Peds 31 Flashcards
Katie is a previously healthy 5-year-old girl with recent URI symptoms followed by a three-day history of bilateral periorbital edema (without signs of conjunctival inflammation and not responsive to antihistamines), decreased appetite, fatigue, and gradually increasing abdominal girth. She has a history of atopy (eczema and wheezing with infections). Her weight today is 23kg, which is up 5kg since last visit 2 months ago. Her height is 111cm. On exam, her tonsils are mildly enlarged without exudate, but this is normal for her age. Lungs CTA. Normal S1, S2. Abdomen mildly distended with dullness to percussion. No tenderness to palpation. No hepatosplenomegaly. No masses. Pitting edema on lower extremities. + Ascites.
VS: BP 93/54, HR 102, RR 22, temp 37.7
Urine dipstick results: proteinuria 4+ without hematuria
What is the leading dx? What labs do you order?
Nephrotic syndrome
Urine dipstick (for quick results), UA, BUN, creatinine, CMP/BMP electrolytes, total cholesterol, albumin
What are 2 causes of nephrotic syndrome? Differentiating findings for either?
Minimal change disease - normal BP, proteinuria W/O hematuria
Glomerulonephritis - high BP, proteinuria W/ hematuria (foamy pink colored urine)
What’s the appropriate treatment for minimal change disease?
Corticosteroids (Prednisone or prednisolone x6 weeks, then taper for 6 weeks)
Sodium restriction to a level of 1500-2000 mg daily - d/t edema
What lab results would you expect for nephrotic syndrome caused by minimal change disease?
Elevated urine protein: creatinine ratio and in the nephrotic range
Normal renal function
Hyponatremia
Hypoalbuminemia
Hypercholesterolemia
Nephrotic syndrome diagnosis puts one at risk for developing which 4 infections? What can you do to prevent these infections?
Spontaneous bacterial peritonitis, pneumonia, cellulitis, UTI
When in remission, give vaccines: polyvalent pneumococcal, varicella, influenza
An 8-year-old boy presents with a one day history of tea-colored urine and edema and is noted to have a blood pressure of 140/90 mmHg. Two weeks ago, he presented with fever, sore throat, headache, and abdominal pain. At that time, he did not have a runny nose, congestion or cough. He was treated with appropriate antibiotics for his diagnosis and made a full recovery. Which of the following diagnostic findings would be most consistent with his new symptoms?
A. ANA positive B. Gram negative organisms on urine culture C. Low anti-streptolysin O titer D. Low C3 complement E. Normal C3 complement
D. Low C3 complement
This is a common finding in PSGN (post-streptococcal glomerulonephritis)
A 6-year-old boy comes to the clinic with a chief complaint of scrotal swelling, recent weight gain, and decreased appetite. Vital signs are normal and there is no evidence of cardiac disease or jaundice. Further workup reveals isolated proteinuria on urinalysis, hypoalbuminemia, and hyperlipidemia, consistent with nephrotic syndrome. If this patient were to receive a kidney biopsy, which of the following histological patterns would be most likely be seen on light microscopy?
A. Enlarged, hypercellular glomeruli with neutrophil invasion
B. Glomeruli showing diffuse capillary and glomerular basement thickening
C. Mostly normal glomeruli and mesangial proliferation but with areas of juxtamedullary glomeruli showing segmental scarring in one or more lobules
D. Normal glomeruli
E. Tram-track appearance of the glomerular basement membrane and subendothelial immune complex deposition
D. Normal glomeruli
Katie is a 5-year-old girl with three-day history of swelling of her face, especially around the eyes. Her mother has also noticed that her pants have become too tight for her, and that she has gained nearly 5 pounds despite a decreased appetite. About a week prior to the start of the swelling, her mother recollects an episode of rhinorrhea, cough, and sore throat. Urinalysis shows no red blood cells, but you have no other data from urinalysis due to a lab error. On exam, temperature is 98.8 F, heart rate is 95 bpm, blood pressure is 95/65 mmHg. Her face demonstrates periorbital edema. Heart and lung exams are normal. Abdominal exam shows some abdominal fullness but no masses or organomegaly. Both feet appear slightly puffy and there is pitting edema. Which of the following is the most likely cause?
A. Allergic reaction B. Congestive heart failure C. Nephritis D. Nephrotic syndrome E. Sinusitis
D. Nephrotic syndrome
Brian, a 5-year-old boy with swelling around both his eyes and an abdomen that looks “bigger than normal,” is brought in by his father to your preceptor’s office. He explains that he noticed the puffy eyes and bigger belly two days ago, but they have been getting worse each day. It seemed to appear out of nowhere, and Brian has been completely healthy except he had some upper respiratory symptoms several weeks before these symptoms developed. Brian makes urine in the office bathroom and the father comes back concerned that it is very dark and cola colored. His blood pressure taken by the nurse right before entering the room is elevated. Based on the above information, which of the following does Brian likely have?
A. Acute post-infectious glomerulonephritis B. Allergic conjunctivitis C. Minimal change disease D. Periorbital cellulitis E. Viral upper respiratory infection
A. Acute post-infectious glomerulonephritis
A 7-year-old girl is brought to her pediatrician because of recurrent puffy eyes. She presented one week ago because of the same problem and was diagnosed with allergies. She was started on an intranasal steroid with no relief. Her mother states she has become increasingly tired and mentions that she has recently outgrown all of her shoes. The patient has no other symptoms and is at the 50th percentile for height and weight, is afebrile, and well-appearing. Her heart and lung exam are normal. She has no hepatomegaly and no evidence of rash. She is noted to have bilateral pedal edema. What is your next step in diagnosis/management?
A. CBC with manual differential B. Echocardiogram C. Flonase trial for an additional week D. Liver enzymes E. Urinalysis
E. Urinalysis
What are 3 indications for a renal biopsy in patients with nephrotic syndrome?
Steroid resistant (8 weeks after taking steroids without change in condition) to better determine etiology (minimal change vs other etiology such as focal segmental glomerulosclerosis)
Children who have hematuria, hypertension, and/or elevated creatinine suggestive of another etiology of nephrotic syndrome, such as glomerulonephritis as the etiology (excluding those who are diagnosed with post-infectious glomerulonephritis).
Children > 10-12 years of age.
