Renal

Question 1

Evaluation steps for persistent microscopic hematuria

Answer 1

Check urine calcium/cr ratio

If > 0.25 - check for 24 hr calcium excretion. A value of more than four is positive for hypercalciuria. Do RUS to r/o stone.

If < 0.25 - full workup

Question 2

What are the most commonly palpated masses in infants

Answer 2

Hydronephrotic kidneys (likely due to UPJ obstruction)

Multicystic dysplastic kidney

Question 3

What are other urinary tract anomalies that occur with multicystic dysplastic kidney disease and how frequently do they occur

Answer 3

UPJ obstruction, Vesicoureteral reflux, Posterior urethral valve, megaureter and duplication

50%

Question 4

Presentation of infant with prune belly

Answer 4

Bilateral hydronephrosis (due to posterior urethral valves), undescended testicles and poor anterior abdominal wall musculature

Question 5

Minimal change disease presents around what age and who is affected

Answer 5

2-8 yrs

Males more commonly affected 2:1

Question 6

Complications of minimal change disease

Answer 6

Hyponatremia

Vascular thrombosis (suspect when pt presents with hematuria)

Peritonitis

Question 7

Cholesterol in minimal change disease

Answer 7

VLDL production increases leading to high LDL/HDL ratio

Question 8

Which proteins are lost with minimal change disease

Answer 8

Immunoglobulins - complement levels also lower leading to immunodeficiency

Albumin lowers which then doesn’t bind calcium and leads to hypocalcemia

Thyroxine binding globulin lowers leading to functional hypothyroidism

Question 9

How does minimal change disease lead to hypercoagulability

Answer 9

Fibrinogen, factor v and VII increase

Question 10

What leads to worse prognosis in minimal change disease and you would want to do a renal biopsy

Answer 10

Age > 10
Persistent or gross hematuria
Hypertension 
Renal insufficiency
Low c3 

(2 or more would be needed)

If proteinuria lasts after 4 wks of daily prednisone a renal biopsy is also indicated

Question 11

What kidney disorders present with low complement level

Answer 11

Post strep, membranoproliferative gomerulonephritis, systemic lupus

Question 12

How do you calculate FeNa

Answer 12

(Urine na / serum na) / (urine cr / plasma cr)

Question 13

How do you control blood pressure in pt with pheochromocytoma

Answer 13

Alpha adrenergic blockade- phenoxybenxamine

Avoid beta blocker because may cause paradoxical increase in BP

Question 14

Pre renal AKI lab findings

Answer 14

Kidney is working!

Urine sodium (<20) and fractional excretion of sodium will be low (<1)

Urine osmolality is high (>500) - bc tubules reabsorb sodium and water

BUN/Cr ratio is high

Question 15

Renal AKI lab findings

Answer 15

Kidney not working!

Urine sodium (>40) and fractional excretion of sodium will be high (>1%)

Urine osmolality will be low because the kidney dumps everything

BUN/Cr is low

Question 16

How do varicocele present

Answer 16

Left sided
Heavy sensation or bag of worms
Swelling decreases when the pt lies down

Question 17

What position do you want to examine kids with suspecting retractile testes

Answer 17

Tailor position / frog-leg

Question 18

Evaluation for undescended tests

Answer 18

Newborn period - ultrasound and urology evaluation to r/o ambiguous genitalia

3-6 months if still not descended refer to urology for orchiopexy at 12-18 months

Question 19

Syndromes associated with hypospadias

Answer 19

SLOB

Silver Russell syndrome
Laurence moon biedl syndrome
Opitz syndrome
Beckwidth wiedemann syndrome

Question 20

Define phimosis

Answer 20

Inability to retract the foreskin in a boy older than 3 yrs old

Question 21

Common cause of non sexually transmitted urethritis

Answer 21

Urethral instrumentation following a surgical procedure

Question 22

Risk factors for testicular tumors

Answer 22

Cryptorchidism, gonadal dysgenesis, previous testicular cancer, family Hx, Klinefelter syndrome

Question 23

Labs to order to screen for testicular cancer

Answer 23

Lactate dehydrogenase, beta hcg, alpha fetoprotein