Pediatrics - Renal Emergencies Flashcards
History of strep suggests
PSGN
Hx of bloody diarrhea suggests
HUS (CBC shows thrombocytopenia)
Organomegaly on PE in young children may suggest
Fluid overload
Hematuria, casts, proteinuria suggest
GN
Proteinuria alone suggests
Nephrotic syndrome
Hyaline casts may be seen in
ATN
Urine SG is often high (>1.025) in what renal failure?
Prerenal
CBC shows eosinophilia, what renal dx suggested?
Interstitial nephritis
In prerenal failure, treat dehydration and hypovolemia with a 10-20ml/kg bolus of
NS
How are RBC transfused in kids in the setting of hemorrhagic shock?
10 ml/kg
Diagnostics for Nephrotic syndrome
Hypoproeteinemia
Low albumin
Protein:Creatinine ratio >2 in 1st am void
Hypercholesterolemia
Generalized edema
PE to assess for pulmonary effusion, edema, facial swelling (anasarca)
Tx for volume overload in children
1-2 mg/kg furosemide
Children with nephrotic syndrome are at high risk for:
Bacterial peritonitis from strep pneumo
GN is often associated with
HTN
Most common serologic markers of PSGN in kids
Anti-streptolysin titer
Low C3
Tx for PSGN
Supportive
Renal bx not indicated
F/U with Nephropathy
Tx for Berger’s/IgA Nephropathy
Bx is diagnostic
ACE inhibitors or ARBs for HTN (esp w/ proteinuria)
Refer to Outpt Nephropathy
Tx focuses for HSP
Rest, analgesics, hydration
Consult Nephrology
Triad of HUS
Microangeiopathic hemolytic anemia
AKI
Thrombocytopenia
Complications of E. Coli enteritis/Shiga toxin
HUS Acute gastroenteritis DM Acidosis Colitis Intussusception HTN Heart failure
Peripheral smear in microangiopathic hemolytic anemia
Schistocytes
Helmet cells
Burr cells
Diagnostic to do for HUS
Get stool sample
CBC w/ diff
UA
Contraindications for tx of suspected HUS in peds
Do not give abx
Do not give antiperistaltics
Do not give platelets
Most common signs of primary HTN in children (4)
HA
Sleep disturbances
Chest pain
Abd pain
Medication causes of HTN in children
OCT
Steroids
Drugs of abuse
Lower BP in legs vs arms, or left vs right suggests
Coarctation of the aorta
Diagnostics to order in children with HTN
CXR EKG \+/- head CT if neuro findings present Renal U/S +/- CT/MRI \+/- Echocardiogram
Tx hypertensive emergency peds
ABCs
Reduce MAP by 25% over 8 hours
Tx hypertensive urgency
Oral antihypertensives
D/C with outpatient F/U
Medication causes of hematuria
NSAIDs Anticonvulsants Warfarin Diuretics Penicillin Chlorpromazine
Imagine choice for macroscopic hematuria
US to rule out structural defects and malignancy
What is an avoidable risk factor for development of hemolytic uremic syndrome?
Antibiotic use during infection with E. Coli O157:H7
