Renal

Question 1

How does renal vein thrombosis present? dx?

Answer 1

infant who is dehydrated, birth depression, polycythemia, or DM mom

hx oliguria, hematuria, palpable enlarged kidneys

dx = renal US /w renal vein doppler studes

Question 2

What are signs of lobar nephronia? How do you treat?

Answer 2

long fever curve w/ antibitoics

treat: prolonged IV and PO abx

Question 3

What are signs of urolithiasis? diagnose?

Answer 3

obstructive sx w/ dysuria, urgency, frequency

dx: non contrast CT to dx # and location of stones and check for hydronephrosis

Question 4

What are signs of fanconi syndrome?

Answer 4

anorexia, polydipsia, polyuria, vomit, unexplained fevers

have glucosuria w/ normal blood sugar, phosphaturia, aminoaciduria, high urine pH, mild albuminuria

Question 5

What is next step if you see high protein in kid’s urine?

Answer 5

repeat urine dipstick on 2 separate occasions to differentiate transient vs persistent proteinuria

once its persistent –> do 24 hr urine collection for protein + renal US

Question 6

What is likely to present w/ painless hematuria?

Answer 6

renal papillary necrosis

normal appearing RBCs in urine

Question 7

What are findings in acute glomerulonephritis?

Answer 7

hematuria w/ htn, proteinuria, drysmorphic RBCs, RBC casts

Question 8

What do you see in urine in acute interstitial nephritis?l

Answer 8

lots of WBCs w/ eos, not likely to have hematuria

Question 9

What do you see in urine in acute tubular necrosis?

Answer 9

granular casts, hematuria, renal tubular epithelial cells

Question 10

What are sx of goodpasture? how do you dx?

Answer 10

pulmonary hemorrhage, progressive renal impairment

dx: hemosiderin laden macrophages on sputum or pulm secretions, antibodies to glomerular basement membrane

Question 11

What are sx/signs of HUS? treat?

Answer 11

bloody diarrhea + anemia (RBC hemolysis) + thrombocytopenia (activated coagulation cascade) + renal failure (high creatinine, hematuria, proteinuria, casts)

treat: supportive w/ controlling htn, fluid/electrolyte/nutrition

Question 12

What is treatment for post strep glomerulonephitis?

Answer 12

treat underlying infection if still present, monitor BP nd fluid restrict

Question 13

What is type 1 (distal) RTA?

Answer 13

poor k secretion into urine due to genetic, med, autoimmune

urine pH > 5.5, low-normal K
low serum HCO3, high Cl
chronic met acidosis

Question 14

What is treatment for rental tubular acidosis?

Answer 14

oral bicarb replacement

Question 15

What is type 2 (proximal) RTA?

Answer 15

due to poor bicarb resorption, seen in fanconi syndrome

urine pH

Question 16

What is type 4 RA?

Answer 16

aldosterone resistance, due to obstructive uropathy or CAH

urine pH

Question 17

What risk factor, histo finding in membranous nephropathy?

Answer 17

risks: Hep B
histo: thick BM, subepithelial spikes

Question 18

What risk factor, histo finding in FSGS nephropathy?

Answer 18

risks: HIV
histo: crescent formation

Question 19

What histo finding in minimal change nephropathy? dx? next step?

Answer 19

T cell mediated injruy to podocytes –> effacement of foot processes on EM

Dx: proteinuria, hypoalbuminuria, renal biopsy w/o microscopic change

Tx: steroids

Question 20

What does it suggest if hum/bruit at CVA and hypertension? What test/finding to dx?

Answer 20

fibromuscular dysplasia

on angiography have string of beads in renal artery

Question 21

What is next step for working up UTI in kid? who gets this?

Answer 21

US bladder/renal

-

Question 22

Who gets CVUG?

Answer 22

if abnormal renal US or

- pts

Question 23

What is most common cause of recurrent UTI?

Answer 23

vesicoureteral refleux –> can lead to hydroureter + hydronephrosis

Question 24

What is complication of VUR?

Answer 24

recurrent pyelo –> blunting calices and focal parenchymal scarring

more prone to renal insufficiency, ESRD