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Pediatrics > RENAL & GU DISORDERS > Flashcards

RENAL & GU DISORDERS Flashcards

1
Q

Remember what can pyridium effect?

A

Orange urine & can stain HARD contacts

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2
Q

Red urine can either be…?

A

Heme positive or heme negative

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3
Q

What causes heme-positive urine?

A

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

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4
Q

What causes heme-negative urine?

A

Drugs, dye, and some foods

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5
Q

What would cause hemoglobinuria?

A

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

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6
Q

What would cause myoglobinuria?

A

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

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7
Q

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

A

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

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8
Q

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

A

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

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9
Q

What happens if hematuria persists for 1-2 weeks?

A

Order urine culture, renal ultrasound, renal panel, CBC

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10
Q

What is benign familial hematuria?

A

Asymptomatic hematuria without renal abnormalities in multiple family members

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11
Q

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

A

E.coli!

UTI’s peak during toilet training

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12
Q

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

A

Pyelonephritis!!

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13
Q

How do you confirm pyelo?

A

UA, urine culture, and possibly a renal ultrasound

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14
Q

How do you treat pyelo in a child?

A

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

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15
Q

What’s the Abx you could start them on?

A

Nitrofurantinoin (otherwise Cipro – but increasing resistance)

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16
Q

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

A

Cystitis

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17
Q

How do you confirm the diagnosis of cystitis?

A

Hx, PE, UA, and urine culture

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18
Q

How do you treat cystitis & what are you preventing?

A

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

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19
Q

When would you treat a UTI in a child?

A

Only treat if culture confirms and sxs are present

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20
Q

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

A

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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21
Q

What does a dipstick detect?

A

Albuminuria & change in urine concentration

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22
Q

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

A

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

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23
Q

What if proteinuria persists for the other testings?

A

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

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24
Q

What is the most common cause proteinuria in children?

A

Orthostatic proteinuria – benign

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25
Q

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

A

Minimal change disease

26
Q

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

A

Focal segmental glomerulosclerosis

27
Q

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?

A

Primary nephrotic syndrome

28
Q

How do you diagnose primary nephrotic syndrome?

A

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

29
Q

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

A

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

30
Q

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

A

Cyclophosphomides or Cyclosporine

31
Q

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

A

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

32
Q

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?

A

Congenital nephrotic syndrome

33
Q

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

A

TIN = Tubulointerstitial nephritis

34
Q

What is not present in TIN on physical exam?

A

Hematuria & proteinuria are ABSENT

35
Q

How do you treat TIN?

A

Supportive

36
Q

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

A

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

Supportive

37
Q

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

A

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

38
Q

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

A

*Post-streptococal Glomerulonephritis

39
Q

How would you diagnose glomerulonephritis?

A

*Positive strep infection & Ultrasound = see enlarged kidneys

40
Q

How do you treat post-streptococcal glomerulonephritis?

A

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

41
Q

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

A

*Throat = Anti-streptolysin O tite

Skin = Deoxyribonuclease B anti-streptococcal

42
Q

What type of glomerulonephritis is due to an isolated disease?

A

Membranous glomerulopathy

43
Q

How do you diagnose a membranous glomerulopathy?

A

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

44
Q

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

A

*Hemolytic-Uremic Syndrome (HUS)

45
Q

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

A

Hemolytic-Uremic Syndrome

46
Q

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

A

Fever, abdominal pain, bloody diarrhea, vomiting

47
Q

How do you diagnose Hemolytic-uremic syndrome?

A

CBC – HGB is low & helmut & burr cells

Renal Panel – indicates acute renal failure (hyperkalemia, elevated BUN, and elevated creatinine)

48
Q

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?

A

Henoch-Schonlein Purpura Nephritis

49
Q

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

A

Toxic Nephropathy

50
Q

When does routine BP screening begin?

A

Age 3

51
Q

What is considered a high BP in a child?

A

95th percentile

52
Q

What symptoms might a child have along with hypertension?

A

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

53
Q

What type of labs do you get for pediatric hypertension?

A

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

54
Q

What is the most common cause of hypertension in children?

A

Vesicoureteral reflex

55
Q

What is vesicoureteral reflex?

A

retrograde flow of urine from bladder to ureter and renal pelvis

56
Q

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

A

Prevent pyelo, renal scarring, and progression to end stage renal disease

Abx prophylaxis – Nitro ¼ of the normal dose

57
Q

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

A

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

58
Q

At what age do you treat bed wetting with pharmacotherapy?

A

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

59
Q

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

A

Hypospadius

60
Q

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

A

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)

61
Q

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

A

Phimosis

Topical steroid TID x 3 weeks to loosen the skin

62
Q

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?

A

Paraphimosis – a medical emergency! Lubrication may help to treat

Pediatrics (12 decks)

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