Renal

Question 1

Proteinuria found on urine dipstick

• what is cause most likely?
• next step?

Answer 1

Most likely transient proteinuria

Reevaluate with repeat urine dipstick testing on 2 separate occasions to r/o persisten proteinuria

Question 2

Sodium, K, Cl requirement per day?

Answer 2

Na = 3-4 meq/kg/day

K = 2 meq/kg/day

Cl = 1 meq/kg/day

Question 3

Vesicoureteral reflux

• what is it
• sx
• dx
• tx

Answer 3

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

Question 4

Acute poststreptococcal glomerulonephritis

• what is it
• sx
• dx
• tx

Answer 4

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

Question 5

Alport syndrome

Answer 5

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

Question 6

Hemolytic uremic syndrome

Answer 6

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

Question 7

Nephrotic syndrome characteristics

Answer 7

Proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia

Question 8

HTN common in minimal change disease?

Answer 8

NO

Will have normal C3

Question 9

Tx minimal change disease

Answer 9

Steroid

Cyclophosphamide (if unresponsive to steroids or recurrs)

Question 10

Complications of nephrotic syndrome

Answer 10

Infection

Prone to developing spontaneous peritonitis 2/2 strep pneumo
- always give polyvalent pneumococcal vaccine!

Question 11

Abonrmal lab values in:

• Williams
• DiGeorge
• Beckwith Weidman Syndrome

Answer 11

Williams - hypercalcemia

DiGeorge - hypocalcemia

Beckwith-Weidman Syndrome - hypoglycemia

Question 12

Type 1 renal tubular acidosis

Answer 12

Distal RTA

Defect in H+ secretion

Acidotic
Hypo K
Inc urinary pH

Usually get nephrolithiasis

Question 13

Type 2 renal tubular acidosis

Answer 13

Decreased bicarb reabsorption in PCT

Fanconi syndrome is common cause

Question 14

Type 4 renal tubular acidosis

Answer 14

Defect in Na/K exchange in DCT

Hyper K
Hyper Cl
Acidosis

Common causes in kids:

• obstructive uropathy
• renal dz
• multicystic dysplastic kidneys

Question 15

Renal tubular acidosis can present as…

Answer 15

growth failure
FTT

Low bicarb level
Increased Cl

Normal anion gap metabolic acidosis

Question 16

Indications for renal and bladder ultrasound

Answer 16

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

Question 17

Indications for voiding cystourethrogram

Answer 17

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

Question 18

When giving IV boluses, what do you use?

Answer 18

ONLY use isotonic solutions

• 0.9% saline
• lactated Ringer’s

Question 19

1 cause of urinary tract obstruction in newborn boys

Answer 19

Posterior urethral valves

Will cause oligohydramnios –> potter sequence

Question 20

Causes of secondary enuresis

Answer 20

Psychological stress

UTI (dysuria, hesitancy, urgency, ab pain)

DM (polyuria, polydipsia, polyphagia, wt loss)

Diabetes insipidus (polyuria, polydipsia)

OSA (snoring, dry mouth, fatigue, irritability)

Question 21

Minimal change disease

• LM
• EM

Answer 21

LM = nothing

Immunofluorescence = nothing

EM = diffuse efacement of foot processes of podocytes

Question 22

Renal vein thrombosis

Answer 22

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

Question 23

Result of coombs test in HUS

Answer 23

NO positive

Question 24

Tx HUS

Answer 24

Fluid and electolyte management

- DO NOT use antibiotics

Question 25

Prehn sign

Answer 25

pain relief upon elevation of testicle

Question 26

Idiopathic hypercalciuria

Answer 26

Recurrent gross hematuria
persistent microscopic hematuria

Complaints of dysuria
Ab pain w/o initial stone formation

Question 27

Why is there elevated LDL in nephrotic syndrome?

Answer 27

Inc generalized protein synthesis in live

Decrease in lipid metabolism 2/2 reduced plasma lipoprotein lipase levels

Question 28

Tx edema in pts with nephrotic syndrome

Answer 28

albumin infusions + diuretic

Question 29

Bartter syndrome

Answer 29

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