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peds > Renal > Flashcards

Renal Flashcards

1
Q

What is a risk from umbilical artery catheterization?

A

Renal artery embolism –> ischemic kidney injury –> hypertension

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2
Q

What systems does Alport syndrome affect? What is typical presentation?

A

Defective type IV collagen:
Glomerular basement membrane (splitting)
–> hematuria
Cochlea –> sensorineural hearing loss
Eyes –> anterior lenticonus (conical lens protrusion)

Boy <10 yo with hematuria after recent respiratory infection; FHx of CKD

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3
Q

Lamellated GBM due to longitudinal splitting of the macula densa

A

Alport syndrome

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4
Q

Typical presentation of minimal change disease

A

Age <6 with proteinuria (no hematuria, renal insufficiency or HTN)
Renal biopsy shows effacement of podocyte foot processes
Generalized edema (anasarca)

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5
Q

IgA nephropathy presentation

A

Gross hematuria
Upper respiratory symptoms (sore throat, rhinorrhea)

NO hypertension or renal insufficiency

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6
Q

APSGN treatment

A

Self-limited - treat volume overload/HTN

Furosemide
CCB (e.g. nifedipine)

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7
Q

Wilms tumor can occur sporadically but is present in what syndromes?

A

WAGR (Wilms, aniridia, GU abnormalities, retardation)

Beckwith-Wiedemann

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8
Q

What age range is Wilms tumor?

A

Age 2-5

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9
Q

Symptoms of Wilms tumor

A

Largely asymptomatic
Abdominal pain
Hematuria
HTN - due to renin secretion by tumor cells and/or compression of renal vasculature

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10
Q

What are 2 ways NSAIDs can cause kidney injury?

A

COX enzyme inhibition –> decreased vasodilatory prostaglandin –> renal afferent arterial vasoconstriction –> reduced GFR, renal ischemia, AKI
Usually in the context of existing hypovolemia (vomiting, diarrhea)

Drug-induced interstitial nephritis - rash, fever, eosinophila, WBCs/WBC casts in urinalysis

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11
Q

Autosomal recessive polycystic kidney disease signs

A

Large flank masses
Potter faces (flattened ears/nose, micrognathia from oligohydramnios)
Respiratory distress from pulmonary hypoplasia

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12
Q

Diagnosis of vesicoureteral reflux

A

Voiding cystourethrogram

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13
Q

Long-term evaluation for renal scarring

A

Renal scintigraphy with dimercaptosuccinic acid

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14
Q

What is a common cause of isolated gross hematuria?

A

Nephrolithiasis - doesn’t necessarily cause pain in children because stones in kidney itself

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15
Q

How is severe vesicoureteral reflux treated? What causes it?

A

Prophylatic antibiotics
Shortened intravesical segment of ureter –> incomplete ureteral compression –> retrograde flow

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16
Q

How does hypovolemia lead to hypokalemia?

A

Renin-angiotensin-aldosterone –> K+ excretion from kidneys

17
Q

What is the first thing to do in both primary and secondary nocturnal enuresis?

A

Urinalysis

18
Q

Urethritis accompanies what arthritis?

A

Reactive arthritis, which may follow an enteric diarrheal infection (Campylobacter, Shigella)

19
Q

How does nephrotic syndrome cause hyponatremia?

A

Hypoalbuminemia –> low circulating volume –> ADH stimulated –> more water reabsorption –> hyponatremia
Hyperlipidemia –> pseudohyponatremia (lipids cause blood to be milky, causing lab measurement of Na to be false)

20
Q

Minimal change disease treatment

A

Corticosteroids for 12 weeks (6 weeks full dose + 6 weeks taper)
Low sodium (1500-2000 mg daily)

Furosemide + 25% albumin only for children who are symptomatic (discomfort from massive ascites or scrotal/labial edema, respiratory distress from pleural effusions)

21
Q

What is pathogenesis of minimal change disease?

A

Dysregulation of T cell subpopulations –> cytokines damage capillary wall of glomerulus –> epithelial podocyte injury

22
Q

What is the most common organism causing nephrotic syndrome spontaneous peritonitis?

A

S pneumo

Should get polyvalent pneumococcal vaccine, 2 doses Varicella (if not already immunized), and annual flu shot

23
Q

When is voiding cystourethrogram indicated?

A

> =2 febrile UTI
Abnormal renal ultrasound
Fever >=39 with bacteria other than E coli
Signs of CKD (ie poor growth, HTN)

24
Q

Under what age should renal/bladder US be performed for a first febrile UTI?

A

2 yo - should be performed after fever and symptoms have already resolved
Also treat with 1-2 weeks of antibiotics

25
Q

Focal segmental glomerulosclerosis kidney presentation

A

Nephrotic syndrome with hematuria and HTN

26
Q

PSGN kidney presentation

A

Nephritic syndrome with low C3 - due to epithelial podocyte disruption, glomerular damage, and permeability
AKI, edema, HTN - due to thickened basement membrane

27
Q

Are RBC casts seen with HUS?

A

No

28
Q

Urinary stasis promotes formation of what kinds of stones?

A

Calcium stones

29
Q

Children taking NSAIDs in what setting can lead to acute renal vasoconstriction and prerenal AKI?

A

Periods of hypovolemia (e.g. gastroenteritis)

peds (25 decks)

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