Renal and cardiac pediatric pearls Flashcards
What clinical signs can point to acute PSGN? (7)
gross hematuria
HTN
edema
UA reveals hematuria/proteinuria of varying degrees
ASO titers elevated
low serum C3
deposition of immune complexes in glomeruli
How to treat patients with PSGN? prognosis?
supportive care
good prognosis
What is the prognostic indicator of long term renal damage in children with henoch schonlein?
the development of proteinuria along with hematuria indicates long term renal damage
What are the signs and symptoms of henoch? (7)
gross hematuria abdominal pain bloody stool purpura over lower legs, butt, elbows hives emesis and nausea diarrhea
What are the signs and symptoms of a UTI in children? (9)
fever with no identifiable cause frequency urgency dysuria loss of control decreased intake strong smelling urine dark urine stomach pain
What are the acceptable methods of obtaining a urine specimen when UTI is suspected?
clean catch
catheterization
suprapubic aspiration
if child is acutely ill, febrile and empiric antibiotics are going to be given, try to obtain a urine sample via cath or SPA prior to medication being given
What are the criteria for diagnosis of a UTI?
if clean catch, the presence of both pyuria and at least 50,000 colonies per ml of a single pathogenic organism
if catheter, pyuria and a colony count of 50,000 or 10,000-50,000 confirmed by repeat
What is the most common pathogen causing UTI in children?
E coli
How do you treat a UTI?
if not acutely ill, cephalosporin like cefixime or cefdinir.
if acutely ill, third generation cephalospirins like ceftriaxone
when do you image a child’s urinary tract?
after the first UTI in boys, renal and bladder US. include VCUG if any anomalies are found
after second UTI, VCUG
When do you refer a UTI patient to a specialist?
in the case of a dilating VUR if obstructive uropathy is present if renal abnormalities are identified kidney function impaired pt HTN
When do you refer a patient with a murmur to a cardiologist?
grade 4 murmur or above
diastolic murmur
increased intensity when patient stands
Cyanotic congenital heart diseases: 5
truncus arteriosus transposition of great vessels tricuspid atresia TOF total anomalous vascular return hypoplastic left heart ebsteins anomaly pulmonary atresia
Acyanotic congenital heart diseases: 4
ASD
VSD
PDA
CoA
How do you check for a possible congenital anomaly in an infant before they are discharged from hospital?
check O2 saturation preductal and post ductal, LE, UE. if its less than 90%, they fail. if repeated 3 times and still between 90-95, or greater than 3% difference, they fail
