Pediatric Cardiac and Renal Diseases Flashcards
Post infectious acute GN (PIAGN) is a recent strep throat followed by… (6)
What is deposited in the glomerulus?
What is the treatment?
Gross hematuria HTN (Na+ and water retention) Edema UA positive for hematuria and proteinuria Elevated ASO titer Low serum C3
Immune complexes
Supportive care, they do well with this
What is the prognostic indicator of long-term renal damage in kids with Henoch-Schonlein purpura?
The development of proteinuria along with hematuria is prognostic for long-tern kidney damage
Signs and symptoms of UTI in kids include…
Fever Decreased intake Smelly urine Dark urine Stomach pain Frequency Urgency Dysuria Loss of control Occasional emesis, diarrhea
What is the best way to obtain a urine sample in kids?
If this cannot be done, what else will work? (2)
What is the problem with bag samples?
If a child is acutely ill, febrile and empiric ABX are going to be given , what methods are preferred? (2)
Clean-catch
Catheterization
Suprapubic aspiration
They’re only helpful if negative and CANNOT be used for culturing.
Catheterization or SPA
Criteria for diagnosis of UTI in kids via clean-catch:
Via catheter:
Via SPA:
Pyuria and >50K colonies per mL of a single uropathogenic organism in a good specimen (baby must be poddy trained)
Pyuria and colony count of 50K CPM or 10-50K CPM confirmed by repeat
Pyuria and ANY growth on culture
Most common pathogen in UTI in kids is:
G- possibilities
G+ possibilities
E coli (60%)
G-: Klebsiella, Proteus, Entero, Pseudo
G+: Staph sapro, Enterococcus (catheter), S. aureus
When should imaging be done for UTI in kids for boys’ 1st time and girls’ 2nd time?
After the 2nd one?
For boys’ 1st UTI and girls’ 2nd (maybe 3rd):
- renal/bladder US (anatomic anomaly, obstruction, etc)
- include VCUG if there are anatomic abn, temp > 39, or pathogen that is not E coli, or poor growth + HTN
After 2nd UTI
-VCUG to look for VUR
What grades of VUR will resolve on their own? Which may require Tx?
What occurs if it is not treated?
What are further long-term complications? (4)
1-2 don’t need treatment
3 maybe
4, 5 do generally
Renal scarring > loss of renal parenchyma between calyces and capsule
-long-term > HTN, poor renal function, proteinuria, ESRD
If the child is NOT acutely ill and tolerating PO, what is given for UTI?
If the child is acutely ill or not tolerating PO, what can be given for UTI?
How long to treat if afebrile vs. febrile?
Oral ABX: Cephalosporin (cefixime or cefdinir) - resistance to amoxicillin-clav and TMP/SMX is increasing.
Parenteral 3rd gen cephalosporin (ceftriaxone)
Afebrile - 3-4 days
Febrile - 10-14 days
When should a child with UTI be referred to a specialist? (5)
Grades 3-5 VUR Obstructive uropathy Renal abnormalities Poor renal function Pt is HTN
Which congenital heart defects are cyanotic (right to left shunt)?
Truncus arteriosus Transposition of the great vessels Trucuspid atresia ToF Total anomalous pulmonary vascular return
Which congenital heart defects are acyanotic (left to right shunt)?
ASD
VSD
PDA
Coarct of Aorta
Screening for Critical CHD in newborns is just a…
What should be done if an infant fails?
A screen!
It is an indication for a more thorough assessment of the cause of decreased oxygen sats.
When are oxygen sats checked in newborns?
What are babies at risk for if not checked?
Checked pre-ductal and post-ductal.
These babies are at risk for sudden death when ductus arteriosus closes.
List the criteria for referring a patient with a murmur to a cardiologist…
Grade 4 or above Diastolic murmur Increased intensity when standing A symptomatic murmur Obscured heart sounds Weak femoral pulses Clicks Family Hx of sudden death Abn heart sounds (except S3) Predisposing conditions for congenital heart lesions
