Renal Flashcards
most reliable indicator of glomerular function?
Serum creatine
what can BUN change with?
Diet
dehydration (artificially elevated)
which stimulates the bone marrow to make red blood cell
EPO, erythropoietin
regulates blood pressure
Renin
form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
Calcitriol
what elevated wastes will there be with kidney failure
urea
creatinine
potassium
what does tachypneic/ kussmal breathing indicate?
Acidosis
as you get rid of chloride (with furosemide) what will you kidneys hang onto?
Bicarb
If you are hyperkalemia what can happen?
Go into an arrhythmia
What is the most common abdominal mass on newborn exam?
Large kidney
what can cause a large kidney?
urinary flow obstruction
polycystic kidney
renal parenchymal abnormality
what urine exam is done in the lab?
urinalysis
what is the single most reliable indicator of glomerular function?
SrCr
what does renal US help you look at?
Renal size, structure, hydronephrosis, cysts, Bladder size.
what does US with doppler on the kidney helps you look for?
renal blood flow , resistance, thrombus
what are CT and MRI good at identifying
stones, parenchyma
what are VCUG good at identifying?
look for contrast to travel up the ureters to the kidneys when it shouldn’t be
does a horseshoe kidney create a problem?
No, as long as there are 2 ureters
What does unilateral renal agenesis possibly suggest?
IDM
VACTREL
turner’s
what is bilateral renal agenesis?
Potters
What will a kid with potters syndrome look like?
low set earns
pulmonary hypoplasia causing resp failure
beaked nose
what is an early problem of PKD?
HTN
how do you diagnose PKD?
RUS
which type of PKD is responsible for the majority of cases of PKD?
dominant
what type of PKD presents in infancy?
recessive
what type of PKD is associated w/ other cysts?
dominant
what type of PDK is characterized by marked enlargement of both kidneys
recessive
Typically present in middle adulthood.
Assoc with other cysts : hepatic, pancreatic, ovarian and cerebral aneurysm
autosomal dominant PKD
Marked bilat renal enlargement. Interstitial fibrosis and tubular atrophy. Renal Failure early childhood
autosomal recessive PKD
most common cause of bladder outlet obstruction in males
Posterior urethral valves
what does obstruction at the Uretero-pelvic junction lead to?
Hydronephrosis
what does obstruction at the uretero-vesical junction lead to?
Hydroureter and hydronephrosis
tx for posterior urethral valves?
surgical drainage is needed
Reflux of urine from bladder to ureter during bladder contraction, or back up from bladder (ie neurogenic bladder)
Veicourethral reflux
when will do prophylaxis abx in a child ?
scarring or severe vesicoureteral reflux
what grade of vesicourethral reflux start to cause renal damage?
Grade IV
what do you get for prophylaxis for UTIs with vesicourethral reflux?
Nitrofuratoin
bactrim
what grade of vesicoureteral reflux do you consider surgical re-implantation of ureter?
Grade IV
who is vesicoureteral reflux more common in?
girls, also a familial component
cryptorchidism and absent abdominal musculature ( due to a number of urinary tract abnormalities) often due to posterior urethral valves.
Prune belly syndrome
what else occurs with posterior urethral valves?
dysplastic kidneys
dilated urinary tract
malformed bladder
hematuria and dysuria can indicate what?
cystitis
urethritis
back pain and hematuria can indicate what?
pyelonephritis
what type pain will a stone have?
colicky pain
what will urine look like with glomerular nephritis?
tea colored, smokey (broken down RBCs too numerous to count)
will have RBC casts
with glomerular nephritis be painful or painless?
painless
what is the most common identifiable cause of hematuria (gross of micro)?
UTI
If there is hematuria + what the probability of nephritis/ nephropathy goes up?
proteinuria
what is march heamturia?
normal, due to exercise (ex- marathon)
causes of acute nephritis?
post-infectious
vasculitis, SLE
IgA neuropathy and membranoproliferative GN
4 main signs of glomerular nephritis?
Hematuria
high Cr
HTN
edema
what are some nonspecific symptoms of glomerulonephritis?
may have HTN
fever is uncommon
Does post streptococcal glomeruloneprhitis usually have proteinura?
No
what are massive fluid shifts with severe injury to the kidney?
Anasarca (extreme generalized edeme)
ascities
when does post-strep GN occur?
5-21 days after infection
what complement may be low with some form of post-strep GN?
C3
Tx for post-strep GN?
Supportive
Abx if GAS still present
treat HTN
how long may children with post-strep GN have hematuria?
a year
Presents as asymptomatic microscopic hematuria or gross hematuria during minor acute illness
Normal complement, 50% IgA elevated, no h/o strep.
IgA nephropathy GN
if IgA nephropathy GN is severe what can happen?
proteinuria (nephrotic syndrome)
who is IgA nephropathy GN common in?
older male adolescents- young adults
Tx for IgA nephropathy GN?
steroids (chronic)
most common “chronic” form of GN in children
membranoproliferative GN
what will have low complement, proteinuria, hematuria, HTN,
membranoproliferative GN
what type of membranoproliferative GN is often responsive to steroids?
type 1
how do you diagnose membranoproliferative GN?
biopsy
what can also cause membranoproliferative GN?
autoimmune (SLE, scleroderma, sjogrens)
cancer (leukemia lymphoma)
infections (hep, endocarditis, malaria)
Autoimmune vasculitis following viral infections. Often also presents with microhematuria
Henoch-Schonelin GN
Tx for Henoch-Schonelin GN?
Steroids
what is the mechanism of proteinuria?
Damage to basement membrane that allows protein to leak out
what else can cause proteinuria?
vigorous exercise or febrile illness orthostatic nephrotic syndrome (proteinuria and hematuria)
can conditions can create a nephrotic syndrome?
membranoproliferative glomerulonephritis
IgA nephropathy
what is the most common nephrotic syndrome?
minimal change
what are some symptoms of nephrotic syndrome?
Hypoproteinemia sudden edema asciites hyperlipidemia increased infection risk (Immunoglobulins are proteins)
where is a common location of nephrotic syndrome?
periorbital
most kids who show up with nephrotic syndrome will have what?
idiopathic (minimal change dz)
renal insufficiency is the same as what?
high creatinine
tx for nephrotic syndrome
prednisone for 6 weeks then taper
immunosupressive drugs in relapsing dz
should you give diuretics for nephrotic syndrome?
No, because they already have low circulating volume, its just all in the tissue not the vessels
what is Renal failure, hemolytic anemia, and thrombocytopenia that follow a GI (diarrheal) infection.
Hemolytic-uremic syndrome
most common organism that causes hemolytic-uremic syndrome?
E. coli O157:H7 which produces a verotoxin that causes endothelial damage in glomeruli
when is hemolytic -uremic syndrome most common
6 mo- 4 years
patient presents with Abdominal pain, Vomiting and diarrhea (often bloody)
Within a week, weakness, pallor, irritability, petechiae, oliguria. what do you suspect?
hemolytic-uremic syndrome (HUS)
what will a blood smear of HUS look like?
schistocytes
burr cells
fragmented RBC (intravascular hemolysis)
do you give abx or antidiarrheals for HUS?
no, abx increase risk of HUS
don’t want antidiarrheals because want to get VT toxins out
if you have a high reticulocyte count want is happening
body is recognizing anemia and try to produce more RBCs
Prerenal causes of ARF
hypovolemia dehydration (most common in kids) hemorrhage burns poor cardiac output
what are some renal causes of ARF
acute glomerulonephritis, vasculitis, myoglobinuria
hemolytic-uremic syndrome
nephrotoxic injury (from gent, acyclovir)
what usually causes post renal ARF
obstructive
complications of ARF.
Fluid overload
hyperkalemia +/- hyponatremia
metabolic acidosis
uremia
tx of ARF
furosemide with careful monitoring
acute dialysis
most common cause of chronic renal failure under 10 years old
congenital/ developmental abnormalities of kidneys
most common cause of chronic renal failure in those >10 years old
nephritis/ nephrosis (membranoproliferativre GN undiagnosed)
common complications of CRF
HTN metabolic acidosis growth failure Ca, PO4, VItD deficiencies rickets later can have CNS problems
most common cause of HTN in kids
coarctation of the aorta
pheochromocytoma (catecholamine excess)
what can HTN and ataxis/ opsoclonus indicate?
neuroblastoma
what does HTN Truncal obesity, acne, striae indicate?
cushings’
A BP cuff should cover how much of the arm?
2/3
who do UTIs most common occur in in kids?
uncircumcised males
big times for UTIs
neonates
toilet training
sexual activity
what causes most UTIs?
E. Coli
symptoms of a UTI in neonates/ infants
vomiting
fever or hypothermia
poor weight gain
strong urine odor
symptoms of a UTI in a child
vomiting abdominal or flank pain fever frequency urgency dysuria enuresis
Is CVA tenderness common in young children?
No
Way to collect urine from a child?
Catheter
suprpubic needle
signs of infection on a urine dip
leukocyte esterase
nitrites
What is the definitive test for UTI
Urine culture
What constitutes a complicated UTI
high fever
persistent vomiting
dehydrates
neonates through infants <3 months
Tx for complicated UTI
inpatient
IV amp and gent
What consititutes an uncomplicated UTI
Nontoxic
tolerating oral meds and fluids
Tx for uncomplicated UTI
cephalosporins
Bactrim
Augmentin
7-10 days in children
Prophylaxis for recurrent UTI/ high grade VUR
bactrim
nitrofuratoin
who needs a renal US for a UTI
All infants 2-4 months with first UTI
Who gets a voiding cystourethrogram?
RUS is abnormal
recurrence of febrile UTI
2 drugs used in kids that have trouble with nighttime accidents
Imipramine
desmopressin (DDAVP)
Who is it more common to have night time bed wetting?
Males, tends to be familial
Malposition of the urethral opening
Not assoc with urinary tract anomalies
Hypospadias
When is it more likely to have renal abnormalities or rectum goes up with hypospaidias?
The farther back it goes
when do most hypospadias repairs occur?
18 months
Shoudl males with hypospadias be circumcised?
No
adherence of foreskin
Phimosis
retractable behind glands, then stuck: causing swelling and pain. –lubricant to reduce, or emergent circumcision.
Paraphimosis
Tx for phimosis if infected/ inflamed
Topical steroids
gentle stretching
circumcision
Does phimosis need a medical intervention?
No, only does when parents mess with it
undescended testes
Cryptorchidism
If you can’t find the testes in a male infant what do you do?
Ultrasound
If tests are high in the belly what do you do?
Get surgery consult, not likely to descend on their own
There is an increased risk of what is testes stay in the belly.
Cancer and infertility
Can a hydrocele be pushed back up into the belly?
No, but a hernia can
What tint will a hydrocele have?
Blueish hue
transiluminates
What is the major cause of the acute scrotum in boys <6 yrs old?
Testicular torsion
How do you dx testicular torsion?
Tender on palpation
Cremasteric reflex absent
US with Doppler shows no blood flow to teste
