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Pediatrics final > Urinary tract and kidneys > Flashcards

Urinary tract and kidneys Flashcards

1
Q

Congenital anomalies of the urinary tract (2)

A
  • 10% of children
  • varying degrees of renal dysgenesis (unilateral agenesis or multicystic dysplasia, with compensatory hypertrophy)
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2
Q

Renal dysgenesis (3)

A
  • simple hypoplasia
  • forms of dysgenesis
  • discovery by elevated serum creatinine
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3
Q

Polycystic kidney disease (3)

A
  • autosomal dominant or recessive
  • ARPKD cystic kidneys are nonfunctional in utero
  • hypertension is an early problem
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4
Q

Medullary Cystic Disease/ Juvenile Nephronophthisis (2)

A
  • cysts of varying size in the renal medulla with tubular and interstitial nephritis
  • renal failure and signs of tubular dysfunction
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5
Q

Obstructive uropathy (3)

A
  • obstruction and the uretropelvic junction as a result of intrinsic muscle abnormalities, aberrant vessels or fibrous bands
  • can cause hydronephrosis and presents as an abdominal mass
  • urgent surgical drainage of urine is needed
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6
Q

Prune belly syndrome (2)

A
  • association of urinary tract anomalies with cryptorchidism and absent abdominal musculature
  • seen in renal dysplasia and other urologic abnormalities
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7
Q

Microhematuria possible causes (5)

A
  • if painful: investigate for UTI or injury
  • if with dysuria and back pain: pyelonephritis
  • if with colicky flank pain: stone passing
  • if blood is bright red or clots: bleeding disorders, trauma, AV malformations
  • if with abdominal mass: urinary tract obstruction, cystic disease, tumors
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8
Q

The diagnosis of ___________ should not rely solely on a urine “dipstick” evaluation, but should be verified by a microscopic RBC count.

A

Hematuria

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9
Q

Hypercalcuria is excretion of calcium in excess of _____ mg/kd/d

A

4 mg/kd/d

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10
Q

Random urine calcium/creatinine ratio of what value requires verification of hypercalcuria with 24h collection?

A

ratio above 0.2

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11
Q

Acute Poststreptococcal Glomerulonephritis diagnosis (2)

A
  • The diagnosis of acute poststreptoccocal glomerulonephritis is supported by a recent history (7–14 days previously) of group A β-hemolytic streptococcal infection, typically involving the pharynx or skin.
  • also with antistreptolysin O titer or by high titers of other antistreptococcal antibodies
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12
Q

Clinical presentation of GN (9)

A
  • gross hematuria
  • serum creatinine increase
  • edema
  • hypertension
  • dark colored urine
  • microscopic examination of RBCs: too numerous to count
  • RBC casts
  • headache, fever
  • sometimes massive proteinuria
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13
Q

Treatment and recovery of GN (4)

A
  • within weeks
  • renal biopsy
  • corticosteroids
  • hemodialysis or peritoneal dialysis may be necessary in severe cases
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14
Q

IgA nephropathy (5)

A
  • asymptomatic gross hematuria
  • not associate with strep infection; after minor acute febrile illness or stress
  • in 50% serum IgA is elevated
  • gross hematuria resolves within days
  • treatment is not indicated unless severe (corticoids and immunosupressants)
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15
Q

Henoch-Schönlein Purpura symptoms

A
  • maculopapules
  • purpuric rash primarily
  • on the dorsal surfaces of the lower extremities and buttocks
  • bloody diarrhoea, abdominal pain and joint pain
    hypertension
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16
Q

Henoch-Schönlein Purpura treatment

A

corticosteroids (for joint and abdominal pain)

17
Q

Henoch-Schönlein Purpura renal involvement

A

Ranges from mild GN with microhematuria to severe GN and varying degrees of renal insufficiency

If GN+massive protenuria+renal insufficiency - poor prognosis

18
Q

Membranoproliferative Glomerulonephritis (5)

A
  • chronic GN in chilhood
  • diagnosis is made by he histologic appearance
  • type I responds to corticosteroids
  • type II has worse prognosis (end-stage renal failure)
  • C3 is depressed in both cases and used to measure response to treatment
19
Q

Lupus Glomerulonephritis (3)

A
  • SLE diagnosis is made based on many features and lab findings (+ ANA, depressed serum complement, increased double-stranded DNA)
  • treatment is by prednisone, azathioprine, cyclophosphamide, tacrolimus, rituximab etc.
  • 10-15% develop end-stage disease
20
Q

Hereditary Glomerulonephritis what is the most common syndrome?

A

Alport Syndrome

21
Q

Alport syndrome (5)

A
  • characterised by hearing loss and GN,
  • occurring predominantly in males
  • chronic form of GN
  • does not present with the clinical features typically seen in patients with acute processes
  • in progressive GN, end-stage disease happens in 2-3rd decade of life
22
Q

Acute interstitial nephritis symptoms and findings (4)

A
  • diffuse or focal inflammation
  • edema of the renal interstitium
  • secondary involvement of the tubules
  • fever, rigor, abdominal and flank pain, rashses
23
Q

Acute interstitial nephritis cause

A

Beta lactam antibiotics, such as methicilin

24
Q

Acute interstitial nephritis diagnosis (3)

A

urinalysis: leukocyturia and hematuria
urinary sediment: eosinophils
biopsy: tubular and interstitial inflammation

25
Q

Acute interstitial nephritis treatment (3)

A

Immediate identification and removal of the causative agent is imperative and may be all that is necessary

corticosteroids

dialysis

26
Q

Idiopathic nephrotic syndrome of childhood (minimal change disease)

A
  • proteinuria, hypoproteinemia, edema, and hyperlipidemia
    -result of any form of glomerular disease - rarely be associated with a several extra renal conditions
27
Q

In minimal change disease glomerular morphology is unremarkable except for fusion of _______ of the _______

A

foot processes
glomerular basement membrane

28
Q

Treatment of minimal change disease (4)

A
  • corticosteroid treatment:
  • Prednisone, 2 mg/kg/d (maximum, 60 mg/d), is given for 6 weeks as a single daily dose.
  • The same dose is then administered on an alternate-day schedule for 6 weeks; thereafter, the dose is tapered gradually and discontinued over the ensuing 2 months.
  • The goal of this regimen is the disappearance of proteinuria !
29
Q

In minimal change disease immunisation with ___________ and _____________ is advised

A

with pneumococcal conjugate and polysaccharide vaccines

30
Q

Focal glomerular sclerosis causes what?

A

Focal glomerular sclerosis is one cause of corticosteroid resistant or frequent relapsing nephrotic syndrome.

31
Q

Recurrent focal glomerular sclerosis is treated with (2)

A

plasmapheresis and/or rituximab

32
Q

Renal vein thrombosis

A
  • in newborns, renal vein thrombosis may complicate sepsis or dehydration.
  • in infants of diabetic mothers, umbilical vein catheterisation, hypercoagulable state or thrombocytosis
  • Renal vein thrombosis is less common in older children and adolescents (trauma)
33
Q

HEMOLYTIC-UREMIC SYNDROME (HUS)(2)

A
  • most common glomerular vascular cause of acute renal failure in childhood
  • The diarrhea-associated form is usually the result of infection with Shiga toxin–producing (also called verotoxinproducing) strains of Shigella or Escherichia coli !
34
Q

HUS clinical findings

A

bloody diarrhea,
followed by hemolysis and
renal failure.
abdominal pain, diarrhea, and vomiting
Hypertension and seizures develop in some children—especially those who develop severe renal failure and fluid overload

Circulating verotoxin causes endothelial damage, which leads to platelet deposition, microvascular occlusion with subsequent hemolysis, and thrombocytopenia.

Hematuria and proteinuria are often present. The serum complement level is normal except in those cases related to congenital predisposition.

35
Q

ACUTE RENAL FAILURE

A

Acute renal failure is the sudden inability to excrete urine of sufficient quantity or composition to maintain body fluid homeostasis.

36
Q

Acute renal failure causes

A

Explanations include quickly reversible problems such as dehydration or urinary tract obstruction, as well as new-onset renal disease (acute glomerulonephritis), drug-related toxic nephropathies, or renal ischemia

37
Q

Acute renal failure clinical findings

A
  • oliguria with subsequent variable rise in serum creatinine and BUN
  • oliguria (immediately reversible cause: volume depletion, urinary tract obstruction orhypotension should be considered first)
38
Q

Treatment of acute renal failure

A
  • maintain normal blood pressure and volume
  • administration of pressor drugs for hypotension
  • diuretics (furosemide 1-5mg/kg)
  • acute dialysis
39
Q

Indications for acute dialysis in acute renal failure (4)

A

1)severe hyperkalemia,
2) unrelenting metabolic acidosis
3) fluid overload with or without severe hypertension or congestive heart failure 4) symptoms of uremia

Pediatrics final (8 decks)

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