Peds Nephrology (Exam 4)

Question 1

What criteria must be met to diagnose pediatric CKD?

Answer 1

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

Question 2

Most common cause of pediatric CKD?

Answer 2

Congenital diseases (60% of cases)

Question 3

Name 5 congenital diseases that can cause pediatric CKD.

Answer 3

Obstructive uropathy
Renal hypoplasia
Renal dysplasia
Reflux nephropathy
PKD

Question 4

What is the second most common cause of pediatric CKD?

Answer 4

glomerular disorders

Question 5

Name 3 causes of glomerular disorders?

Answer 5

FSGS
Membranoproliferative glomerulonephritis
Minimal change disease

Question 6

Presenting signs and symptoms of non-glomerular pediatric CKD?

Answer 6

Polyuria
Elevation in serum Cr
Poor growth

Question 7

Presenting signs and symptoms of pediatric glomerular CKD?

Answer 7

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

Question 8

What imaging study would you order for suspected pediatric CKD?

Answer 8

Ultrasound

Question 9

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

Answer 9

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

Question 10

How do you slow progression of pediatric CKD?

Answer 10

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

Question 11

Symptoms of pediatric CKD?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Treatment for mineral bone disease?

Answer 13

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

Question 14

Renal replacement therapy should be considered at what GFR?

Answer 14

GFR <30

Question 15

1st line renal replacement therapy?

Answer 15

Kidney transplantation

Question 16

2nd and 3rd line renal replacement therapies?

Answer 16

2nd: Peritoneal dialysis
3rd: Hemodialysis

Question 17

Examples of obstructive uropathy?

Answer 17

Stricture
Stones
Stenosis
Posterior ureteral valves

Question 18

What is reflux nephropathy (vesicoureteral reflux)?

Answer 18

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

Question 19

What is renal dysplasia?

Answer 19

Malformed kidneys

Question 20

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

Answer 20

False - usually smaller than normal

Question 21

Is renal dysplasia unilateral or bilateral?

Answer 21

Can be either

Question 22

What is multicystic dysplasia

Answer 22

Nonfunctioning dysplastic kidney with multiple cysts

Question 23

What is renal hypoplasia?

Answer 23

Low number of structurally normal nephrons

Question 24

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

Answer 24

Renal scarring

Ruled out by DMSA radionuclide scan

Question 25

What is renal agenesis?

Answer 25

Congenital absence of renal parenchymal tissue.

Question 26

Is renal agenesis more common in males or females?

Answer 26

males

Question 27

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

Answer 27

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

Question 28

What does FSGS stand for?

Answer 28

Focal segmental glomerulosclerosis

Question 29

What is FSGS?

Answer 29

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

Question 30

Causes of FSGS?

Answer 30

Genetics Injury to podocytes from drug toxicity or infection Secondary causes

Question 31

Most common signs/symptoms of FSGS?

Answer 31

Acute onset of nephrotic syndrome

Question 32

Symptoms of nephrotic syndrome?

Answer 32

Edema, hypoalbuminemia, proteinuria

Question 33

Diagnosis of FSGS is made by?

Answer 33

Renal biopsy

Question 34

Treatment of FSGS?

Answer 34

ACEI/ARB for HTN/proteinuria | Statin/niacin for HLD

Question 35

2 major causes of membranoproliferative glomerulonephritis?

Answer 35

Immune-complex mediated | Complement mediated

Question 36

In membranoproliferative glomerulonephritis, characteristic changes are seen on _____

Answer 36

light microscopy

Question 37

Treatment for mild membranoproliferative glomerulonephritis?

Answer 37

ACEI/ARB

Question 38

Treatment for severe membranoproliferative glomerulonephritis?

Answer 38

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

Question 39

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

Answer 39

Minimal change disease

Question 40

Why is it called minimal change disease?

Answer 40

No changes are seen on light microscopy | but there is effacement of podocyte foot processes on electron micriscopy

Question 41

Causes of minimal change disease?

Answer 41

``` Idiopathic After viral URI neoplasms(Hodgkin) Meds (lithium) Hypersensitivity reactions ```

Question 42

Signs/symptoms of MCD?

Answer 42

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

Question 43

MCD increases risk of

Answer 43

Infection Thromboembolic events severe hyperlipidemia

Question 44

Diagnosis of MCD?

Answer 44

clinical

Question 45

Treatment for MCD?

Answer 45

Prednisone for a good while or cyclophosphamide or rituximab

Question 46

What is horseshoe kidney?

Answer 46

When one pole of each kidney fuses to the other

Question 47

Horseshoe kidney is associated with

Answer 47

other congenital anomalies (up to half) | Turner syndrome, trisomy 13, 18 and 21

Question 48

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

Answer 48

Wilms tumor (a type of kidney tumor)

Question 49

Prognosis for patients with horseshoe kidney?

Answer 49

Good, most don't need any intervention | Some get chronic UTIs

Question 50

Imaging studies for horseshoe kidney?

Answer 50

Ultrasound | Voiding cystourethrogram