Renal Flashcards
What is a risk from umbilical artery catheterization?
Renal artery embolism –> ischemic kidney injury –> hypertension
What systems does Alport syndrome affect? What is typical presentation?
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
Lamellated GBM due to longitudinal splitting of the macula densa
Alport syndrome
Typical presentation of minimal change disease
Age <6 with proteinuria (no hematuria, renal insufficiency or HTN)
Renal biopsy shows effacement of podocyte foot processes
Generalized edema (anasarca)
IgA nephropathy presentation
Gross hematuria
Upper respiratory symptoms (sore throat, rhinorrhea)
NO hypertension or renal insufficiency
APSGN treatment
Self-limited - treat volume overload/HTN
Furosemide
CCB (e.g. nifedipine)
Wilms tumor can occur sporadically but is present in what syndromes?
WAGR (Wilms, aniridia, GU abnormalities, retardation)
Beckwith-Wiedemann
What age range is Wilms tumor?
Age 2-5
Symptoms of Wilms tumor
Largely asymptomatic
Abdominal pain
Hematuria
HTN - due to renin secretion by tumor cells and/or compression of renal vasculature
What are 2 ways NSAIDs can cause kidney injury?
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
Autosomal recessive polycystic kidney disease signs
Large flank masses
Potter faces (flattened ears/nose, micrognathia from oligohydramnios)
Respiratory distress from pulmonary hypoplasia
Diagnosis of vesicoureteral reflux
Voiding cystourethrogram
Long-term evaluation for renal scarring
Renal scintigraphy with dimercaptosuccinic acid
What is a common cause of isolated gross hematuria?
Nephrolithiasis - doesn’t necessarily cause pain in children because stones in kidney itself
How is severe vesicoureteral reflux treated? What causes it?
Prophylatic antibiotics
Shortened intravesical segment of ureter –> incomplete ureteral compression –> retrograde flow
How does hypovolemia lead to hypokalemia?
Renin-angiotensin-aldosterone –> K+ excretion from kidneys
What is the first thing to do in both primary and secondary nocturnal enuresis?
Urinalysis
Urethritis accompanies what arthritis?
Reactive arthritis, which may follow an enteric diarrheal infection (Campylobacter, Shigella)
How does nephrotic syndrome cause hyponatremia?
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)
Minimal change disease treatment
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)
What is pathogenesis of minimal change disease?
Dysregulation of T cell subpopulations –> cytokines damage capillary wall of glomerulus –> epithelial podocyte injury
What is the most common organism causing nephrotic syndrome spontaneous peritonitis?
S pneumo
Should get polyvalent pneumococcal vaccine, 2 doses Varicella (if not already immunized), and annual flu shot
When is voiding cystourethrogram indicated?
> =2 febrile UTI
Abnormal renal ultrasound
Fever >=39 with bacteria other than E coli
Signs of CKD (ie poor growth, HTN)
Under what age should renal/bladder US be performed for a first febrile UTI?
2 yo - should be performed after fever and symptoms have already resolved
Also treat with 1-2 weeks of antibiotics
Focal segmental glomerulosclerosis kidney presentation
Nephrotic syndrome with hematuria and HTN
PSGN kidney presentation
Nephritic syndrome with low C3 - due to epithelial podocyte disruption, glomerular damage, and permeability
AKI, edema, HTN - due to thickened basement membrane
Are RBC casts seen with HUS?
No
Urinary stasis promotes formation of what kinds of stones?
Calcium stones
Children taking NSAIDs in what setting can lead to acute renal vasoconstriction and prerenal AKI?
Periods of hypovolemia (e.g. gastroenteritis)
