Renal

Question 1

Kid suffers a laceration to his flank, which diagnostic test should you use

Answer 1

CT-for trauma:ormally US is used to avoid radiation, but for trauma CT is 1st line to detect any GU lacerations, bleeding

Question 2

baby boy hasn’t urinated in the first 24 hours suprapubic mass oligohydramnios

Answer 2

Posterior urethral valves-redundant membrane preventing urination -cant urinate–>oligohydramnios -normal or higher Cr bc mom filters Cr -suprapubic mass=enlarged bladder

Question 3

how do you diagnose posterior urethral valves

Answer 3

straight catheter-to bypass the obstruction is both diagnostic and therapeutic–>baby now pees Surgery-to remove excess tissue

Question 4

why does an ectopic ureter only occur in girls

Answer 4

Boys-ectopic ureter implants above the ext urethral sphincter Girls-ectopic ureter implants below the ext urethral sphincter often in the urethra–>never been dry

Question 5

13 yo boy with rhinorrhea, myalgia, fatigue, and fever has proteinuria on urine dipstick, no hematuria,pyruria, or casts. what is the best next step

Answer 5

Repeat urine dipstick in 1 week. If (+) again then 2) do a 24 hr urine protein, 3)renal biopsy if + to check for PSGN, IgA nephropathy, etc -Takehome: febrile illnesses can cause transient proteinuria.

Question 6

scrotal mass -transilluminate…. -no transillumination… -swelling through the inguinal ring -bag of worms -acute painful swelling

Answer 6

hydrocoele: fail to close processus vaginalis testicular cancer inguinal hernia varicocoele testicular torsion

Question 7

baby has scrotal swelling that transilluminates. -diagnosis -RX

Answer 7

Diagnosis: hydrocoele-patent processus vaginalis RX: reassurance bc most close by 1 yr. After 1 yr then perform surgery

Question 8

what is the inciting event in potter sequence

Answer 8

urinary tract abnormality–>dec urine output P-pulmonary hypoplasia-bc amniotic fluid (urine) is req for lung development O-oligohydramnios (dec amniotic fluid due to dec urine output) T-twisted face T-twisted skin E-extremity defects R-renal failure

Question 9

Pt with a family history of sickle cell who doesn’t have the disease has hematuria

Answer 9

Renal papillary necrosis-occurs in people with sickle cell trait

Question 10

sickle cell trait renal complications

Answer 10

renal papillary necrosis-painless hematuria renal medullary cancer-bc renal papilla are in the medulla hyposthenuria-secrete dilute urine due to damage to the medullary vasa recta causing loss of concentrating ability distal renal tubular acidosis-

Question 11

when is renal biopsy in kids indicated

Answer 11

-any type of nephritic syndrome -nephrotic syndrome that hasn’t responded to steroids -nephrotic syndrome in kids >10 yrs

Question 12

pt has puffy face, pretibial edema, proteinuria >3 g/day, dec albumin. -disease -next step in management

Answer 12

-disease=minimal change disease -next step-give steroids bc mech is a T cell attack against podocytes

Question 13

sickle cell trait+ excess urination

Answer 13

hyposthenuria=produce excessive dilute urine due to damage of the

Question 14

can’t see can’t pee can’t hear a bee

Answer 14

Alport syndrome: X linked defect in type 4 collagen->splitting of the BM -eye isssues -hematuria -sensorineural hearing loss

Question 15

hematuria+abdominal pain+bruising on legs, buttocks

Answer 15

Henoch Schonlein Purpura (IgA vasculitis) -hematuria+IgA nephropathy signs (hematuria, RBC casts):IgA deposition in the mesangium of kidney -abdominal pain: IgA in the visceral vessels -palpable purpura skin: IgA in the skin

Question 16

abdominal mass that crosses the midline

Answer 16

Neuroblastoma

Question 17

abdominal mass that doesn’t cross the midline

Answer 17

Wilm’s tumor (nephroblastoma)

Question 18

Treatment of Strep pharyngitis prevents both PSGN and acute rheumatic fever

Answer 18

Prevents acute rheumatic fever only, not PSGN

Question 19

what imaging study is done to examine for renal function, scarring

Answer 19

Renal scintigraphy -ex: vesicouteral reflux pt diagnosed via VCUG, monitored for renal insufficiency, renal scarring via renal scintigraphy

Question 20

child younger than 10 yrs and older than 10 yrs with nephrotic syndrome, how should they be evaluated

Answer 20

child <10 yrs-clinically, given steroids child>10 yrs-renal biopsy to (rule out other nephrotic diseases), steroids

Question 21

most common cause of proteinuria in kids

Answer 21

Transient proteinuria-usually during a febrile illness (malaise, rhinorrhea -incidental finding on urine dipstick -perform a repeated urine dipstick -if (+) then do a 24 hour urinary protein for confirmation -if (+) consider renal US and renal biopsy

Question 22

how to collect urine samples in -diapered kids -kids

Answer 22

diapered kids-catheter, or aspiration of urine from the bladder kids-careful clean catch

Question 23

Name the 3 types of renal tubular acidosis with their characteristic findings

Answer 23

Question 24

7 yo Little boy with nightime bedwettting

Answer 24

Primary nocturnal enuresis

• kids >5 yrs old never achieved nightime dryness
• family history
• RX:

eneuresis alarms: #1 most effective, but takes 3-4 months to take effect

desmopressin (ADH)-prevents eneuresis at night, immediate effect but high rate of relapse @ stopping

• dec fluids b4 bedtime
• void b4 bedtime