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Pediatrics > Pedia Nephrology > Flashcards

Pedia Nephrology Flashcards

1
Q

regulates GFR by decreasing the surface available for filtration by closure of the filtration slits

A

Podocyte

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2
Q

Generate prostaglandin and control GFR, serves as structural support which also act as accessory cells and APC in immune response

A

Mesangial Cells

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3
Q

Trace the arterial blood supply of kidney

A

renal artery-segmental artery-lobar a.-interlobar a.-arcuate a.-interlobular a.

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4
Q

Trace the venous blood flow of the kidney

A

interlobular a.-arcuate a.- interlobar a.-renal a.-abdominal aorta-IVC

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5
Q

True or False, Thus kidney have an endocrine function

A

True

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6
Q

increase production of angiotensin 2 when there is a fall in intravascular volume which will lead to release in aldosterone from the adrenal cortex and release of ADH from the posterior pituitary

A

Renin

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7
Q

release when there is a decrease in serum sodium concentration, that will promote Na+ ion and water reabsorption in the DCT and collecting duct

A

aldosterone

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8
Q

promotes the loss of Na+ Cl- and water chiefly by increasing GFR when there is increase in atrial pressure

A

atrial natriuretic peptide

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9
Q

most active form of Vitamin D that promotes Ca+ and phosporus absorption from the gut

A

1,25 dihydroxycalciferol

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10
Q

Most common cause of abdominal mass in the newborn

A

Multicystic dysplastic Kidney

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11
Q

Leading cause of ESRD in the first decade of life

A

Bilateral Renal Hypoplasia

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12
Q

Common functional anomaly

A

vesicoureteral reflux (VUR)

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13
Q

(+) drooping Lily sign

A

vesicoureteral reflux (VUR)

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14
Q

Most common cause of severe obstructive uropathy in children, commonly found in male with palpable distended bladder and weak urinary stream

A

Posterior Urethral valves

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15
Q

Most common acute nephritic syndrome in 5-12 years old

A

Post streptoccocal acute Glomerulonephritis

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16
Q

Most common chronic glomerular disease worldwide

A

IGA nephropathy(Berger’s Disease)

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17
Q

Most common glomerular disease leading to ESRD

A

IGA nephropathy

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18
Q

Most common cause of chronic glomerularnephritis in older children and young adults

A

Membranoproliferative Glomerulonephritis(MPGN)

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19
Q

Most common cause of nephrotic syndrome in adults

A

Membranous Nephropathy

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20
Q

Contralateral hydronephrosis 5-10%
Risk for Hypertension which is renin mediated
Risk for Wilm’s tumor
horse shoe kidney

A

Multicystic dysplastic kidney

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21
Q

Autosomal dominant disease whichis associated with anatomical deformities such as ureteral duplication, ureterocoele, and ureteral ectopia

A

Primary vesicoureteral reflux

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22
Q

Enumerate the Grade of Primary vesicoureteral reflux

A

G1: reflux into the non dilated ureter
G2: reflux into the upper collecting system without dialation
G3: reflux to the dilated ureter and or blunting of the calyceal fornices
G4: reflux to the grossly dilated ureter
G5: massive reflux with significant ureteral dilatation and tortousity and loss the papillary impression

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23
Q

What is the corner stone treatment of Primary vesicoureteral reflux?

A

daily antibiotic prophylaxis

  • Cotrimoxazole
  • Trimetoprim
  • Nitrofurantoin
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24
Q

Most common serious bacterial infection in <24 months who have fever without localizing sign

A

Pyelonephritis

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25
Q

Condition with (+) urine culture with no symptoms and most common in girls, preschool and school age

A

Asymptomatic Bacteriuria

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26
Q

Level of urine WBC in Pyuria

A

> 5/hpf of >20 mm3

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27
Q

Microhematuria means

A

> 5/hpf

28
Q

Urinalysis findings in patient with Urinary tract infection

A

Pyuria which is more confirmatory that diagnostic
(+)Nitrites and leukocytes esterases
Microscopic hematuria for cystitis
WBC cast for pyelonephritis

29
Q

Gold standard for diagnosis of UTI

A

Urine Culture showing >100,000 colonies of a single pathogen

30
Q

Most sensitive and accurate diagnostic imaging for study of renal scarring

A

Renal Cortical Scintigraphy( Dimercaptosuccinic acid)

31
Q

Treatment for Acute Cystitis

A

Trimetoprim sulfamethoxazole- against E.coli 3-5 day course
Nitrofurantoin 5-7mg/kg/24hrs
Amoxicillin 50mg/kg/ 24hrs

32
Q

Drug of choice for oral therapy of patient with acute febrile infection suggestive of pyelonephritis

A

Cefixime

fluoroquinolone or ciprofloxacin for resistant organism like pseudomonas in >17years old

33
Q

hematuria lasting for 4 days which commonly found in males affected by Adenovirus types 11 and 21 or even E. coli

A

Acute hemorrhagic Cystitis

34
Q

A child with sudden edema, oliguria, hematuria, hypertension or renal insufficiency with no previous renal disease

A

Acute Nephritic Syndrome

35
Q

Recurrent significant hematuria and proteinuria demonstrable on sequencial urine testing beyond 1 month

A

Persistent Glomerulonephritis

36
Q

anticipated complication of PSAGN

A

hypertensive encephalopathy
Congestive heart failure
Acute Renal Failure

37
Q

Urinalysis: RBC cast, proteinuria and PMN
Mild normochromic anemia due to hemodilution and low grade hemolysis
Low C3( hypocomplementemia) which returns to normal after8-12 weeks after onset

A

Post streptococcal acute glomerulonephritis (PSAGN)

38
Q

Confirmation test for invasive streptococcal infection

A

(+) throat culture
Elevated ASO tites
Anti Dnase B levels— best to document in cutaneous streptococcal infection

39
Q

Most essential management in patient with PSAGN

A

Fluid restriction 20-30ml/kg/BW
thus monitoring intake and output is needed
Diuresis usually with furosemide at 1mg/kg/dose is also given

40
Q

What medication should be given in a patient with PSAGN + hypertension

A

Hydralazine 0.15-0.30mg/kg, CCB, ACEi

41
Q

A slowly progressive disorder which presents with recurrent gross hematuria associated with URTI or GIT infection with normal serum C3 level

A

IGA nephropathy (Berger’s disease)

42
Q

Primary treatment for Berger’s disease

A

blood pressure control

43
Q

Autosomal dominant, x linked dominant, presence of COL4A5 gene, and vacuolated foam cells in glomeruli
imunofluorescence negative

A

Alport’s Syndrome

44
Q

Persistent Hypocomplementemia >6-8 weeks common in second decade of life with thickening of of glomerular basement membrane and proliferation of mesangial cells for type I & III
Increase in ASO titer at onset

A

Membrano proliferative GN (MPGN)

45
Q

Clinical manifestation of MPGN

A

asymptomatic proteinuria
acute nephritic syndrome
Nephrotic- Nephritic syndrome

46
Q

Management for MPGN

A

High dose alternate day Presnisone (20mg) for 5-10 yrs
High dose Methylprednisolone pulse therapy 15-30mg/kg/dose
Plasmapheresis for severe state

47
Q

(+) Thickened capillary wals due to comb like deposits of IgG and C3
(+) Association of Hepatitis B antigenemia

A

Membranous Nephropathy (MGN)

48
Q

rapidly progressing disease with histopath finding of crescent in the glomeruli
Manifestation: Hemorrhage in the lungs and kidneys which are GBM anti GBM mediated occurence

A

Goodpasture syndrome

49
Q

Management for Goodpasture Syndrome

A

Plasmapheresis

50
Q

small vessel vasculitis with cutaneous and systemic complication,
(+)gross hematuria, purpuric rash, arthritis, abdominal pain appearing 1-3 weeks after URTI
Nephritis occur upto 12 weeks after initial presentation

A

Henoch Schonlein Purpura Nephritis (HSP)

51
Q

Treatment for HSP

A

Low dose Prednisone- to reduce risk of development

Dypyridamole and heparin or warfarin- provide benefit in severe form

52
Q

Triad of proteinuria, hypoproteinemia and hyperlipidemia

A

Nephrotic Syndrome

53
Q

Main abnormality in Nephrotic Syndrome

A

Massive Proteinuria >2g/24hrs due to the glomerular wall permeability

54
Q

Sudden disruption of renal function resulting from oliguria or anuria and internal imbalance

A

Acute Renal failure

55
Q

3 etiologic Categories of AKI

A
  1. Prerenal : 72% most common
    there is decrease perfusion of the normal kidney probably secondary to sepsis, perinatal asphyxia or CHF, shock
    2.Intrinsic: 15% renal parenchymal injury
    mediated by immune mechanism
  2. Postrenal: 13% urinary tract obstruction impending the good flow
56
Q

Metabolic manifestation of AKI

A

Hyperkalemia: mos serious abnormality
Hyponatremia
Hypocalcemia
Acidosis

57
Q

BUN Creatinine ratio differences in diagnosing AKI

A

Prerenal: >20:1 mg/dl increase BUN in normal Crea
Intrinsic: <10:1 mg/dl both BUN and Crea elevated

58
Q

Most common cause of Acute Renal failure in young children in US
<4years old

A

Hemolytic Uremic Syndrome(HUS)

59
Q

Diarrhea associated (D+) & shiga toxin associated with ingestion of contaminated undercooked beef that harbors E. coli 0157:H7

A

Hemolytic Uremic Syndrome(HUS)

60
Q

Triad of Hemolytic Uremic Syndrome(HUS)

A
  1. microangiopathic hemolytic anemia (hgb:5-9g/dl)
  2. Thrombocytopenia (20,000-100,000/mm3)
  3. ARF (oliguric/anuric)
61
Q

Normal platelet count

A

150,000-400,000

62
Q

At the 2-week check-up of a term female infant, the mother reports a grayish and sometimes bloody vaginal discharge since birth. The
infant’s mother and grandmother are the only caretakers. Examination of the external genitalia reveals an intact hymen with a thin grayish mucous
discharge. Which of the following is the most appropriate next step?
a. Parental reassurance
b. MRI of the brain
c. Ultrasound of the abdomen
d. Gonorrhea and chlamydial swabs
e. Referral to social services for possible sexual abuse

A

a. Parental reassurance

63
Q

The delivery of a newborn boy is remarkable for oligohydramnios. The infant (pictured) is also noted to have undescended testes and
clubfeet, and to be in respiratory distress. Which of the following is the most likely diagnosis to explain these findings?
a. Surfactant deficiency
b. Turner syndrome
c. Prune belly syndrome
d. Hermaphroditism
e. Congenital adrenal hyperplasia

A

c. Prune belly syndrome

malformation that occurs mostly in males
lax, wrinkled abdominal wall, a dilated urinary tract, and intra-abdominal testicular tissue.

Oligohydramnios and commonly associated pulmonary
complications, such as pulmonary hypoplasia and pneumothorax,

64
Q

A 17-year-old boy is brought to the emergency department by his parents with the complaint of coughing up blood. He is stabilized, and his
hemoglobin and hematocrit levels are 11 mg/dL and 33%, respectively. During his hospitalization, he is noted to have systolic blood pressure
persistently greater than 130 mm Hg and diastolic blood pressure greater than 90 mm Hg. His urinalysis is remarkable for hematuria and
proteinuria. Of the following, which is likely to result in the correct diagnosis?
a. Culture of stool for Escherichia coli O157:H7
b. Measurement of antibodies to the glomerular basement membrane
c. Twenty-four hour urine collection for protein excretion
d. Measurement of serum antistreptolysin levels
e. Obtaining a renal ultrasound with renal vein Doppler flow studies

A

b. Measurement of antibodies to the glomerular basement membrane

Dx: good pasture syndrome
pulmonary hemorrhage can be life threatening and the
renal impairment progressive. Diagnosis is suggested by finding hemosiderin-laden macrophages on sputum or pulmonary secretions and the finding
of antibodies to the glomerular basement membrane; a kidney biopsy may be required as well

65
Q

A 17-year-old boy is brought to the emergency department by his parents with the complaint of coughing up blood. He is stabilized, and his
hemoglobin and hematocrit levels are 11 mg/dL and 33%, respectively. During his hospitalization, he is noted to have systolic blood pressure
persistently greater than 130 mm Hg and diastolic blood pressure greater than 90 mm Hg. His urinalysis is remarkable for hematuria and proteinuria. What is the most likely diagnosis?

A

Good Pasture syndrome

pulmonary hemorrhage can be life threatening and the
renal impairment progressive. Diagnosis is suggested by finding hemosiderin-laden macrophages on sputum or pulmonary secretions and the finding
of antibodies to the glomerular basement membrane; a kidney biopsy may be required as well

66
Q

A 1-year-old child has been admitted to the hospital for failure to thrive. The family reports that the child is always crying for something to
drink but voids almost constantly despite their limiting his liquid intake. They report 3 previous hospital admissions in the first 6 months of life for
dehydration that was not associated with vomiting or diarrhea. Over the years, other family members reportedly have had similar histories. Which
of the following steps is most likely to assist in ascertaining the correct diagnosis?
a. Three day calorie count with high calorie nutritional supplements
b. Measurement of serum and urine glucose levels and serum hemoglobin A1C
c. Repeated measurement of serum sodium and urine specific gravity levels during a controlled fluid restriction challenge
d. Obtain skeletal survey, an ophthalmologic evaluation, and call child protective services
e. Measurement of serum protein, cholesterol, and triglyceride levels as well as 24 hour urine protein excretion measurement

A

c. Repeated measurement of serum sodium and urine specific gravity levels during a controlled fluid restriction challenge

Dx: classic central nephrogenic diabetes insipidus
the urine is hypotonic and produced in large volumes because the distal tubule and collecting duct of the kidneys fail to respond to antidiuretic hormone (vasopressin).

Pediatrics (6 decks)

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