Renal Flashcards
stimulates the bone marrow to make red blood cell
erythropoietin
regulates blood pressure
renin
the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
calcitriol
problems in the glomerulus
allow proteins and RBC to be filtered though the basement membrane into urine
problems in kidney tubules
allow abnormal excretion of H+ , CL- , Bicarb , Na+, K+
What are the standard serum indicators of renal function?
BUN and Cr
What is the most reliable single indicator of glomerular function?
Cr
What radiographic study would you use to evaluate a patient for polycystic kidney disease?
renal ultrasound
most common abdominal mass on newborn exam
large kidney
unilateral renal agenesis can be associated with
IDM, VACTERL, Turner’s
most common type of PKD
autosomal dominant
clinically mild or insignificant renal abnormalities
unilateral renal agenesis, horseshoe kidney, pelvic or ectopic kidneys
renal parenchymal abnormalities (problematic)
dysgenesis or PKD
bilateral renal agenesis
Potter’s
PKD presents in infancy
recessive
PKD associated with other cysts
dominant
PKD characterized by marked enlargement of both kidneys
recessive
Marked bilat renal enlargement. Interstitial fibrosis and tubular atrophy. Renal Failure early childhood
ARPKD
Typically present in middle adulthood.
Assoc with other cysts : hepatic, pancreatic, ovarian and cerebral aneurysm
ADPKD
most common cause of bladder outlet obstruction in males. Male infant with anuria or poor stream
posterior urethral valves
treatment posterior urethral valves
urgent surgical drainage necessary
Reflux of urine from bladder to ureter during bladder contraction, or back up from bladder (ie neurogenic bladder)
vesicoureteral reflux
complications vesicoureteral reflux
recurrent UTI, renal damage, HTN, CKD
VUR prophylaxis
nitro or bactrim
which grade of VUR should you consider surgically re-implanting the ureter
grade IV and up
Only occurs in males, account for 20% of all childhood end-stage renal failure
posterior urethral valves
this can be associated with posterior urethral valves. Can see cryptorchidism and absent abdominal musculature
Prune belly syndrome
dysplastic kidneys, dilated urinary tract, and malformed blasser
posterior urethral valves
hematuria- non glomerular
dysuria, associated back pain (pyelonephritis), colicky pain, bright red blood or clots
hematuria- glomerular (nephritis)
tea colored urine, smoky, RBC TNTC, +/-RBC casts, painless
most common cause of hematuria (gross or micro)
UTI
what makes you heavily suspect nephritis/nephropathy
proteinuria plus hematuria
common signs GN
high Cr, edema, HTN, hematuria
most common for of GN in childhood
acute post-streptococcal GN
History of culture + GAS , or +antistreptolysis O titer
Can have low complement (C3) levels
acute post-streptococcal GN
treatment acute post-strep GN
No specific treatment. Supportive. Antibiotics if GAS still present. Treat HTN
Presents as asymptomatic microscopic hematuria or gross hematuria during minor acute illness. Normal complement, no h/o strep
IgA nephropathy
treatment IgA nephropathy
steroids (chronic), anti-inflammatories promising (fish oil, vitamin E)
most common “chronic” form of GN in children (progress 50% to renal failure over 10 years)
membranoproliferative GN
Abnormal immune response with deposition in glomerular membrane
Proteinuria, hematuria, hypocomplementemia, HTN
membranoproliferative GN
Type 1 membrano GN
responsive to steroids
Type II membrano GN
Rare, but Most common GN that progresses to Chronic Renal Failure (not very responsive to steroids)
how do you diagnose membrano GN
biopsy
What types of things can cause membrano GN
Autoimmune ( SLE, scleroderma, sjogrens)
Cancer ( leukemia, lymphoma)
Infections ( Hepatitis, endocarditis, malaria )
treat membrano GN
steroids, immunosupressants
Autoimmune vasculitis following viral infections
Microhematuria common with purpura
Henoch-Schonlein GN
treat HSP
steroids
are you worried about mild proteinuria in children?
NOPE. Most mild proteinuria in children is “normal”
Vigorous exercise or febrile illness
Orthostatic
most common nephrotic syndrome
minimal change disease
two big symptoms of nephrotic syndrome
excessive proteinuria, sudden onset of edema
this often follows flu like illness, presents with periorbital edema, vague malaise, oliguria
Idiopathic (minimal change disease) NS
this NS will present with lack of HTN, hematuria, renal insufficiency (you wont see Cr abnormalities)
minimal change disease
treat minimal change disease
prednisone (long taper) rarely diuretics (the patient already has low circulating volume) immunosuppressive drugs if relapsing
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
hemolytic-uremic syndrome
presents with renal failure, hemolytic anemia, and thrombocytopenia
hemolytic-uremic syndrome
blood smear shows schistocytes, burr cells, fragmented RBC
HUS
CBC- leukocytosis, low platelets
Retic- high
Coombs- negative
UA- hematuria, proteinuria casts
HUS
treat HUS
Management – Primarily directed at renal failure (managing fluid and electrolytes )
No antibiotics: increases risk of HUS
No antidiarrheals: increases exposure to VT toxins
mortality associated with HUS
CNS complications
most common cause of ARF in kids
Hypovolemia leads to underperfusion
dehydration – most common in kids
Hemorrhage
burns
post renal causes ARF
usually obstructive
complications of ARF
Fluid overload
Hyperkalemia +/- hyponatremia
Metabolic acidosis
Uremia
treatment ARF
furosemide
acute dialysis
causes of chronic RF in kids
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)
causes of HTN in kids
Renal Coarc of Aorta catecholamine excess endocrine essential HTN (diagnosis of exclusion)
when do you start screening kids for BP
3 years
gold standard for UTI diagnosis
urine culture
gold standard for UTI diagnosis infants
suprapubic aspiration
bugs for UTIs
e coli, klebsiella, proteus, enterobacter, staph saphrophyticus
treat complicated UTI
inpatient
IV ampicillin and gentamicin
(any child less than 3 months old is considered complicated)
treat uncomplicated UTI
cephalosporins, trimethoprim/sulfa, augmentin
who should have a RUS
all infants 2-24 months with first UTI
who should have a VCUG
infants who have had an abnormal RUS or if there is recurrence of febrile UTIs
What can renal US show us
kid size, number, position, hydronephrosis, hydroureter, dysplasia, renal scarring
what can VCUG show us
bladder anatomy, vesicoureteral reflux, and posterior urethral valves
what can you prescribe for voiding dysfunction, should you need to?
imipramine or DDAVP (desmopressin)
Malposition of the urethral opening
Not assoc with urinary tract anomalies
hypospadias
this condition can require complex surgical repair in males… DO NOT CIRCUMCISE
hypospadias
most frequent place for hypospadias
glanular
adherence of foreskin
phimosis
foreskin is retractable behind glands, then gets stuck: causing swelling and pain
paraphimosis
treat phimosis
topical steroids, gentle stretching, circumcision
treat paraphimosis
lubricant to reduce or emergent surgical circumcision
undescended testicle
crytporchidism
how do you locate the testies in cryptorchidism
milk around to find them
abdominal US if cant find
besides cryptorchidism, when may i not be able to find testies
Retractile testes, absent testes, ectopic testes
bulge in scrotum, blueish hue, transilluminates
hydrocele
Enlarged right testis, red
Tender on palpation
Cremasteric reflex absent
Excruciating pain
testicular torsion
test for testicular torsion
doppler
major cause of acute scrotum in boys under six
testicular torsion
