Pedia Nephrology Flashcards by Yuna Eberwein

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

Podocyte

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

Mesangial Cells

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Trace the arterial blood supply of kidney

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

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Trace the venous blood flow of the kidney

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

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True or False, Thus kidney have an endocrine function

True

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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

Renin

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

aldosterone

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

atrial natriuretic peptide

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

1,25 dihydroxycalciferol

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Most common cause of abdominal mass in the newborn

Multicystic dysplastic Kidney

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Leading cause of ESRD in the first decade of life

Bilateral Renal Hypoplasia

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Common functional anomaly

vesicoureteral reflux (VUR)

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(+) drooping Lily sign

vesicoureteral reflux (VUR)

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

Posterior Urethral valves

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Most common acute nephritic syndrome in 5-12 years old

Post streptoccocal acute Glomerulonephritis

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Most common chronic glomerular disease worldwide

IGA nephropathy(Berger’s Disease)

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Most common glomerular disease leading to ESRD

IGA nephropathy

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

Membranoproliferative Glomerulonephritis(MPGN)

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Most common cause of nephrotic syndrome in adults

Membranous Nephropathy

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

Multicystic dysplastic kidney

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

Primary vesicoureteral reflux

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Enumerate the Grade of Primary vesicoureteral reflux

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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What is the corner stone treatment of Primary vesicoureteral reflux?

daily antibiotic prophylaxis

Cotrimoxazole
Trimetoprim
Nitrofurantoin

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

Pyelonephritis

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

Asymptomatic Bacteriuria

Level of urine WBC in Pyuria

> 5/hpf of >20 mm3

Microhematuria means

> 5/hpf

Urinalysis findings in patient with Urinary tract infection

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

Gold standard for diagnosis of UTI

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

Most sensitive and accurate diagnostic imaging for study of renal scarring

Renal Cortical Scintigraphy( Dimercaptosuccinic acid)

Treatment for Acute Cystitis

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

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

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

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

Acute hemorrhagic Cystitis

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

Acute Nephritic Syndrome

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

Persistent Glomerulonephritis

anticipated complication of PSAGN

hypertensive encephalopathy Congestive heart failure Acute Renal Failure

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

Post streptococcal acute glomerulonephritis (PSAGN)

Confirmation test for invasive streptococcal infection

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

Most essential management in patient with PSAGN

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

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

Hydralazine 0.15-0.30mg/kg, CCB, ACEi

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

IGA nephropathy (Berger's disease)

Primary treatment for Berger's disease

blood pressure control

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

Alport's Syndrome

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

Membrano proliferative GN (MPGN)

Clinical manifestation of MPGN

asymptomatic proteinuria acute nephritic syndrome Nephrotic- Nephritic syndrome

Management for MPGN

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

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

Membranous Nephropathy (MGN)

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

Goodpasture syndrome

Management for Goodpasture Syndrome

Plasmapheresis

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

Henoch Schonlein Purpura Nephritis (HSP)

Treatment for HSP

Low dose Prednisone- to reduce risk of development | Dypyridamole and heparin or warfarin- provide benefit in severe form

Triad of proteinuria, hypoproteinemia and hyperlipidemia

Nephrotic Syndrome

Main abnormality in Nephrotic Syndrome

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

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

Acute Renal failure

3 etiologic Categories of AKI

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 3. Postrenal: 13% urinary tract obstruction impending the good flow

Metabolic manifestation of AKI

Hyperkalemia: mos serious abnormality Hyponatremia Hypocalcemia Acidosis

BUN Creatinine ratio differences in diagnosing AKI

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

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

Hemolytic Uremic Syndrome(HUS)

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

Hemolytic Uremic Syndrome(HUS)

Triad of Hemolytic Uremic Syndrome(HUS)

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

Normal platelet count

150,000-400,000

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. Parental reassurance

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

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,

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

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

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

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

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).