Renal Flashcards
- patient with recent exercise
- grossly bloody urine
- UA with 0-2 RBCs
Myloglobinuria
- repeat microscopic hematuria
- calcium/Cr ratio > 0.25
- may be on Lasix
- may present with abdominal pain and dysuria
- check RUS
Hypercalciuria
- microscopic hematuria after an MVA or sports injury
- one day old with palpable flank mass
- unilateral flank mass onUS
- hydronephrosis on CT
UPJ obstruction
- proteinuria present during the daytime but disappears when the pt has been laying down
- negative fresh urine sample upon waking and a subsequent positive one
Orthostatic hematuria
- x-linked dominant
- BL sensorineural hearing loss, ocular defects, ultimate renal failure
- MC in males
Alport Syndrome
- enlarged kidney with non communicating cysts and thin parenchyma
- unilateral flank mass
- oligohydramnios and minimal fluid in the bladder
- associated with UPJ obstruction, VUR, PUV, megaureter and duplications
- VCUG to r/o comorbid abnl
- RUS best initial study to order
- associated with congenital hepatic fibrosis and portal HTN (hematemesis, palpable liver, thrombocytopenia, splenomegaly)
Multicystic Dysplastic Kidney Disease
-associated with intracranial aneurysms
ADPKD
- autosomal recessive
- polyuria, enuresis, polydipsia, hyposthenuria
- short stature, retinitis pigmentosa, anemia
Juvenile-onset Medullary Cystic Kidney Disease
- MC cause of urinary retention in females
- mass protruding from the urethral meatus
- dysuria, hematuria, abd pain
Ureterocele
- Grade 1 or 2: no Tx, periodic cultures
- Grade 3: PPx Abx with f/u VCUG
- Grade 4 or 5: surgery
- females need PPx cultures
VUR
- palpable bladder, weak urinary system
- prenatal US with hydronephrosis and reduced renal parenchyma
- pass a catheter
- immediate urological correction
- risk for renal failure within 5 years
- occurs exclusively in males
PUV
- Dx: > 100K colonies
- MC E.coli, also klebsiella, enterococcus, adenovirus
- RUS indicated if pyelo, newborn, male
UTI
- no abdominal musculature
- prone to chronic UTIs, dilated ureters, and large bladders
- newborn with decreased UOP, soft abd musculature, undescended testicles, and distended bladder
Eagle Barrett
- hypoproteinemia, proteinuria, edema
- -MC: minimal change disease
- MC ages 2-8 in males
- decreased UOP, abd pain, and weight gain
- nl renal function
- hypercoagulable
- lose Ig, albumin, and thyroxine binding globulin resulting in immunodeficiency, hypocalcemia, and hypothyroidism
Nephrotic syndrome
-presence of RBC casts
glomerular disease
Red Urine
Oliguria
Proteinuria
Elevated BPP and BUN
Glomerulonephritis
Post-strep GN
Membranoproliferative GN
SLE
low complement levels
- loss of foot processes
- responds to Prednisone
- many go onto remission in adolescence
Minimal Change Disease
- MC in teenagers
- leads to progressive renal failure
- unpresponsive to steroids
FSGS
- low C3
- requires aggressive treatment to prevent renal failure
Membranoproliferative GN
- result of throat or skin infx
- HTN, edema, and hematuria
- low albumin due to hemodilution
- C3 low for up to 2 months
- Tx: supportive, fluid restriction
Post-strep GN
- hematuria > 8wk
- low serum complement persisting
- HTN
- proteinuria
- abnl renal fxn
Reasons to biopsy
- elevated serum IgA
- IgA deposits on renal Bx
- children younger than 10
- gross painless hematuria several days after an URI
- mild abd pain
- persistent proteinuria indicates worsening disease
IgA nephropathy
- FTT
- anemia (decr erythropoietin)
- metabolic acidosis (bicarb loss, decreased acid excretion)
- secondary hyperparathyroidism (elevated Phos, low Ca)
- uremia (high BUN)
- HTN (salt and water retention, incr renin)
- neuro abnl (mental status changes, seizures, peripheral neuropathies)
- hypocalcemia (decreased calcitriol)
- Derm issures (dry skin, pruritis, bruising)
Chronic renal failure
- hemolytic anemia
- renal failure
- thrombocytopenia
- present with anemia and pallor, abd pain, decr UOP, purpura and ecchymoses, seizures, lethargy, HTN
- caused by E. coli (meat and milk)
- Tx: replacement of insensible losses
HUS
- BP >95%ile fro age and sex, taken on 3 separate occasions
- use appropriate size cuff
- check BUN and Cr
HTN
Polycystic Kidney Disease O (zero) Enzyme (11 hydroxylase deficiency) Urinary Reflux Nephropathy Neonatal problem (BPD) Deficiency (17 hydroxylase)
Heart (Coarc, Renal artery stenosis)
Adrenal (pheo)
Reflux nephropathy (again)
Difficult to fit in (Cushingoid)
Risk factors for HTN
- family history of HTN
- short obese patient
Renal or Endocrine problem
-h/o prematurity with HTN
Renal injury 2/2 umbilical catheterization
-HTN with joint pain, swelling
Connective Tissue Disorder like Lupus
-HTN with flushing, palpitations, fever, and weight loss
Pheochromocytoma
–HTN with muscle cramps, wekaness
Hypokalemia 2/2 hyperaldosteronism
-HTN onset with sexual development
One of the enzyme deficiencies
-HTN with pale color and edema
Renal disease
- HTN with pale color, increased sweating at rest, flushing, abdominal mass
- Tx: alpha blockade
- B blockers are contraindicated (unopposed alpha effect) cause worsening HTN
Pheochromocytoma
-HTN with wide spaced nipples and webbing of the neck
Turner Syndrome (Coarc)
-HTN with Elfin facies
Williams Syndrome (AS)
-HTN with decreased femoral pulses or low BP in legs v arms
Coarc
-causes of dysuria in a preadolescent female
Pinworms
Poor hygeine
Trauma
Vaginitis
-dysuria in an adolescent female who is not sexually active
UTI
-dysuria in an adolescent female who is sexually active
UTI
GC/CT
-dysuria in an adolescent male
GC/CT
-child’s age +2
Bladder capacity
-UOP 1-2mL/kg/day
Infant UOP
-population with increased FeNa
Neonates
