Peds Renal Flashcards
Define Hematuria
The presence of 5 or more RBCs per high power field in 3 consecutive fresh centrifuged specimens obtained over the span of a few weeks
(either gross or microscopic)
What are some drugs that can cause red urine?
Rifampin
Nitrofurantoin
Pyridium
Sulfa drugs
What foods can turn urine red?
beets
rhubarb
fruit juices
Dehydration in newborns can cause urine changes that look like blood. What is the cause?
Uric acid crystals in the urine in newborns can cause a brick red color
Bilirubin can also cause red tint
While UAs are no longer recommended at annual well-child check-ups, when are they still often done?
5 year check up
pre-participation physicals
If you see reddish urine, how do you confirm that it’s blood?
UA or UA with micro
(You have to do this to make sure it’s blood and not a *red* herring lol)
Which is more ominous:
Hematuria alone or Hematuria with Proteinuria?
Hematuria and Proteinuria together
What are the sx of Post-Infectious Acute Glomerulonephritis (PIAGN)?
Recent strep throat followed by:
gross hematuria and proteinuria
HTN
swelling
elevated ASO
low serum C3
What is the pathology of PIAGN?
What is the treatment?
deposition of immune complexes in glomeruli
Supportive care, usually recover
In HSP, what is indicative of potential long-term renal damage?
proteinuria along with hematuria
Note: this condition is hard to diagnose and kids feel bad for a LONG time. Must f/u with regard to UAs and RBC and protein-until urine is clear
What will you see in asymptomatic (isolated) hematuria?
- No gross blood, 25% will no longer demonstrate hematuria if followed for 5 years
- rarely have significant renal disease
- must be monitored for proteinuria and hypertension
- ask Fmhx (benign familial hematuria)
what is the cause of asymptomatic microscopic hematuria?
How is it diagnosed?
hypercalcuria
urine Ca/Cr ratio is >0.2 indicating excess Ca excretion
What is March Hematuria?
What is the common presentation?
What to do about it?
after vigorous exercise, it is not unusual to see some RBCs in the urine
Likely presentation is a child/adolescent coming in for PE after sports practice
Repeat UA at a more sedentary time, like first thing AM
What are s/s of UTI in children?
Fever
decreased intake
strong smelling urine
dark urine
stomach pain
frequency/urgency/dysuria/incontinence
?emesis/diarrhea
How do you obtain a clean-catch urine specimen if a child is unable to void on command?
When are bag samples helpful?
catheterization
suprapubic aspiration
try to obtain before empiric abx given if they are indicated
Bag samples are only helpful if negative and are NOT appropriate for culture
What is the criteria to diagnose a UTI by clean catch?
presence of pyuria and at least 50,000 colonies per ml of a single uropathogenic organism
What is the criteria for diagnosing UTI by catheter collection?
pyuria and colony count of 50,000 CPM or 10-50,000 CPM confirmed by repeat meets criteria
What is the criteria for diagnosing UTI by suprapubic aspiration?
pyuria and ANY growth on culture meets criteria
a high WBC count in urine indicating a UTI will have what positive test?
positive Leukocyte Esterase
Nitrates present in urine likely indicate which pathogen?
E. coli
What is the most common pathogen in UTIs in children?
E. coli
(others include Klebsiella, proteus, enterococcus, pseudomonas)
What are some G+ bacteria that cause UTIs?
S. saphrophyticus
Enterococcus (catheters)
S. aureus (rare)
How do you treat a UTI in a patient who is not acutely ill and is tolerating PO?
Cephalosporin like cefixime or cefdinir
resistance to amoxicillin and TMP/SMX is increasing
How do you treat acutely ill pt’s or those not able to tolerate PO?
parenteral cefriaxone (3rd gen cephalosporin)
When is imaging of the urinary tract indicated?
What modality?
after first UTI in boys and second UTI in girls
Renal and bladder US and may include VCUG if any abnormalities seen on US or if there is fever and pathogen other than E. coli or poor growth and HTN
When a VCUG is done after the second UTI, what are we looking for?
evidence of vesicoureteral reflux, grade 1-5
notorious for causing renal scarring
What is renal scarring?
What are some long term complications?
loss of renal parenchyma between the calyces and the renal capsule
- HTN
- Decreased renal function
- Proteinuria
- ESRD
When will a PCP refer to a specialist?
dilating vesicoureteral reflux (grades III-V)
Obstructive Uropathy
Renal Abnormalities
Kidney function impairment
HTN
Bowel/Bladder dysfunction
