Renal, Urinary Systems and Electrolytes Flashcards
Treatment:
Primary Enuresis
- Behavior modifications
- Alarm therapy
- Desmopressin (first-line): can provide immediate relief for stressed families when options 1 & 2 have failed, but has a high relapse rate if used alone.
Which patients should have a voiding cystourethrogram as a part of the work up for a first febrile UTI?
VCUG is not reccommended for first febrile UTI in children younger than 2 unless:
- renal ultrasound shows abnormalities
- patient is a neonate
- recurrent UTIs
What is the work-up and treatment for first febrile UTI in a child younger than 2 years?
- renal and bladder ultrasound
2. Treat with 1-2 weeks of antibiotics
What is the most common cause of urinary tract obstruction in newborn boys?
Posterior urethral valves
Diagnosis:
Posterior urethral valves on prenatal ultrasonography
- bladder distension
- bilateral hydroureters
- bilateral hydronephrosis
What are the major complications of urinary tract obstruction in utero?
Low urine production –> Oligohydraminos –> pulmonary hypoplasia –> respiratory distress
What is the most common cause of nephrotic syndrome in adolescents and adults?
Membranous nephropathy
Define nephrotic syndrome.
- edema
- proteinuria
- hypoalbuminemia
Which vaccine preventable virus is associated with an increased risk for membranous nephropathy in adolescents and adults?
Active Hepatitis B infection
*Vaccination reduces this risk.
What is a common presenting sign of new-onset type 1 diabetes mellitus in children?
nocturnal enuresis
Clinical manifestation:
Polyuria
Polydipsia
diabetes mellitus
In pediatrics these are common presenting symptoms of new onset type 1 diabetes mellitus.
What is a potential sequelae of severe vesicoureteral reflux?
recurrent or chronic pyelonephritis
What are the major complications of recurrent or chronic pyelonephritis?
- parenchymal scarring
- hypertension
- renal insufficiency
Diagnosis:
vesicoureteral reflux
Definitive diagnosis is made by voiding cystourethrogram.
What renal complications are associated with sickle cell trait?
- painless hematuria
- urinary tract infections
- renal medullary cancer
How do you differentiate transient proteinuria from persistent proteinuria?
Perform a urine dipstick on 3 separate occasions to differentiate between transient and persistent proteinuria.
Clinical Manifestations:
Henoch-Schonlein purpura
- palpable purpura on the lower extremities
- arthralgias
- abdominal pain
- renal disease
Diagnosis:
Immunofluroescence microscopy in Henoch-Schonlein purpura
IgA deposition in the kidney
Pathogenesis:
Henoch-Schonlein purpura
IgA mediated vasculitis of the small vessels
What is the work up for a suspected UTI in a child?
- Urine Analysis
- Urine culture
*Patients in diapers should undergo straight catheterization to obtain a sterile specimen and avoid contamination with stool or skin flora.
Clinical Manifestation:
- recurrent hematuria
- sensorineural deafness
- family history of renal failure
Alport’s syndrome
Clinical Manifestation:
4 week old infant with projectile, nonbilious vomiting that occurs after each feed.
Pyloric stenosis
Diagnosis:
Electrolyte abnormalities associated with pyloric stenosis
- hypochloremia
- hypokalemia
- metabolic acidosis (low bicarbonate)
“hypochloremic, hypokalemic metabolic acidosis”
Treatment:
Pyloric stenosis
pyloromyotomy
*Be sure to correct the electrolyte balance (“hypochloremic, hypokalemic metabolic acidosis”) prior to surgery!
What is the most common age range for presentation with pyloric stenosis (projectile, nonbilious vomiting after each feed)?
3-5 weeks
Clinical Manifestation:
Renal Tubular acidosis
failure to thrive
Why do patients with renal tubular acidosis present with failure to thrive?
They have a chronic, normal anion gap metabolic acidosis.
Pathogenesis:
Renal Tubular Acidosis
- defect in hydrogen excretion in the kidney
2. defect in bicarbonate resorption in the kidney
Treatment:
Renal Tubular Acidosis
Oral bicarbonate replacement
Pathogenesis:
most common cause of UTI in females
bacteria ascends into the bladder from vaginal introitus
Why is sexual intercourse an important risk factor for UTIs in women?
Sexual intercourse allows for the introduction of uropathogens into the urethra.
What risk factor is associated with recurrent cystitis in toddlers? Describe the pathogenesis.
Chronic constipation is a important risk factor for recurrent cystitis in toddlers.
impacted stool –> rectal distension –> bladder compression –> incomplete voiding –> urinary stasis –> infection
What is the most common cause of nephrotic syndrome in pre-adolescent children?
Minimal change nephropathy
Treatment:
Minimal change nephropathy
Steroids (high responsive)
Note, renal biopsy is NOT required for initial diagnosis and is not routinely obtained in patients younger than 10.
Treatment:
initial resuscitation for hypovolemic hypernatremia
Isotonic solution (i.e. normal 0.9% saline)
