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Pediatrics > Renal > Flashcards

Renal Flashcards

1
Q

stimulates the bone marrow to make red blood cell

A

erythropoietin

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2
Q

regulates blood pressure

A

renin

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3
Q

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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4
Q

problems in the glomerulus

A

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

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5
Q

problems in kidney tubules

A

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

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6
Q

What are the standard serum indicators of renal function?

A

BUN and Cr

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7
Q

What is the most reliable single indicator of glomerular function?

A

Cr

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8
Q

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

A

renal ultrasound

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9
Q

most common abdominal mass on newborn exam

A

large kidney

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10
Q

unilateral renal agenesis can be associated with

A

IDM, VACTERL, Turner’s

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11
Q

most common type of PKD

A

autosomal dominant

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12
Q

clinically mild or insignificant renal abnormalities

A

unilateral renal agenesis, horseshoe kidney, pelvic or ectopic kidneys

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13
Q

renal parenchymal abnormalities (problematic)

A

dysgenesis or PKD

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14
Q

bilateral renal agenesis

A

Potter’s

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15
Q

PKD presents in infancy

A

recessive

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16
Q

PKD associated with other cysts

A

dominant

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17
Q

PKD characterized by marked enlargement of both kidneys

A

recessive

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18
Q

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

A

ARPKD

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19
Q

Typically present in middle adulthood.

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

A

ADPKD

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20
Q

most common cause of bladder outlet obstruction in males. Male infant with anuria or poor stream

A

posterior urethral valves

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21
Q

treatment posterior urethral valves

A

urgent surgical drainage necessary

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22
Q

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

A

vesicoureteral reflux

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23
Q

complications vesicoureteral reflux

A

recurrent UTI, renal damage, HTN, CKD

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24
Q

VUR prophylaxis

A

nitro or bactrim

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25
Q

which grade of VUR should you consider surgically re-implanting the ureter

A

grade IV and up

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26
Q

Only occurs in males, account for 20% of all childhood end-stage renal failure

A

posterior urethral valves

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27
Q

this can be associated with posterior urethral valves. Can see cryptorchidism and absent abdominal musculature

A

Prune belly syndrome

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28
Q

dysplastic kidneys, dilated urinary tract, and malformed blasser

A

posterior urethral valves

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29
Q

hematuria- non glomerular

A

dysuria, associated back pain (pyelonephritis), colicky pain, bright red blood or clots

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30
Q

hematuria- glomerular (nephritis)

A

tea colored urine, smoky, RBC TNTC, +/-RBC casts, painless

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31
Q

most common cause of hematuria (gross or micro)

A

UTI

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32
Q

what makes you heavily suspect nephritis/nephropathy

A

proteinuria plus hematuria

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33
Q

common signs GN

A

high Cr, edema, HTN, hematuria

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34
Q

most common for of GN in childhood

A

acute post-streptococcal GN

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35
Q

History of culture + GAS , or +antistreptolysis O titer

Can have low complement (C3) levels

A

acute post-streptococcal GN

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36
Q

treatment acute post-strep GN

A

No specific treatment. Supportive. Antibiotics if GAS still present. Treat HTN

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37
Q

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

A

IgA nephropathy

38
Q

treatment IgA nephropathy

A

steroids (chronic), anti-inflammatories promising (fish oil, vitamin E)

39
Q

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

A

membranoproliferative GN

40
Q

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

A

membranoproliferative GN

41
Q

Type 1 membrano GN

A

responsive to steroids

42
Q

Type II membrano GN

A

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

43
Q

how do you diagnose membrano GN

A

biopsy

44
Q

What types of things can cause membrano GN

A

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

45
Q

treat membrano GN

A

steroids, immunosupressants

46
Q

Autoimmune vasculitis following viral infections

Microhematuria common with purpura

A

Henoch-Schonlein GN

47
Q

treat HSP

A

steroids

48
Q

are you worried about mild proteinuria in children?

A

NOPE. Most mild proteinuria in children is “normal”
Vigorous exercise or febrile illness
Orthostatic

49
Q

most common nephrotic syndrome

A

minimal change disease

50
Q

two big symptoms of nephrotic syndrome

A

excessive proteinuria, sudden onset of edema

51
Q

this often follows flu like illness, presents with periorbital edema, vague malaise, oliguria

A

Idiopathic (minimal change disease) NS

52
Q

this NS will present with lack of HTN, hematuria, renal insufficiency (you wont see Cr abnormalities)

A

minimal change disease

53
Q

treat minimal change disease

A 
prednisone (long taper)
rarely diuretics (the patient already has low circulating volume)
immunosuppressive drugs if relapsing
54
Q

this usually follows a GI infection. Shiga toxin producing “verotoxin” which causes endothelial damage in glomeruli and interstitial vessel thrombosis.
E. coli O157:H7 most common
Less commonly salmonella or shigella

A

hemolytic-uremic syndrome

55
Q

presents with renal failure, hemolytic anemia, and thrombocytopenia

A

hemolytic-uremic syndrome

56
Q

blood smear shows schistocytes, burr cells, fragmented RBC

A

HUS

57
Q

CBC- leukocytosis, low platelets
Retic- high
Coombs- negative
UA- hematuria, proteinuria casts

A

HUS

58
Q

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

59
Q

mortality associated with HUS

A

CNS complications

60
Q

most common cause of ARF in kids

A

Hypovolemia leads to underperfusion
dehydration – most common in kids
Hemorrhage
burns

61
Q

post renal causes ARF

A

usually obstructive

62
Q

complications of ARF

A

Fluid overload
Hyperkalemia +/- hyponatremia
Metabolic acidosis
Uremia

63
Q

treatment ARF

A

furosemide

acute dialysis

64
Q

causes of chronic RF in kids

A

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

65
Q

causes of HTN in kids

A 
Renal
Coarc of Aorta
catecholamine excess
endocrine
essential HTN (diagnosis of exclusion)
66
Q

when do you start screening kids for BP

A

3 years

67
Q

gold standard for UTI diagnosis

A

urine culture

68
Q

gold standard for UTI diagnosis infants

A

suprapubic aspiration

69
Q

bugs for UTIs

A

e coli, klebsiella, proteus, enterobacter, staph saphrophyticus

70
Q

treat complicated UTI

A

inpatient
IV ampicillin and gentamicin
(any child less than 3 months old is considered complicated)

71
Q

treat uncomplicated UTI

A

cephalosporins, trimethoprim/sulfa, augmentin

72
Q

who should have a RUS

A

all infants 2-24 months with first UTI

73
Q

who should have a VCUG

A

infants who have had an abnormal RUS or if there is recurrence of febrile UTIs

74
Q

What can renal US show us

A

kid size, number, position, hydronephrosis, hydroureter, dysplasia, renal scarring

75
Q

what can VCUG show us

A

bladder anatomy, vesicoureteral reflux, and posterior urethral valves

76
Q

what can you prescribe for voiding dysfunction, should you need to?

A

imipramine or DDAVP (desmopressin)

77
Q

Malposition of the urethral opening

Not assoc with urinary tract anomalies

A

hypospadias

78
Q

this condition can require complex surgical repair in males… DO NOT CIRCUMCISE

A

hypospadias

79
Q

most frequent place for hypospadias

A

glanular

80
Q

adherence of foreskin

A

phimosis

81
Q

foreskin is retractable behind glands, then gets stuck: causing swelling and pain

A

paraphimosis

82
Q

treat phimosis

A

topical steroids, gentle stretching, circumcision

83
Q

treat paraphimosis

A

lubricant to reduce or emergent surgical circumcision

84
Q

undescended testicle

A

crytporchidism

85
Q

how do you locate the testies in cryptorchidism

A

milk around to find them

abdominal US if cant find

86
Q

besides cryptorchidism, when may i not be able to find testies

A

Retractile testes, absent testes, ectopic testes

87
Q

bulge in scrotum, blueish hue, transilluminates

A

hydrocele

88
Q

Enlarged right testis, red
Tender on palpation
Cremasteric reflex absent
Excruciating pain

A

testicular torsion

89
Q

test for testicular torsion

A

doppler

90
Q

major cause of acute scrotum in boys under six

A

testicular torsion

Pediatrics (15 decks)

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