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
Focal segmental glomerulosclerosis kidney presentation
Nephrotic syndrome with hematuria and HTN
26
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
27
Are RBC casts seen with HUS?
No
28
Urinary stasis promotes formation of what kinds of stones?
Calcium stones
29
Children taking NSAIDs in what setting can lead to acute renal vasoconstriction and prerenal AKI?
Periods of hypovolemia (e.g. gastroenteritis)