peds nephrology

Question 1

Work up and DDx for hematuria

Answer 1

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

Question 2

Proteinuria eval and ddx

Answer 2

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

Question 3

DDx for polyuria

Answer 3

1st sign of renal failure
or
Type 1 DM or diabetes insipidus

Question 4

DDx anuria

Answer 4

Urinary tract obstruction

Acute renal failure

Question 5

Enuresis

Answer 5

Nocturnal > overactive bladder > UTI > Sexual trauma

Question 6

clinical presentation of glomerular nephritis

Answer 6

Gross hematuria, increased serum creatinin, edema, hypertension, urine maybe coffee or tea colored, possible RBC casts

Question 7

Nephrotic syndrome

Answer 7

massive proteinuria

Question 8

IgA nephropathy

Answer 8

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

Question 9

Henoch-Schonlein purpura

Answer 9

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

Question 10

acute interstitial nephritis

Answer 10

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.

Question 11

Idiopathic nephrotic syndrome of childhood (minimal change disease)

Answer 11

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.

Question 12

Hemolytic Uremic Syndrome

Answer 12

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

Question 13

Types of diabetes insipidus

Answer 13

Central: decreased secretion of ADH
Nephrogenic: decreased ability to concentrate urine because of resistance to ADH action in the kidney

Question 14

Nephrotic diabetes insipidus

Answer 14

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…

Question 15

Peds UTIs EPi and sx.

Answer 15

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.

Question 16

UTI labs

Answer 16

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.

Question 17

Testicular torsion

Answer 17

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

Question 18

Epididymitis

Answer 18

Eti: C. trachomatis or N. gonorrhoeae,
Sx: Pain, swelling, inflammation of the epididymis
Dx: clinical
Tx: ceftriaxone +doxy

Question 19

Vesicoureteral reflux

Answer 19

Eti; flow from the bladder back up the ureters. Inadequate closure or pressure.
S/sx: Hypotension, recurrent UTI

Question 20

Polycystic kidney disease

Answer 20

Eti: inherited, clusters of cyst develop within the kidneys
S/sx: enlarged kidneys, HTN, growth failure
Dx: renal US

Question 21

Cryptorchidism

Answer 21

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

Question 22

Hypospadias
/
Epispadias

Answer 22

Hypo: Urethral meatus on ventral (bottom) shaft
Epi: meatus on dorasl side
Dx: clinical 
Tx: surgical 
Don't cicumcise
Refer to urologist

Question 23

Varcicele

/

Hydrocele

Answer 23

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