Pediatric Nephrology Flashcards
What’s red flag signs/components of history for nephrology issues in children?
History of:
- hematuria
- proteinuria
- abdominal/costovertebral angle/flank pain
- recent serious pain or trauma
- sudden weight gain or edema
- complicated birth (especially oligodendrogliomas/polyhydramnios)
- **congenital anomalies with eyes/ears or external genitalia (this is common)
How to take BP in children
Right upper extremity and the cuff should cover 2/3rds of the child’s upper arm.
- peripheral pulses should also be palpable
should also always palpate the abdomen, even this has nothing to do with BP
should have BP measured every year starting at 3 yrs
Labs to observe for urinary function in children
BUN:creatinine ratio
- normal = 10:1
- increases with urine flow decreases, obstruction and dehydration
most single reliable indicator of GFR is the serum level of creatinine
What are the basic 3 steps in a routine urinalysis?
Gross inspection
Dipstick screening
Microscopic examination
What does smoky-brown or tea-colored urine imply?
Glomerulonephritis
- this is indicative of stagnated blood that is decomposed with its iron oxidized
What are causes of frank hematuria (very bright red urine)
Trauma
Kidney stones
UTI’s
Strenuous exercise
Secondary HTN and children
Most common in younger children
- most often caused by renal abnormalities (if they have elevated BP, need to check for renal or CV abnormalities)
- severely elevated BP (stage 2) and symptomatic HTN suggest secondary HTN more in children
Causes includes: 10%
- glomerulonephritis
- VUR/ obstruction nephropathy
- HUS
- congenital abnormalities of urinary tract
renovascular HTN accounts for 90% of secondary HTN
Prune belly
“eagle-Barrett syndrome”
Congenital abnormality where a child is born without abdominal musculature
- also shows renal and Urinary tract abnormalities
- **75% of these cases present with dilated ureters and VUR
- may also show cryptochidism
- may also show intestinal malrotation
wayyyy more common in boys (20x more)
major determinant of prognosis = degree of cystic renal dysplasia
Treatment = early orchiopexy and just monitor
Cryptochidism
Undescended testies
- very common male pediatric disorders, especially in premature children (33%)*
- 75% will spontaneously descend by 3 months. If they dont by 6 months (but especially by 15months ) probably need surgery
uncorrected cryptochidism = increased risk of infertility and testicular malignancies
To check for this, must check the placement and turgor of the testicles on all physical exams for infants and well check ups
Treatment = surgery after 6 months-18 months
- never use hormonal therapy
When should a disorder of sex development be suspected always?
In a phenotypic male with bilateral non palpable testies
- in this case it could be a virilized female with congenital adrenal hyperplasia
Risk always goes up the less palpable the testicles are
Congenital adrenal hyperplasia (CAH)
Is a autosomal recessive disorder of cortisol biosynthesis (usually deficiency)
- causes an increase in the secretion of adrenocorticotropic hormone (ACTH) which in turn leads to adrenal hyperplasia and increases in intermediate metabolites production
Usually leads to precocious puberty in males and sexual infantilism in females
- will change the infants genitalia if not corrected (females will have enlarged clitoris which looked like a penis, and males will have either normal looking or cryptochidism
- *can be life threatening since uncorrected cortisol deficiencies can lead to low aldosterone production = salt-wasting and hyponatremia**
- is termed simple virilizing disease if the aldosterone is not reduced.
What is the most common cause of CAH
21-hydroxylase deficiency
- this enzyme is required for the synthesis of cortisol and aldosterone
- if you dont have this enzyme, cortisol and aldosterone turns into testosterone
Symptoms of serious CAH
Usually present by 10-14 days of age
Progressive weight loss
Anorexia
Vomiting
Dehydration
Weakness
Hypotension*
Hypoglycemia and hyponatremia*
Hyperkalemia*
- = most dangerous and will lead to shock if not corrected
Postnatal androgen excess
Untreated CAH deficiency produces this
- * harder to see in males since they will appear normal and don’t usually develop adrenal insufficiency
Signs:
- rapid somatic growth and accelerated skeletal maturation with premature closure of epiphyseal plates(look super tall when young, but short at adulthood)
- increase pubic and axillary hair for their age
- premature acne and deep voice
- enlarged penis/scrotum with normal testie size
What ages are UTIs most common in children?
First year = #1
- male:female ratio = 2.8:5.4
(Females more likely to get it)
- **if a male is going to get a UTI, It is far more common in the 1st year of life
- **more common in uncircumcised males
- first UTI females is usually by the age of 5yrs old
Beyond first year male:female ratio = 1:10
commonly presents with a fever with NO OTHER symptoms
