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General Peds Boards > Renal/Urology > Flashcards

Renal/Urology Flashcards

1
Q

Acute epididymitis s/sx and etiology

A
  • S/sx: unilateral pain, scrotal swelling and erythema

- Etiology: prepubertal boys is most commonly postviral, sexually active adolescents most common is STI

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2
Q

Reflux nephropathy

A
  • History of recurrent infections and small kidneys

- Hypertension, proteinuria, albuminuria

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3
Q

Orthostatic proteinuria

A

Increased urinary protein excretion during the day when the patient is active and normal excretion when supine/asleep for 2 hours (need a first morning urine)

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4
Q

UTI diagnosis guidelines

A
  • Needs to be cath specimen in kids less than 2

- > 50,000 CFUs of a single pathogen and/or suspicious UA

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5
Q

Treatment of UTI

A
  • E. coli is most common bug
  • IV: 3rd gen cephalosporins (cefotax or rocephin) or gent
  • PO: cephalosporin, augmentin, or bactrim
  • Treat for 7-14 days
  • Renal ultrasound indicated for febrile infants (< 2)
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6
Q

Hemolytic uremic syndrome micro

A
  • Shiga toxin from E. coli 0157:H7
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7
Q

HUS signs/symptoms

A
  • Bloody diarrhea
  • Microangiopathic hemolytic anemia, thrombocytopenia
  • Elevated creatinine/BUN
  • Seizures/neuro symptoms
  • Rash: purpura, ecchymoses
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8
Q

Preferred treatment choice for renal replacement in CKD

A
  • Renal transplant

- Has lower morbidity and improved growth if this can happen before dialysis is required

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9
Q

Clinical feature of orchitis

A
  • Testicular pain and swelling (gradual onset)
  • Fever, dysuria, urethral discharge, N/V, urinary frequency
  • Exam: redness and swelling over the affected testicle
  • Associated with STIs in adolescent/young adults and MUMPS!!
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10
Q

Triad of acute glomerulonephritis

A

Cola colored urine, hypertension, azotemia

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11
Q

Glomrerulonephritis type with low C3 and low C4

A

Lupus related

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12
Q

Glomrerulonephritis type with low C3 and normal C4

A

Postinfectious GN or membranoproliferative GN

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13
Q

Presentation of Wilm’s Tumor

A

Mom giving kid a bath and felt a mass on their side (peak age is 3 years)
- Highly curable (90% survival over 4 years)

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14
Q

Symptoms of Wilm’s Tumor

A
  • Painless abdominal mass
  • Hypertension
  • Hematuria
  • Hemihypertrophy
  • Aniridia
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15
Q

Syndromes associated with Wilm’s Tumor

A
  • Beckwith Weidmann
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16
Q

Imaging/treatment of Wilm’s Tumor

A
  • Does not calcify on xray

- Nephrectomy? with chemo and radiation

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17
Q

Diagnosis of microscopic hematuria

A
  • 5 or more RBCs per HPF
  • Transient hematuria can be caused by trauma, exercise, or fever
  • Repeat the UA in a few weeks if only have microscopic hematuria (can be present in 2-3% of school aged kids that goes away)
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18
Q

Benign familial hematuria workup

A
  • If family history and no other symptoms, nothing to do

- Just need to monitor for hypertension and proteinuria

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19
Q

Athlete with gross hematuria with UA with < 5 RBCs on microscopic exam

A

Myoglobinuria

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20
Q

Workup for persistent microscopic hematuria

A
  • Check a urine Ca/Cr ratio –> if elevated then need 24 hour urine calcium to diagnose hypercalciuria
  • If Ca/Cr ratio is normal then need more workup
  • Sickle cell disease can be a cause of hematuria
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21
Q

Cause of red diaper in a newborn

A
  • Urate crystals

- Need to check a UA but will likely be normal

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22
Q

GFR equation

A

Height (cm) x 0.413 / serum Cr

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23
Q

Reason why infants might not have nitrites with UTI

A

Nitrite takes 4 hours to develop and infants pee more than that

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24
Q

Red urine that is dipstick positive but RBC negative on microscopy

A

Hemoglobinuria or myoglobinuria

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25
Q

Painless tea or coke colored urine with RBC casts

A

Glomerular disease

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26
Q

Bright red urine with clots

A

Structural anatomical abnoramlity including kidney stones

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27
Q

Causes of benign protein in urinalysis

A

Fever, exercise, alkaline urine, concentrated urine

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28
Q

Symptoms of kidney stones

A

Hematuria, abdominal/flank pain, urinary frequency, dysuria, maybe fever

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29
Q

Risks for kidney stones

A
  • Most common are calcium stones
  • Distal RTA, hypercalciuria (hyperparathyroidism, hypercalcemia, loop diuretics), carbonic anhydrase inhibitors, infection, excessive sodium ingestion, excessive animal protein ingestion
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30
Q

Benign orthostatic proteinuria symptoms

A
  • Proteinuria increased when active and exercise
  • Need a first morning urine (protein/creatinine ratio < 0.2)
  • Common in adolescents
  • Usually < 1 gram per day
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31
Q

Kidney stone workup

A

Plain x-ray (will miss uric acid stones, small stones, or stones overlying bone)
Ultrasound
Metabolic workup
CT scan (this is the BEST diagnostic tool)

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32
Q

Definition of nephrotic syndrome

A
  • Heavy proteinuria (UPC > 2)
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia (cholesterol around 400)
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33
Q

Kidney stone treatment

A
  • < 5 mm usually pass on their own
  • If larger than that may require percutaneous nephrolihotomy
  • Long term increase fluid intake and restrict salt intake, may also need a thiazide diuretic
34
Q

Minimal change nephrotic syndrome symptoms

A
  • Present at age 2-6

- Edema, anasarca, can have intercurrent illness

35
Q

Minimal change nephrotic syndrome labs

A
  • Proteinuria +/- hematuria
  • Normal Cr/BP
  • Hypoalbuminemia, hypercholesterolemia
  • Normal C3 and negative ANA
36
Q

Treatment for minimal change disease

A
  • Supportive: salt restriction, diuretics, free water restriction, albumin/lasix if intravascularly dry
  • Pharmacologic: steroids (response to steroids is most important prognostic factor)
37
Q

Congenital nephrotic syndrome symptoms and genetics

A
  • In the first 3 months of life
  • Fetal proteinuria –> elevated AFP
  • These kids are steroid resistant leading to ESRD and require a transplant
  • Genetics: nephrin, NPHS1, on chromosome 19
38
Q

Hematuria, bilateral sensorineural hearing loss, ocular defects, renal failure

A
  • Alport syndrome
  • X linked dominant so mostly in boys
  • Females can be asymptomatic carriers
39
Q

Denys-Drashs yndrome

A
  • Hypertension, gonadoblastoma
    Wilms tumor, male pseudohermaphroditism
  • Infantile nephrotic syndrome
  • WT1, choromsome 11
40
Q

Multicystic dysplastic kidney disease symptoms and diagnosis

A
  • Unilateral flank mass in a neonate
  • More common in boys (but girls that have it are more likely to have bilateral)
  • 50% of the time associated with other urinary tract anomalies: UPJ obstruction, VUR, posterior urethral valves
  • Can be found prenatally with oligohydramnios
  • Need renal ultrasound to confirm then need a VCUG to assess for other anomalies
41
Q

Autosomal recessive polycystic kidney disease symptoms

A
  • Bilateral kidney masses

- Chronic portal hypertension (hematemesis, palpable liver, thrombocytopenia, splenomegaly)

42
Q

Post infectious glomerulonephritis symptoms

A
  • 7-21 days after infection
  • Hypertension (can be severe and labile)
  • Edema
  • Decreased GFR
  • Rarely progresses to CKD
43
Q

Post infectious glomerulonephritis labs

A
  • VERY LOW C3 (normalizes around 2 months after, if it doesn’t normalize think about MPGN)
  • Normal C4, normal ANA
  • Strep: ASO, anti DNAse B
  • Staph: anti teichoic acid antibodies
  • Proteinuria: improves over 1-2 months
  • Microscopic hematuria can persist for 18-24 months
44
Q

What is a normal C3 level

A

Around 100

45
Q

Ureterocele symptoms

A

Think of UTI symptoms

  • Dysuria, hematuria, and/or abdominal pain
  • MCC urinary retention in fmeales
  • Can lead to urinary tract obstruction
46
Q

Acute glomerulonephritis biopsy findings

A

Subepithelial humps and PMNs

47
Q

Membranoproliferative glomerulonephritis biopsy findings

A

Subendothelial deposits and double contour GBM (tram tracking)

48
Q

Lumus glomerulonephritis labs and biopsy

A
  • Low C3 and Low C4, positive ANA

- Biopsy: Full house Immunofluorscopy (IgG, IgA, IgM, C3, C1q, fibrinogen, properidin)

49
Q

IgA nephropathy symptoms

A
  • Happens WHEN YOU’RE SICK or just a couple days after (and can recur with minor illnesses)
  • Gross painless hematuria
  • Common in adolescents (not less than 10)
  • Rarely progresses to CKD but if it does, can recur in alllograft
50
Q

IgA nephropathy labs and biopsy findings

A
  • Mesangial deposits on biopsy
  • Normal C3, normal C4, negative ANA, hematuria and proteinuria
  • Persistent proteinuria correlates with worsening/progressive disease
51
Q

Reason to not place a foley with gross ureteral bleeding

A

Can cause a false tract or urethral stricture

52
Q

Causes of urethral strictures

A

Trauma, recent surgical procedure (iatrogenic), infections (gonorrhea)

53
Q

Newborn with bilateral hydronephrosis, undescended testicles, poor anterior abdominal wall musculature

A
  • Prune belly syndrome

- Have posterior urethral valves –> need immediate VCUG if bilateral hydronephrosis in males

54
Q

Newborn male with palpable bladder and wake urinary stream

A

Posterior urethral valves

55
Q

A girl who is always wetting her pants despite thorough workup

A

Ectopic urethral opening

56
Q

Unstable bladder management

A
  • Have daytime urinary frequency but no symptoms at night (leg crossing/squatting during the day)
  • Tx: timed voiding to avoid UTIs, can use anticholinergic agents if needed
57
Q

UTI organisms

A
  • E coli is most common
  • Others: Klebsiella, enterococcus, adenovirus
  • Can be associated with constipation
58
Q

Test after first febrile UTI

A
  • Renal ultrasound

- If second febrile UTI or US is abnormal then need VCUG

59
Q

UTI prophylactic antibiotics

A
  • Amoxicillin (esp in infants)
  • Bactrim
  • Nitrofurantoin
60
Q

Complications of nephrotic syndrome

A
  • Hypercoagulability: due to increased fibrinogen, factor V and VII, and increased platelets
  • Hypercholesterolemia: due to increased VLDL production
  • Immunodeficiency: due to immunoglobulins lost
  • Hypocalcemia: due to low albumin
  • Hyponatremia
  • Vascular thrombosis
  • Peritonitis (pneumococcal most commonly)
  • Other pneumococcal infections (due to hypogammaglobulinemia)
61
Q

Minimal change disease patient who then gets hematuria

A

Concern for vascular thrombosis

62
Q

Risk factors for worse prognosis in nephrotic syndrome

A
  • Age > 10
  • Persistent or gross hematuria
  • Hypertension
  • Renal insufficiency
  • Low C3 complement levels
63
Q

Focal segmental glomerulosclerosis (FSGS) symptoms

A
  • Common in teenagers
  • Nephrotic syndrome symptoms
  • Leads to progressive renal failure
  • NORMAL C3
64
Q

Pre-renal acute renal failure

A
  • FeNA will be low (< 1%)
  • Urine osmolality will be high
  • Causes: blood or fluid losses, cardiac disease
65
Q

Intrinsic acute renal failure

A
  • FeNa will be high (> 1%) and urine osmolality will be low

- Causes: ATN, interstitial nephritis, HUS, glomerulonephritis, nephrotoxic drugs

66
Q

Nephrotoxic drugs

A 
Aminoglycosides
Cyclosporine
Tacrolimus
Cisplatin
Carboplatin
Ifosfamide
Ibuprofen
Aspirin
Omeprazole
67
Q

Complications of chronic kidney disease

A
  • Growth failure (nutrition problems and bone mineralization abnormalities)
  • Anemia (decreased EPO production)
  • Metabolic acidosis (bicarb loss)
  • Uremia (elevated BUN –> need to restrict protein intake)
  • Hypertension (salt/water restriction helps)
  • Neurological abnormalities
  • Secondary hyperparathryroidism (low vitamin D –> decreased calcium absorption –> elevated PTH)
  • Increased phosphorus (leads to additional hypocalcemia)
68
Q

Indications for treatment with erythropoietin

A
  • Hemoglobin less than 8 in CKD

- Complications: polycythemia –> hypertension and thrombosis

69
Q

Creatinine level changes in peds patients

A
  • Higher in newborns due to maternal creatinine levels

- Increase with age due to increased muscle mass with growth

70
Q

Treatment for pheochromocytoma hypertension

A
  • Alpha blocker (phenoxybenzamine)
  • Don’t use a beta blocker because it can lead to a paradoxical increase in BP
  • Surgical resection will help the BP
71
Q

Symptoms of inguinal hernia

A
  • Bulge in supapubic or scrotal area that increases in size with crying
  • Incarcerated –> irritability, tender abdomen, vomiting
72
Q

Painless scrotal swelling that transilluminates

A

Hydrocele

73
Q

Left sided scrotal swelling, heavy sensation, bag of worms, decreases when patient lies down

A

Varicocele

74
Q

Facts about undescended testicles

A
  • Bringing it down can improve fertility but doesn’t eliminate risk of malignancy
  • Descended testicle on opposite side has increased malignancy risk but not as high as the undescended
75
Q

When to refer for undescended testicles

A
  • Refer by 3-6 months of age

- Repair by 12-18 months

76
Q

Symptoms of retractile testes

A

Non-palpable testicle, try to re-examine in frog leg position
- Can be retractile that re-ascends and stays there so this would need to be referred to urology

77
Q

Nonpalpable testes in newborn workup

A
  • Testicular ultrasound prior to discharge home
  • Urologic referall
  • Could be presentation of ambiguous genitalia or CAH
78
Q

Syndromes associated with hypospadias

A
  • Russell Silver syndrome
  • Laurence-Moon-Biedl Syndrome
  • Opitz Syndrome
  • Beckwith Wiedemann syndrome

**NO CIRC in patients with hypospadias, should be corrected surgically at 6 months

79
Q

Micropenis associations

A
  • Prader Willi syndrome
  • Kallmann sydrome
  • GH deficiency
  • Septo-optic dysplasia
  • Hypoglycemia
  • Penis length less than 2.5 cm (1 inch) –> do endocrine/genetic workup
80
Q

Symptoms of testicular torsion

A
  • Sudden severe scrotal pain
  • No cremasteric reflex (it is already elevated)
  • Can be unilateral or bilateral
  • Need urgent ultrasound with doppler
81
Q

Symptoms of phimosis

A
  • Inability to retract foreskin in a kiddo older than age 3

- Tx with topical steroid cream and gentle retraction

82
Q

Firm, painless solid scrotal mass workup

A

Testicular cancer

  • Bilateral ultrasound
  • LDH, b-HCG, AFP

High risk factors: cryptorchidism, gonadal dysgenesis, family history, klinefelter syndrome

General Peds Boards (24 decks)

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