Renal Clinical Medicine Part 6: Pediatrics (Newman) Flashcards
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?
The presence of 3 or more RBCs per high power field
What can cause a positive urine dipstick result to occur with no intact red blood cells present?
1) Myoglobin
2) Hemoglobin
What can cause a brick red color in the diaper of newborns?
Uric acid crystals in urine
When are urinalysis typically done in pediatric patients?
1) 5 year old check up
2) Pre-participation physicals
When confirming that the color of the urine is actually from blood what should be ordered?
UA with microscopy
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?
1) Glomerular
2) Extraglomerular is uniform
3) Glomerular
4) Extraglomerular
Which is more ominous, hematuria alone or hematuria and proteinuria together?
Hematuria and proteinuria together
If a child presents with periorbital edema with gross hematuria along with proteinuria what is the most likely diagnosis?
What usually precedes this?
(HYHO)
1) Post Infectious Acute Glomerulonephritis
2) Strep throat
Post Infectious Acute Glomerulonephritis leads to deposition of immune complexes in?
Glomeruli
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?
IgA vasculitis (Henoch-Schonlein Purpura)
What is prognostically indicative of potential long term renal damage in IgA vasculitis (Henoch-Schonlein Purpura) patients?
(HYHO)
Development of proteinuria along with the hematuria
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?
1) Asymptomatic (isolated) Hematuria
2) Proteinuria and HTN
If the urine Ca-to-Creatinine ratio is more than 0.2, this is indicative of?
What does it cause?
1) Hypercalciuria
2) Asymptomatic microscopic hematuria
If a child presents with hematuria after sports practice what is the most likely diagnosis?
March hematuria
What are some signs and symptoms of UTI in children?
HYHO
1) Fever
2) Frequency
3) Urgency
4) Dysuria
5) Loss of control
What population of children have the highest prevalence of UTI?
(HYHO)
Caucasian girls with a fever
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)
1) Clean-catch urine specimen
2) Cleanliness
What samples are only helpful if negative and are not appropriate for culture?
(HYHO)
Bag urine sample
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)
1) Catheterization of the bladder
2) Supra-pubic aspiration
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?
Obtain a urine sample via catheterization or suprapubic aspiration
What is the criteria for the diagnosis of a UTI if the urine is collected by clean catch or by catheter?
1) Pyuria
2) At least 50,000 colonies per ml of a SINGLE uro-pathogenic organism
What is the criteria for the diagnosis of a UTI if the urine is collected by suprapubic aspiration?
1) Pyuria
2) Any growth on culture
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?
1) Leukocyte Esterase
2) Urine Nitrate Testing
What bacteria is the most common cause of UTI?
HYHO
Escherichia coli (E. coli)
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?
1) Cephalosporin like cefixime or cefdinir
2) Third generation cephalosporin (ceftriaxone)
What type of imaging should be done after the first UTI in boys and second in girls?
(HYHO)
Renal and bladder ultrasound
When do you want to include a VCUG (voiding cystourethrogram) when imaging for UTI?
(HYHO)
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
A VCUG is looking for evidence of?
Vesicoureteral reflux
Vesicoureteral reflux is notorious for?
Renal scarring
What is renal scarring?
The loss of renal parenchyma between the calyces and the renal capsule
When does the primary care provider refer to a specialist?
1) Dilating vesicoureteral reflux (grades III-V)
2) Obstructive uropathy is present
3) HTN
4) Renal abnormalities
5) Kidney function is impaired
Empiric treatment of a child with UTI/pyelonephritis must include coverage for?
(HYHO)
Escherichia coli
