Week 5: Pediatric Renal Study Questions Flashcards
Define Primary enuresis:
Causes (from up to date): nocturnal polyuria, detrusor overactivity, and disturbed sleep, maturational delay, genetics, and abnormal secretion of antidiuretic hormone (ADH, vasopressin)
Primary: child has never been dry greater than 6 month period of time. Is only classified as primary if child >5 years old
Define Secondary enuresis:
Causes (from up to date): nocturnal polyuria, detrusor overactivity, and disturbed sleep, maturational delay, genetics, and abnormal secretion of antidiuretic hormone (ADH, vasopressin)
Secondary: Child previously dry for greater than 3-6 months & now has “accidents”
- Nocturnal: night bed wetting in child who has been dry for 6 months
- Diurnal: incontinence or accidents during daytime for children who have been dry for 3 months
What underlying disease processes should you rule out when working up a case of enuresis?
Posterior urethral valves or other anatomic abnormality, spinal dysraphism, diabetes, kidney disease
What treatment options could you offer a child with primary or secondary enuresis?
a. Enuresis alarm (only thing mentioned in her slides)
b. Other treatments: motivational therapy, desmopressin
What are the signs and symptoms of a urinary tract infection in an infant?
Fever, irritability, failure to thrive, vomiting, diarrhea, infrequent voiding w/ abodominal distention
What are the signs and symptoms of a UTI in a preschooler?
Fever, abdominal pain, dysuria, enuresis
What are the signs and symptoms of a UTI in an adolescent?
Dysuria, frequency, urgency (more similar to adults)
When bacteria are found in a urine sample of a small child, is that result considered positive for a UTI?
When no growth occurs on a UA in a small child, is that result considered negative for a UTI?
a. Presence of bacteria would be a + for UTI
b. Absence of bacteria would not exclude UTI because there could be errors in collection, culture, etc.
c. TX: culture specific, for E coli 3rd generation cephalosporin is recommended d/t resistance
When is a bagged urine specimen acceptable and when is it not, for the diagnosis of UTI?
a. Bagged specimen is not recommended d/t high false positive rate
b. Only mention using it to get a negative to prevent the need for catheterization
((useful only if they are negative.))
What are adjunctive naturopathic therapeutics for UTI in children?
Sugar free cranberry/blueberry
What is the first step of diagnosing VUR (vesicoureteral reflux) prenatally? After birth?
Prenatally: hydronephrosis on prenatal ultrasonography
After birth: Postnatal renal ultrasound alone is performed initially. A VCUG is performed only in selected patients who have abnormalities on a postnatal renal ultrasound, who develop a UTI during observation, or who have a family history of VUR. There is some debate on whether an ultrasound should be done first or if a VCUG should be done right away, but VCUG will have higher radiation exposure
How likely is VUR to resolve? (please list the percentages for each stage)
Grade 1: 72%
Grade 2: 61%
Grade 3: 49%
Grade 4/5: 32%
What is the most likely sign of Wilm’s Tumor? What age group does this tumor affect most?
Sign: abdominal mass or swelling
Age grp: most common renal malignancy in children <15
(2/3 of cases are diagnosed before age 5, and 95% before age 10.)
- most common renal malignancy in children (accounts for 95% of cases)
- 2nd M/C=Renal cell carcinoma accounts for the other 5%
What are the main symptoms of nephrotic syndrome?
Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine, caused by damage to small blood vessels in the kidneys that filter waste and excess water from the blood.
Symptoms include swelling around the eyes and in the feet and ankles, foamy urine, and weight gain due to excess fluid retention.
Labs:
- Nephrotic range proteinuria − Urinary protein excretion greater than 50 mg/kg per day
- Hypoalbuminemia − Serum albumin concentration less than 3 g/dL (30 g/L)
- Edema
- Hyperlipidemia
- In children first sign is usually edema after an inciting event (URI or bug bite)
What are the key components to diagnosis of Minimal Change Disease?
***Recommended tx: prednisone
a. Clinical diagnosis based on S/Sx of nephrotic syndrome
a. Clinical diagnosis based on S/Sx of nephrotic syndrome
* Foamy appearance of the urine.
* Poor appetite.
* Swelling (especially around the eyes, feet, and ankles, and in the abdomen)
* Weight gain (from fluid retention)
b. Most predictive values are:
- –Age younger than six years of age
- –Absence of hypertension
- –Absence of hematuria by Addis count
- –Normal complement levels
- –Normal renal function
(Kidney disease in which large amounts of protein is lost in the urine. It is one of the most common causes of the Nephrotic Syndrome worldwide.)
