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Pediatrics > Renal > Flashcards

Renal Flashcards

1
Q

what are 3 other jobs in the kedney besides removing wastes?

A

erythropoietin, or EPO, which stimulates the bone marrow to make red blood cell
renin, which regulates blood pressure
calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

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2
Q

what regulates BP?

A

Renin

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3
Q

what stimulates the bone marrow to make red blood cell

A

EPO

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4
Q

what is the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

A

calcitriol

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5
Q

problems where allow proteins and RBC to be filtered though the basement membrane into urine

A

problems in glomerulus

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6
Q

problems where allow abnormal excretion of H+ , CL- , Bicarb , Na+, K+.

A

Problems in tubule

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7
Q

What radiographic study would you use to evaluate a patient for polycystic kidney disease?

A

RUS - good for parenchymal disease

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8
Q

Your pt is a 3day old male who is brought in by his parents who state he “hasn’t been peeing much, and his belly seems to be getting larger and harder”. Good prenatal care, no complications.
The infant was a routine vaginal delivery without any complication who went home at ~36hrs feeding well without vomiting. They confirm that the infant has stooled several times. When asked, they said he didn’t pee much in the hospital but they were told that was OK, and to watch for him to start peeing more – but they don’t think he is peeing more.
Your exam is notable only for a distended abdomen with palpably enlarged bladder and right kidney. WHAT IS THIS?

A

posterior urethral valves

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9
Q

in littles HTN is a ____ problem

A

Renal

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10
Q

what are symptoms of renal disease in neonates and infants?

A

Abdominal or flank mass, hematuria, anuria/oliguria

Hypertension

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11
Q

what are symptoms of renal disease in children and adolescents?

A 
Tea/cola/red colored urine, or hematuria
Hypertension
Frequency/Urgency/dysuria
Polyuria, oliguria
Edema
proteinuria
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12
Q

on PE you see tachypneic / kussmal breathing …

A

acidosis

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13
Q

on PE you see tachycardia and kidney disease if

A

hypovolemic

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14
Q

on PE you see arrhythmia and kidney disease if

A

hyperkalemic

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15
Q

on PE you find on the skin…. pts towards kidney disease?

A

poor skin turgor, dry, edema

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16
Q

what genital abn will you see with kidney disease?

A

abnormalities, (hypospadias, cryptorchidism, ambiguous genitalia

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17
Q

in children abd mass that is most common is

A

large kidney

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18
Q

if you see an increased BUN

A

Low renal perfusion of RBF

Nitrogen also affected by protein intake, catabolism, steroids… therefore

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19
Q

what is BUN:cr ratio?

A

10:1

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20
Q

increased Cr =

A

Cr is most reliable single indicator of glomerular function

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21
Q

what is normal serum Cr?

A

Nl serum Cr < 1 in older children*

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22
Q

what could hematuria mean?

A

Glomerular – nephritis, familial, post-strep
ATN
UTI, trauma

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23
Q

what could proteinuria mean?

A

Glomerular - nephropathy

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24
Q

what does US show

A

Renal size, structure, hydronephrosis, cysts, Bladder size.

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25
Q

what does US w doppler show?

A

renal blood flow , resistance, thrombus

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26
Q

what does VCUG show?

A

VUR

voiding urethral reflux

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27
Q

what can CT and MRI show?

A

stones, parenchyma

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28
Q

Clinically mild or insignificant renal abnormalities

3

A

-Unilateral renal agenesis
IDM, VACTERL, Turner’s, + assoc with anomalies
-Horseshoe kidney
-Pelvic or ectopic kidneys

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29
Q

Renal parenchymal abnormalities 2

A 
Dysgenesis – spectrum
Unilateral / bilateral
Polycystic kidney disease PKD
Autosomal recessive
Autosomal dominant
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30
Q

what is the most common PKD?

A

AD

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31
Q

what PKD is worse?

A

AR

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32
Q

IN childhood, may be diagnosed via palpation of abdominal mass
HTN is an early problem
Rate of progression of renal insufficiency varies
Dx by RUS

A

PKD

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33
Q

Accounts for the majority of cases of PKD

A

AD

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34
Q

PKD - Presents in infancy

A

AR

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35
Q

what PKD Associated with other cysts (ovarian - hepatic)

A

AD

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36
Q

Accounts for the majority of cases of PKD

A

AR

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37
Q

Marked bilat renal enlargement. Interstitial fibrosis and tubular atrophy. Renal Failure early childhood

A

ARPKD

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38
Q

Typically present in middle adulthood.

Assoc with other cysts : hepatic, pancreatic, ovarian and cerebral aneurysm

A

ADPKD

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39
Q

most common cause of bladder outlet obstruction in males

A

posterior urethral valves

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40
Q

Male infant with anuria or poor stream

Urgent surgical drainage necessary

A

posterior urethral valves

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41
Q

what causes hydronephrosis only?

A

Ureteral obstruction

Uretero-pelvic junction

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42
Q

what causes hydronephrosis and hydroureter?

A

obstruction of-vesical junction

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43
Q

what is Reflux of urine from bladder to ureter during bladder contraction, or back up from bladder (ie neurogenic bladder)

A

VUR

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44
Q

what are complications of VCUR?

A

-recurrent UTI – when we treat
-Renal damage
Hydrostatic
Infectious
-HTN, CKD

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45
Q

Grade of VUR that Do not typically cause renal damage

Outgrow by age 4-6 years

A

I-III

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46
Q

do we prophylax grades I-III VCUR

A

Nitrofurantoin (Macrobid) or
sulfamethoxazole-trimethoprim (Bactrim)
50% of UTIs recur without prophylaxis
Surveillance urine culture

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47
Q

what is more common in girls and may run in family?

A

VCUR

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48
Q

how do you treat grade IV VCUR?

A

Surgical re-implantation of ureter

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49
Q

what may be easily palpable on posterior urethral valves?

A

Kidneys and bladder

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50
Q

what in posterior urethral valves causes ascites?

A

Leakage proximal to obstruction

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51
Q

what is most likely cause of prune belly syndrome?

A

posterior urethral valves

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52
Q

what is cryptorchidism and absent abdominal musculature ( due to a number of urinary tract abnormalities)

A

prune belly syndrome

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53
Q

what causes non glomerular dysuria and hematuria?

A

cystitis or urethritis

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54
Q

what causes non glomerular associated with back pain and hematuria

A

pyelonephritis

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55
Q

what causes non glomerular hematuria and colicky pain?

A

stone

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56
Q

what causes non glomerular hematuria and bright red clots

A

bleeding d/o or trauma

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57
Q

what does glomerular hematuria have?

A

Tea colored, smoky
RBC TNTC
+/- RBC casts
Painless

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58
Q

what is march hematuria?

A

microscopic hematuria caused by running

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59
Q

what has Tea colored, smoky – RBCs that have been broken down
RBC TNTC – to numerous to count
+/- RBC casts
Painless

A

Glomerular nephritis

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60
Q

If proteinuria + hematuria…

A

probability of nephritis/nephropathy goes up

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61
Q

what are causes of microscopic hematuria?

A

March hematuria” - normal
Hypercalciuria , Stones, Sickle cell
Primary concern – glomerulonephritis*
UTI

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62
Q

what is the most common cause of hematuria?

A

UTI

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63
Q

what are causes of acute nephritis?

A

Post-infectious (PSGN)
Vasculitis (HSP)or rarely, SLE
IgA nephropathy and membranoproliferative GN
Antibody deposition and injury to glomerulus
Cancers, infections
Antiglomerular basement membrane disease (Good pasture syndrome) rare

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64
Q

Gross hematuria – Tea/cola/red colored.
Microscopic RBC’s too numerous to count
RBC casts (diagnostic, but not always present)
Edema, periorbital and extremities
Other symptoms non specific – fever uncommon, may have HTN. what is this?

A

Glomerulonephritis

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65
Q

if there is massive proteinuria (nephrotic syndrome) , anasarca, ascities dt injury what is it?

A

Glomerulonephritis

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66
Q

Most common form of GN in childhood

A

Acute post-streptococcal GN

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67
Q

how do you dx Acute post-streptococcal GN? hx and other associated symptoms?

A

History of culture + GAS , or +antistreptolysis O titer
Can have low complement (C3) levels
May develop renal failure and hypertension
Many have persistent microhematuria

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68
Q

how do you treat Acute post-streptococcal GN

A

No specific treatment. Supportive. Antibiotics if GAS still present. Treat HTN
85% of affected children recovery totally

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69
Q

is hematuria normal in Acute post-streptococcal GN for up to a year?

A

yes

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70
Q

what is IgA Nephropathy GN

A

IgA deposition – inflammation of glomeruli

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71
Q

how does IgA Nephropathy GN present?

A

Presents as asymptomatic microscopic hematuria or gross hematuria during minor acute illness
Normal complement, 50% IgA elevated, no h/o strep

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72
Q

who gets IgA Nephropathy GN

A

young adolescents and adult

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73
Q

if have nephrotic syndrome what do you have in urine?

A

protein

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74
Q

how do you treat IgA Nephropathy GN

A

steroids

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75
Q

most common “chronic” form of GN in children (progress 50% to renal failure over 10 years)

A

Membranoproliferative GN

76
Q

if pt keeps coming back for GN what might they have?

A

Membranoproliferative GN

77
Q

what is Membranoproliferative GN and presents as?

A

Abnormal immune response with deposition in glomerular membrane
Proteinuria, hematuria, hypocomplementemia, HTN

78
Q

what is type I Membranoproliferative GN

A

Often responsive to steroids

79
Q

what is type II Membranoproliferative GN

A

Rare, but Most common GN that progresses to Chronic Renal Failure (not very responsive to steroids)

80
Q

how do you dx type of Membranoproliferative GN

A

bx

81
Q

Membranoproliferative GN is caused with?

A

Autoimmune ( SLE, scleroderma, sjogrens)
Cancer ( leukemia, lymphoma)
Infections ( Hepatitis, endocarditis, malaria)

82
Q

what is Henoch-Schönlein GN (vasculitis)

A

Autoimmune vasculitis following viral infections

83
Q

what is common with HS purpura?

A

Microhematuria

84
Q

how do you treat HSP?

A

steroids

85
Q

is mild proteinuria normal?

A

yesVigorous exercise or febrile illness
Orthostatic
Test first morning void for protein

86
Q

nephrotic syndrome is

A

(proteinuria and hematuria)

87
Q

what is the most common primary NS

A

minimal change disease

88
Q

Excessive proteinuria causes?

A

Hypoproteinemia
Edema, ascites
Hyperlipidemia
Increased infection risk

89
Q

what is onset of edema in NS?

A

sudden

90
Q

what other symptoms of NS

A

Anorexia, malaise, abdominal pain
HTN 25%
Diarrhea, respiratory distress from edema

91
Q

Often follows flu-like illness
Presents with edema (often periorbital)
Vague malaise, oliguria, occ abdominal pain

A

minimal change disease (idiopathic)

92
Q

what sx does minimal change disease lack that other nephrotic syndromes have?

A

Lack of HTN, hematuria, renal insufficiency

93
Q

renal insuff is the same as….

A

high creatinine

94
Q

how do you treat minimal change disease?

A

prednisone - long tapered course

95
Q

what does failure to respond to steroids mean in NS

A

not minimal change disease

96
Q

we do not use___ in minimal change syndrome?

A

diuretics

97
Q

4 yr old patient with pallor, bloody diarrhea, abdominal pain, dark urine.
PMH unremarkable, no allergies, no meds. Child complained of belly pain after eating out with family 2 days ago. Vomited x 1and had diarrhea yesterday.Parents arent sure if it was bloody then but definitely today.
Labs: Stool culture, CBC, Electrolytes with BUN/Cr ,Serum albumin, Urinalysis
Results: Ecoli o157:H7 in stool
Hct27% ( > 40%) Platelets 70K ( > 150K)
Cr 1.8 (

A

Hemolytic-Uremic Syndrome

98
Q

what is Hemolytic-Uremic Syndrome

A

Renal failure, hemolytic anemia, and thrombocytopenia

99
Q

what is an important cause of acute renal failure in children?

A

Hemolytic-Uremic Syndrome

100
Q

what does causes Hemolytic-Uremic Syndrome most commonly?

A

E.coli

101
Q

what else can cause Hemolytic-Uremic Syndrome

A

Shiga toxin producing “verotoxin” which causes endothelial damage in glomeruli and interstitial vessel thrombosis.
E. coli O157:H7 most common
salm or shig less commonly

102
Q

what are the age ranges for Hemolytic-Uremic Syndrome

A

6 mo - 4 years

103
Q

Presentation:
-Abdominal pain, Vomiting and diarrhea (often bloody)
-Within a week, weakness, pallor, irritability, petechiae, oliguria
-Profound anemia, increased retic count
Platelet deposition  microvascular occlusion
-HTN and seizures in some ~20%
Endothelial damage CNS

A

HUS

104
Q

what does blood smear show for HUS?

A

Schistocytes, burr cells, fragmented RBC

= intravascular hemolysis

105
Q

what does CBC show for HUS?

A

Leukocytosis common,
Platelets low
Retic count – high

106
Q

what does UA show for HUS?

A
  • hematuria, proteinuria, casts
107
Q

how do you treat HUS?

A

Management – Primarily directed at renal failure (managing fluid and electrolytes )
No antibiotics: increases risk of HUS
No antidiarrheals: increases exposure to VT toxins

108
Q

how quickly do children recover from HUS?mortality?

A

most commonly children recover within 2-3 weeks. 95%
50% recover normal renal function
Residual disease (ie HTN) ~ 30% , end stage renal disease ~ 15%.
Mortality associated with CNS complications 3-5%

109
Q

what are prerenal cause of ARF?

A

Hypovolemia leads to underperfusion  ATN
dehydration – most common in kids
Hemorrhage
burns
Poor cardiac output (heart failure , septic shock)

110
Q

what is the most common cause of prerenal ARF

A

Hypovolemia leads to underperfusion  ATN

111
Q

what are renal causes of ARF?

A

Acute glomerulonephritis, vasculitis, myoglobinuria
Hemolytic-uremic syndrome
Nephrotoxic injury (medications ie gent , acyclovir)

112
Q

what are post renal causes of ARF?

A

obstructive

113
Q

marked by Sudden inability to excrete urine. Filtration and formation of urine dependent on RBF – dependent on CO and volume.

A

ARF

114
Q

how do you treat ARF

A

dialysis

115
Q

what are the complications of ARF?

A

Fluid overload
Hyperkalemia +/- hyponatremia
Metabolic acidosis
Uremia

116
Q

what is the course of ARF?

A

Polyuria and recovery, or

Chronic Renal Failure

117
Q

what are causes of CRF? under 10 and over 10

A

Congenital/developmental abnormalities of kidneys < 10y
Nephritis/Nephrosis (membranoproliferative GN undx) >10y
Hemolytic uremic syndrome or other causes of acute renal failure that don’t resolve

118
Q

what are complications of CRF?

A

Hypertension
Metabolic acidosis, Growth failure, disturbances of Ca, PO4, Vit D. rickets
Anemia (normocytic, normochromic)
Later on – uremia -malaise, anorexia, nausea and CNS - coma

119
Q

how do you manage CRF?

A

Diet and medical management

Dialysis & transplantation

120
Q

renal cause of HTN?

A

Renal parenchymal disease
Renovascular ( ie renal artery stenosis, arterial clot)
PCKD, GN, HUS, SLE, toxins

121
Q

CV causes of HTN?

A

coarctation of aorta

122
Q

hormone cause of HTN?

A

Catecholamine excess
Pheochromocytoma
Endocrine
CAH, Cushings syndrome, or steroid therapy

123
Q

how is essential HTN diagnosed?

A

diagnosis of exclusion

124
Q

what is a tumor that secretes catecholamines?

A

pheochromocytoma

125
Q

HTN +Abdominal bruit, diminished leg pulses=

A

CoA

126
Q

HTN +Café au lait spots =

A

neurofibromatosis

127
Q

HTN +Flank Mass =

A

Kidney disease

128
Q

HTN +Ataxis / opsoclonus =

A

neurblastoma

129
Q

HTN +Tachycardia with flushing and diaphoresis=

A

pheochromocytoma

130
Q

HTN +Truncal obesity, acne, striae =

A

cushings

131
Q

Most common secondary HTN etiology in childhood is

A

renal

132
Q

what are renal causes of HTN

A

Renin-angiotensin system “failure”

Parenchymal disease or renal vascular abnormalities

133
Q

how do you treat 2ndary HTN

A

ACE inhibitors, Ca-channel blockers

134
Q

how do you treat HTN crisis?

A

Nifedipine, Hydralazine, nitroprusside

135
Q

when does AAP recommends age to screen BP is

A

3

136
Q

who in the neonates gets UTI?

A

Males > Females 3-5:1

Uncircumcised > circumcised

137
Q

who in infants and children gets UTI?

A 
boys rare after infancy
3% to 8% of girls
Peak age around toilet training
Uncommon after age 8, but
Common again in sexually active teens
138
Q

gold standard of getting urine from a lil one is?

A

supra pubic tap

139
Q

will a UA be neg in pediatric UTI?

A

yes 20% of the time

140
Q

what is gold standard of dx a UTI?

A

culture

141
Q

what is the most common bug of UTI?

A

E.coli

142
Q

what bacteria causes UTI in sexually active?

A

Staph saphrophyticus

143
Q

how do you treat complicated UTI?

A

Inpatient

IV Amp and Gent

144
Q

what is the presentation of complicated UTI?

A

High fever
Persistent vomiting
Dehydrated

145
Q

any child less than 3 mo with a uti

A

considered complicated and should be hospitalized

146
Q

how do you present with uncomplicated uti?

A

Nontoxic

Tolerating oral medications and fluids

147
Q

how do you tx uncomplicated UTI?

A

Cephalosporins
Trimethoprim/Sulfa
Augmentin
7-10 days in children

148
Q

who needs prophylaxis of UTI?

A

– recurrent UTI, high grade VUR

149
Q

what do you use for prophylaxis of UTI

A

Bactrim and Macrobid

150
Q

who should have a renal US?

A

All infants 2- 24 months with first UTI

151
Q

what does renal US show?

A 
Kidney size, number and position
Hydronephrosis (dilation of pelvis & calyces)
Hydroureter (dilation of ureter)
Dysplasia
Renal scarring
152
Q

who should get a VCUG?

A

If RUS abnormal

If recurrence of febrile UTI

153
Q

what does VCUG show?

A

Bladder anatomy
Vesicoureteral reflux (and grade of reflux)
Posterior urethral valves

154
Q

who has voiding dysfxn?

A

Frequent in preschool age kids

155
Q

what causes voiding dysfxn?

A

Immaturity of bladder and micturition pathways

156
Q

when should child be continent?

A

4-5yrs

157
Q

how do you work up voiding dysfxn?

A

UA and Ucx for UTI

158
Q

how do you treat voiding dysfxn?

A

Behavioral modification: bed wetting alarms
Rx imipramine or DDAVP in selected kids

Inguinal hernias common

159
Q

what is hypospadias?

A

Malposition of the urethral opening

Not assoc with urinary tract anomalies

160
Q

how do you treat hypospadias?

A

Complex surgical repair in males

DO NOT CIRCUMCIZE

161
Q

when is hypospadias repaired?

A

before 18 mo

162
Q

what are 2 anomalies of the penis?

A

phimosis, paraphimosis

163
Q

what is phimosis?

A

adherence of foreskin

Physiologic: should be retractable by adolescence

164
Q

how do you treat phimosis?

A

, topical steroids, gentle stretching, circ

165
Q

what is paraphimosis?

A

retractable behind glands, then stuck: causing swelling and pain

166
Q

how do you treat paraphimosis?

A

lubricant to reduce, or emergent circumcision.

167
Q

what is cryptorchidism?

A

: undescended teste

168
Q

most of the time cryptorchidism is

A

unilateral in the canal

169
Q

Inability to palpate testes does not =

A

cryptorchidism

170
Q

when does spontaneous descent not occur after?

A

1 yrs

171
Q

if they dont decend cryptorchidism has an increased risk of?

A

cancer and infertility

172
Q

how does testicular torsion present?

A

Enlarged testis
Tender on palpation
Cremasteric reflex absent

173
Q

The major cause of the acute scrotum in boys < 6y

A

testicular torsion

174
Q

on testes:
Blueish hue
Transilluminates

A

Hydrocele

175
Q

how do you dx testicular torsion?

A

US with doppler

176
Q

the bp cuff should cover…

A

2/3 of the arm

177
Q

what could cause renal HTN in the newborn period? 3

A

Congenital anomalies of kidneys or renal vasculature
Obstruction of urinary tract
Thrombosis of renal vasculature or kidneys

178
Q

what can cause nephrolithiasis?

A

-Inborn errors of metabolism
Cystine, glycine, urates, oxlates
-Hypercalciuria (familial) , distal RTA
-Large stones in children with spina bifida with paralyzed lower limbs. (Neurogenic Bladder)

179
Q

what are symptoms of nephrolithiasis? radiates?

A

colicky pain in flank or lower abdomen
Can radiate to the groin
Vomiting common
Younger children: mottling and fussiness.

180
Q

what studies should be done for nephrolithiasis?

A

RUS will see stones in the kidney
CT to visualize lower tract
No contrast – will obscure view

181
Q

how do you treat nephrolithiasis?

A

Treat primary problems
Hydration and pain control
Surgery rare – only obstruction, intractable pain, chronic infections.

182
Q

what are causes of UTI?

A 
-Dysfunctional voiding
Delayed voiding
Incomplete bladder emptying
Spina bifida and other nerve damage
-Poor hygiene – ascending infection, >85% Ecoli. (nl fecal flora)
-Sexual activity
-Vesicoureteral Reflux (cause vs. effect)
-Neurogenic bladder
-Obstruction
Hydronephrosis
Mass
Constipation
183
Q

how does a neonate present with UTI

A

Vomiting, fever or hypothermia, poor weight gain, strong urine odor ,

184
Q

how does an infant present with UTI?

A

Vomiting, diarrhea, fever, poor weight gain, strong urine odor

185
Q

how does a child present with UTI?

A

Vomiting, abdominal or flank pain, fever, frequency, urgency, dysuria, enuresis

186
Q

how does an adolescent present with UTI?

A

Fever, abdominal or flank pain, frequency, urgency, dysuria

187
Q

what is unusual in children with UTI

A

CVA tenderness

Pediatrics (9 decks)

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