Renal-Fahim Flashcards
You are asked by an obstetrician to evaluate the results of intrauterine ultrasonography of a 35-year-old healthy female who is in the 20th week of her fourth pregnancy. Her husband is 41 years old and healthy, as are her three children. Ultrasonography reveals a probable male fetus that has severe bilateral hydronephrosis and oligohydramnios. Of the following, the MOST likely cause of the intrauterine hydronephrosis is:
A. autosomal dominant polycystic kidney disease
B. autosomal recessive polycystic kidney disease
C. medullary cystic disease
D. posterior urethral valves
E. prune belly syndrome
D. posterior urethral valves
A 2 y/o boy is brought to ER w/ complaints of fever, chills, and flank pain. His immunizations are UTD, and his mother states that it is his second time to have these symptoms. His tempterature is 39.1 (102.2) and PE is unremarkable except for CVA tenderness on the right. A CBC shows leukocytosis and UA shows the presence of WBC and RBC in the urine. What is the most likely mechanism of this patient’s recurrent complaints? A. immunoglobulin deficiency B. Nephroblastoma C. Poststreptococcal glomerulonephritis D. Vesicoureteral reflux
D. Vesicoureteral reflux
A 2 month old infant is found to have a horseshoe kidney. Which structure prevents this abnormal kidney from occupying its appropriate position? A. Aorta B. Celiac Trunk C. Inferior Mesenteric artery D. Inferior vena cava E. Superior mesenteric artery
C. Inferior Mesenteric artery
What is the most common cause of UTI’s?
E. coli
What should be considered in any child
UTI
UA obtained via catheter
How should you treat patients 2 months to 2 years old that have a UTI and are toxic appearing, dehydrated or unable to retain oral intake?
hospitalize and IV antibiotics
Who should be imaged for a UTI/
- All children younger than 5 years of age who have a febrile UTI
- GIRLS younger than 3 years of age and boys younger than 1 year of age experiencing a first UTI
- Children who have recurrent UTIs,
- Patients who do not respond promptly to appropriate antimicrobial therapy.
What is the most common site of urinary tract obstruction in children?
Uretero-Pelvic Junction Obstruction (UPJ)
Which collecting system problem can present with not peeing straight or severe hydronephrosis at a young age?
Posterior urethral valve
Nephrotic syndrome is characterized by severe protineuria, decreased serum albumin, and edema. This results from damage to one or more components of the glomerular capillary wall. In particular, the glomerular basemement membrane is essential for maintaining serum oncotic pressure. In nonpathological states, which of the following properties of the GBM prevent albumin from being freely filtered into the urine?
A. a combination of small pore size and negatively charged pore-forming molecules prevents albumin filtration
B. a combination of small pore size and positively charged pore-forming molecules prevents albumin filtration.
C. Albumin is freely filtered across the basement membrane but is readily reabsorbed along the nephron.
D. The positive charge of proteoglycans in the basement membrane repels albumin
E. The small size of the glomerular basement membrane pores excludes albumin molecules.
A. a combination of small pore size and negatively charged pore-forming molecules prevents albumin filtration
What does >3.5 g/day of protein in the urine or > 50 mg/kg/24 hours indicate?
Nephrotic symdrome
Which nephrotic syndrome presents with a uniform thickening of the glomerular capillary wall without significant mesangial proliferation (spike and dome appearance)?
Membranous glomerulopathy
“Be a member in the spike and dome club”
What is the nephrotic syndrome associated with fused foot processes? What is the prognosis?
Minimal change disease
good prognosis (only protein in urine in 2-6 yo)
What is Burger’s Disease?
IgA deposits in the mesangium (“A Messy Burger)
What nephrotic disorder has sub epithelial immune complex deposits describes as lumpy bumpy?
Post-strep GN
Which nephropathy presents with a uniform thickening of the glomerular capillary wall without significant mesangial proliferation (spike and dome appearance)?
Membranous glomerulopathy
(“Be a member in the spike and dome club”)
associated with SLE and drugs and can be with infection
Which nephropathy associated with effacement of the foot processes (fused foot processes)? What is the prognosis?
Minimal change disease
good prognosis (only protein in urine in 2-6 yo)
What is Berger’s Disease? How long after a URI is this seen?
- IgA nephropathy
- IgA deposits in the mesangium (“A Messy Burger)
- RIGHT AFTER a URI
Which nephropathy has sub epithelial immune complex deposits describes as lumpy bumpy? How long after an infection will this occur?
Post-strep GN
weeks after an infection
coca-cola urine
Which nephropathies have low serum complement?
PMS
Post-strep GN
Membranoproliferative GN
Systemic Lupus
A 16 year old boy comes to the physician w/ a 1 year hx of intermittent, painless hematuria without dysuria or increased frequency of micturition. He says he has also had several respiratory infections and adds that the hematuria increased w/in several days of the infections. Which of the following is most likely to be found if the boy is diagnosed with IgA nephropathy (Berger’s disease)? A. increased antistreptolysin O titer B. Lumpy-bumpy electron dense deposits C. Mesangial deposits D. Protienuria exceeding 3.5gm/24hr E. Subepithelial deposits
C. Mesangial deposits
A 5-year-old previously healthy girl is brought to the emergency department because of a 2-day history of fever and occasional vomiting. Her temperature is 102.5° (38.8°C), heart rate is 130 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 96/60 mm Hg. She is well-appearing, and her physical examination findings are normal. A complete blood count shows a white blood cell count of 7 x 10³/mcL (7 x 109/L) with a normal differential count. Her urinalysis shows a specific gravity of 1.020 and 1+ protein, but otherwise completely negative findings. Of the following, the MOST appropriate management of this girl’s proteinuria is to:
A. obtain a 24-hour urine protein collection
B. order a spot urine protein/creatinine ratio
C. perform renal ultrasonography
D. refer her to a nephrologist for follow-up
E. repeat the urinalysis after her illness has resolved
E. repeat the urinalysis after her illness has resolved
If you have organomegaly with a cherry red spot, what should you think of? What if you do NOT have organomegaly?
Organomegaly=Niemann Pick
No organomegaly=Tay Sachs
If you have organomegaly with a cherry red spot, what should you think of? What if you do NOT have organomegaly? What is deficient in each of these?
Organomegaly=Niemann Pick (deficiency in sphingomyelinase)
No organomegaly=Tay Sachs (deficient in hexoseaminidase A–> accumulation of GM 2)
