or furosemide
- CCB and beta-blockers

Prognosis

Proteinuria should resolve in ~4wks, C3 normalize in ~8wks
Microhematuria can persist for a “few years”
Long-term:
- Persistent hematuria/proteinuria in 5-20%
- Chronic kidney disease 1%
- Hypertension 3%

Question 45

Q

What 2 diagnoses should you consider with URTI and painless, gross hematuria

In chronic nephritic syndrome, what medication is typically considered for proteinuria >0.5g/day?

What features are associated with Alport syndrome?

Answer

A

IgA Nephropathy + Alport syndrome

ACEi/ARB

Alport syndrome

Progressive sensorineural hearing loss (SNHL)
Lens/retina anomalies
Esophageal/tracheobronchial leiomyomas

Question 46

Q

What 3 features are seen with prune belly syndrome?

What is the most common non-urologic manifestation seen with this diagnosis?

Answer

A

Bilateral cryptorchidism
Abdominal wall laxiety from deficient musculature
Urinary tract dilation (bilateral hydroureteronephrosis)

Pulmonary hypoplasia

Question 47

Q

List 3 risk factors for renal vein thrombosis

Answer

A

Prematurity
Maternal gestational diabetes or preeclampsia
Perinatal asphyxia
Hypercoagulability (factor V leiden, protein C deficiency)
Polycythemia
Sepsis
UVC malplacement

Question 48

Q

What are the 3 main features of hemolytic uremic syndrome?

What is the most common cause of HUS?

What one clinical feature would make you think you had to follow their renal function over the long term?

Answer

A

Thrombocytopenia
Hemolytic anemia
Renal insufficiency

Shiga-toxin-producing Escherichia coli (STEC)

Significant proteinuria persisting 1 year after episode

Question 49

Q

List 4 reasons for normocytic anemia in children with chronic renal failure.

Answer

A

Lack of erythropoeitin production
Poor nutrition secondary to anorexia and vomiting due to uremia - low iron, folate, B12
Hemodialysis causing blood loss
Reduced red cell life span

Question 50

Q

You are present at the delivery of a 30wk premature baby. The medical student asks you how much sodium to put into the IV solution.

What would you tell her?

What are 2 reasons for your choice.

Answer

A

None.

Lack of sodium promotes postnatal diuresis and acute contraction of extracellular compartment
Renal capacity to retain and excrete sodium load is reduced (would lead to hypernatremia + respiratory distress if given)

Question 51

Q

What is the monitoring process for glomerular disease post-HSP?

Answer

A

Late-onset nephritis may develop up to 6 months after acute illness:

Checked UA and BP weekly for the first 4 weeks, then monthly for 6 months
Cases with severe renal involvement may need empiric immune suppression or even renal transplant (1-2% develop ESRD)

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Nephrology/Urology Flashcards

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