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Pediatrics > Proteinurea & Hematuria > Flashcards

Proteinurea & Hematuria Flashcards

1
Q

What proteins does urine dipstick detect?

A

Albuminurea

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2
Q

Name diseases with proteinurea that are less likely to be detected by dipstick?

A
  • Tubular proteinuria
  • bence jones
  • gamma globulins
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3
Q

What does the depth of color in dipstick indicate in proteinurea

A

Increase protein excretion

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4
Q

What does trace, +1, +2, +3, +4 indicate in dipstick tests: of protein

A
  • trace: between 15-30
  • 1: between 30-100
  • 2: between 100-300
  • 3: between 300 -1000
  • 4: >1000
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5
Q

Name false positive results from proteinurea in dipstick

A
  • gross hematuria
  • concentrated urine
  • alkaline urine
  • antiseptic and radiocontrats
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6
Q

Name false negative results from proteinurea in dipstick

A

Non-albumin proteins - diluted urine

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7
Q

In which group of population is transient proteinurea more common

A

School aged and adolecent

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8
Q

What are the causes that may cause transient proteinurea

A

Exercise, fever, dehydration, cold weather, stress, seizures, heart failure

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9
Q

What are the findings of proteinurea in dipstick?

A

They don’t exceed +2

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10
Q

What is orthostatic proteinurea?

A

Proteinurea when standing up in an asymptomatic school aged-adolecent child

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11
Q

How to treat orthostatic postural proteinurea?

A

No need, it’s benign codnition just folllow up

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12
Q

How to establish diagnosis for orthostatic proteinurea?

A

By early morning sample after being supine over the night (negative) - after standing up during the day (positive)

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13
Q

What are the dipstick finding in glomerular proteinurea?

A

From 1g to 30 grams in one day

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14
Q

When to suspect glomerular proteinurea?

A
  • first morning protein\creatining >1

- proteinura w\ HTN, hematuria, edema, renal dysfunction

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15
Q

What is the treatment of choice for minimal changr disease?

A

Corticosteroid

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16
Q

What is the worst prognosis of primary nephrotic syndrome?

A

Focal segmental GN

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17
Q

Whats the % of response to steroid in primary NS?

A
  • 90% in minimal
  • 50% mesengial
  • 20% in focal segmental
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18
Q

Whats the outcome after focal segmental ns

A

ESRD

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19
Q

What are the lab findings in blood for nephrotic syndrome?

A
  • low albumin
  • high cholesterol
  • normal BUN\creatinine (high if Intravascular depletion or dehydration)
  • normal C3 (in MCNs)
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20
Q

What are the lab findings in urine for nephrotic syndrome?

A
  • high specific gravity
  • proteinuria (>40mg\hr) - (creatinine ratio >2.0)
  • oligiureia
  • hematuria (micro & asymp)
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21
Q

What are the indications for renal biopsy for nephrotic syndrome?

A
  • gross hematuria
  • HTN
  • renal insufficiency
  • Hypocomplementemia
  • age <1 yr - >10yr
  • steroid resistance (after initial steroid)- steroid dependent (before 2nd line)
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22
Q

What are the clinical manifestations of minimal change disease?

A
  • generalized edema
  • normal\low BP
  • thrombosis
  • bacterial infection (sbp)
  • hyperlipedemia complication (rare in child)
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23
Q

What is the most common form of nephrotic syndrome in childhood?

A

Idiopathic nephrotic syndrome (primary)

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24
Q

What is the common (age\gender) to develop minimal change nephrotic syndrome?

A

2-6 years

Males

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25
Q

What may trigger Mcns

A
  • infections (minor)
  • reaction to insect bites\bee stings
  • poison ivy
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26
Q

what is the recommended diet for child w\nephrotic syndrome

A

Low fat and salt - high protein

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27
Q

What should be ruled out before starting steroid therapy?

A

Tb infection

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28
Q

Treatment of nephrotic syndrome:

A
  • diuretic “mod-severe edema”
  • salt restricted albumin “severe edema”
  • steroid (definitive)
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29
Q

What are the presentations of severe edema?

A

Anasarca - genital - pulmonary edema

30
Q

What is the definition of remission after steroid therapy in Ns

A

Negative urine protein for 3 consecutive days

31
Q

What is the definition of relapse after steroid therapy in Ns

A
  • 2+ or more protein in Ua >3d
  • hypoalbuminemia
  • edema
32
Q

When to consider patient steroid resistant?

A

Fail to have remission after 6-8w of steroid therapy

33
Q

tx of Steroid resistant:

A
  • renal biopsy

- 2nd line tx (cyclosporine + tacrolimus)

34
Q

What to suspect in case of steroid resistance in Ns?

A

Other cause (not mcns)

35
Q

What are the mimickers of hematuria?

A

Dyes - hemoglbinurea - myoglobinurea - mensturation - factious

36
Q

What medication can mimic hematuria

A

Rifampicin

37
Q

How to confirm hematuria?

A

urine Dipstick + microscopy

38
Q

Define hematuria in urine microscopy

A

> 5 RBC\HPF (centerfuged)

Or >6 (>10) RBC\0.9mm (uncenterfuged)

39
Q

How much blood is enough to make urine look bloody?

A

1ml of blood in 1L of urine

40
Q

Does color of blood in urine indicate severity?

A

No

41
Q

What causes transient hematuria

A

Fever or sternous exercise

42
Q

What to do if you diagnose patient with transient hematuria?

A

Repeat UA after 1 week

43
Q

Define persistent hematuria:

A

3 of 3 consequetive urine specimen obtained 1 week apart

44
Q

What is the most common etiology of hematuria?

A

Glomerular es

45
Q

What is the next step when you find child with hematuria?

A

Check family members + check BP

46
Q

Name common gomerular causes of hematuria

A
  • post streptococcal (post infectious)
  • henoch schonlein purpura
  • IgA nephropathy
47
Q

What are the tubulointerstital causes of hematuria

A
  • acute tubular necrosis
  • tubulointerstitial nephritis
  • Autosomal dominant PCKD
48
Q

What induces ATN?

A

Shock - drugs

49
Q

What induces TIN

A

Drgu

50
Q

What are the causes of hematuria in lower urinary tract

A

Stones, hypercalcuria, infection, foreign body

51
Q

What are the vascular causes of hematuria?

A

Renal vein\artery thrombosis

seen in umbilical artery\vein catheterizaition in baby

52
Q

What are the coagulopathy causes of hematuria

A

Hemophilia, thrombocytopenia, sickle cell

53
Q

What is the most common cause of acute nephritis in children

A

Post infectious GN

54
Q

What is the organism to commonly cause PIGN?

A

Group A beta-hemolytic strep

55
Q

What is the typical presentation for post infectious gn

A

After skin or throat infection

56
Q

What are the lab findings of PIGN?

A
  • hematuria (variable micro to gross)
  • proteinuria
  • low C3 & CH50
  • normal C4
  • HTN
  • elevated serum creatinine
  • positive streptozyme\ASOT - throat or skin culture
57
Q

What is the duration of infection before developing PIGN?

A

1-3 weeks (pharyngitis)

3-6 weeks (skin infection)

58
Q

What is the picture of PIGN?

A

Nephritic mostly but can be nephrotic

59
Q

What is the treatment of choice for PIGN

A
  • lasix for HTN
  • medical treatment of acute kidney injury
  • penicillin
  • follow up
60
Q

Why use penicillin in PIGN?

A

To avoid spread of infection

61
Q

What is the prognosis of PIGN?

A

90% will have complete resolution

But small subset will have late renal complication (HTN - proteinurea - renal insufficency)

62
Q

How long does complement, proteinurea, and hematuria take to resolve after treatment of PIGN?

A
  • complement (1\2m)
  • proteinurea (6m)
  • hematuria (1\2y)
63
Q

What is the most common cause of recurrent gross hematuria?

A

IgA nephropathy

64
Q

Differentiate between IgA and post-streptococcal infection?

A

Both are amongst the most common causes of hematuria
- PIGN: acute, acquired, skin and pharyngitis

  • IgA:, primary, recurrent gross or presistant microhematuria, URTI and vaccination
65
Q

What type of microscopy used to detect IgA nephropath

A

Immunoflurescene (IgA deposits)

66
Q

What is the prognosis of IgAN

A
  • most live normal

- 50% develop ESRD - renal failure

67
Q

What indicates bad prognosis of IgAN

A

Proteinurea, HTN, BUN\Creat

68
Q

What is the prognosis of alport syndrome?

A

Poor

All will progress to worsen status

69
Q

What is the triad of alport syndrome?

A
  • ocular abnormalities
  • sensoryneural hearing loss
  • glomerular disease
70
Q

What is the part of the glomeruli that shows the disorder in alport syndrome?

A

Basement membrane disorder (Type 4(

71
Q

What is the genetic mutation in alport syndrome?

A

Alpha 3,4, and 5 chains of type 4 collagen

X-linked (AR or AD)

72
Q

What is considered always pathological

(Proteinurea or hematuria)?

A

Proteinurea

Pediatrics (41 decks)

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