Peds Nephro/GU Flashcards
Asymptomatic patient with 5+ RBC on UA and normal BUN/Cr. Possible dx?
Benign Familial Hematuria - check FHX
Color of blood from pre-renal, renal, and post-renal?
pre-renal (myoglobin) = dark red
renal (kidneys) = tea/cola
post-renal = bright red
Concern of adult smoker with painless gross hematuria?
transitional cell carcinoma of bladder; refer to urology
hematuria + hearing loss + visual changes =
Alport syndrome
Treatment of Alport syndrome
- progressive; no tx
- Refer to nephrology because leads to kidney failure
- Need dialysis and transplant
hematuria + ASO titer =
Post-Strep Glomerulonephritis (PSGN)
UA results of PSGN
tea-colored
red cell casts
Supportive therapy for patients with proteinuria
HTN control (ACE-I)
gross hematuria + URI
IgA Nephropathy (Berger’s Disease)
IgA nephropathy treatment
self-limiting
Prednisone
Possible causes of Myoglobinuria
extreme exercise, high fever, crush injury, burn, sepsis
Labs in myoglobinuria
elevated CK, LDH
hyperkalemia
hyperphosphate
UA: dark urine, no blood
Myoglobinuria treatment
increase hydration
Mannitol
Alkalinize urine
Definition of hematuria
+5 RBC per high powered field on 2 separate occasions (microscopic or gross)
HUS is preceded by ______ infection 3-7 days prior.
E. coli
HA and petechial rash with decreased urination and dark urine following an episode of bloody diarrhea. Classic presentation of what dx?
HUS
Lab results of HUS
- Anemia, thrombocytopenia
- Elevated LDH, bili, PTT, d-dimer, BUN/Cr
- Hematuria with RBC casts
HUS treatment
supportive
If HUS suspected, then what also must be checked for?
MAHA on peripheral blood smear
E. coli O157:H7 in stool
Henoch Schonlein Purpura triad
- vague abd pain
- arthritis
- rash - petechial, purpuric; ONLY waist down
Always check ______ levels when petechial rash.
platelet (order CBC)
What is major similarity and difference between HUS and HSP?
HUS has thrombocytopenia (low platelets) and HSP doesn’t
Both have petechial rash and hematuria
Henoch Schonlein Purpura treatment
NSAIDs
steroids for bloody stool
Gold standard lab for proteinuria
24 hr urine collection
Benign, asx proteinuria common in school-aged children.
orthostatic proteinuria
Sudden onset edema of eyes and genitals in patient < 6 yo with +2 proteins in urine and elevated triglycerides. Likely dx?
Minimal Change Disease
Signs of nephrotic syndrome (seen in Minimal Change Disease but not in orthostatic proteinuria)
edema
proteinuria
hyperlipidemia
low albumin (low blood protein)
Signs of UTI in pediatrics
Fever without source Poor feeding, vomiting Sudden incontinence or enuresis Strong smelling urine Abdominal tenderness
Renal U/S vs VCUG for UTI evaluation in children?
US: boy, < 2 yo, GU anomalies, recurrent UTI (+3/yr)
VCUG: UTI fails to respond after 2 days of abx, < 2 yo with 2nd UTI, recurrent UTI any age
Causative organisms of UTI
E. coli (>75%)
Klebsiella, Proteus, Enterococci, Group B strep, Pseudomonas
Adenovirus
Recurrent UTI’s lead to progressive ______ damage.
renal
Gold Standard for UTI dx? Gold Standard for infants?
urine culture (children/adults)
cathed specimen (infants)
UTI treatment
Cipro x 7-14 days
adjust per culture
When should UTI be admitted for IV therapy?
- any infant < 3 mon with febrile UTI
- signs of sepsis, urinary obstruction, or significant underlying disease
- unable to tolerate fluids/meds
VCUG gold standard for _______.
vesicoureteral reflux
primary vs secondary enuresis? which is more concerning?
primary: accidents in child who have never been potty trained
secondary: accidents after successful potty training (> 6 mon dry)
* secondary more concerning
Must presume _______ in any baby < 3 mon old with unexplained fever.
pyelonephrities; admit for IV fluids and do renal US
Neuro problems with enuresis
spina bifida
cerebral palsy
Inheritance of infantile PCKD
autosomal recessive
All patients with infantile/recessive PCKD have what?
congenital hepatic fibrosis; causes secondary portal HTN
PCKD treatment
- Manage HTN, liver disease
- 50% need renal transplant by age 60
Dx of adult PCKD
+FHX
recurrent UTI, pyelo
renal U/S: 2 cysts in one kidney or 1 on each kidney
How is recessive PCKD dx’d?
renal U/S in utero showing oligohydraminos
inability to pull back foreskin and “ballooning” of foreskin
phimosis
Phimosis treatment
Urologist ASAP if can’t urinate
Normal retraction at 3 yo
What is paraphimosis? How is it treated?
retraction of foreskin past coronal sulcus; tight ring impairs blood flow
medical emergency! manual reduction
apparent small sized penis due to pubic region fat
buried penis
Lab changes in Congenital Adrenal Hyperplasia
Elevated adrenal androgens (DHEA, testosterone)
Low Na, high K, low glucose
salt wasting and dehydration symptoms + ambiguous genitalia
Congenital Adrenal Hyperplasia
inflammation of glans and foreskin of penis
Balanoposthitis/Posthitis
Common causes of Balanoposthitis/Posthitis
Candida, Strep
phimosis
Hypo or Epispadias
urine exits in wrong spot either below (hypo) or above (epi)
penis length 2 std deviations below mean
microphallus
Endocrinologic and genetic causes of microphallus
endo: hypogonadotropic hypogonadism, primary testicular failure
genetic: Prader Willi Syndrome
Normal progression of testes descent and by what age?
abdomen -> inguinal canal -> scrotal sac
by 6 months old
retractible testes vs cryptorchidism
retractible are descended testes that pull up into inguinal canal due to hyperactive cremasteric reflex
cryptorchidism are true undescended testes
How should undescended testes be dx’d and tx’d?
- If non-palpable, milk down from inguinal canal; monitor
- If still not palpable, testicular US
- If still not found, abd CT and send to urology for orchidopexy
- If bilat check CAH and chromosomes)
Risk of undescended testes
crypto: infertility, testicular cancer
+ Prehn
elevation of testes relieves pain; seen in undescended testes
Non-painful swelling of testes in 16 yo with “bag of worms” felt on palpation.
varicocele
Newborn boy with non-painful testes. Edema and + transillumination sign on PE.
hydrocele
Management of varicocele and hydrocele
varicocele - benign; infertility risk
hydrocele - resolves at age 6-12 mon; no infertility risk
Male with acute abdominal pain radiating to groin, N/V. Testes are swollen and tender with (-) Prehn sign and no cremasteric reflux.
testicular torsion
dx and tx of testicular torsion
scrotal U/S with flow doppler
Immediate referral to urology for surgery
Testicular pain without N/V. + Prehn sign and cremasteric reflex intact. Likely dx?
epididymitis
How to r/o testicular torsion in suspected epididymitis?
testicular US
Sudden onset of pain in upper pole of testes and “blue dot” sign on exam.
torsion of appendix testes
Etiology of epididymitis
viral or bacterial
STDs
urethritis, prostatitis, UTI
Possible cause of bilateral testicular pain 4-6 days after parotiditis?
Mumps (check vaccine status)
Complications of mumps
infertility
aseptic meningitis
When is an inguinal hernia a medical emergency?
incarcerated/unreducable protrusion that does not cause pain
Painful scrotal swelling DDX
Epididymitis Orchitis/Mumps Testicular torsion Torsion of Appendix testes Incarcerated Inguinal Hernia
Painless scrotal swelling DDX
Hydrocele Varicocele Unincarcerated Inguinal Hernia Nephrotic Syndrome Testicular Tumors Fragile-X syndrome Klinefelter Syndrome
Chromosomal defect that causes macro-orchidism and one that causes micro-orchidism
Macro: Fragile-X
Micro: Klinefelter Syndrome
