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Peds Shelf > Renal/GU > Flashcards

Renal/GU Flashcards

1
Q

How do you calculate an anion gap?

A

Na - (Cl + bicarb) = 12 +/- 2

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2
Q

What is a normal pH, Pco2 and O2 sat?

A

pH = 7.4

Pco2 = 40

sat = 98%

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3
Q

What can cause a respiratory acidosis?

A

Sedative OD

Hypoxemia

Pneumonia

Pulmonary edema

Airway obstruction/Bronchospasm

Brain stem injury

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4
Q

What causes a metabolic acidosis?

A

Increase in exogenous acid = MUDPILES

Inc. in endogenous acid = sepsis/lactic acid

Decrease in bicarb = diarrhea

Decreased acid elimination

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5
Q

What causes a metabolic alkalosis?

A

Loss of H+ = vomiting

Contractions of extracellular fluid volume

excessive bicarb (licorice, Cushings, hyperaldo)

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6
Q

A 6-week old child has a 2-week history of projectile vomiting that is not bile-stained. He is dehydrated and slightly jaundiced.

Na 138, K 3.0, Cl 88, HCO3 35 pH 7.52

A

Hypochloremic Metabolic Alkalosis

Give IVF!

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7
Q

An asthmatic in respiratory distress has a normal pH and normal Pco2 - what are you concerned about?

A

Impending respiratory failure

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8
Q

Failure H+ secretion in the distal tubule and collecting duct

A

Distal RTA

Hypercaliuria

Nephrocalcinosis

Nephrolithiasis

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9
Q

Decreased reabsorption of bicarb in the proximal tubule

A

Type 2: Proximal RTA

Isolated vs. Fanconi’s Syndrome

Rickets 2/2 phosphate wasting

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10
Q

Inadequate production or reduced response to aldosterone in the distal tubule

A

Type 3: Mineralocorticoid deficiency RTA

Adrenal problem or decreased renin production from JGA (interstitial damage)

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11
Q

Signs and Symptoms of RTA

A

Polyuria & dehydration

Anorexia, vomiting, constipation

Hypotonia

**Children often present with growth failure

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12
Q

Of the three RTAs which is lifelong and can lead to renal failure?

A

Distal - inc H+ secretion, stones

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13
Q

What is the most common cause of ARF in toddlers?

A

HUS

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14
Q

What can cause renal ARF?

A

GN

ATN

Interstitial nephritis

Small-vessel thrombosis -HUS or renal vein thrombosis

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15
Q

What are signs/symptoms of acute renal failure?

A

Oliguria

Edema

HTN

CHF

Seizures

Uremic encephalopathy

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16
Q

What metabolic derangements are seen with Acute Renal Failure

A

Hyper K

Hypo Ca and Hyper Phos

Anemia

Hyponatremia

Metabolic Acidosis

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17
Q

What causes the metabolic acidosis seen in patients with renal failure?

A

Decreased excretion of H+ and ammonia

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18
Q

What is the most common cause of CRF in children < 5 yo?

A

Anatomic anomalies

Renal hypoplasia, dysplasia, or malformation

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19
Q

Most patients with chronic renal failure are weak and have ____.

A

HTN

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20
Q

What is the expected BUN/Cr ratio in patients with prerenal acute renal failure?

A

BUN/Cre > 20

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21
Q

What are indications for emergent dialysis?

A

Acidosis

Electrolytes

Ingestion - toxins

Overload - fluid

Uremia

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22
Q

When do you treat kids with CKD with transfusion?

A

Hgb < 6

Use epo

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23
Q

How do you treat hypertensive emergencies in kids with CKD?

A

Salt restrict

ACE

β-blocker

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24
Q

On a routine exam, a 10 yo girl has HTN confirmed by repeated BP measurements. BP 160/90 in the right arm, and similar in L arm and R leg. What is the next most appropriate diagnostic step?

A

Renal Disease

UA

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25
Q

What are the most common causes of HTN in children?

A

Renal | 75%

Infection

GN

HUS

Obstructive uropathy

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26
Q

Wilms tumor is associated with what mutations on what chromosome?

A

p53, Ch 11

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27
Q

How do you treat a CKD patient who presents with bleeding due to defective platelets 2/2 uremia

A

Dialysis

Desmopressin

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28
Q

How does Wilms Tumor usually present? (4)

A

Age < 3

Abdominal/flank mass

Vomiting

HTN - obstruction of renal artery

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29
Q

How do you diagnose Wilms Tumor?

A

US and CT

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30
Q

How do you treat a Wilm’s Tumor

A

Non-hematogenous extension into abdomen = nephrectomy and chemo +/- radiation

Hematogenous mets or bilateral renal mets = Nephrectomy, 3 drug chemo, pulmonary irradiation

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31
Q

WAGR Syndrome

A

Wilms’ Tumor

Aniridia

GU malformation

Mental Retardation - del. @ 11p13

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32
Q

AD vs AR PKD

A

AR = Infant, dilated collecting ducts + cirrhosis/portal HTN

AD = 4th/5th decade, dilated tubules, present with hematuria/pain/mass/HTN

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33
Q

What is the leading cause of ESRD in the first decade?

A

Renal Hypoplasia

Fewer calyces and nephrons

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34
Q

A 1-week old male has wrinkled abdomen w/o abdominal musculature. He also has clubfeet and is in respiratory distress. His bladder is distended and easily palpable and neither testis is in his scrotum. BUN 30, Cr 2, Hco3 15.

A

Prune Belly Syndrome

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35
Q

Who gets horseshoe kidney?

A

7% are associated with Turners Syndrome

4x more common with Wilms’ Tumor

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36
Q

Nephrotic Syndrome

A

Proteinuria > 3.5g/24 hr

Hypoproteinemia

Hyperlipidemia

Edema, periorbital edema

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37
Q

What is the most common cause of nephrotic syndrome in kids?

A

Minimal change disease

Mesangial Proliferation

Focal sclerosis

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38
Q

How do you diagnose nephrotic syndrome?

A

Clinically

Confirmatory biopsy - fusion of epithelial foot processes EM

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39
Q

How do you treat nephrotic syndrome in kids?

A

Steroids - most will respond

Salt restrict to dec. edema

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40
Q

Patients losing protein in the urine are at risk for what?

A

Hypercoagulable state

Nephrotic loss of Antithrombin III

41
Q

Post-Strep GN

A

Immune complex disease from Group A β-hemolytic strep

10-14 days post strep infection

42
Q

How do you diagnose post strep GN?

A

Light microscopy - Enlarged glomeruli w/ mesangial proliferation and exudation of neutrophils

IF microscopy: Granular pattern

EM: Electron-dense humps on epithelial side

43
Q

How do you treat post strep GN?

A

Penicillin for 10 days

Peritoneal dialysis for fluid overload

**Microscopic hematuria can take 1 year to resolve

44
Q

What is the underlying abnormality in rapidly progressive GN?

A

Crescents in the majority of glomeruli

**Can progress thru several forms of GN**

45
Q

What are the crescents in RPGN made of?

A

Proliferative epithelial cells of the capsule

Fibrin

Macrophages

46
Q

What is the prognosis of RPGN? What can you try for treatment?

A

Poor prognosis

May respond to steroids of cyclophosphamide

47
Q

What is the most common cause of GN in older children?

A

Membranoproliferative GN

48
Q

Lobular, split glomeruli

Lobular C3 deposits

Immune complex deposits in mesangial and subendothelial regions

A

Membranoproliferative GN

Nephrotic Syndrome, Hematuria, HTN

Poor prognosis

49
Q

How does Membranous GN present?

A

Nephrotic syndrome +/- hematuria

Immune complex disease of kidney

Spike and dome on epithelial side of GBM

**Uncommon in children, most common in adults

50
Q

Do you treat membranous GN in children

A

Most cases spontaneously resolve

51
Q

What is the most common cause of gross hematuria in children?

A

IgA nephropathy

52
Q

Diffuse thickening of GBM w/o proliferative change

Granular IgG and C3 on epithelial side

A

Membranous

53
Q

How is “nephrotic syndrome” best controlled

A

Salt restriction

Diuretics

54
Q

A patient presents with hemoptysis, sinusitis, and GN

A

Wegener’s granulomatosis

55
Q

A patient presents with hemoptysis, dyspnea and ARF.

A

Goodpastures Syndrome

56
Q

What are 3 types of “normal” proteinuria?

A

Up to 150 mg/day

Postural (supine to standing)

Febrile - fever > 101˚

Exercise

57
Q

What are causes of Acute Interstitial Nephritis? (5)

A

Drugs, infection, sarcoid, GN, transplant rejection

PCN, cephalosporins, sulfonamides, rifampin

Phenytoin, thiazides, furosemide, allopurinol, amphotericin B, NSAIDS

58
Q

How do patients with AIN present?

A

ARF or generalized tubular dysfxn

59
Q

How do you diagnose AIN?

A

Renal bx: interstitial lymphocytes/plasma cells/Eφ/Nφ

Edema present

Normal glomeruli

60
Q

How do you treat AIN?

A

Remove inciting agent - kids often recover

61
Q

What causes Chronic Interstitial Nephritis? (3)

A

Drugs = analgesics, lithium

Infections

Vesicoureteral reflux

62
Q

How do kids with chronic interstitial nephritis present?

A

Symptoms of CKD

Nausea/vomiting

HA, fatigue

HTN

Growth failure

63
Q

How do you diagnose CIN?

A

Lymphocytes and plasma cells in interstitium

Fibrosis

Sclerosed glomeruli 2/2 ischemia

64
Q

What is the most common manifestation of SLE in childhood?

A

Lupus nephritis

65
Q

How does a renal vein thrombosis in infancy present?

A

Acute gross hematuria

Flank mass and pain

66
Q

How do you diagnose RVT?

A

US = enlarged kidnesy

Doppler = little renal function

67
Q

Which infants get RVT?

A

Dehydration

Shock

Sepsis

68
Q

What older kids get RVT? (4)

A

Nephrotic syndrome (membranous)

Cyanotic heart disease

Hypercoagulable states

Contrast

69
Q

What are the s/sx of neurogenic bladder (3)

A

Urinary incontinence (retention, overflow, frequency, urge)

UTIs

Upper tract deteriorations

70
Q

How do you diagnose urolithiasis?

A

Plain X-ray = Calcium and struvite (90%)

Abdominal CT = better for stones and hydronephrosis

71
Q

Struvite stones normally come from what?

A

Urease containing bugs, most commonly Proteus

[Mag, phosphate, ammonium]

72
Q

When do you see Uric Acid stones? (5) How do you treat?

A

Hyperuricosuria

Lesch-Nyhan

Post-chemo

Myeloproliferative disorders

IBD

**Radiolucent**

Allopurinol & Alkalinize Urine

73
Q

Where do you see Cystine stones? How do you treat?

A

Cystinuria, AR

Renal epithelial cells can’t absorb cystine, lysine, arginine, ornithine

D-penicillamine

74
Q

How do you treat calcium stones?

A

Thiazide

Potassium Citrate

Dietary Ca

Fluids

75
Q

When do you need to intervene?

A

> 5-6 mm via stent or lithotripsy

**obstruction or hydronephrosis

76
Q

What are predisposing factors to UTIs?

A

Female or uncircumcised male

VUR

Toilet training

Bubble baths

Tight clothes

Nylon panties/bathing suit

77
Q

What are the most common UTI pathogens?

A

E. coli

Klebsiella

Proteus

Enterococci

Staph saprophyticus

78
Q

Does cystitis cause fever?

A

No! Pyelonephritis

79
Q

7 yo girl with urinary urgency, frequency, suprapubic pain, and no flank pain or mass. UA shows many leukocytes, 2-5 RBCs, and no protein or casts. What is the next step?

A

Urine Culture

80
Q

How might an infant or a kid < 2 yo present with a UTI?

A

Neonate: FTT, feeding irregularities, diarrhea, vomiting, fever, hyperbili

1 month - 2 yo: Colic, irritability, GI complaints

81
Q

How do you diagnose UTI

A

> 100k colonies of single bacteria

> 10k colonies in symptomatic child

Any bacterial growth from properly obtained urine

Leukocytes > 5

Hematuria

White cell casts

82
Q

How do you treat a UTI?

A

2 mo- 2 years: 10-14 days of IV abx

Older: 5-7 days PO abx

Pyelo = 2 wks IV β-lactam/cephalosporin

83
Q

What kids with UTIs get renal US?

A

Children < 5 yo

All male children

**R/o hydronephrosis, dilation of distal ureter, bladder hypertorphy

84
Q

What kids with UTIs get a voiding cytourethrogram?

A

Kids < 5 yo

** Looking for VUR**

85
Q

How do you treat VUR?

A

Low dose antibiotic ppx, UA + culture q 3-4 months

Surgery if breakthrough UTI, unresolving or severe reflux

86
Q

Cryptorchidism

A

Failure of testes to descend by 6 months of age

Infertility, seminoma (regardless of treatment), hernia, torsion

87
Q

If testes are not palpated in the inguinal canal?

A

Orchiopexy after 12 months

88
Q

If testes are palpated in the inguinal canal?

A

LHRH therapy controversial

89
Q

Choriocarcinoma

A

Malignant tumor of syncytiotrophoblasts and cytotrophoblasts

High hCG

Surgery + chemo + radiation

90
Q

What is the most common germ cell tumor?

A

Seminoma

91
Q

Seminoma

A

High β-hCG

Radiation = good prognosis

92
Q

Dysgerminomas are associated with ___________.

A

XY gonadal dysgenesis

Y-DNA probes are important in diagnosis

93
Q

Yolk sac tumor

A

High α-fetoprotein, malignant germ cell tumor

Peak during infancy and childhood

94
Q

Sertoli Cell Tumors

A

Malignant sex cord stroma tumors

Produce Estrogen - feminization and precocious puberty

Dx: CT and horomone

Surgery + chemo

95
Q

What causes painful ulcers?

A

Chancroid - ducrei

Herpes

96
Q

What STDs cause painless ulcers?

A

Lymphogranuloma venereum (LGV)

Syphilis

97
Q

What STDs causes urethral discharge?

A

Gonorrhea

Chlamydia

Trichomonas

98
Q

How do you diagnose BV?

A

Fishy odor

Clue Cells

pH > 4.5

99
Q

How do you treat gonorrhea?

A

IM ceftriaxone

Peds Shelf (11 decks)

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