Volume 2 Flashcards
(33 cards)
How do you diagnose nephrotic syndrome?
- protein/creat ratio >200 mg/mmol
2. 24 hr protein > 40mg/m2/hr
What is Liddle syndrome?
- pseudoaldosteronism
- autosomal dominant disorder
- Early, and frequently severe HTN- low plasma renin activity
- metabolic alkalosis
- hypokalemia
- normal to low levels of aldosterone
- abnormal kidney function, with excess reabsorption of Na +loss of K from the renal tubule
- combination of low sodium diet and potassium-sparing diuretic drugs (
what is pre-HTN and how do you manage it?
> 90th - < 95th
need lifestyle changes, wgt mgnt, diet/exercise
recheck in 6 mon
what is stage 1 HTN and how do you manage it?
> 95 th + 5 mmHg
Lifestyle changes
recheck in 1-2 weeks
start therapy
refer to nephro
what is stage 2 HTN and how do you manage it?
> 99th + 5 mmHg
lifestyle changes
recheck in < 1 week
start therapy
refer to nephro
what is hypertensive crisis
> than stage 2 HTN
What is hypertensive urgency
high BP and mild signs but no end organ damage
can ahve mild HA and vomiting
what is a hypertensive emergency
severe HTN and life threatening symptoms of end organ damage
encephalopathy Sz Heart failure = LVH facial palsy/ hemiplegia visual symptoms
what is the etiology of HTN in a < month
renal artery thrombosis
coarctation
renal parenchymal disease
BPD
what is the etiology of HTN for > 1 month to 10 yrs
renal parenchymal coarctation renovascular disease essential endocrine
what is the etiology of HTN in a > 10 yrs
essential
white coat
renal
what are possible endocrine causes of HTN
hyperthyroid hyperparathyroid CAH cushings pheo neuroblastoma
what are drugs that cause HTN
stimulant meds OCP steroids smoking cocaine tacrolimus cyclosporine
what are screening investigations for confirmed HTN?
Cr, urea, lytes, CBC, TSH, FT4 uric acid plasma renin fasting lipid profile, fasting glucose Urinalysis and culture Renal ultrasound Cardiac echo/ECG optho to assess damage
who should start anti-hypertensive Rx?
- if symptomatic
- if secondary HTN
- If has DM
- If no change despite nonpharm measures
- if Hypertensive target-organ damage
how do you manage a HTN emergency
- Admit to PICU
- Goal is to decrease BP to < 95th by ↓ by 25% in the first 8 hours +
- Gradually normalizing over 26 to 28 hours
- IV sodium nitroprusside - monitor Inc HR & cyanide
- IV Labetelol – combined α and β blocking agent. Acts quickly (within 2-5 min) but lasts up to 2-4 hours. May lead to bradycardia and bronchospasm.
- IV Esmolol – ultrashort acting cardioselective β blocking agent. Onset of action is 60s with an offset of 10-20 min.
- IV Hydralazine – direct vasodilator of smooth muscle. Can lead to tachycardia and fluid retention. Onset of action is 5-30 min. Given as bolus q4-6 hours rather than continuous infusion.
How do you manage HTN urgency?
- Lower BP over a course of hours to days with either IV or oral anti-hypertensives depending on the symptomology
- Options include;
Hydralazine (Iv or oral)
Clonidine (oral) Central acting & should be avoided in those with altered mental status
Minoxidil (oral) – arteriolar vasodilation.
what is the WU for multicystic dysplastic kidney
need US
if abn US - need VCUG because 30% can have VUR
what is multicystic renal dysplasia
non inherited disease
abnormal nephron dev
minimal or no functioning renal tissue, LEFT > r
if BL - lethal - Potter’s
+/- VUR on other side and enlarged
most often, the effected kidney involutes
some risk of Wilms - some suggest regular monitoring
what is the most common cause for an abdominal mass in the newborn?
MCDK
what are genetic syndromes associated with renal cysts
AD polycystic AR polycystic T 21, T18, T 13 Von-Hippel Lindau TS
what is true polyuria and polydipsia
> 2L/m2/day
what is the WU for polyuria and polydipsia
serum for osmolality, sodium, potassium, Ca BUN/creatinine, glucose urine for osmolality, specific gravity, and glucose determination
what are diagnostic criteria for DI
serum osmolality is >300 mOsm/kg
AND
urine osmolality is <300 mOsm/kg
