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 from 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?

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?

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 of 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?

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?

Answer 16

Caucasian female with a fever

Question 17

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

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

Answer 17

1) Clean-catch urine

2) Bag urine sample

Question 18

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 18

Obtain a urine sample via catheterization or suprapubic aspiration

Question 19

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

Answer 19

1) Pyuria

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

Question 20

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

Answer 20

1) Pyuria

2) Any growth on culture

Question 21

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 21

1) Leukocyte Esterase

2) Urine Nitrate Testing

Question 22

What bacteria is the most common cause of UTI?

Answer 22

Escherichia (E. coli)