Renal/Uro Flashcards
Cryptorchidism definition, sx, dx, tx
Testicle that has not descended into the scrotum by 4mo
MC on the right side; 10% bilateral; rare in full-term babies, 30% chance in pre-term
MC found just outside the external ring (suprascrotal), inguinal canal, or in the abdomen
INCREASED RISK 🡪 prematurity, low birth weight
sx
*empty, small, poorly rugated scrotum
*may have inguinal fullness
dx
PE
Scrotal U/S
MRI
tx
*orchiopexy by 1y of age *ASAP after 4mo
*observation for some
Acute Cystitis definition, sx, dx, tx
PATHO: usually an ascending infection of the lower urinary tract from the urethra
Etiologies:
*E. coli MC
*staph saprophyticus 2nd MC in sexually active
Risk Factors: female (10-fold risk over males), urinary tract abnormality that causes stasis, obstruction, or reflux
sx
NB, infants: nonspecific s/sxs – fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, sepsis; +/- strong, foul-smelling or cloudy urine
Older children: similar to adults – fever, frequency/urgency, dysuria, incontinence, abdominal pain, hematuria
dx
UA: pyuria (>5WBCs/hpf), hematuria, leukocytes esterase, nitrites, cloudy urine, bacteriuria
Urine culture: gold standard
*epithelial (squamous cells) = contamination
Renal/bladder U/S (RBUS): vesicoureteral reflux (VUR) in 30-50% of peds w/ UTI <1yo
*AAP: RBUS for anyone 2-24mo following first febrile UTI
*other indications: recurrent, febrile UTIs, family hx of renal/urologic disease, poor growth, or HTN, children who don’t respond as expected to abx therapy
tx
- cephalosporin (Cefixime) x14d – first line
- Augmentin, TMP-SMX
- phenazopyridine (analgesic)
*turns urine orange
Acute Pyelonephritis definition, sx, dx, tx
Infection of the upper GU tract (kidney parenchyma & renal pelvis)
PATHO: usually an ascending infection of the lower urinary tract
Etiologies: E. coli MC
Risk Factors: DM, hx of recurrent UTIs or kidney stones, pregnancy, congenital urinary tract malformations
sx
Upper tract sxs: fever, chills, back/flank pain; N/V
Lower tract sxs: dysuria, urgency, frequency
PE:
+ CVA tenderness
Fever, tachycardia
dx
UA:
*pyuria (>10WBCs/hpf)
*leukocyte esterase
*nitrites
*hematuria, cloudy urine
*WBC casts – HALLMARK
CBC: leukocytosis w/ left shift
Urine culture: definitive
tx
Outpatient: FQs first line (“floxacin”)
Inpatient: cephalosporins, FQs, aminoglycosides, penicillins
ADMIT: older age, signs of obstruction, comorbid conditions, inability to tolerate PO abx, <2yo
Pregnancy: IV ceftriaxone
Enuresis definition, sx, dx, tx
Definition: involuntary loss of urine in a child >5yrs
Successful bladder control is usually achieved between the ages of 24-36mo, although many developmentally normal children take significantly longer
Primary Enuretic: pts who have never successfully maintained a dry period
*primary nocturnal enuresis is thought to be due to delayed maturational control or inadequate levels of ADH secretion during sleep
Secondary Enuretic: dry for several months before regular wetting occurs
sx
Occurs >2x/wk for >3mo consecutively
Age: >5yo
dx
UA/culture – r/o infection
Hx & physical w/ fluid intake, stool, & voiding diary
*investigate abnormal patterns seen in conditions like constipation or diabetes insipidus
tx
Pts <5yrs do not require investigation or tx
*behavior modification: nighttime audio alarm
*DDAVP – less urine produced overnight
*with all therapies, the cure rate is 15% per year after the age of 5
Acute Glomerulonephritis (AGN) definition
Immunologic inflammation of the glomeruli, leading to protein & RBC leakage into the urine
Characterized by HTN, hematuria (RBC casts), azotemia, & proteinuria (edema)
IgA Nephropathy (Berger’s Disease) definition
IgA Nephropathy (Berger’s Disease): MC cause
*often affects young males within days after URI or GI infection (due to IgA immune complexes)
*IgA is the first line of defense in respiratory & GI secretions, so infections may cause IgA overproduction
Post-Infectious glomerulonephritis definition
Post-Infectious:
*MC after group A strep 10-14d after skin (impetigo) or pharyngeal infection
*Classically: 2-14yrs boy w/ facial edema up to 3wks after strep w/ scanty, cola-colored/dark urine (hematuria & oliguria)
*↑ anti-streptolysin (ASO) titers, low serum complement (C3)
Membranoproliferative/Mesangiocapillary glomerulonephritis definition
Membranoproliferative/Mesangiocapillary:
*due to SLE, viral hepatitis (HCV, HBV), hypocomplementemia, cryoglobulinemia
*usually presents w/ mixed nephritic-nephrotic picture
Rapidly Progressive Glomerulonephritis (RPGN) definition
Rapidly Progressive Glomerulonephritis (RPGN):
*associated w/ poor prognosis (progression to ESRD in weeks-months)
*crescent formation on bx (crescents formed due to fibrin & plasma protein deposition collapsing the crescent shape of Bowman’s capsule)
Alport’s Syndrome definition
Alport’s Syndrome: genetic; renal failure, hearing loss
Goodpasture’s Disease definition
Goodpasture’s Disease: + anti-GBM antibodies
*antibodies against type IV collagen of the glomerular basement membrane (GBM) in kidney & lung alveoli
*presents w/ AGN + hemoptysis
Vasculitis definition
Vasculitis: lack of immune deposits + ANCA Ab
*microscopic polyangiitis (vasculitis of small renal vessels): (+) P-ANCA antibodies
*granulomatosis w/ polyangiitis (Wegner’s): necrotizing vasculitis 🡪 (+) C-ANCA
Acute Glomerulonephritis (AGN) sx, dx, tx
Hematuria hallmark (cola or tea-colored urine)
Fever, abdominal or flank pain, malaise, oliguria (AKI)
PE: HTN common, edema not as common as in nephrotic syndrome
Alport’s: isolated persistent painless hematuria
*Ophthalmologic exam: anterior lenticonus (anterior part of lens has conical shape)
dx
UA: hematuria, RBC casts
*proteinuria (usually <3.5g)
↑ BUN & creatinine
enal bx: gold standard – hypercellular, immune complex deposition
Berger’s: IgA mesangial deposits in glomeruli
Post-Infectious: + ASO titers, low serum complement
Goodpasture’s: + anti-GBM antibodies, linear IgG deposits
Vasculitis: + ANCA antibodies
*Microscopic Polyangiitis: + P-ANCA
*Wegener’s: + C-ANCA
Alport’s: C3/C4 levels
*serum BUN:creatinine >20:1
*UNa <20mEq/L
*FENA <1%
*urine osmolality variable
*urinary sediment: red cells, dysmorphic red cells, & red cell casts
tx
Steroids to control inflammation, salt/fluid restriction
IgA nephropathy: glucocorticoids
Post-infectious: supportive + abx
RPGN or severe disease: steroids + cyclophosphamide + plasmapheresis
HTN: vasodilators, diuretics, fluid restriction
Symptomatic azotemia: dialysis
Medications to control hyperkalemia, pulmonary/peripheral edema, acidosis
Nephrotic Syndrome definition + causes (minimal change disease, membranous nephropathy, focal)
Kidney disease characterized by proteinuria, hypoalbuminemia, hyperlipidemia, & edema
Primary Etiologies:
Minimal Change Disease: MCC in children
*may occur in the setting of viral syndrome, allergies, or Hodgkin disease
*loss of negative charge of basement membrane promotes proteinuria
Membranous Nephropathy: MCC in Caucasian males >40yrs
*may be seen w/ SLE, viral hepatitis, malaria, meds (Penicillamine), hypocomplementemia
Focal Segmental Glomerulosclerosis
*in the setting of HTN, heroin, HIV
*African Americans
Secondary Etiologies:
*DM MC secondary cause in adults
*SLE, Amyloidosis, hepatitis, Sjogren syndrome, Sarcoidosis, medications, infections, malignancy
Nephrotic Syndrome sx, dx, tx
*generalized edema (esp. periorbital in children) usually worse in the morning
*may develop frothy urine – ascites & anasarca if severe
*anemia
*DVT – loss of protein C, S, & antithrombin III + liver production of more clotting proteins
dx
UA: initial test – proteinuria causing “foamy urine,” lipiduria
*Microscopy: oval Maltese cross-shaped fat bodies (fatty casts)
*urine albumin: creatinine ratio
*24hr urine protein >3.5g/d gold standard
*hypoalbuminemia, hyperlipidemia
Renal Bx – definitive dx
*Minimal Change Disease: podocyte damage seen on electron microscope
*Membranous Nephropathy: thick basement membrane
tx
*glucocorticoids – first line for Minimal Change Disease; FSGS
Edema reduction:
*diuretics, 1L fluid & sodium restriction
Proteinuria reduction: ACEI/ARBs
Hyperlipidemia: diet modification, statins
