peds nephrology Flashcards
Work up and DDx for hematuria
Eval: urinalysis + culture
DDx: Kidney dz (isolated glomerular disease (IgA nephropathy, postinfectious GN),
Multisystem disease with glomerulus involvement: SLE, Henoch-Schonlein, goodpasture, granulomatosis with polyangitis, HUS)
Tubuloninterstitial dz (pyelo, interstitial nephritis, ATN)
Vascular
Urinary tract disease: inflammation (cystitis, urethritis), urolithiasis, trauma, coagulopathy, AVM
Proteinuria eval and ddx
Eval: urinalysis, first morning protein/creatiine ratio, 24 hr urine protein
Ddx: TRANSIENT, fever, dehyrdation, cold exposure, seizures, stress
Glomerular dz, diabetic nephropathy, sicklee cell nephropathy, acute postinfectious GN, IgA nephropathy
DDx for polyuria
1st sign of renal failure
or
Type 1 DM or diabetes insipidus
DDx anuria
Urinary tract obstruction
Acute renal failure
Enuresis
Nocturnal > overactive bladder > UTI > Sexual trauma
clinical presentation of glomerular nephritis
Gross hematuria, increased serum creatinin, edema, hypertension, urine maybe coffee or tea colored, possible RBC casts
Nephrotic syndrome
massive proteinuria
IgA nephropathy
Eti: IgA deposition in glomerular mesangium, either primary renal disease or due to cirrhosis, celiac, HIV, cytomegalovirus
Epi: most common glomerular disease world wide, Asia, M>W
S/sx: Gross hematuria during acute unrelated illness, NOT PAINFUL
Dx: biopsy
Tx: most cases resolve, no meds, Severe cases: steroids
Henoch-Schonlein purpura
IgA mediated disorder
Disorder that causes inflammation and bleeding in the small blood vessels in the skin, joints, intestines and kidneys.
S/sx: 4 main: rash, joints, GI, Kidney
purplish rash on LE and buttock, abd pain, aching joints, kidney damage, bloody diarrhea
Tx: steroids
acute interstitial nephritis
Diffuse or focal inflammation and edema of the renal interstitium, most commonly drug related (B-lactam abx, NAIDs, PPI) or infection
Sx: Fever, rigor, abd or flank pain, rashes.
Classic triad: Fever, rash, arthralgias
Labs: WBCs, WBC casts, Eosinophilia
Tx: remove causative agent, steroids.
Idiopathic nephrotic syndrome of childhood (minimal change disease)
Epi: generally younger than 6 at onset
Sx: Periorbital swelling, oliguria, influenza-like syndrome, few days then increasing edema ->anasrca
Most only vague malaise or abd pain
Labs: Plasma albumin conc low, lipid levels increase
Tx: steroids.
Hemolytic Uremic Syndrome
MC glomerular vascular cause of acute renal failure in kids
Defined as: simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury
Diarrhea associated form: shiga toxin producing bacteria (raw beef, unpasteurized food)
- also drugs, viruses (HIV), pneumoococcal.
Sx: (shigella or E.coli); prodrome abd pain, diarrhea, vomiting. Next: oliguria, pallor, bleeding (mostly GI)
Dx: anemia, RBC fragments, high reticulocyte count
Tx: fluid an delectrolyte replenishment, EPO, transfusion
Types of diabetes insipidus
Central: decreased secretion of ADH
Nephrogenic: decreased ability to concentrate urine because of resistance to ADH action in the kidney
Nephrotic diabetes insipidus
Eti: renal tubular resistance to vasopressin, genetic x linked, lithium therapy, hypokalemia, hypercalcemia, renal dz.
Sx: PolyU, PolyD, nocturia
Dx: H2O dep and desmopressin test to determine type
Tx: increase free H2O and low salt diet, HCTZ…
Peds UTIs EPi and sx.
Epi: under 3 months uncircumcised boys > girls.
Over 6 months > than boys.
Newborns and infants: nonspecific signs, hypothermia, jaundice, poor feeding, irritability, v, failure to thrive, sepsis.
Preschool: abdominal or flank pain, v, fever, frequency, dysuria, urgency, enuresis
School age: classic: frequency, dysuria, urgency
Pylo: fever, vomiting, flank pain, CVA tender.
UTI labs
Labs; Pyuria > 5 WBCs per high power field.
Urinary nitrate: enteric organisms, however 70% of kids with UTIs have neg nitrates.
Gold standard: culture of urine
Image: recommend ultrasound for kids with UTI looking for congential abnormalities.
Testicular torsion
Eti: inadequate fixation to the tunica vaginalis
Sx: acute and severe, radiates to the lower abdomen
Dx: no cremasteric reflex, color doppler US
Tx: medial to lateral thigh, or surgical intervention
Epididymitis
Eti: C. trachomatis or N. gonorrhoeae,
Sx: Pain, swelling, inflammation of the epididymis
Dx: clinical
Tx: ceftriaxone +doxy
Vesicoureteral reflux
Eti; flow from the bladder back up the ureters. Inadequate closure or pressure.
S/sx: Hypotension, recurrent UTI
Polycystic kidney disease
Eti: inherited, clusters of cyst develop within the kidneys
S/sx: enlarged kidneys, HTN, growth failure
Dx: renal US
Cryptorchidism
Eti: HPA axis issues, androgen synthesis
Epi : 1% of full term males, 30% premies
S/sx: R>L right descend later
Tx: HCG BID x5 weeks
Hypospadias
/
Epispadias
Hypo: Urethral meatus on ventral (bottom) shaft Epi: meatus on dorasl side Dx: clinical Tx: surgical Don't cicumcise Refer to urologist
Varcicele
/
Hydrocele
Vari: Dilation of scrotal veins
Sx: bag of worms, mostly left sided. No tx or surgery
Hydro: accumulation of fluid in the scrotum, not reducable + transillumination. Tx: observe until 2 yrs, surgery if increasing size or post 2
