Peds Nephrology Flashcards
What criteria must be met to diagnose pediatric CKD?
GFR <60 for > 3 months
or
GFR >60 + evidence for structural damage (albuminuria, proteinuria, pathologic abnormalities on histology or imaging)
Most common cause of pediatric CKD?
Congenital diseases (60% of cases)
Name 5 congenital diseases that can cause pediatric CKD.
Obstructive uropathy Renal hypoplasia Renal dysplasia Reflux nephropathy PKD
What is the second most common cause of pediatric CKD?
glomerular disorders
Name 3 causes of glomerular disorders?
FSGS
Membranoproliferative glomerulonephritis
Minimal change disease
Presenting signs and symptoms of non-glomerular pediatric CKD?
Polyuria
Elevation in serum Cr
Poor growth
Presenting signs and symptoms of pediatric glomerular CKD?
Tea or cola colored urine (hematuria, RBC casts)
Edema
Elevation of serum Cr
Elevated BP for age
What imaging study would you order for suspected pediatric CKD?
Ultrasound
When managing pediatric CKD, you want to treat reversible kidney dysfunction. What are some reversible causes of kidney dysfunction?
Decreased perfusion to kidneys (hypotension, volume depletion, some medications) Nephrotoxic drugs (NSAIDs, contrast, aminoglycosides)
How do you slow progression of pediatric CKD?
Same as adults - ACEI/ARB for kids with HTN + proteinuria
Symptoms of pediatric CKD?
Anorexia, fatigue, N/V, pericarditis, bone and mineral disease, decreased neurocognitive function.
What are some examples of mineral bone disease that can occur secondary to pediatric CKD?
Growth failure, AVN, skeletal fractures/deformity/pain, vascular calcification
Treatment for mineral bone disease?
Diet, calcium binders, vitamin D2/D3, Vitamin D analogs
Renal replacement therapy should be considered at what GFR?
GFR <30
1st line renal replacement therapy?
Kidney transplantation
2nd and 3rd line renal replacement therapies?
2nd: Peritoneal dialysis
3rd: Hemodialysis
Examples of obstructive uropathy?
Stricture
Stones
Stenosis
Posterior ureteral valves
What is reflux nephropathy (vesicoureteral reflux)?
Retrograde passage of urine from the bladder to the upper urinary tract
What is renal dysplasia?
Malformed kidneys on a microscopic level
T/F? Kidneys with renal dysplasia are usually normal in size
False - usually smaller than normal
Is renal dysplasia unilateral or bilateral?
Can be either
What is multicystic dysplasia
Nonfunctioning dysplastic kidney with multiple cysts
What is renal hypoplasia?
Low number of structurally normal nephrons
What diagnosis must be excluded before diagnosing renal hypoplasia?
How do you rule this out?
Renal scarring
Ruled out by DMSA radionuclide scan
What is renal agenesis?
Congenital absence of renal parenchymal tissue.
Is renal agenesis more common in males or females?
males
T/F? patients with renal agenesis are more likely to have other nonrenal abnormalities.
True - malformations of heart, genitals, bones, gi tract, and respiratory tract are common
What does FSGS stand for?
Focal segmental glomerulosclerosis
What is FSGS?
Sclerosis in parts of at least 1 glomerulus in the entire kidney biopsy specimen
Causes of FSGS?
Genetics
Injury to podocytes from drug toxicity or infection
Secondary causes
Most common signs/symptoms of FSGS?
Acute onset of nephrotic syndrome
Symptoms of nephrotic syndrome?
Edema, hypoalbuminemia, proteinuria
Diagnosis of FSGS is made by?
Renal biopsy
Treatment of FSGS?
ACEI/ARB for HTN/proteinuria
Statin/niacin for HLD
2 major causes of membranoproliferative glomerulonephritis?
Immune-complex mediated
Complement mediated
In membranoproliferative glomerulonephritis, characteristic changes are seen on _____
light microscopy
Treatment for mild membranoproliferative glomerulonephritis?
ACEI/ARB
Treatment for severe membranoproliferative glomerulonephritis?
An immunosuppressant such as cyclophosphamide or
MMF (Mycophenolate Mofetil) +steroids
or
rituximab
What is the most common cause of nephrotic syndrome in kids?
Minimal change disease
Why is it called minimal change disease?
No changes are seen on light microscopy
but there is effacement of podocyte foot processes on electron micriscopy
Causes of minimal change disease?
Idiopathic After viral URI neoplasms(Hodgkin) Meds (lithium) Hypersensitivity reactions
Signs/symptoms of MCD?
Tachycardia, peripheral vasoconstriction, oliguria, decreased GFR, elevation of plasma renin, aldosterone, and norepinephrine
MCD increases risk of
Infection
Thromboembolic events
severe hyperlipidemia
Diagnosis of MCD?
clinical
Treatment for MCD?
Prednisone for a good while
or
cyclophosphamide or rituximab
What is horseshoe kidney?
When one pole of each kidney fuses to the other
Horseshoe kidney is associated with
other congenital anomalies (up to half)
Turner syndrome, trisomy 13, 18 and 21
Patients with horseshoe kidney are at increase risk for what tumor?
Wilms tumor (a type of kidney tumor)
Prognosis for patients with horseshoe kidney?
Good, most don’t need any intervention
Some get chronic UTIs
Imaging studies for horseshoe kidney?
Ultrasound
Voiding cystourethrogram
