Renal Disorders

Question 0

Which of the following best supports urinary tract infection (meron mahabang case about a girl with urinary symptoms)

a. midstream urine with ___
b. Catheterized specimen with 100,000 CFU

Answer 0

No answer given

Question 1

Patient with AGN still had low C3 after 3 months. What is your next approach?

a. Give another course of antibiotics
b. Start prednisone
c. Do Kidney biopsy

Answer 1

c. Do Kidney biopsy
* Nelson’s 18th: Renal biopsy is considered in the presence of: ARF, nephrotic syndrome, no evidence of strep infection, normal complement levels, or hematuria/proteinuria/diminished renal function/low C3 levels persistent more than 2 months after disease onset.

Question 2

A child was diagnosed with minimal change disease, asymptomatic. What should you do before starting steroids?

a. Do TST
b. Do TST and CXR
c. Treat with Isoniazid

Answer 2

a. Do TST

Question 3

Noted rbc cast and dysmorphic. Where did come from? 
A. convoluted tubules 
B. collecting ducts 
C. glomerulus 
D. ureters

Answer 3

C. NTP19 Ch 505.1
Acute Poststreptococcal glomerulonephritis
Urinalysis demonstrates red blood cells (RBCs), often in association with RBC casts, proteinuria, and polymorphonuclear leukocytes. A mild normochromic anemia may be present from hemodilution and low-grade hemolysis. The serum C3 level is significantly reduced in >90% of patients in the acute phase and returns to normal 6-8 wk after onset. Although serum CH50 is commonly depressed, C4 is most often normal in APSGN, or only mildly depressed.

Question 4

Patient presented with hematuria, Hypertension, proteinuria. He was diagnosed with IgA nephropathy. What is the primary treatment?
A.
B. control BP
C. corticosteroids
D. angiotensin-receptor antagonists regimen

Answer 4

(Nelson 19 th edition) The primary treatment of IgA nephropathy is appropriate blood pressure control. Fish oil, which contains anti-inflammatory omega-3 polyunsaturated fatty acids, decreases the rate of disease progression in adults. Immunosuppressive therapy with corticosteroids or more intensive multidrug regimens may be beneficial in some patients. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are effective in reducing proteinuria and retarding the rate of disease progression when used as single agents or in combination.

Question 5

Triad of microangiopathic haemolytic anemia, thrombocytopenia, and renal insuficiency 
A. Henoch Schonlein 
B. Hemolytic Uremic Syndrome 
C. SLE Nephritis 
D.

Answer 5

B NTP19 Ch 512 Hemolytic Uremic Syndrome
Hemolytic Uremic Syndrome (HUS) is one of the most common causes of community-acquired acute kidney failure in young children. It is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency

Question 6

Patient with renal failure and hemoptysis 
A. 
B. Goodpasture Disease 
C. 
D.

Answer 6

B NTP19 Ch 511 Goodpasture Disease
Goodpasture disease is rare in childhood. Patients usually present with hemoptysis from pulmonary hemorrhage that can be life-threatening. Concomitant renal manifestations include acute nephritic syndrome with hematuria, proteinuria, and hypertension, which usually follows a rapidly progressive course. Renal failure commonly develops within days to weeks of clinical presentation. Uncommonly, patients can have anti-GBM nephritis manifesting as isolated, rapidly progressive glomerulonephritis without pulmonary hemorrhage. In essentially all cases, serum anti-GBM antibody is present and complement C3 level is normal.

Question 7

36. Excellent in evaluating renal anatomy and suprarenal tumors
    a. ct scan
    b. KUB
    c. IVP
    d. VCUG

Answer 7

a. CT scan ?

Question 8

Px with arthritis, abdominal pain, rashes, with findings on urinalysis

Answer 8

HSP

Question 9

42.Microscopic hematuria in PSGN may persist until

Answer 9

1-2 years p.1740

Question 10

Pre-renal and renal causes of acute renal failure may be differentiated by the following EXCEPT:​
​a.  Urine eosinophils
​b.  Urine specific gravity
​c. Urine Sodium
​d.  BUN/Crea ratio

Answer 10

A. (p. 1769, Nelson’s). Table 527-1. Prerenal ARF I characterized by diminished effective circulating arterial volume, which leads to inadequate renal perfusion and a decreased glomerular filtration rate. Common causes of pre-renal ARF include dehydration, sepsis, hemorrhage, hypoalbuminemia and cardiac failure. Intrinsic renal ARF includes a variety of disorders characterized by renal parenchymal damage. HUS is the most common cause of intrinsic ARF in North America.