Renal & Urological Disorders

Question 1

UTI

MC: gram (-) rod

Answer 1

best initial: UA

most accurate: urine culture

Question 2

Tx: Cystitis (dysuria)
Tx: Pyelonephritis (flank pain, fever)

Answer 2

Cystitis: Amoxicillin, TMP-SMX
Pyelonephritis: IV ceftriaxone or ampicillin/gentamicin

Question 3

Do not give:

Answer 3

Sulfas or Nitrofurantoin < 1 yo
Tetracyclines: < 7 yo
Quinolones: < 16 yo

Question 4

UTI further management:

Answer 4

-F/U 1 week after antibiotics to make sure urine is sterile

Question 5

When do you obtain VCUG & Renal U/S?

Answer 5

-Children of any age with 2 or more febrile UTIs
-First febrile UTI with: family hx of renal disease;
poor growth; hypertension; organism other than e.coli

Question 6

Vesicoureteral Reflux (VUR)

• MC urological problem in children
• retrograde flow from bladder into ureter and renal pelvis

Answer 6

Dx: VCUG and renal scan; if scarring is present follow Cr
Tx: Antibiotic prophylaxis to prevent damage (amoxicillin)
Surgery if: breakthrough UTI; new scars; fails to resolve

Question 7

Obstructive Uropathy:

• final presentation of OU is sepsis or infection
  dx: VCUG & renal U/S

Answer 7

Boys: Posterior Urethral Valves
- distended bladder + weak stream
Girls: Hydronephrosis and PKD

Question 8

APGN: h/p

Answer 8

h/p: 5-12 yo; 1-2 weeks after strep pharyngitis or 3-6 wks after skin infection (impetigo)
Triad: edema; hematuria; hypertension

Question 9

APGN: dx

Answer 9

dx: UA; Low C3; need (+) throat culture or ab titer to strep
specific: anti-DNase antigen
tx: penicillin (erythromycin if pen-allergic);
(no antihypertensives, no steroids)

Question 10

IgA Nephropathy (Berger's)
-mcc chronic glomerular disease worldwide

Answer 10

h/p: 20-30’s; gross hematuria after URI or GI infection
w/u: mild proteinuria, HTN; normal C3
tx: blood pressure control

Question 11

Alport Syndrome (can't see, can't pee, can't hear) 
- defect in collage IV

Answer 11

h/p: young boy; family h/o renal problems, SN hearing loss
- hearing difficulties; ocular abnormalities;
- asymptomatic microscopic hematuria; intermittent gross
hematuria

Question 12

Polycystic Kidney Disease (AR: infantile type)

- 80% have 10 yr survival

Answer 12

• bilateral flank masses and hypoplasia
• HTN, ARF, Oliguria
  dx: U/S kidney; U/S liver; tx; dialysis & transplant

Question 13

Nephrotic (minimal change disease)

Answer 13

h/p: 2-6 yrs of age;

• proteinuria; hypoalbuminemia; edema; hyperlipidemia; —-
• normal C3/C4
• accurate: renal biopsy (effacement of foot processes)

Question 14

Minimal change disease: tx

Answer 14

Supportive care: sodium restriction, fluid restriction

best initial tx: Oral prednisone

Question 15

Complications of nephrotic syndrome:

Answer 15

*must immunize against pneumococcus and varicella
*increased urinary loss of IGs & complement
Infection: spontaneous bacterial peritonitis
Thromboembolism: loss of antithrombin, protein C & S