RENAL & GU DISORDERS

Question 1

Remember what can pyridium effect?

Answer 1

Orange urine & can stain HARD contacts

Question 2

Red urine can either be…?

Answer 2

Heme positive or heme negative

Question 3

What causes heme-positive urine?

Answer 3

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

Question 4

What causes heme-negative urine?

Answer 4

Drugs, dye, and some foods

Question 5

What would cause hemoglobinuria?

Answer 5

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

Question 6

What would cause myoglobinuria?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

What happens if hematuria persists for 1-2 weeks?

Answer 9

Order urine culture, renal ultrasound, renal panel, CBC

Question 10

What is benign familial hematuria?

Answer 10

Asymptomatic hematuria without renal abnormalities in multiple family members

Question 11

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

Answer 11

E.coli!

UTI’s peak during toilet training

Question 12

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

Answer 12

Pyelonephritis!!

Question 13

How do you confirm pyelo?

Answer 13

UA, urine culture, and possibly a renal ultrasound

Question 14

How do you treat pyelo in a child?

Answer 14

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

Question 15

What’s the Abx you could start them on?

Answer 15

Nitrofurantinoin (otherwise Cipro – but increasing resistance)

Question 16

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

Answer 16

Cystitis

Question 17

How do you confirm the diagnosis of cystitis?

Answer 17

Hx, PE, UA, and urine culture

Question 18

How do you treat cystitis & what are you preventing?

Answer 18

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

Question 19

When would you treat a UTI in a child?

Answer 19

Only treat if culture confirms and sxs are present

Question 20

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

Answer 20

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

Voiding cystourethrogram – 2 weeks AFTER UTI

Question 21

What does a dipstick detect?

Answer 21

Albuminuria & change in urine concentration

Question 22

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

Answer 22

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

Question 23

What if proteinuria persists for the other testings?

Answer 23

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

Question 24

What is the most common cause proteinuria in children?

Answer 24

Orthostatic proteinuria – benign

Question 25

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

Answer 25

Minimal change disease

Question 26

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

Answer 26

Focal segmental glomerulosclerosis

Question 27

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?

Answer 27

Primary nephrotic syndrome

Question 28

How do you diagnose primary nephrotic syndrome?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

Cyclophosphomides or Cyclosporine

Question 31

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

Answer 31

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

Question 32

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?

Answer 32

Congenital nephrotic syndrome

Question 33

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

Answer 33

TIN = Tubulointerstitial nephritis

Question 34

What is not present in TIN on physical exam?

Answer 34

Hematuria & proteinuria are ABSENT

Question 35

How do you treat TIN?

Answer 35

Supportive

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

*Post-streptococal Glomerulonephritis

Question 39

How would you diagnose glomerulonephritis?

Answer 39

*Positive strep infection & Ultrasound = see enlarged kidneys

Question 40

How do you treat post-streptococcal glomerulonephritis?

Answer 40

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

Question 41

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

Answer 41

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

Question 42

What type of glomerulonephritis is due to an isolated disease?

Answer 42

Membranous glomerulopathy

Question 43

How do you diagnose a membranous glomerulopathy?

Answer 43

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

Question 44

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

Answer 44

*Hemolytic-Uremic Syndrome (HUS)

Question 45

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

Answer 45

Hemolytic-Uremic Syndrome

Question 46

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

Answer 46

Fever, abdominal pain, bloody diarrhea, vomiting

Question 47

How do you diagnose Hemolytic-uremic syndrome?

Answer 47

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

Question 48

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?

Answer 48

Henoch-Schonlein Purpura Nephritis

Question 49

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

Answer 49

Toxic Nephropathy

Question 50

When does routine BP screening begin?

Answer 50

Age 3

Question 51

What is considered a high BP in a child?

Answer 51

95th percentile

Question 52

What symptoms might a child have along with hypertension?

Answer 52

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

Question 53

What type of labs do you get for pediatric hypertension?

Answer 53

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

Question 54

What is the most common cause of hypertension in children?

Answer 54

Vesicoureteral reflex

Question 55

What is vesicoureteral reflex?

Answer 55

retrograde flow of urine from bladder to ureter and renal pelvis

Question 56

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

Answer 56

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

Question 57

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

Answer 57

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

Question 58

At what age do you treat bed wetting with pharmacotherapy?

Answer 58

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

Question 59

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

Answer 59

Hypospadius

Question 60

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

Answer 60

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)

Question 61

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

Answer 61

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

Question 62

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?

Answer 62

Paraphimosis – a medical emergency! Lubrication may help to treat