RENAL & GU DISORDERS Flashcards by Denise Bekkedahl

Remember what can pyridium effect?

Orange urine & can stain HARD contacts

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Red urine can either be…?

Heme positive or heme negative

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What causes heme-positive urine?

Hemoglobin (protein of blood FREE from RBC’s) or Myoglobin (protein of muscle)

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What causes heme-negative urine?

Drugs, dye, and some foods

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What would cause hemoglobinuria?

Hemolytic anemia (rapid disintegration of RBC’s, exceeding the ability of blood protein to bind to hemoglobin)

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What would cause myoglobinuria?

Skeletal muscle injury – from trauma or even after exercise, or in rhabdomyolysis (with five fold increase in CK levels)

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What do you need to check for in hematuria of a child?

Family Hx; social Hx; PE (including vitals, edema, hepatosplenomegaly, abdominal mass, anatomic abnormalities of external genitalia)

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If a child has hematuria and is not acutely ill, what diagnostics would you do?

Repeat the UA (first morning urination!!) on two other occasions within 1-2 weeks

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What happens if hematuria persists for 1-2 weeks?

Order urine culture, renal ultrasound, renal panel, CBC

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What is benign familial hematuria?

Asymptomatic hematuria without renal abnormalities in multiple family members

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What type of bacteria most commonly causes UTI in children? When do UTI’s peak in children?

E.coli!

UTI’s peak during toilet training

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If a child presents with abdominal pain, flank pain, fever, with nausea and vomiting, what diagnosis?

Pyelonephritis!!

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How do you confirm pyelo?

UA, urine culture, and possibly a renal ultrasound

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How do you treat pyelo in a child?

Abx therapy is dependent on urine culture. Also consider dehydration (or sepsis is unable to hold fluids)

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What’s the Abx you could start them on?

Nitrofurantinoin (otherwise Cipro – but increasing resistance)

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If a child presents with dysuria, frequency, urgency, odor of urine, and abdominal pain, what diagnosis?

Cystitis

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How do you confirm the diagnosis of cystitis?

Hx, PE, UA, and urine culture

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How do you treat cystitis & what are you preventing?

Urine culture guides Abx, treat early to prevent progression to pyelo

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When would you treat a UTI in a child?

Only treat if culture confirms and sxs are present

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When would you do imaging on a child with a UTI? What type of imaging?

If first UTI is occurring before age 5, febrile UTI, recurring UTI, or a male with a UTI

Voiding cystourethrogram – 2 weeks AFTER UTI

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What does a dipstick detect?

Albuminuria & change in urine concentration

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If proteinuria is found on a dipstick with absence of other symptoms, what do you do?

Repeat the dipstick on 2-3 other occasions – first AM urine!

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What if proteinuria persists for the other testings?

24 hour urine excretion – upper limit of normal is 150mg/24 hours

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What is the most common cause proteinuria in children?

Orthostatic proteinuria – benign

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What is the most common primary nephrotic syndrome, due to reaction to corticosteroid therapy?

Minimal change disease

What type of primary nephrotic syndrome is the worst and often leads to renal failure?

Focal segmental glomerulosclerosis

If a male child has facial and lower extremity edema (that almost looks like an allergic reaction) along with abdominal pain, diarrhea, and irritability, what diagnosis?

Primary nephrotic syndrome

How do you diagnose primary nephrotic syndrome?

3-4+ proteinuria (persisting); urinary protein exceeds 150mg/24hr; serum creatinine is normal

How do you treat primary nephrotic syndrome or ANY generalized edema?

Hospitalize, close monitoring of volume status, maybe diuretics as directed by peds nephrologist First episode between age 1-8 = initiate corticosteroid (60mg/day divided) If younger than 1 or over 8 or with HTN or hematuria = do a renal biopsy

What are other treatment options besides steroids for primary nephrotic syndrome?

Cyclophosphomides or Cyclosporine

If a child is over the age of 8 with HTN, persisting hematuria, renal dysfunction, and rash or arthralgia, what diagnosis?

secondary nephrotic syndrome (membranous, membranoproliferative glomerulonephritis, postinfectious glomerunephritis, Henoch-Schonlein purpura nephritis)

If there is significant proteinuria in-utero (tested via alpha-fetoprotein) what does that mean? Or if an infant has poorly defined sutures, respiratory troubles, and a premature birth?

Congenital nephrotic syndrome

If a child presents with a fever, rash, and arthralgia with steadily rising creatinine, what diagnosis?

TIN = Tubulointerstitial nephritis

What is not present in TIN on physical exam?

Hematuria & proteinuria are ABSENT

How do you treat TIN?

Supportive

What would cause acute TIN? How do you treat acute TIN?

Abx – possibly immune mediated often presents 1-2 weeks after a viral infection Supportive

What would cause chronic TIN? How would you diagnose & treat chronic TIN?

Analgesics, sickle cell, heavy metal, Alport syndrome (deafness, large thrombocytes, cataracts) with underlying renal disease Diagnose = escalating creatinine levels, ultrasound showing small kidneys Tx = Supportive

If a child has a sudden onset of hematuria, edema, HTN, and renal insufficiency following a strep infection, what diagnosis?

*Post-streptococal Glomerulonephritis

How would you diagnose glomerulonephritis?

*Positive strep infection & Ultrasound = see enlarged kidneys

How do you treat post-streptococcal glomerulonephritis?

*Control renal failure (HTN, sodium restriction, and ACEI), supportive, and appropriate Abx

What would show a recent strep THROAT test (not skin)? What would confirm step SKIN infection?

*Throat = Anti-streptolysin O tite Skin = Deoxyribonuclease B anti-streptococcal

What type of glomerulonephritis is due to an isolated disease?

Membranous glomerulopathy

How do you diagnose a membranous glomerulopathy?

Biopsy – for persisting hematuria and proteinuria and lack of other explanations

What’s the most common cause of acute renal failure in kids?

*Hemolytic-Uremic Syndrome (HUS)

If a child had a GI illness, and now has anemia, uremia, and thrombocytopenia, what diagnosis?

Hemolytic-Uremic Syndrome

How does the child often present with Hemolytic-uremic syndrome?

Fever, abdominal pain, bloody diarrhea, vomiting

How do you diagnose Hemolytic-uremic syndrome?

CBC – HGB is low & helmut & burr cells Renal Panel – indicates acute renal failure (hyperkalemia, elevated BUN, and elevated creatinine)

If a child had a URI a few weeks prior and now has a rash, arthralgia (especially in the groin area), and abdominal pain, what diagnosis?

Henoch-Schonlein Purpura Nephritis

What type of nephropathy is caused by medications or diagnostics dye?

Toxic Nephropathy

When does routine BP screening begin?

Age 3

What is considered a high BP in a child?

95th percentile

What symptoms might a child have along with hypertension?

HA, blurry vision, UTI, edema, rash & DOE

What type of labs do you get for pediatric hypertension?

UA, urine culture, BMP, CBC, renal ultrasound, and EKG

What is the most common cause of hypertension in children?

Vesicoureteral reflex

What is vesicoureteral reflex?

retrograde flow of urine from bladder to ureter and renal pelvis

What is the goal when treating vesicoureteral reflux? And how do we accomplish this?

Prevent pyelo, renal scarring, and progression to end stage renal disease Abx prophylaxis – Nitro ¼ of the normal dose

When does toilet training often begin? When are MOST kids dry through the night?

Begins age 2-3 & MOST are dry through the night by 5

At what age do you treat bed wetting with pharmacotherapy?

Reassurance is key, don’t treat until age 7 with desmopressin (VERY low dose)

What is it called if the opening of the penis is on the top?

Hypospadius

What must you first make sure of when a baby boy is born, and if they hypospadias how do you treat it?

Make sure their urethral opening is in the correct place if not, DO NOT CIRCUMCISE UNTIL 6-12 MONTHS (since they use the foreskin to correct this)

What is it known as when the foreskin cannot be pulled down? How do you treat this?

Phimosis | Topical steroid TID x 3 weeks to loosen the skin

What is it known as when the foreskin is retracted and cannot move back towards the tip of the penis? How do you treat this?

Paraphimosis – a medical emergency! Lubrication may help to treat