Renal Clinical Medicine Part 6: Pediatrics (Newman)

Question 1

Hematuria is characterized as the presence of how many RBCs per high power field in 3 consecutive fresh, centrifuged specimens obtained over the span of a few weeks?

Answer 1

The presence of 3 or more RBCs per high power field

Question 2

What can cause a positive urine dipstick result to occur with no intact red blood cells present?

Answer 2

1) Myoglobin

2) Hemoglobin

Question 3

What can cause a brick red color in the diaper of newborns?

Answer 3

Uric acid crystals in urine

Question 4

When are urinalysis typically done in pediatric patients?

Answer 4

1) 5 year old check up

2) Pre-participation physicals

Question 5

When confirming that the color of the urine is actually from blood what should be ordered?

Answer 5

UA with microscopy

Question 6

When distinguishing between glomerular or extraglomerular hematuria, the presence of RBC casts is indicative of?

Which has uniform RBC morphology while the other is dysmorphic?

Proteinuria is indicative of?

Clots are indicative of?

Answer 6

1) Glomerular
2) Extraglomerular is uniform
3) Glomerular
4) Extraglomerular

Question 7

Which is more ominous, hematuria alone or hematuria and proteinuria together?

Answer 7

Hematuria and proteinuria together

Question 8

If a child presents with periorbital edema with gross hematuria along with proteinuria what is the most likely diagnosis?

What usually precedes this?

(HYHO)

Answer 8

1) Post Infectious Acute Glomerulonephritis

2) Strep throat

Question 9

Post Infectious Acute Glomerulonephritis leads to deposition of immune complexes in?

Answer 9

Glomeruli

Question 10

If a child presents with gross hematuria, abdominal/joint pain, and purpura that present over the buttocks/lower legs/elbows what is the most likely diagnosis?

Answer 10

IgA vasculitis (Henoch-Schonlein Purpura)

Question 11

What is prognostically indicative of potential long term renal damage in IgA vasculitis (Henoch-Schonlein Purpura) patients?

(HYHO)

Answer 11

Development of proteinuria along with the hematuria

Question 12

If a child present with hematuria that is not gross and they have no renal dysfunctions, what is the the most likely diagnosis?

These patients should still be regularly monitored for?

Answer 12

1) Asymptomatic (isolated) Hematuria

2) Proteinuria and HTN

Question 13

If the urine Ca-to-Creatinine ratio is more than 0.2, this is indicative of?

What does it cause?

Answer 13

1) Hypercalciuria

2) Asymptomatic microscopic hematuria

Question 14

If a child presents with hematuria after sports practice what is the most likely diagnosis?

Answer 14

March hematuria

Question 15

What are some signs and symptoms of UTI in children?

HYHO

Answer 15

1) Fever
2) Frequency
3) Urgency
4) Dysuria
5) Loss of control

Question 16

What population of children have the highest prevalence of UTI?

(HYHO)

Answer 16

Caucasian girls with a fever

Question 17

If a child can void on command, what may be obtained when UTI is suspected?

What is key to obtaining a good specimen with this method?

(HYHO)

Answer 17

1) Clean-catch urine specimen

2) Cleanliness

Question 18

What samples are only helpful if negative and are not appropriate for culture?

(HYHO)

Answer 18

Bag urine sample

Question 19

If the child is still in diapers(not potty trained), the most reliable way to obtain a urine specimen for culture and sensitivity is?

(HYHO)

Answer 19

1) Catheterization of the bladder

2) Supra-pubic aspiration

Question 20

When UTI is suspected, if a child is acutely ill, febrile and empiric antibiotics are going to be given, what do you want to do prior to the medication being given?

Answer 20

Obtain a urine sample via catheterization or suprapubic aspiration

Question 21

What is the criteria for the diagnosis of a UTI if the urine is collected by clean catch or by catheter?

Answer 21

1) Pyuria

2) At least 50,000 colonies per ml of a SINGLE uro-pathogenic organism

Question 22

What is the criteria for the diagnosis of a UTI if the urine is collected by suprapubic aspiration?

Answer 22

1) Pyuria

2) Any growth on culture

Question 23

What enzyme is present in most WBCs and is tested for in the urine for bacterial infections?

What is another screening test for presence of UTI?

Answer 23

1) Leukocyte Esterase

2) Urine Nitrate Testing

Question 24

What bacteria is the most common cause of UTI?

HYHO

Answer 24

Escherichia coli (E. coli)

Question 25

When treating a UTI, what can be given to children that are not acutely ill and/or can tolerate oral antibiotics?

What is given to acutely ill and/or not tolerating PO so must be given parenterally?

Answer 25

1) Cephalosporin like cefixime or cefdinir

2) Third generation cephalosporin (ceftriaxone)

Question 26

What type of imaging should be done after the first UTI in boys and second in girls?

(HYHO)

Answer 26

Renal and bladder ultrasound

Question 27

When do you want to include a VCUG (voiding cystourethrogram) when imaging for UTI?

(HYHO)

Answer 27

1) Abnormalities seen on RBUS
2) Combination of temp >102.2°F and pathogen other than E.Coli
3) Poor growth and hypertension is part of the clinical presentation
4) Repeated UTIs

Question 28

A VCUG is looking for evidence of?

Answer 28

Vesicoureteral reflux

Question 29

Vesicoureteral reflux is notorious for?

Answer 29

Renal scarring

Question 30

What is renal scarring?

Answer 30

The loss of renal parenchyma between the calyces and the renal capsule

Question 31

When does the primary care provider refer to a specialist?

Answer 31

1) Dilating vesicoureteral reflux (grades III-V)
2) Obstructive uropathy is present
3) HTN
4) Renal abnormalities
5) Kidney function is impaired

Question 32

Empiric treatment of a child with UTI/pyelonephritis must include coverage for?

(HYHO)

Answer 32

Escherichia coli