Renal Flashcards
Proteinuria found on urine dipstick
- what is cause most likely?
- next step?
Most likely transient proteinuria
Reevaluate with repeat urine dipstick testing on 2 separate occasions to r/o persisten proteinuria
Sodium, K, Cl requirement per day?
Na = 3-4 meq/kg/day
K = 2 meq/kg/day
Cl = 1 meq/kg/day
Vesicoureteral reflux
- what is it
- sx
- dx
- tx
Backflow of urine from bladder –> kidney
2/2 incompetence of vesicoureteral junction
Common cause of HTN in kids and can lead to renal scaring
Reflux seen in 50% boys w/ posterior urethral valves
Dx:
- VCUG
- use ISC to grade 1-5
Tx
- can resolve w/ time
- abx ppx (TMP/SMX or nitrofurantoin)
- surgery for grade 4 or 5 reflux or persistent UTI
Acute poststreptococcal glomerulonephritis
- what is it
- sx
- dx
- tx
After group A beta hemolytic strep infections
- throat
- skin
Happen 1-2 wks after strep infection
Hematuria
Edema
HTN
Renal insufficiency
Dx
- RBC casts on UA
- DNase B antigen to test for past group A strep infection
- mild anemia
- decreased C3
- renal bx not needed in classic cases
Tx
- abx sometimes
Alport syndrome
1 hereditary nephritis
X linked dominant
Asymptomatic hematuria + sensorineural hearing loss
Dx
- renal bx showing glomerular sclerosis + thickened basement membrane
- foam cells
Tx
- men more prone to developing ESRD and need transplant - women are ok
Hemolytic uremic syndrome
Usually 2/2 E coli O157:H7
Acute renal failure
MIcroangiopathic hemolytic anemia
Thrombocytopenia
Helmet + burr cells
Coombs -
Tx:
- manage renal failure
- peritoneal dialysis
- steroids not helpful
Vs TTP - ttp usually in young women; also affects CNS
Nephrotic syndrome characteristics
Proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
HTN common in minimal change disease?
NO
Will have normal C3
Tx minimal change disease
Steroid
Cyclophosphamide (if unresponsive to steroids or recurrs)
Complications of nephrotic syndrome
Infection
Prone to developing spontaneous peritonitis 2/2 strep pneumo
- always give polyvalent pneumococcal vaccine!
Abonrmal lab values in:
- Williams
- DiGeorge
- Beckwith Weidman Syndrome
Williams - hypercalcemia
DiGeorge - hypocalcemia
Beckwith-Weidman Syndrome - hypoglycemia
Type 1 renal tubular acidosis
Distal RTA
Defect in H+ secretion
Acidotic
Hypo K
Inc urinary pH
Usually get nephrolithiasis
Type 2 renal tubular acidosis
Decreased bicarb reabsorption in PCT
Fanconi syndrome is common cause
Type 4 renal tubular acidosis
Defect in Na/K exchange in DCT
Hyper K
Hyper Cl
Acidosis
Common causes in kids:
- obstructive uropathy
- renal dz
- multicystic dysplastic kidneys
Renal tubular acidosis can present as…
growth failure
FTT
Low bicarb level
Increased Cl
Normal anion gap metabolic acidosis
Indications for renal and bladder ultrasound
Infants and children < 24 mo with first febrile UTI
Recurrent febrile UTIs in kids of any age
UTI in child of any age w/ family hx of renal or urologic disease, HTN, or poor growth
Children who d not respond to appropriate abx treatment
Indications for voiding cystourethrogram
Hydronephrosis on renal and bladder US
Evidence of renal scarring on renal and bladder US
Evidence of high-grade vesioureteral reflux on renal and bladder US
Evidence of obstructive uropathy on renal and bladder US
Atypical or complex clinical presentation
Recurrence of febrile UTI
Children with 1st febrile UTI and FHxs of renal or urologic dz, poor growth and hypertension
Children w/ 1st febrile UTI with a non-E coli organism
When giving IV boluses, what do you use?
ONLY use isotonic solutions
- 0.9% saline
- lactated Ringer’s
1 cause of urinary tract obstruction in newborn boys
Posterior urethral valves
Will cause oligohydramnios –> potter sequence
Causes of secondary enuresis
Psychological stress
UTI (dysuria, hesitancy, urgency, ab pain)
DM (polyuria, polydipsia, polyphagia, wt loss)
Diabetes insipidus (polyuria, polydipsia)
OSA (snoring, dry mouth, fatigue, irritability)
Minimal change disease
- LM
- EM
LM = nothing
Immunofluorescence = nothing
EM = diffuse efacement of foot processes of podocytes
Renal vein thrombosis
Seen more often in infants that are dehydrated, had birth depression, have polycythemia, ir were born to diabetic mothers
presents with oliguria + hematuria + palpable kidney
Confirm with renal US with renal V doppler studies
Result of coombs test in HUS
NO positive
Tx HUS
Fluid and electolyte management
- DO NOT use antibiotics
Prehn sign
pain relief upon elevation of testicle
Idiopathic hypercalciuria
Recurrent gross hematuria
persistent microscopic hematuria
Complaints of dysuria
Ab pain w/o initial stone formation
Why is there elevated LDL in nephrotic syndrome?
Inc generalized protein synthesis in live
Decrease in lipid metabolism 2/2 reduced plasma lipoprotein lipase levels
Tx edema in pts with nephrotic syndrome
albumin infusions + diuretic
Bartter syndrome
AR condition
HYPO K HYPER Ca Alkalosis HYPER aldo HYPERreniemia
BP normal
Usually present 6-12 mo
- FTT
- constipation
- weakness
- vomiting
- polyuria + polydipsia
Tx:
- prevent dehydration
- nutritional support
- return K level to normal
