Pediatric Pearls 2

Question 1

Diagnose acute post-streptococcal glomerulonephritis

Answer 1

Post Infectious Acute Glomerulonephritis (PIAGN)

Recent strep throat followed by:
Gross hematuria c/w glomerular involvement
HTN: mainly due to Na+ and water retention
Swelling/edema: due to sodium and water retention
UA reveals hematuria and proteinuria of varying degrees
Elevated ASO titer
Low serum complement C3
Deposition of immune complexes in glomeruli
Supportive care, usually these kids do fine

Question 2

Name the prognostic indicator of long-term renal damage in children with Henoch-Schonlein Purpura.

Answer 2

The development of PROTEINURIA along with the hematuria is a prognostically indicative of potential long term renal damage

This condition is hard to diagnose and kids feel crummy for a LONG time

Question 3

Name the most common urinary pathogens in children

Answer 3

Escherichia coli is the most common bacterial cause of UTI in children
Accounts for 57-67% of UTI’s in children

Other gram-negative pathogens:
Klebsiella
Proteus
Enterococcus
pseudomonas

Gram-positive bacteria pathogens:
Staphylococcus saprophyticus
Enterococcus (especially if indwelling catheter or post-instrumentation)
Staphylococcus aureus (rare)

Question 4

Describe the criteria for the diagnosis of a UTI in a child

Answer 4

If the urine is collected by clean catch, the presence of both pyuria AND at least 50,000 colonies per ml of a SINGLE uro-pathogenic organism in an appropriately collected specimen of urine (child needs to be potty trained)

If the urine is collected by catheter, pyuria and a colony count of 50,000 CPM or 10,000-50,000 CPM confirmed by repeat meets criteria

If the urine is collected by suprapubic aspiration, pyuria and ANY growth on culture meets criteria

Question 5

Describe the recommendations for imaging in children with UTI’s

Answer 5

After the first UTI in boys, second (or sometimes third) in girls

Renal and bladder ultrasound
Looking for anatomic abnormalities, evidence of obstruction with secondary dilatation, or duplication of collecting system/ureters

Include VCUG (the contrast stuff) if
any anomalies are identified on RBUS
OR
The combination of temp > 39°C and a pathogen other than E. coli
OR
Poor growth and hypertension is part of the clinical presentation

After the second UTI (so now for anyone)
VCUG
Looking for evidence of vesicoureteral reflux
Grade 1-5
Notorious for causing renal scarring

Question 6

List the most common causes of obstructive uropathy in children

Answer 6

• posterior urethral valve (only in boys!)
• ureteropelvic junction obstruction
• duplex kidney can do it too

Question 7

Identify appropriate first-line antibiotic choices for the empiric treatment in a child with a UTI/pyelonephritis

Answer 7

If not acutely ill and tolerating (po) you can try oral antibiotics
Cephalosporin like cefixime or cefdinir.
Resistance to amoxicillin-clav and TMP/SMX is increasing
Fluoroquinolones can be used (and are increasingly used in younger children)

If acutely ill or not tolerating PO, parenteral
Third generation cephalosporin (ceftriaxone)
Add ampicillin if enterococcus is suspected
Length of treatment

If afebrile UTI, 3-4 days may be sufficient
If febrile UTI (pyelonephritis), 10-14 days
Improvement should be seen in 24-48 hours
Always modify antibiotic choice as per culture results

Question 8

List the indications for referral of a pediatric patient with a UTI to a specialist.

Answer 8

• In cases of dilating vesicoureteral reflux (grades III-V)
• If obstructive uropathy is present
• When renal abnormalities are identified
• When kidney function is impaired
• If the patient is hypertensive
• If bowel and bladder dysfunction is refractory to primary care measures

Question 9

Develop a differential diagnosis for a newborn with tachypnea.

Answer 9

• A SILENT CARDIAC LESION if u can’t find anything else wrong
• fever
• transient tachypnea of newborn – extra fluid in lung
• RDS

Question 10

Describe the newborn pulse oximetry screening test used to detect critical congenital heart disease prior to discharge from the nursery

Answer 10

see slides

Question 11

what are the cyanotic congenital heart disorders?

Answer 11

Five T's
Truncus arteriosus
Transposition of the great vessels
tricuspid atresia
tetrology of fallot
total anomalous pulmonary vascular return

Question 12

what are the acyanotic congenital heart disorders?

Answer 12

ASD, VDS, PDA, CoA