Renal - (Part 2) - Unit 3

Question 1

What are the three different types of nephrotic syndrome?

Answer 1

Minimal change nephrotic syndrome (most common), Secondary Nephrotic syndrome (often due to acute glomerulonephritis, can be due to other diseases such as lupus) and congenital nephrotic syndrome (transplant by age 2)

Question 2

What is minimal change nephrotic syndrome?

Answer 2

Autoimmune process that occurs one week after an immune assault - increases glomerular permeability to protein - leads to MASSIVE MASSIVE MASSIVE urinary protein loss.

Question 3

Which is the most common presentation of glomerular injury in pediatrics?

Answer 3

Nephrotic syndrome

Question 4

What are the four main issues in nephrotic syndrome?

Answer 4

Massive proteinuria, hyperlipidemia, edema, hypoalbuminemia

Question 5

Proteins in the blood help hold fluid in the blood vessel, so if you potty out the protein…the water passes from the vascular space to the tissues. T/F?

Answer 5

True

Question 6

Who is most likely to get nephrotic syndrome? (Hint - think of a certain little one you know and love…)

Answer 6

Preschoolers & males

Question 7

What are some manifestations of nephrotic syndrome?

Answer 7

Weight gain, edema (begins with facial edema), diarrhea, decreased urine output, urine is dark and frothy!, and normal/slightly decreased BP

Question 8

What is severe generalized edema called?

Answer 8

Anasarca

Question 9

Why do we see the lines on the nails (muehrcke) for nephrotic syndrome patients?

Answer 9

Due to prolonged hypoalbumemia.

Question 10

Why would the child with nephrotic syndrome experience high levels of platelets?

Answer 10

Hemoconcentration

Question 11

How do we diagnose nephrotic syndrome?

Answer 11

History, MASSIVE MASSIVE MASSIVE proteinuria, hypoalbuminemia, hyperlipidemia (cholesterol may be as high as 400-1500)

Question 12

How do we manage nephrotic syndrome?

Answer 12

Managed at home, decrease protein, regular diet but Na restriction, don’t need high protein (no evidence), 3 months corticosteroids, immunosuppressive (cytoxan - reduces relapse), loop diruetics

Question 13

What are some complications of nephrotic syndrome?

Answer 13

Renal failure, infection, cellulitis, pneumonia, relpase

Question 14

What is the accumulation of nitrogenous waste within the body?

Answer 14

Azotemia

Question 15

What is renal failure?

Answer 15

The inability of the kidney to excrete waste or conserve water/electrolytes

Question 16

What is the most common cause of renal failure in children?

Answer 16

Dehydration and poor perfusion

Question 17

What are the causes of acute renal failure (3)

Answer 17

Prerenal (due to reduction in renal perfusion in a normal kidney), intrinsic (diseases and nephrotoxic agents that damage kidneys), post renal (obstruction)

Question 18

What is stimulated in the presence of hypovolemia and decreased glomerular perfusion?

Answer 18

Renin, Aldosterone, ADH - leads to an even more decreased renal flow.

Question 19

ARF - elevated BUN, severe reduction in glomerular filtration, stimulation of renin mechanism (leads to vasoconstriction), reduction in renal blood flow. T/F?

Answer 19

True

Question 20

What are some manifestations of ARF?

Answer 20

Oliguria (less than 1ml/kg/hr), edema, HTN, circulatory congestion, cardiac arrhythmia’s (r/t hyperkalemia), seizures (r/t hyponatremia/hypocalcemia), metabolic acidosis

Question 21

What electrolytes are increased in ARF?

Answer 21

PUMP - potassium, urea, magnesium, phosphate

Question 22

What electrolyte is decreased in ARF?

Answer 22

Calcium

Question 23

what are some complications of ARF?

Answer 23

Anemia, seizures/coma, cardiac failure, death

Question 24

How do we treat ARF?

Answer 24

Prevention, treat underlying cause, dialysis, fluids, foods HIGH in carbs and FAT but low in protein, TPN, manage complications

Question 25

Peritoneal dialysis - how is it done?

Answer 25

Water and solutes diffuse across the child’s peritoneum.

Question 26

High glucose concentration in the fluids = more pulled from the peritoneum during peritoneal dialysis. T/F?

Answer 26

True

Question 27

What are some complications of peritoneal dialysis?

Answer 27

Peritonitis, pain during infusion of fluids, leakage around the catheter, respiratory symptoms (too much abdominal fluids, leakage of fluid to chest from hole in diaphragm)

Question 28

Who is NOT a candidate for peritoneal dialysis?

Answer 28

Abdominal incisions, respiratory distress, bowel perforation

Question 29

What 3 major manifestations are seen in hemolytic uremic syndrome?

Answer 29

Hemolytic anemia, thrombocytopenia, renal failure

Question 30

Who is most likely going to get HUS?

Answer 30

Children between the ages of 6 months and 3 years

Question 31

What causes HUS?

Answer 31

Most cases have no causative agent - typically Shigella or E-Coli - but has been traced to undercooked and unpasteurized foods.

Question 32

What historical finding might you see in someone with HUS?

Answer 32

An acute GI infection or an acute respiratory infection.

Question 33

What happens with HUS?

Answer 33

The endothelial lining of the glomerular arterioles are damaged and platelets and fibrin clots occlude blood vessels (leads to anemia and thrombocytopenia)

Question 34

The glomeruli are usually the site of primary injury in HUS - what are the other organs?

Answer 34

Liver, brain, heart, pancreas, muscles

Question 35

What are some manifestations of HUS?

Answer 35

Bloody diarhea, hypertension, fever, lethargy, anemia, renal failure, elevated reticulocyte count, thrombocytopenia, normal Pt, PTT, fibrinogen, and coagulation factors

Question 36

What does an elevated lactase dehydrogenase (LDH) level mean?

Answer 36

Increased indirect bili (intravascular hemolysis)

Question 37

How do we manage HUS?

Answer 37

Supportive care, dialysis, managing complications (renal failure, anemia, CNS alterations, abdominal symptoms)

Question 38

What temp should meat be cooked to?

Answer 38

74 degrees C or 165 degrees F