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Own peds boards > Renal > Flashcards

Renal Flashcards

1
Q

Define hematuria

A

> 20RBC/mm3 unspun urine; >5RBC/hpf spun urine

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2
Q

If pt has discolored urine, what three large categories can it be and how to test?

A

macroscopic - hematuria
dipstick positive = pigmenturia (free Hb, myoglobin)
Metabolites - porphyrins, bilirubin

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3
Q

Cast

A

glomerular

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4
Q

Bright red/pink

A

nonglomerular

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5
Q

papillary necrosis, UTI, obstruction, painful clots

A

sickle cell

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6
Q

Categories of non-glomerular

A

interstitial disease (infection, drugs, nephrocalcinosis, ATN, cystic disease); tumors (Wilm’s, TS, nephroblastoma); vascular (renal thrombosis, infants of DM mom)

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7
Q

Proteinuria, RBC casts, high bp, edema, weight gain, oliguria

A

glomerulonephritis

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8
Q

Hematuria with preceding or concurrent illness

A

IgAN, APSGN

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9
Q

Hematuria with fmhx

A

Alport, TBMN

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10
Q

Hematuria with h/o bleeding/bruising

A

vWD, traumatic hematuria

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11
Q

h/o hgb AS, Ss, SC, SBthal

A

papillary necrosis, SC nephropathy, exercise-induced rhabdo

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12
Q

Pattern: progressive, sensorineural hearing loss, anterior lenticonus

A

Alport

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13
Q

Name post-renal causes of hematuria

A

hydronephrosis, UP junction, UV junction obstruction, posterior urethral valves, lithiasis (stone - colicky pain, fmhx) hypercalcuria (ca/cr high >0.2)

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14
Q

Name bladder and urethra causes of hematuria

A

Trauma, inflammation, viral cystitis, TB, bact, Cytoxan, hemoorhagic cystitis, hemangioma

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15
Q

When to biopsy in cases of renal disease

A

1) hi proteinuria
2) persistent hypocomplementemia
3) chronic renal insufficiency
4) fmhx of nephritis with deafness
5) recurrent gross hematuria

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16
Q

How do you workup for hypercalciuria

A

spot urine, normal is <0.2, for confirmation of >0.2 do 24hr urine collection and if >4mg/kg/day = dx hypercalciuria

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17
Q

Pattern: dysplasia, unilateral agenesis, brachial fistulas, preauricular pits, hearing loss

A

brachio-oto-renal (BOR)

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18
Q

Pattern: renal angiomyolipomas, cystic kidneys, renal cell carcinoma

A

TS

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19
Q

Pattern: Renal failure with oligohydramnios, small posteriorly set ears, micrognathia, beaked nose, wide set eyes, pulmonary hypoplasia

A

Potters

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20
Q

Pattern: nephronopthisis, cystic disease, renal dysplasia, tapetoretinal degeneration, retinal dysplasia

A

Senior locken syndrome

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21
Q

Pattern: renal failure, enlarged nontrabeculated bladder with thickened walls, lung hypoplasia, b/l cyrptoorchidism

A

Prune belly

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22
Q

Pattern: diffuse mesangial sclerosis, nephrotic syndrome, Wilm’s tumor, male pseudohermaphrodism

A

Drash

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23
Q

Pattern: glomerular involvement, dermal telangectasia

A

Fabry’s disease

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24
Q

Pattern: various renal defects, absence of intrahepatic bile duct, jaundice, vertebral defects, hyperlipidemia

A

Alagille’s

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25
Q

Pattern: renal aplasia or hypoplasia, double collecting system, unilateral aplasia of pectoralis major, ipsi synbrachydactylyl, hypoplasia or breast and nipple

A

Polard

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26
Q

Define nephrotic

A

Proteinuria >40mg/m2/hr (4+); dipstick 4+
Hypoalbuminemia <2.5g/dL
Edema
Hyperlipidemia

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27
Q

Pattern; endema, normal bp or low; no changes in light microscopy, epithelial foot process effacement on EM

A

Minimal change nephrotic

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28
Q

Rx for MCNS

A

Replete fluids and prednisone

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29
Q

What is the best prognostic indicator for MCNS

A

Response to steroids

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30
Q

How to eval for proteinuria?

A

1st morning urine dip, blood (cr, bun, electrolytes, serum albumin, cholesterol, strep serologies), imaging - renal Us, VCUG

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31
Q

High protein after standing

A

orthostaic proteinuria

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32
Q

Albumin leaks through nephrotic/glomerulonephritis

A

glomerular proteinuria

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33
Q

Tubulointerstitial, hereditary or acquired tubulopathies

A

nonglomerular (LMW proteinuria)

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34
Q

If serum is lo in albumin what category of proteinuria is it most likely

A

glomerular proteinuria

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35
Q

What are the complications of nephrotic syndrome

A

Peritonitis (IV abs) pneumococcal, enteric bacteria
Other infection (bacteremia, pneumonia, cellulitis, meningitis, varicella)
Thromboembolism - PE, renal vein thrombosis, DVT
Hypovolemia

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36
Q

What is the main difference between minimal change disease and acute glomerulonephritis?

A

HTN

Edema is the same

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37
Q

Pattern: RBC casts, increased Cr, fluid Na/water retention causes increased edema, htn

A

acute glomerulonephritis

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38
Q

Which 3 kidney disorders present with low C3?

A

APSGN (post strep GN), lupus, MPGN

Low C3 is a marker of complement consumption

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39
Q

Rx for acute glomerulonephritis presentation

A

steroids, plasmapheresis, cytoxans

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40
Q

Pattern: microangiopathic hemolytic anemia, thrombocytopenia, renal injury, diarrhea 5 - 10 days before, high LDH, low haptoglobin, coombs negative

A

HUS (E. coli 157:H7)

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41
Q

What are extrarenal manifestation of HUS?

A

CNS (seizures, obtundation, coma, stroke), liver (hepatitis, GB, hydrops)
Pancreatitis, diabetes, +/- leukocytosis, bloody diarrhea

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42
Q

Pattern: coombs, anemia, pulmonary infiltrate, bacteremia or meningitis

A

pneumococcal HUS

43
Q

Pattern: microscopic hematuria, 1 epsidoe of gross hematuria, HTN, decreased GFR

A

IgA

44
Q

Difference in onset time of post-strep and IgA

A

Post-strep - 1 week post-infection

IgA Immediately with infection

45
Q

Pattern: palpable purpura, arthritis, arthralgia, abdominal pain, renal disease (hematuria), lower limb abnormality

A

Henloch Scholein Purpura

46
Q

Pattern: renal agenesis, ectopia, hydronephrosis, UPJ obstruction, vertegral anomalies, anal atresia, TE fistula, radial dysplasia, cardiac defects

A

VATER syndrome

47
Q

Pattern: membranoproliferative glomerulonephritis, dextrocardia, sinusitis, immotile cilia, bronchiectasis

A

Kartagener syndrome

48
Q

pattern: multiple glomerular lesions, nephritis, nephrotic syndrome, immunodeficiency

A

AIDS

49
Q

Pattern: renal artery/vein thrombosis

A

infant of DM

50
Q

Pattern: flank mass and red urine and HTN and nausea/vomiting, hydronephrosis

A

UPJ obstruction

51
Q

When does primary enuresis resolve by?

A

15yrs

52
Q

When is daytime continence typically achieved by?

A

4yrs

53
Q

What are some problems that can cause incontinence?

A

overactive bladder, abnormal contraction during filling, void postponement, dysfunctional voiding

54
Q

What is dysfuctional voiding?

A

Inability to relax sphincter and pelvic floor during voiding

55
Q

What is the most successful way to treat enuresis?

A

Alarm

56
Q

What is the most common cause of chronic kidney disease?

A

Posterior urethral valves

57
Q

How do you best work up posterior urethral valve?

A

US, bilateral hydro with big bladder and posterior urethra. Must get VCUG with voiding phase without catheter

58
Q

Rx for posterior urethral valves

A

ablation

59
Q

Which cystic disease typically only involves 1 kidney

A

multicystic dysplastic kidney

60
Q

Which cystic disease involve both kidney

A

AR and ADPKD, VHL, TS, renal agenesis

61
Q

Which cystic disease - single?

A

multicystic dysplastic kidney

62
Q

Which cystic disease - microcysts

A

ARKD

63
Q

Which cystic disease - large cysts

A

ADKD

64
Q

Which cystic disease - congenital hepatic fibrosis that is periportal

A

ARKD

65
Q

Which cystic disease - associated with TS, cerebral aneurysms, hepatic cysts

A

ADKD

66
Q

Which cystic disease - HTN

A

ARKD

67
Q

Which cystic disease - abdominal mass, flank pain, hematuria

A

ADKD

68
Q

Which cystic disease - renal insufficiency after 30 years

A

ADKD

69
Q

Pattern: bilateral renal agenesis, pulmonary hypoplasia, limb deformities, flatten facies

A

Potter sequence

70
Q

Pattern: Vertebral, cardiac, TE fistula, renal and limb chromosomal abnormality

A

VACTERL

71
Q

Renal agenesis can be seen in other diseases.

A

Mullerian agenesis, another with absence of vas deferens

72
Q

Pattern: hydronephrosis, mass, hematuria, pain, horseshow kidney

A

UPJ obstruction

73
Q

Pattern: hydronephrosis, cystic dilation of terminal ureter within bladder, associated with duplicated system

A

uterocele

74
Q

2nd most common cause of hydronephrosis

A

congenital megaureter

75
Q

W/u for renal trauma?

A

CT +/- contrast

76
Q

Pattern: pelvic fracture, free fluid in cul de sac +/- gross hematuria

A

Bladder trauma - should CT

77
Q

Pattern: perineal penile hematoma, blood at meatus, inability to void

A

urethral injuries

78
Q

W/u for urethral injuries

A

male - retrograde urethrography

female - cystoscopy

79
Q

Pattern: flank pain, recurrent UTI, underlying renal/urinary tract abnormalities

A

nephrolithiasis

hypercalcuria >0.2 spot

80
Q

What is preferred imaging for nephrolithiasis

A

CT>US>plain film

81
Q

Best test for VUR and PUV

A

VCUG

82
Q

Best test for CT

A

UVJ or UPJ obstruction

83
Q

Best test for hydronephrosis

A

US

84
Q

Indication for absolute renal/bladder US

A

2mo to 2 yrs with febrile UTI

85
Q

Which VUR grade puts patient at increased risk of acute inflammatory damage and scarring?

A

VUR 3-5

86
Q

Pattern: FTT, short stature, renal rickets, anemia, HTN, electrolyte disturbances

A

chronic kidney disease

87
Q

Pattern/Rx: HTN, sore throat, Coca-Cola urine

A

PIAGN - diuretics

88
Q

Pattern/Rx: HTN, flushing

A

Pheochromocytoma - alpha/beta blocker

89
Q

Pattern/Rx: severe IVH

A

central cause - clonidine

90
Q

Pattern/Rx: recurrent UTIs

A

Renal scarring - ACE inhibitor

91
Q

Which drugs to avoid with bilateral RAS?

A

Ace inhibitor

92
Q

Which drugs to avoid depression, asthma, diabetes

A

Beta blocker

93
Q

Rx for HTN urgency/emergency

A

Immediate 25% reduction in bp; normalization gradual (24-48hrs)

94
Q

Renal causes of HTN

A

acute GN, scarring, renal artery stenosis (NF, UAC placement)

95
Q

Cardiac cause of HTN

A

aortic coarctation

96
Q

Endo causes of HTN

A

pheochromocytoma, CAH, primary hyperaldosteronism

97
Q

Neuro causes of HTN

A

increased ICP, familial dysautonomia, GBS, pain and anxiety

98
Q

Drugs that cause HTN

A

steroids, lead/mercury poisoning, amphetamines, cough and cold medicine, NSAIDs, OCPs, licorice

99
Q

Most likely cause of HTN in newborn

A

RA or RV thrombosis

100
Q

Most likely cause of HTN in 1 year old

A

coarctation

101
Q

Most likely cause of HTN in <6 year old

A

renal parenchyma, renovascular disease

102
Q

Most likely cause of HTN in >6 year old

A

renal parenchyma, renovascular, essential HTN, coarct

103
Q

Pattern: hydronephrosis, thickening of the walls

A

PUV associated with renal dysplasia

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