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PEDS > Renal > Flashcards

Renal Flashcards

1
Q

most reliable indicator of glomerular function?

A

Serum creatine

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2
Q

what can BUN change with?

A

Diet

dehydration (artificially elevated)

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3
Q

which stimulates the bone marrow to make red blood cell

A

EPO, erythropoietin

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4
Q

regulates blood pressure

A

Renin

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5
Q

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

A

Calcitriol

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6
Q

what elevated wastes will there be with kidney failure

A

urea
creatinine
potassium

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7
Q

what does tachypneic/ kussmal breathing indicate?

A

Acidosis

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8
Q

as you get rid of chloride (with furosemide) what will you kidneys hang onto?

A

Bicarb

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9
Q

If you are hyperkalemia what can happen?

A

Go into an arrhythmia

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10
Q

What is the most common abdominal mass on newborn exam?

A

Large kidney

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11
Q

what can cause a large kidney?

A

urinary flow obstruction
polycystic kidney
renal parenchymal abnormality

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12
Q

what urine exam is done in the lab?

A

urinalysis

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13
Q

what is the single most reliable indicator of glomerular function?

A

SrCr

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14
Q

what does renal US help you look at?

A

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

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15
Q

what does US with doppler on the kidney helps you look for?

A

renal blood flow , resistance, thrombus

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16
Q

what are CT and MRI good at identifying

A

stones, parenchyma

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17
Q

what are VCUG good at identifying?

A

look for contrast to travel up the ureters to the kidneys when it shouldn’t be

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18
Q

does a horseshoe kidney create a problem?

A

No, as long as there are 2 ureters

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19
Q

What does unilateral renal agenesis possibly suggest?

A

IDM
VACTREL
turner’s

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20
Q

what is bilateral renal agenesis?

A

Potters

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21
Q

What will a kid with potters syndrome look like?

A

low set earns
pulmonary hypoplasia causing resp failure
beaked nose

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22
Q

what is an early problem of PKD?

A

HTN

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23
Q

how do you diagnose PKD?

A

RUS

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24
Q

which type of PKD is responsible for the majority of cases of PKD?

A

dominant

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25
Q

what type of PKD presents in infancy?

A

recessive

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26
Q

what type of PKD is associated w/ other cysts?

A

dominant

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27
Q

what type of PDK is characterized by marked enlargement of both kidneys

A

recessive

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28
Q

Typically present in middle adulthood.

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

A

autosomal dominant PKD

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29
Q

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

A

autosomal recessive PKD

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30
Q

most common cause of bladder outlet obstruction in males

A

Posterior urethral valves

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31
Q

what does obstruction at the Uretero-pelvic junction lead to?

A

Hydronephrosis

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32
Q

what does obstruction at the uretero-vesical junction lead to?

A

Hydroureter and hydronephrosis

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33
Q

tx for posterior urethral valves?

A

surgical drainage is needed

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34
Q

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

A

Veicourethral reflux

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35
Q

when will do prophylaxis abx in a child ?

A

scarring or severe vesicoureteral reflux

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36
Q

what grade of vesicourethral reflux start to cause renal damage?

A

Grade IV

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37
Q

what do you get for prophylaxis for UTIs with vesicourethral reflux?

A

Nitrofuratoin

bactrim

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38
Q

what grade of vesicoureteral reflux do you consider surgical re-implantation of ureter?

A

Grade IV

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39
Q

who is vesicoureteral reflux more common in?

A

girls, also a familial component

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40
Q

cryptorchidism and absent abdominal musculature ( due to a number of urinary tract abnormalities) often due to posterior urethral valves.

A

Prune belly syndrome

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41
Q

what else occurs with posterior urethral valves?

A

dysplastic kidneys
dilated urinary tract
malformed bladder

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42
Q

hematuria and dysuria can indicate what?

A

cystitis

urethritis

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43
Q

back pain and hematuria can indicate what?

A

pyelonephritis

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44
Q

what type pain will a stone have?

A

colicky pain

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45
Q

what will urine look like with glomerular nephritis?

A

tea colored, smokey (broken down RBCs too numerous to count)
will have RBC casts

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46
Q

with glomerular nephritis be painful or painless?

A

painless

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47
Q

what is the most common identifiable cause of hematuria (gross of micro)?

A

UTI

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48
Q

If there is hematuria + what the probability of nephritis/ nephropathy goes up?

A

proteinuria

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49
Q

what is march heamturia?

A

normal, due to exercise (ex- marathon)

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50
Q

causes of acute nephritis?

A

post-infectious
vasculitis, SLE
IgA neuropathy and membranoproliferative GN

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51
Q

4 main signs of glomerular nephritis?

A

Hematuria
high Cr
HTN
edema

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52
Q

what are some nonspecific symptoms of glomerulonephritis?

A

may have HTN

fever is uncommon

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53
Q

Does post streptococcal glomeruloneprhitis usually have proteinura?

A

No

54
Q

what are massive fluid shifts with severe injury to the kidney?

A

Anasarca (extreme generalized edeme)

ascities

55
Q

when does post-strep GN occur?

A

5-21 days after infection

56
Q

what complement may be low with some form of post-strep GN?

A

C3

57
Q

Tx for post-strep GN?

A

Supportive
Abx if GAS still present
treat HTN

58
Q

how long may children with post-strep GN have hematuria?

A

a year

59
Q

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

A

IgA nephropathy GN

60
Q

if IgA nephropathy GN is severe what can happen?

A

proteinuria (nephrotic syndrome)

61
Q

who is IgA nephropathy GN common in?

A

older male adolescents- young adults

62
Q

Tx for IgA nephropathy GN?

A

steroids (chronic)

63
Q

most common “chronic” form of GN in children

A

membranoproliferative GN

64
Q

what will have low complement, proteinuria, hematuria, HTN,

A

membranoproliferative GN

65
Q

what type of membranoproliferative GN is often responsive to steroids?

A

type 1

66
Q

how do you diagnose membranoproliferative GN?

A

biopsy

67
Q

what can also cause membranoproliferative GN?

A

autoimmune (SLE, scleroderma, sjogrens)
cancer (leukemia lymphoma)
infections (hep, endocarditis, malaria)

68
Q

Autoimmune vasculitis following viral infections. Often also presents with microhematuria

A

Henoch-Schonelin GN

69
Q

Tx for Henoch-Schonelin GN?

A

Steroids

70
Q

what is the mechanism of proteinuria?

A

Damage to basement membrane that allows protein to leak out

71
Q

what else can cause proteinuria?

A 
vigorous exercise or febrile illness
orthostatic 
nephrotic syndrome (proteinuria and hematuria)
72
Q

can conditions can create a nephrotic syndrome?

A

membranoproliferative glomerulonephritis

IgA nephropathy

73
Q

what is the most common nephrotic syndrome?

A

minimal change

74
Q

what are some symptoms of nephrotic syndrome?

A 
Hypoproteinemia
sudden edema
asciites
hyperlipidemia
increased infection risk (Immunoglobulins are proteins)
75
Q

where is a common location of nephrotic syndrome?

A

periorbital

76
Q

most kids who show up with nephrotic syndrome will have what?

A

idiopathic (minimal change dz)

77
Q

renal insufficiency is the same as what?

A

high creatinine

78
Q

tx for nephrotic syndrome

A

prednisone for 6 weeks then taper

immunosupressive drugs in relapsing dz

79
Q

should you give diuretics for nephrotic syndrome?

A

No, because they already have low circulating volume, its just all in the tissue not the vessels

80
Q

what is Renal failure, hemolytic anemia, and thrombocytopenia that follow a GI (diarrheal) infection.

A

Hemolytic-uremic syndrome

81
Q

most common organism that causes hemolytic-uremic syndrome?

A

E. coli O157:H7 which produces a verotoxin that causes endothelial damage in glomeruli

82
Q

when is hemolytic -uremic syndrome most common

A

6 mo- 4 years

83
Q

patient presents with Abdominal pain, Vomiting and diarrhea (often bloody)
Within a week, weakness, pallor, irritability, petechiae, oliguria. what do you suspect?

A

hemolytic-uremic syndrome (HUS)

84
Q

what will a blood smear of HUS look like?

A

schistocytes
burr cells
fragmented RBC (intravascular hemolysis)

85
Q

do you give abx or antidiarrheals for HUS?

A

no, abx increase risk of HUS

don’t want antidiarrheals because want to get VT toxins out

86
Q

if you have a high reticulocyte count want is happening

A

body is recognizing anemia and try to produce more RBCs

87
Q

Prerenal causes of ARF

A 
hypovolemia
dehydration (most common in kids)
hemorrhage
burns
poor cardiac output
88
Q

what are some renal causes of ARF

A

acute glomerulonephritis, vasculitis, myoglobinuria
hemolytic-uremic syndrome
nephrotoxic injury (from gent, acyclovir)

89
Q

what usually causes post renal ARF

A

obstructive

90
Q

complications of ARF.

A

Fluid overload
hyperkalemia +/- hyponatremia
metabolic acidosis
uremia

91
Q

tx of ARF

A

furosemide with careful monitoring

acute dialysis

92
Q

most common cause of chronic renal failure under 10 years old

A

congenital/ developmental abnormalities of kidneys

93
Q

most common cause of chronic renal failure in those >10 years old

A

nephritis/ nephrosis (membranoproliferativre GN undiagnosed)

94
Q

common complications of CRF

A 
HTN
metabolic acidosis
growth failure 
Ca, PO4, VItD deficiencies
rickets
later can have CNS problems
95
Q

most common cause of HTN in kids

A

coarctation of the aorta

pheochromocytoma (catecholamine excess)

96
Q

what can HTN and ataxis/ opsoclonus indicate?

A

neuroblastoma

97
Q

what does HTN Truncal obesity, acne, striae indicate?

A

cushings’

98
Q

A BP cuff should cover how much of the arm?

A

2/3

99
Q

who do UTIs most common occur in in kids?

A

uncircumcised males

100
Q

big times for UTIs

A

neonates
toilet training
sexual activity

101
Q

what causes most UTIs?

A

E. Coli

102
Q

symptoms of a UTI in neonates/ infants

A

vomiting
fever or hypothermia
poor weight gain
strong urine odor

103
Q

symptoms of a UTI in a child

A 
vomiting
abdominal or flank pain
fever
frequency
urgency
dysuria
enuresis
104
Q

Is CVA tenderness common in young children?

A

No

105
Q

Way to collect urine from a child?

A

Catheter

suprpubic needle

106
Q

signs of infection on a urine dip

A

leukocyte esterase

nitrites

107
Q

What is the definitive test for UTI

A

Urine culture

108
Q

What constitutes a complicated UTI

A

high fever
persistent vomiting
dehydrates
neonates through infants <3 months

109
Q

Tx for complicated UTI

A

inpatient

IV amp and gent

110
Q

What consititutes an uncomplicated UTI

A

Nontoxic

tolerating oral meds and fluids

111
Q

Tx for uncomplicated UTI

A

cephalosporins
Bactrim
Augmentin
7-10 days in children

112
Q

Prophylaxis for recurrent UTI/ high grade VUR

A

bactrim

nitrofuratoin

113
Q

who needs a renal US for a UTI

A

All infants 2-4 months with first UTI

114
Q

Who gets a voiding cystourethrogram?

A

RUS is abnormal

recurrence of febrile UTI

115
Q

2 drugs used in kids that have trouble with nighttime accidents

A

Imipramine

desmopressin (DDAVP)

116
Q

Who is it more common to have night time bed wetting?

A

Males, tends to be familial

117
Q

Malposition of the urethral opening

Not assoc with urinary tract anomalies

A

Hypospadias

118
Q

When is it more likely to have renal abnormalities or rectum goes up with hypospaidias?

A

The farther back it goes

119
Q

when do most hypospadias repairs occur?

A

18 months

120
Q

Shoudl males with hypospadias be circumcised?

A

No

121
Q

adherence of foreskin

A

Phimosis

122
Q

retractable behind glands, then stuck: causing swelling and pain. –lubricant to reduce, or emergent circumcision.

A

Paraphimosis

123
Q

Tx for phimosis if infected/ inflamed

A

Topical steroids
gentle stretching
circumcision

124
Q

Does phimosis need a medical intervention?

A

No, only does when parents mess with it

125
Q

undescended testes

A

Cryptorchidism

126
Q

If you can’t find the testes in a male infant what do you do?

A

Ultrasound

127
Q

If tests are high in the belly what do you do?

A

Get surgery consult, not likely to descend on their own

128
Q

There is an increased risk of what is testes stay in the belly.

A

Cancer and infertility

129
Q

Can a hydrocele be pushed back up into the belly?

A

No, but a hernia can

130
Q

What tint will a hydrocele have?

A

Blueish hue

transiluminates

131
Q

What is the major cause of the acute scrotum in boys <6 yrs old?

A

Testicular torsion

132
Q

How do you dx testicular torsion?

A

Tender on palpation
Cremasteric reflex absent
US with Doppler shows no blood flow to teste

PEDS (11 decks)

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