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Peds > Renal > Flashcards

Renal Flashcards

1
Q

What is the definition of microscopic hematuria?

A

5+ RBCs/hpf in 3 centrifuged samples of freshly voided urine obtained over several weeks

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2
Q

True or False: The urine is not discolored when there is microscopic hematuria?

A

True

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3
Q

4 RBCs/hpf is considered microscopic hematuria?

A

FALSE (5+)

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4
Q

What are 3 things that can cause a transient hematuria?

A
  1. Minor trauma
  2. Exercise
  3. Fever
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5
Q

What is an important part of evaluating hematuria?

A

Family history

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6
Q

If a patient with hematuria has a family history of hematuria without complications, what could the diagnosis be?

A

Benign familial hematuria

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7
Q

In benign familial hematuria, is it typically microscopic or macroscopic?

A

Microscopic

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8
Q

What is the management for benign familial hematuria?

A

Monitoring for HTN and proteinuria

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9
Q

What is the next step after you get a urine dipstick positive for blood?

A

Obtain a urinalysis with microscopy

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10
Q

What are 3 things that a dipstick positive for blood could be positive for?

A
  1. Hemoglobin
  2. Myoglobin
  3. Porphyrins
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11
Q

What are 2 additional findings in patients with hemoglobinuria?

A
  1. Jaundice
  2. Anemia

-No RBCs in urine so no hematuria

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12
Q

Kid who was vigorously active and has gross hematuria, otherwise asymptomatic, 0-2 RBCs on microscopic urinalysis… most likely diagnosis?

A

Myoglobinuria… 0-2 RBCs/hpf isn’t hematuria

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13
Q

What are 5 things to know in a patient presenting with hematuria?

A

Is there…

  1. Proteinuria
  2. HTN
  3. Abdominal pain
  4. Dysuria
  5. Family history of kidney disease
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14
Q

What % of school-aged children is microscopic hematuria seen normally in?

A

2-3%

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15
Q

After following a school-age child with hematuria for 6 months, what % remain + for hematuria?

A

1%

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16
Q

If you have a kid with hematuria and no other symptoms, what is next step?

A

Repeat urinalysis in a few weeks

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17
Q

If a repeat UA is positive for hematuria, what is the next step?

A

Check a urine Ca/Cr ratio (look for hypercalciuria)

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18
Q

What is a common cause of microscopic hematuria?

A

Hypercalciuria

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19
Q

What should be done if you have persistent hematuria with a calcium/creatinine ratio greater than 0.25?

A

Check 24 hour total calcium excretion

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20
Q

What value for 24 hour total calcium excretion confirms hypercalciuria?

A

> 4.0 mg/day

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21
Q

If you have confirmed hypercalciuria after a 24 hour total calcium excretion, what should b done next?

A

Renal US to rule out a renal stone

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22
Q

What should be done if you have persistnet hematuria with a calcium/creatinine ratio less than 0.25?

A

Obtain serum BUN, creatinine, and electrolytes

-Other labs to consider based on history would be C3, C4, ANA, ds-DNA, CBC, sed rate, urine protein:creatinine ratio, ASO titers, ANCA, and renal/bladder US (to look for UPJ obstruction)

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23
Q

What is a hematological condition you should keep in mind with hematuria?

A

Sickle cell disease

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24
Q

True to False: A child with sickle cell trait (Hgb AS) can develop hematuria?

A

True

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25
Q

When is cystoscopy indicated in a pediatric patient?

A

Never (bladder CA is very unlikely)

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26
Q

What is a red/pink discoloration in the diaper of a newborn likely due to?

A

Urate crystals (not hematuria)- No treatment needed once UA is normal

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27
Q

What is the finding of RBCs in a urine sample that is discolored?

A

Gross hematuria

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28
Q

Name 12 things that can result in gross hematuria.

A
  1. Glomerulonephritis (post infectious- strep, membranoproliferative)
  2. HSP
  3. IgA nephropathy
  4. Hereditary nephritis
  5. Alport syndrome
  6. Benign familial hematuria
  7. Sickle cell disease
  8. UPJ obstruction
  9. Stones
  10. Bleeding disorders
  11. Crystals in the urine
  12. Trauma
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29
Q

How do kids with kidney stones present?

A
  1. Hematuria
  2. Abdominal/flank oain
  3. Urinary frequency
  4. Dysuria
  5. Fever
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30
Q

What medication can turn urine (along with tears and sweat) orange?

A

Rifampin

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31
Q

Painless tea or coke-colored urine with RBC casts and deformed RBCs, but without clots?

A

Glomerular disease

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32
Q

Bright red urine with clots?

A

Non-glomerular disease (lower urinary tract below level of kidneys)

-Could be structural anatomical abnormality- kidney stones, Wilms tumor, cystic kidney disease

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33
Q

True or False: Kids with kidney stones should undergo a full metabolic workup?

A

True

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34
Q

What imaging study is needed for kids with kidney stones?

A

US- to evaluate for stone burden and renal/urological abnormalities

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35
Q

What is the most common type of kidney stones in children?

A

Calcium

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36
Q

What kids are at increased risk for calcium renal stones?

A
  1. Distal RTA
  2. Hypercalciuria- Hyperparathyroidism/hypercalcemia
  3. Loop diuretics
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37
Q

What is the initial diagnostic study when you suspect renal stones?

A

Plain XR or US

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38
Q

What size stones usually pass on their own?

A

Smaller than 5mm

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39
Q

What procedure might be required for kidney stones >5mm?

A

Percutaneous nephrolithotomy

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40
Q

What are some long-term treatment options for kids with kidney stones?

A
  1. Increase fluid intake
  2. Restrict salt intake
  3. Thiazide (if above don’t work)
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41
Q

True or False: Proteinuria in the absence of hematuria or other clinical findings is likely benign?

A

True

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42
Q

What two settings might you see a benign proteinuria?

A
  1. Alkali urine

2. Concentrated urine

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43
Q

What is having proteinuria present during the day, but disappearing when lying down (asleep)?

A

Orthostatic proteinuria

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44
Q

How is othostatus proteinuria confirmed?

A

First void spot urine right after waking (this should show no proteinuria, even though later in the day there may be preoteinuria)

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45
Q

If a first void spot urine right after waking shows no proteinuria (but there is protinuria later in the day), what is done next?

A

Check serum creatinine

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46
Q

If a kid with suspected orthostatic proteinuria has a normal serum creatinine, when can you follow-up?

A

3 months

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47
Q

Kid with proteinuria that doesn’t disappear on first morning specimen, what do you check next?

A

Urine protein/creatinine ratio

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48
Q

A urine protein/creatinine ratio >2 suggests what?

A

Renal disease

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49
Q

What are 3 things that can cause temporary proteinuria?

A
  1. Fever
  2. Exercise
  3. Dehydration
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50
Q

What are 3 things in the history that would point you away from just benign transient proteinuria?

A
  1. Edema
  2. History of UTI
  3. Exposure to toxins
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51
Q

True or False: A 24 hour urine collection is the gold standard for proteinuria in children?

A

False- Serial spot checks are standard

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52
Q

What is another name for Familial Nephritis?

A

Alport syndrome

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53
Q

How is Alport syndrome inherited?

A

X-Linked Dominant

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54
Q

Do males or females get Alport syndrome more frequently?

A

Males

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55
Q

What are findings with Alport syndrome?

A
  1. Hematuria
  2. Bilateral sensorineural hearing loss
  3. Ocular defects
  4. Renal failure
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56
Q

Are males or females with Alport syndrome more likely to develop end-stage renal disease?

A

Males

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57
Q

True or False: Most females with Alport syndrome are asymptomatic carriers?

A

True

*Variability in severity in females from degree of random inactivation of mutated X chromosome due to lyonization

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58
Q

What are the 2 most commonly palpated masses in infants?

A
  1. Hydeonephrotic kidneys (UPJ obstruction)

2. Multicystic dysplastic kidneys

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59
Q

Child with microscopic hematuria after an MVA or sports injury?

A

UPJ obstruction

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60
Q

Newborn with hydronephrosis on prenatal US or palpable flank mass (with confirmation of the unilateral flank mass)

A

UPJ obstruction

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61
Q

What is an enlarged kidney with non-communicating cysts along with thin/no parenchyma and dysplasia?

A

Multicystic dysplastic kidney disease

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62
Q

Is the kidney functional in Multicystic dysplastic kidney disease?

A

No

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63
Q

Is there any treatment for multicystic dysplastic kidney disease?

A

No

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64
Q

What is a unilateral flank mass a clue to?

A

Renal dysplasia

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65
Q

Diagnosis of multicystic dysplastic kidney disease can be suspected prenatally with what 2 things?

A
  1. Oligohydramnios

2. Minimal fluid in bladder

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66
Q

Is multicystic dysplastic kidney disease typically unilateral or bilateral?

A

Unilateral

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67
Q

What % of the time does multicystic dysplastic kidney disease occur with other urinary tract anomalies?

A

50%

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68
Q

Name 4 urinary tract anomalies that can be seen with multicystic dysplastic kidney disease.

A
  1. UPJ obstruction
  2. Vesicoureteral reflux
  3. Posterior urethral valves
  4. Megaureter and duplication
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69
Q

What is necessary to confirm diagnosis of multicystic dysplastic kidney disease?

A

Renal US

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70
Q

What imaging besides renal US is needed in multicystic dysplastic kidney disease?

A

VCUG- rule out comorbid anomalies

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71
Q

What is the typical presentation of ARPKD in infants?

A

Bilateral flank masses, history of oligohydramnios

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72
Q

What is the typical presentation of ARPKD in older kids?

A

Bilateral kidney masses, signs of chronic portal HTN (due to congenital hepatic fibrosis)

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73
Q

What are signs of portal HTN?

A
  1. Hematemesis
  2. Palpable liver
  3. Thrombocytopenia
  4. Splenomegaly
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74
Q

What imaging should the workup for ADPKD include?

A

Renal US

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75
Q

What brain abnormality is ADPKD associated with?

A

Intracranial aneurysms

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76
Q

What is typical in family history for ADPKD?

A

Death from renal disease and/or cerebral aneurysms

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77
Q

How does a ureterocele present?

A

Symptoms mimic UTI: Dysuria, hematuria, abdominal pain

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78
Q

What is the most common cause of urinary retention in females?

A

Ureterocele

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79
Q

Name 2 ways ureterocele can present on exam/imaging.

A
  1. Mass protruding from the urethral meatus

2. Round filling defect on IVP

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80
Q

What can a ureterocele lead to?

A

Urinary tract obstruction

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81
Q

The earlier a UTI presents in life, the more likely what is a contributing factor?

A

Reflux

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82
Q

How is diagnosis of vesicoureteral reflux confirmed?

A

VCUG

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83
Q

What 2 things does management of vesicoureteral reflux depend on?

A
  1. Grade

2. Fact that reflux improves with time

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84
Q

What are the 2 main goals of management in vesicoureteral reflux?

A
  1. Avoid HTN

2. Avoid renal insufficiency/renal failure

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85
Q

True or False: Prophylactic antibiotics are routinely recommended for vesicoureteral reflux?

A

False

*May be indicated for some kids with high grade VUR- urology should decide

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86
Q

What is important for kids with VUR who are febrile?

A

Get urine evaluation ASAP to rule out/treat UTI

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87
Q

What are urethral strictures usually the result of?

A

Uretheral trauma (don’t forget placement of catheter can do this- watch for any recent surgery)

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88
Q

Besides uretheral trauma, what else can cause urethral strictures?

A

Infections (like GC)

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89
Q

When is insertion of a urinary catheter contraindicated?

A

In a patient who is experiencing gross urethral bleeding following trauma

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90
Q

What should you think with a newborn who has a palpable bladder and weak urinary stream?

A

Posterior urethral valves

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91
Q

What 2 things would a prenatal US in a kid with PUV show?

A
  1. Bilateral hydronephrosis

2. Reduced renal parenchyma

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92
Q

What is next step in an infant with a palpable bladder and no urine output?

A

Pass a urine catheter

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93
Q

What should be done once PUV is suspected/confirmed?

A

Consult urology for surgical correction immediately

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94
Q

True or False: Renal failure can occur even after surgical correction of posterior valves?

A

True- Long term followup of bladder function is important

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95
Q

True or False: PUV can occur in males and females?

A

False- only in males

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96
Q

What 3 things are kids with prune belly syndrome prone to?

A
  1. Chronic UTIs
  2. Dilated ureters
  3. Large bladders
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97
Q

What is another name for Eagle Barrett syndome?

A

Prune Belly Syndrome

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98
Q

What is the cause of the problems with chronic UTI, dilated ureters, and large bladders in kids with prune belly syndrome?

A

Posterior uretheral valves

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99
Q

What is the typical triad presentation of prune belly syndrome?

A

Newborn with…

  1. Bilateral hydronephrosis
  2. Undescended testicles
  3. Poor anterior abdominal wall musculature
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100
Q

What does the presentation of males with bilateral hydronephrosis warrant?

A

Immediate VCUG (rule out posterior uretheral valves)

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101
Q

What is something that is very important to pay attention to in a patient presenting with dysuria?

A

Age

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102
Q

What are 4 possible causes of dysuria in a pre-adolescent female?

A
  1. Pinworms
  2. Poor hygiene
  3. Trauma
  4. Vaginitis
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103
Q

What is 1 possible cause of dysuria in an adolescent female who isn’t sexually active?

A

UTI

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104
Q

What are 2 possible causes of dysuria in an adolescent female who is sexually active?

A
  1. UTI

2. Chlamydia/gonoccoal infection

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105
Q

What is a possible cause of dysuria in an adolescent male?

A

Chlamydia/gonococcal infection

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106
Q

Teenage girl treated empirically for UTI still experiencing dysuria, best next step?

A

Additional history, PE, or lab tests (like a pelvic exam)

*Don’t pick additional treatment (like a new abx)

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107
Q

What are 3 causes of urinary frequency and incontinence?

A
  1. UTI
  2. Ectopic urethral opening in females
  3. Unstable bladder
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108
Q

Girl who has had a thorough workup that is negative and continues to wet her pants?

A

Ectopic urethral opening

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109
Q

When do kids with an unstable bladder experience symptoms?

A

Daytime (urinary frequency) and are usually okay at night

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110
Q

What behaviors might kids with unstable bladders do to compensate?

A

Cross legs or squat

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111
Q

What can unstable bladder lead to?

A

UTI (from urine retention)

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112
Q

What are 2 ways to help manage unstable bladder?

A
  1. Timed urination

2. Anticholinergic agents

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113
Q

How is a UTI diagnosed?

A

> 50,000 colonies of a SINGLE organism from a reliable sample (cath or bladder tap)

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114
Q

What virus can cause UTI?

A

Adenovirus (but most UTI are caused by bacteria)

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115
Q

What is the most common but with UTI?

A

E. Coli

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116
Q

What are two other bugs besides E. Coli that can cause UTI?

A
  1. Klebsiella

2. Enterococcus

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117
Q

Kids with what other problem are more likely to get a UTI?

A

Constipation

118
Q

During the first 3 months of life, who is at higher risk for UTI, boys or girls?

A

Boys (especially if uncircumcised)

119
Q

After 3 months of life, who is at higher risk for UTI, boys or girls?

120
Q

What 2 demographic groups are UTIs more common in during adolescence?

A
  1. Sexually active females

2. Homosexual males

121
Q

A positive leukocyte esterase is diagnostic for UTI?

A

False- only suggestive, need a positive urine culture to make diagnosis (even though we often treat empirically)

122
Q

True or False: Asymptomatic bacteruria requires no further intervention

123
Q

True or False: Most kids with febrile UTI can be treated with oral antibiotics?

124
Q

When do you treat kids with IV antibiotics for febrile UTI?

A

If they appear toxic or have persistent emesis

125
Q

How long do you treat for UTI?

126
Q

Name 5 antibiotics that can be used for oral treatment of UTI.

A
  1. Amoxicillin-clavulanate
  2. Trimethoprim-sulfamethoxazole
  3. Cephalexin
  4. Cefizime
  5. Cefuroxime

(Narrow with sensitivities)

127
Q

Name 5 antibiotics that can used for parenteral treatment of UTI.

A
  1. Ceftrixone
  2. Cefotaxime
  3. Gentamivin
  4. Tobramycin
  5. Piperacilin

(Narrow with sensitivites)

128
Q

What 3 antibiotics can be used for UTI prophylaxis if indicated?

A
  1. Amoxicillin (especially for infants)
  2. Trimethoprim-Sulfamethoxazole
  3. Nitrofurantoin
129
Q

What needs to be done after the first febrile UTI?

A

Renal and bladder US… if normal wait and see if they get another UTI

130
Q

When is a VCUG indicated in setting of UTI?

A
  1. After 2nd febrile UTI

2. Is the US obtained after 1st febrile UTI is abnormal in any way

131
Q

What is the triad of nephrotic syndrome?

A
  1. Hypoproteinemia
  2. Proteinuria
  3. Edema
132
Q

Are most cases of nephrotic syndrome in kids primary or secondary?

133
Q

What 5 things can lead to secondary nephrotic syndrome?

A
  1. Infections
  2. Drugs
  3. Malignancies
  4. Lupus
  5. Diabetes

*Several glomerulopathies can also be associated with nephrotic syndrome

134
Q

Most cases of nephrotic syndrome in kids are due to what?

A

Minimal change disease

135
Q

What age group is minimal change disease typically seen in?

136
Q

Is minimal change disease more common in males or females?

A

Males (2:1)

137
Q

Name 4 findings seen with minimal change disease.

A
  1. Decreased urine output
  2. Abdominal pain
  3. Diarrhea
  4. Weight gain
138
Q

True or False: Renal function is normal in minimal change disease

139
Q

How are edema, hypoproteinemia, and proteinuria related?

A

Protein spills to urine causing low serum protein which causes low oncotic pressure which causes edema

140
Q

What 2 things happen to the liver when there is low oncotic pressure?

A
  1. High LDL/HDL ratio

2. Hypercoagulability

141
Q

What causes a high LDL/HDL ratio seen in the setting of low oncotic pressure?

A

VLDL production increases

142
Q

What causes hypercoagulability seen in the setting of low oncotic pressure?

A

Fibrinogen, Facor V, and Factor VII increase, decreased volume, and increased platelet count

143
Q

What three things result from lost protein in the setting of proteinuria?

A
  1. Immunodeficiency
  2. Hypocalcemia
  3. Functional hypothyroidism
144
Q

What causes immunodeficiency in the setting of proteinuria?

A

Immunoglobulins lost by the kidneys in addition to decreased complement levels

145
Q

What causes hypocalcemia in the setting of proteinuria?

A

Albumin is lost by the kidneys (Low albumin decreases bound and available calcium)

146
Q

What cases functional hypothyroidism in the setting of proteinuria?

A

Thyroxine binding globulin is lost in the urine

147
Q

What are 3 complications of nephrotic syndrome?

A
  1. Hyponatremia
  2. Vascular thrombosis
  3. Peritonitis
148
Q

What should be suspected in a kid with minimal change disease who has hematuria?

A

Vascular thrombosis

149
Q

When is hospitalization necessary in minimal change disease?

A

Severe edema or infection

150
Q

What two things are done as initial treatment of minimal change disease?

A
  1. Sodium restriction

2. Prednisone

151
Q

True or False: Fluid restriction is important in the management of minimal change disease?

A

False: Only necessary in severe edema

152
Q

Name 5 things that result in worse prognosis and need for renal biopsy in setting of minimal change disease.

A
  1. Age >10
  2. Persistent or gross hematuria
  3. HTN
  4. Renal insufficiency
  5. Low C3 complement levels

*If there are 2+ of these

153
Q

After how long on daily prednisone is a renal biopsy indicated in minimal change disease if there is still proteinuria?

154
Q

What 2 drugs might be needed in minimal change disease if there is proteinuria after 4 weeks of daily prednisone?

A
  1. Cyclophosphamide

2. Cyclosporine

155
Q

True or False: Relapses are uncommon in minimal change disease?

A

False: 1-2 relapses per year are not uncommon

156
Q

When do replaces stop during minimal change disease?

A

Usually during adolescence

157
Q

What is prognosis in nephrotic syndrome often based on?

A

Response to treatment (steroids)

158
Q

What is suggested by the presence of RBC casts?

A

Glomerular disease

159
Q

Name 7 things that are important to note in nephropathies/nephritidies.

A
  1. ASO
  2. C3
  3. BP
  4. Electrolytes
  5. BUN
  6. Creatinine
  7. Albumin
160
Q

Name 5 buzz phrases to help with cause of hematuria.

A
  1. Positive family history
  2. Recent trauma
  3. Abdominal pain/mass
  4. Recent strep infection
  5. Sickle cell disease
161
Q

Name 4 symptoms of nephritic syndrome.

A
  1. Red urine (hematuria)
  2. Oliguria
  3. Proteinuria
  4. Elevated BP and BUN (azotemia)

“ROPE”

162
Q

Hematuria + Proteinuria indicates what?

A

Glomerulonephritis (Either one by themselves can be benign, but together, no)

163
Q

What is the first division you should think of with causes of glomerulonephritis?

A

Low or normal complement levels

164
Q

What 5 things does nephritic syndrome consist of?

A
  1. Hematuria
  2. Proteinuria
  3. Edema
  4. HTN
  5. Azotemia
165
Q

What causes glomerulonephritis with normal complement?

A
  1. HSP
  2. IgA nephropathy
  3. Idiopathic vasculitis
  4. FSGS
  5. Rapidly progressive glomerulonephritis
166
Q

What age group is FSGS typically seen in?

167
Q

How can FSGS present?

A

Nephrotic syndrome (edema)

168
Q

What does FSGS typically lead to?

A

Progressive renal failure

169
Q

What happens to serum albumin and C3 levels in FSGS?

A

Albumin is low

C3 is normal

170
Q

What happens to C3 in membranoproliferative glomerulonephritis?

171
Q

Why is aggressive treatment needed in MPGN?

A

To prevent renal failure

172
Q

What is a nonsuppurative sequelae of an infection with a nephritogenic strain of group A beta hemolytic strep?

A

Post Strep Glomerulonephritis

173
Q

True or False: Only throat infections can lead to PSGN?

A

False: Throat and skin infections can lead to PSGN

174
Q

What is due to the deposition of immune complexes in the kidney?

175
Q

True or False: PSGN typically doesn’t lead to renal failure?

176
Q

Triad for PSGN?

A
  1. HTN
  2. Edema
  3. Hematuria

*Look for hints of recent illness

177
Q

Where is the edema typically located in PSGN?

A

Eyelids and/or face

178
Q

Tea or cola-colored urine?

A

PSGN (may also be described as rusty or smoky)

179
Q

What 3 things cause glomerulonephritis with low complement?

A
  1. Post strep
  2. Membrano-proliferative
  3. Systemic lupus
180
Q

In PSGN what causes low serum albumin levels?

A

Hemodilution (not proteinuria)

181
Q

How long are C3 levels low in PSGN?

A

Up to 2 months, then return to normal

182
Q

If there is documentation that C3 returns to normal after being low, what glomerulonephritis is differentiated?

A

It is PSGN (vs. Lupus and membranoproliferative where C3 stay low for longer)

183
Q

What is treatment for PSGN?

A

Supportive: Fluids and BP control

184
Q

True or False: Long term outcome for PSGN is poor

A

False- Excellent long term outcome

185
Q

If you see recurrent gross hematuria, what should you think of?

A

IgA nephropathy (not PSGN)

186
Q

What is another name for Berger’s Disease?

A

IgA nephropathy

187
Q

What is associated with elevated serum IgA with IgA deposits noted on renal biopsy?

A

IgA nephropathy (Berger’s Disease) and HSP

188
Q

IgA nephropathy rarely occurs in a child under what age?

189
Q

What is the typical presentation of IgA nephropathy?

A

Gross painless hematuria with (or days after) a URI. Can see mild abdominal pain.

190
Q

Glomerulonephritis with a pharyngitis?

A

IgA nephropathy

191
Q

Glomerulonephritis 1-3 weeks after a pharyngitis?

192
Q

Name 5 instances where a renal biopsy would be indicated.

A
  1. Gross hematuria > 8 weeks
  2. Low serum compliment levels
  3. HTN over 2 weeks
  4. Proteinuria over 6 months
  5. Abnormal renal function
193
Q

What finding correlates with worsening disease in IgA nephropathy?

A

Persistent proteinuria

194
Q

What is the classic triad for HUS?

A
  1. Hemolytic anemia
  2. Renal failure (elevated BUN)
  3. Thrombocytopenia
195
Q

What are the usual initial signs in HUS?

A

Anemia and pallor

196
Q

What typically follows anemia and pallor seen in HUS?

A

Abdominal pain and decreased urine output

197
Q

What skin findings will be described in HUS?

A

Purpura and ecchymoses

198
Q

What neuro and cardio findings might be a part of HUS presentation?

A

Seizures, lethargy, coma, HTN

199
Q

What is HUS often contracted from?

A

Contaminated food or water- E. Coli

200
Q

Question noting decreased urine output and exposure to poorly cooked meat, unpasteurized apple cider/cow milk/goat milk?

201
Q

What can HUS be mistaken for?

A

Leukemia- Anemia, thrombocytopenia, variable white count, elevated BUN/creatinine can happen in both

202
Q

What 2 things in history will point towards HUS v. new-onset leukemia?

A

Presence of diarrhea and hematuria

203
Q

What is the treatment for HUS?

A

Supportive

204
Q

When are antimicrobials given in HUS?

A

Never- they can actually worsen the course

205
Q

What happens to the serum complement levels and Coombs test in HUS?

A

Complement levels are normal

Coombs test is negative

206
Q

What is the definition of acute renal failure?

A

Rapid worsening of renal function along with an increase in BUN/creatinine, often hyperkalemia, metabolic acidosis, and HTN

207
Q

What are the 3 categories of acute renal failure?

A
  1. Pre-renal
  2. Intrinsic
  3. Post-renal
208
Q

What is the most common cause of acute renal failure?

209
Q

In pre-renal acute renal failure, what happens to the urine sodium concentration and FeNa?

A

They are both low (FeNa <1%)

210
Q

In pre-renal acute renal failure, what happens to the urine osmolality?

A

It is high (>350mOsm)

211
Q

What happens to the FeNa in renal causes of acute renal failure?

A

FeNa is high (>1%)

212
Q

What happens to urine osmolality in renal causes of acute renal failure?

A

Low (<350mOsm)

213
Q

What is the equation for FeNa?

A

(Urine Na/Serum Na)/(Urine Cr/Plasma Cr)

214
Q

Name 2 causes of pre-renal acute renal failure

A
  1. Blood/fluid loss

2. Cardiac disease

215
Q

Name 5 causes of intrinsic acute renal failure

A
  1. Acute tubular necrosis
  2. Interstitial nephritis
  3. HUS
  4. Glomerulonephritis
  5. Nephrotoxic drugs
216
Q

Name 1 cause of post-renal acute renal failure

A
  1. Urologic obstruction
217
Q

What electrolyte abnormality is a problem with acute renal failure, regardless of the cause?

A

Hyperkalemia

218
Q

Name 3 ways you can treat hyperkalemia in the setting of acute renal failure

A
  1. Calcium gluconate
  2. Insulin and glucose
  3. Sodium polystyrene sulfonate
219
Q

What do you have to do for a kid in renal failure who is taking medications metabolized by the kidneys?

A

Adjust the dose

220
Q

What happens to the GFR when the creatinine level is 2x normal?

A

It is cut in half

221
Q

What do you typically do to the loading dose and dosing interval for kids in acute renal failure for meds metabolized by the kidney?

A

Keep loading dose same

Increase dosing interval of drug

222
Q

Name some things that are part of treatment of acute renal failure.

A
  1. Correct underlying problem (hypovolemia, meds, ect)
  2. Manage HTN
  3. Manage acidosis
  4. Manage electrolytes
  5. Vit D supplementation
  6. Nutrition/fluid intake
  7. Dialysis
223
Q

In a kid with pre-renal acute of acute renal failure, what type of fluids are given and why?

A

Isotonic, maintain intravascular volume

224
Q

What is another word for renal failure?

225
Q

What 2 common medications are contraindicated in patients with renal disease?

A
  1. ASA

2. NSAIDs

226
Q

Name the 2 most common causes of chronic kidney disease in kids

A
  1. Urologic abnormalities

2. Glomerulopathies

227
Q

What should always be on the differential for a kid with FTT or growth failure?

A

Chronic kidney disease

228
Q

What causes FTT/GF in kids with chronic kidney disease?

A

Multi-factorial: Acidosis, poor nutrition, issues with bone mineralization

229
Q

What causes anemia seen in chronic kidney disease?

A

Decreased EPO production by kidney

230
Q

What type of anemia is seen in chronic kidney disease?

A

Normocytic

231
Q

What is treatment with exogenous EPO indicated in kids with chronic kidney disease?

A

When Hgb drops below 8

232
Q

Name 6 drugs that are nephrotoxic

A
  1. Amnioglycosides
  2. Cyclosporine
  3. Tacrolimus
    Chemo- 4. Cisplatin, 5. Carboplatin, 6. Ifosfamide
233
Q

What side effect can EPO therapy have?

A

Polycythemia

234
Q

Polycythemia with EPO therapy is associated with what 2 things?

A
  1. HTN

2. Thrombosis

235
Q

What 3 things cause the metabolic acidosis seen in chronic kidney disease?

A
  1. Bicarb loss
  2. Decreased production of bicarb by renal tubules
  3. Decreased acid excretion
236
Q

What happens to the BUN in renal failure or obstructive uropathy?

A

Increases (uremia)

237
Q

What is a big part of management of uremia and elevated BUN in chronic kidney disease?

A

Restricted protein intake

238
Q

What causes HTN seen in renal failure?

A

Salt and water retention, sometimes increased renin levels

239
Q

What neurological problems can be manifestations of kidney disease?

A

Changes in mental status, seizures, peripheral neuropathies

240
Q

What causes secondary hyperparathyroidism in chronic kidney disease?

A

Decreased production of 1,25-dihydroxyvitamin D3 (this is active metabolite made in kidneys), leads to decreased calcium absorption, hypokalemia, and elevated PTH

241
Q

What causes increased serum phosphorous in chronic kidney disease?

A

Kidney’s can’t excrete phosphorous
Increases in serum suppresses calcitriol
Increased calcium loss
Increased PTH (snowballs)

242
Q

What dermatological findings are seen in chronic kidney disease?

A

Dry skin
Pruritus
Easy bruisability

243
Q

What do serum creatinine levels correlate with?

A

Muscle mass (thus creatinine increases with age in kids as they get more muscle mass)

244
Q

After adolescence, do males or females have a higher creatinine?

A

Males- more muscle mass

245
Q

What happens to creatinine in the newborn period and why?

A

Elevated- Reflects Mom’s creatinine level

246
Q

Do pre-term or full-term babies have higher creatinine levels?

247
Q

What is one unique reason it is very important to keep kids with chronic kidney disease UTD on their immunizations?

A

They may not qualify for transplant if not up to date

248
Q

What is one set of vaccines that is very important to give prior to a kidney transplant any why?

A

Live- Can’t get them once on immunosuppressive therapy

249
Q

What titers do kids undergoing dialysis need checked regularly?

A

Hepatitis B (antibodies can be removed by dialysis)

250
Q

What are 2 complications that can happen after kidney transplant?

A
  1. Rejection

2. Infection

251
Q

True or False: Prognosis after kidney transplant is good?

252
Q

What is one big problem with kids who have gotten a kidney transplant?

A

Compliance with daily meds

253
Q

Why might kids that have gotten a kidney transplant qualify for growth hormone?

A

They are at risk for poor growth

254
Q

What is the definition for HTN?

A

BP > 95% for age and sex, taken on 3 separate occasions

255
Q

When should routine BP screening start?

A

No later than age 3

256
Q

What should you take note of before getting worried about a high BP?

A

If the right cuff size was used

257
Q

What 2 organs are the main suspects in HTN in kids?

A
  1. Heart

2. Kidneys

258
Q

What should be checked with HTN in a kid?

A
  1. 4 extremity pulses
  2. 4 extremity BP
  3. UA
  4. BUN/Creatinine
  5. Thyroid (hyperthyroidism)
259
Q

Children who are obese are how many more times likely to develop HTN than kids who aren’t?

A

3 times more likely

260
Q

Are older or younger kids more likely to have primary (essential) HTN?

A

Older- Younger the kid, harder you look for cause of HTN

261
Q

Name 10 causes of HTN in kids… mneumonic?

A

POUNND HARD

  • Polycystic kidney disease
  • 0 Enzyme (11 hydroxylase deficiency)
  • Urinary reflux nephropathy
  • Neonatal problem (renal artery stenosis)
  • Neurofibromatosis
  • Deficiency (17 hydroxylase deficiency)
  • Heart (coarctation of aorta)
  • Adrenal (pheochromocytoma)
  • Rheum (Lupus)
  • Due to endocrine (Cushings, hyperthyroidism)
262
Q

Name 5 medications that can cause HTN

A
  1. Albuterol
  2. Contraceptives
  3. Corticosteroids
  4. Decongestants
  5. Illicit drugs
263
Q

What should you think with “family history of HTN” in a kid with HTN?

A

Renal or endocrine problems that run in families

264
Q

What should you think with “prematurity” in a kid with HTN?

A

Renal artery stenosis (secondary to umbilical catheterization)

265
Q

What should you think with “Joint pain/swelling” in a kid with HTN?

A

Connective tissue disorder like lupus

266
Q

What should you think with “Flushing, palpitations, fever, weight loss” in a kid with HTN?

A

Pheochromocytoma

267
Q

What should you think with “Muscle cramps, weakness” in a kid with HTN?

A

Hypokalemia secondary to hyperaldosteronism

268
Q

What should you think with “Onset with sexual development” in a kid with HTN?

A

Enzyme deficiency

269
Q

What ortho circumstance can cause HTN in kids?

A

If they are placed in prolonged traction after an orthopedic procedure

270
Q

What should you think with “Pale color, edema” in a kid with HTN?

A

Kidney disease (pale from poor EPO production)

271
Q

What should you think with “Pale color, increased sweating even at rest, flushing, abdominal mass” in a kid with HTN?

A

Pheochromocytoma

272
Q

What should you think with “Wide spaced nipples, webbing of the neck” in a kid with HTN

A

Turner Syndrome- Coarctation of the aorta

273
Q

What should you think with “Elfin facies, high serum calcium, and friendly” in a kid with HTN?

A

Williams Syndrome- Supravalvular aortic stenosis

274
Q

What should you think with “Decreased femoral pulse or low BP in leg v. arms” in a kid with HTN?

A

Coarctation of the aorta

275
Q

What is the most important non-pharmacological intervention for HTN in obesity is an issue?

A

Weight Loss

276
Q

Name 7 categories of meds for HTN

A
  1. CCB
  2. Vasodilator
  3. ACEi
  4. ARBs
  5. BB
  6. Alpha 2 Agonists
  7. Diuretics
277
Q

What 2 CCB will be use for kids with HTN?

A

Nifedipine or amlodipine

278
Q

What 2 vasodilators can be used for kids with HTN?

A

Hydralazine or minoxidil

279
Q

What 2 ACEi can be used for kids with HTN?

A

Enalapril or lisinopril

280
Q

What ARB can be used for kids with HTN?

281
Q

What 2 BB can be used for kids with HTN?

A

Propranolol or atenolol

282
Q

What is an Alpha 2 agonist that can be used for kids with HTN?

283
Q

What are 3 diuretics that can be used for kids with HTN?

A

Thiazides, furosemide, spironolactone

284
Q

What has to be done before a kid with a pheochromocytoma can have a surgical resection?

A

BP has to be under control

285
Q

What has to be given first for BP control in the setting of a pheochromocytoma?

A

Alpha blocker (phenoxybenzamine)

286
Q

Why is initial treatment with beta blockers contraindicated in kids with a pheochromocytoma?

A

It would lead to unopposed alpha effect and cause increase in BP (have to give alpha blocker first)

287
Q

Short obese patient with HTN?

A

Cushing syndrome

288
Q

When you suspect a renal cause of HTN, what is the next step?

A

Get a renal arteriography with differential central venous renin determination

289
Q

What happens to renin levels in the setting of renal stenosis causing HTN?

A

Renin is higher in renal vein of the involved kidney

290
Q

What can renal scars result in?

Peds (35 decks)

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