Renal, Urinary, & Electrolytes Flashcards
Renal Physiology
Hypovolemia –> RAAS
Angiotensin II
- -increases HCO3 reabsorption
- -increased Aldosterone
Aldosterone
- -increases absorption of (2)?
- -in exchange for secretion of (2)?
Renal Physiology
Hypovolemia –> RAAS
Angiotensin II
- -increases HCO3 reabsorption
- -increases Aldosterone
Aldosterone
- -increases Na, H2O absorption
- -in exchange for wasting of K, H
Renal Physiology
AG equation?
Renal Physiology
AG equals Na - (Cl plus HCO3)
Minimal Change Disease
Pathophys: T cell mediated injury to podocytes –> increased px to albumin
Features:
- -proteinuria
- -edema (periorbital, lower extremities)
- -re: serum albumin, lipids?
Tx?
Minimal Change Disease
–most common pediatric nephrotic syndrome
Pathophys: T cell mediated injury to podocytes –> increased px to albumin
Features:
- -proteinuria
- -hypoalbuminemia
- -edema (periorbital, lower extremities)
- -hyperlipidemia
Tx: Prednisone
Biopsy
–only if unresponsive to steroids or in presence of hematuria
Complication
–infxn (spontaneous bacterial peritonitis via S. pneumoniae)
Renal Biopsy
Associated dx?
- IgA mesangial deposition
- Linear deposition of IgG on the basement membrane
- Fusion or flattening of podocytes (“foot processes”)
- mesangial hypercellularity
- lumpy-bumpy deposits of Ig and complement on GBM and in mesangium
- alternating areas of thickened and thinned capillary loops with splitting of the GBM
Renal Biopsy
- Henoch Schonlein Purpura
- -IgA mesangial deposition - Goodpasture Syndrome
- -linear deposition of IgG on the basement membrane - Minimal Change Disease
- -fusion or flattening of podocytes (“foot processes”) - Membranoproliferative Glomerulonephritis
- -mesangial hypercellularity - Acute Poststreptococcal Glomerulonephritis
- -lumpy-bumpy deposits of Ig and complement on GBM and in mesangium - Alport Syndrome
- -alternating areas of thickened and thinned capillary loops with splitting of the GBM
Alport Syndrome
Features
- -hematuria (increased after URI)
- -hearing deficits
- -ocular abnormalities
MoI?
Name of cells seen on renal biopsy?
Alport Syndrome
MoI: XLD
Features
- -hematuria (increased after URI)
- -hearing deficits
- -ocular abnormalities (extrusion of central part of lens into anterior chamber)
Renal biopsy: foam cells
Acute Poststreptococcal Glomerulonephritis
Etiology
–nephrogenic strain of GAS
Features
- -1-2 wks after pharyngitis or 3-6 wks after impetigo
- -constitutional s/s
- -re: triad?
Biopsy
–lumpy-bumpy deposits of Ig and complement on GBM and in mesangium
Labs
- -RBC casts in urine
- -low C3
- -best test: anti-DNAse antigen
Tx
–penicillin
Acute Poststreptococcal Glomerulonephritis
Etiology
–nephrogenic strain of GAS
Features
- -1-2 wks after pharyngitis, or 3-6 wks after impetigo
- -constitutional s/s
- -triad: edema, HTN, hematuria (coca-cola urine)
Biopsy
–lumpy-bumpy deposits of Ig and complement on GBM and in mesangium
Labs
- -RBC casts in urine
- -low C3
- -best test: anti-DNAse antigen
Tx
–penicillin
UTI
RFs for recurrent UTIs
- -anatomic abnormality
- -re: backflow of urine?
Tx
–which 3 abx are typically used?
UTI
RFs for recurrent UTIs
- -anatomic abnormality
- -vesicoureteral reflux (backflow of urine from bladder to kidney)
- dx test: voiding cystourethrogram
Tx
–amoxicillin, trimethoprim-sulfamethoxazole, nitrofurantoin
Triad:
- -pulmonary hypoplasia
- -flat facies
- -limb deformities?
Dx?
Potter Sequence
Etiology
–renal agenesis or urinary tract defect –> oliguria –> oligohydramnios
Triad: pulmonary hypoplasia, flat facies, limb deformities
Obstructive Uropathy
Features
- -hydronephrosis
- -recurrent UTI, pyelonephritis
- -palpable abdominal mass in newborn
Dx Test
–VCUG
Two common etiologies?
–two different locations
Obstructive Uropathy
Etiologies
- -ureteropelvic junction obstruction
- -posterior urethral valves (boys)
Features
- -hydronephrosis
- -recurrent UTI, pyelonephritis
- -palpable abdominal mass in newborn
Dx Test
–VCUG
Hypovolemic Hypernatremia
Etiologies
- Renal
- -diuretics, glycosuria - Extrarenal
- -GI upset, sweating, burns
S/S: lethargy, AMS, irritability, seizures, mm cramps/weakness, decreased DTRs
Tx: use isotonic saline as initial resuscitation
–what percent saline?
Hypovolemic Hypernatremia
use isotonic (O.9 percent) saline for resuscitation
NB:
Hypervolemic Hypernatremia
Etiologies
–hyperaldosteronism
Sickle Cell Trait (HbA and HbS)
3 renal complications
- -painless hematuria
- -UTI
- -what type of renal cancer?
Sickle Cell Trait
3 renal complications
- -painless hematuria (due to renal papillary necrosis)
- -UTI
- -renal medullary carcinoma
NB: acute interstitial nephritis
- -assoc w hx of medication use
- -rash, eosinophilia
- -eos in urine
Etiologies of Nephrotic Syndrome
- Minimal Change Disease
- -pre-adolescent children - Membranous nephropathy
- -adolescents and adults
- -associated with HBV - FSGS
- -adolescents and adults
- -associated with what infxn?
Etiologies of Nephrotic Syndrome
- Minimal Change Disease
- -pre-adolescents - Membranous Nephropathy
- -adolescents, adults
- -HBV - FSGS
- -adolescents, adults
- -HIV
