PEDS mod 7 Flashcards
What are two times where there are false positive readings on the urine dipstick?
- High specific gravity concentration (SG > 1.025)
2. High pH (pH >7-8)
What are the blood pressure clinical practice guidelines based off of?
Age, sex, height.
What are the 3 important tools that you can use in many kidny related issues?
Hx PE, Blood pressure, urine dipstick.
Normal pediatric creatinine levels are based off of what?
Age. Younger children should not have a creatinine of 1.0 it should be lower since most kids have a creatinine of less than 1.0
AKI is a decrease in…
GFR
What are some causes of pre-renal AKI?
Inadequate perfusion caused by nephrotic syndrome, NSAIDS, ACE inhibitors. Vomiting and diarrhea.
What are some causes of renal AKI?
Glomerulonephritis, HUS, Nephrotoxins.
What is the workup for AKI?
Hx and PE, Labs, UA, renal ultrasound.
If a patient is having vomiting and diarrhea what should you tell them regarding their meds?
Stop taking their NSAIDS and ACE inhibitors to prevent AKI.
What notable drugs are nephrotoxic?
Ceflosporins, Ibuprofin, lisinopril, losartan, piperacillin/ tazobactam, Vancomyasin,
What stage of AKI requires hospital admission?
Stage 3
Defined as abnormalitis of the kidney structure or function, present for >3 months, with implications for health.
CKD.
Can you use the KDIGO CKD staging in patients less than 2 yo?
No.
What other things can CKD cause other than kidney problems?
Neurocognitive*, growth failure, bone and mineral disorders.
CKD will cause kids to struggle in school due to lower IQ’s and poor attention
Leading cause of death in patients with chronic kidney disease?
Cardiovascular disease.
Most common causes of anemia in CKD.
EPO deficiency
Iron deficiency
Child that has fatigue, napping a lot, not exercising as much or unable to keep up with the other kids. Classically will have a low retic count.
CKD and EPO deficiency.
What electrolyte disturbances put you at higher risk for HTN?
Water and sodium imbalances
high potassium or phosphorus.
Metabolic acidosis.
What is the treatment for growth failure in CKD?
Good nutrition, normalize bicarb, treat MBD, give growth hormone.
In CKD, a MBD leads to what?
hyperparathyroidism
What are the two types of dialysis can be done for CKD?
Hemodialysis and peritoneal
what are the criteria for kidney transplant?
atleast 1 year old or 10 kg weight.
typically presents with hematuria, edema, often hypertension and
some proteinuria.
Glomerulonephritis
How is proteinuria quantified?
By age.
Spot protein: Infants >0.5, Children > 0.2, Non-nephrotic 0.2-2, Nephrotic >2.
3 common causes causes of glomerulonephritis.
Post streptococcal/IGN
IgA nephropathy
HSP
has a low C3 which returns to normal in 6-8 weeks.
Post-streptococcal glomerulonephritis
Post-streptococcal glomerulonephritis usually only requires
supportive management like antihypertensive meds, Salt and fluid restriction diuretic, and rarely dialysis.
The prognosis for post-streptococcal glomerulonephritis is
good
Can last for 1 year
Microscopic hematuria
Can last for 6 mo-1 yr
proteinuria
normalizes w/ in 6-8 weeks
C3
Resolves w/ in days
Gross hematuria
Normal C3, recurrent hematuria, Less than 1 week after URI.
IgA nephropathy
C3 decreased, isolated episode of hematuria, 1-2 weeks after URI/pharyngitis, 3-6 weeks after impetigo.
PSGN
Petechia or purpura on lower ext and gluteal region, classically have swelling in hands and feet, abdominal pain, nausea and vomiting. Joint inflammation. Need a urine dip to look for protein and blood.
HSP
3 major causes of postnatal hydronephrosis.
Transient, Vesicoureteral reflux (VUR), Obstruction.
MC cause of hydronephrosis and goes away by the age of 2.
Transient
Least common cause of hydronephrosis.
Obstruction
How is hydronephrosis monitored?
Ultrasounds
How do they diagnos reflux or obstruction?
VCUG and renal scan (how a diuretic is excreted)
Which hydronephrosis is associated with UTI?
Vesicoureteral Reflux
Children with reflux or obstruction need to be followed for progression of
chronic kidney disease
periorbital edema is associated with what?
Nephrotic syndrome
defined by proteinuria, hypoalbuminemia, edema and hyperlipidemia.
Nephrotic syndrome
the most common cause of nephrotic syndrome in children.
Minimal change disease
The primary treatment for minimal change nephrotic syndrome is
steroids. (prednisone)
most common form of polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD)
In autosomal dominant polycystic kidney dz the most common mutation is in what gene?
PKD 1 gene.
What is the treatment for ADPKD?
Focused on slowing the progregression. Proteinuria management, HTN management, no caffeine, keeping hydrated.
This can give rise to HTN in children.
Renal artery stenosis.
Need renal ultrasound w/ doppler.
Renal artery stenosis can be diagnosed sometimes by
Renal ultrasound with doppler.
Renal artery thrombosis can be seen in newborns with
umbilical artery catheters
This can present a flank pain, hematuria, HTN, and AKI.
Renal artery thrombosis
Renal vein thrombosis can be seen most commonly in
Nephrotic syndrome and kidney transplant
defined by microangiopathic hemolytic anemia, thrombocytopenia and acute kidney
injury
Hemolytic Uremic Syndrome (HUS)
HUS is often caused by
E. Coli
Present with bloody diarrhea and abdominal pain.
What is the Tx for Typical HUS?
Supportive care. If acute, the kidney injury can progress to needing dialysis.
