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RRPA Clinical Med II > Peds Nephrology (Exam 4) > Flashcards

Peds Nephrology (Exam 4) Flashcards

1
Q

What criteria must be met to diagnose pediatric CKD?

A

GFR <60 for > 3 months
or
GFR >60 + evidence for structural damage (albuminuria, proteinuria, pathologic abnormalities on histology or imaging)

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2
Q

Most common cause of pediatric CKD?

A

Congenital diseases (60% of cases)

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3
Q

Name 5 congenital diseases that can cause pediatric CKD.

A 
Obstructive uropathy
Renal hypoplasia
Renal dysplasia
Reflux nephropathy
PKD
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4
Q

What is the second most common cause of pediatric CKD?

A

glomerular disorders

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5
Q

Name 3 causes of glomerular disorders?

A

FSGS
Membranoproliferative glomerulonephritis
Minimal change disease

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6
Q

Presenting signs and symptoms of non-glomerular pediatric CKD?

A

Polyuria
Elevation in serum Cr
Poor growth

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7
Q

Presenting signs and symptoms of pediatric glomerular CKD?

A

Tea or cola colored urine (hematuria, RBC casts)
Edema
Elevation of serum Cr
Elevated BP for age

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8
Q

What imaging study would you order for suspected pediatric CKD?

A

Ultrasound

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9
Q

When managing pediatric CKD, you want to treat reversible kidney dysfunction. What are some reversible causes of kidney dysfunction?

A 
Decreased perfusion to kidneys (hypotension, volume depletion, some medications)
Nephrotoxic drugs (NSAIDs, contrast, aminoglycosides)
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10
Q

How do you slow progression of pediatric CKD?

A

Same as adults - ACEI/ARB for kids with HTN + proteinuria

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11
Q

Symptoms of pediatric CKD?

A

Anorexia, fatigue, N/V, pericarditis, bone and mineral disease, decreased neurocognitive function.

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12
Q

What are some examples of mineral bone disease that can occur secondary to pediatric CKD?

A

Growth failure, AVN, skeletal fractures/deformity/pain, vascular calcification

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13
Q

Treatment for mineral bone disease?

A

Diet, calcium binders, vitamin D2/D3, Vitamin D analogs

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14
Q

Renal replacement therapy should be considered at what GFR?

A

GFR <30

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15
Q

1st line renal replacement therapy?

A

Kidney transplantation

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16
Q

2nd and 3rd line renal replacement therapies?

A

2nd: Peritoneal dialysis
3rd: Hemodialysis

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17
Q

Examples of obstructive uropathy?

A

Stricture
Stones
Stenosis
Posterior ureteral valves

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18
Q

What is reflux nephropathy (vesicoureteral reflux)?

A

Retrograde passage of urine from the bladder to the upper urinary tract

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19
Q

What is renal dysplasia?

A

Malformed kidneys

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20
Q

T/F? Kidneys with renal dysplasia are usually normal in size

A

False - usually smaller than normal

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21
Q

Is renal dysplasia unilateral or bilateral?

A

Can be either

22
Q

What is multicystic dysplasia

A

Nonfunctioning dysplastic kidney with multiple cysts

23
Q

What is renal hypoplasia?

A

Low number of structurally normal nephrons

24
Q

What diagnosis must be excluded before diagnosing renal hypoplasia?
How do you rule this out?

A

Renal scarring

Ruled out by DMSA radionuclide scan

25
Q

What is renal agenesis?

A

Congenital absence of renal parenchymal tissue.

26
Q

Is renal agenesis more common in males or females?

A

males

27
Q

T/F? patients with renal agenesis are more likely to have other nonrenal abnormalities.

A

True - malformations of heart, genitals, bones, gi tract, and respiratory tract are common

28
Q

What does FSGS stand for?

A

Focal segmental glomerulosclerosis

29
Q

What is FSGS?

A

Sclerosis in parts of at least 1 glomerulus in the entire kidney biopsy specimen

30
Q

Causes of FSGS?

A

Genetics
Injury to podocytes from drug toxicity or infection
Secondary causes

31
Q

Most common signs/symptoms of FSGS?

A

Acute onset of nephrotic syndrome

32
Q

Symptoms of nephrotic syndrome?

A

Edema, hypoalbuminemia, proteinuria

33
Q

Diagnosis of FSGS is made by?

A

Renal biopsy

34
Q

Treatment of FSGS?

A

ACEI/ARB for HTN/proteinuria

Statin/niacin for HLD

35
Q

2 major causes of membranoproliferative glomerulonephritis?

A

Immune-complex mediated

Complement mediated

36
Q

In membranoproliferative glomerulonephritis, characteristic changes are seen on _____

A

light microscopy

37
Q

Treatment for mild membranoproliferative glomerulonephritis?

A

ACEI/ARB

38
Q

Treatment for severe membranoproliferative glomerulonephritis?

A

An immunosuppressant such as cyclophosphamide or
MMF (Mycophenolate Mofetil) +steroids
or
rituximab

39
Q

What is the most common cause of nephrotic syndrome in kids?

A

Minimal change disease

40
Q

Why is it called minimal change disease?

A

No changes are seen on light microscopy

but there is effacement of podocyte foot processes on electron micriscopy

41
Q

Causes of minimal change disease?

A 
Idiopathic
After viral URI
neoplasms(Hodgkin)
Meds (lithium)
Hypersensitivity reactions
42
Q

Signs/symptoms of MCD?

A

Tachycardia, peripheral vasoconstriction, oliguria, decreased GFR, elevation of plasma renin, aldosterone, and norepinephrine

43
Q

MCD increases risk of

A

Infection
Thromboembolic events
severe hyperlipidemia

44
Q

Diagnosis of MCD?

A

clinical

45
Q

Treatment for MCD?

A

Prednisone for a good while
or
cyclophosphamide or rituximab

46
Q

What is horseshoe kidney?

A

When one pole of each kidney fuses to the other

47
Q

Horseshoe kidney is associated with

A

other congenital anomalies (up to half)

Turner syndrome, trisomy 13, 18 and 21

48
Q

Patients with horseshoe kidney are at increase risk for what tumor?

A

Wilms tumor (a type of kidney tumor)

49
Q

Prognosis for patients with horseshoe kidney?

A

Good, most don’t need any intervention

Some get chronic UTIs

50
Q

Imaging studies for horseshoe kidney?

A

Ultrasound

Voiding cystourethrogram

RRPA Clinical Med II (45 decks)

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