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1
Q

normal characteristics of urine

A

pH 5-9
specific gravity 1.001 - 1.035
protein < 20 mg/dL
urobilinogen up to 1 mg/dL

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2
Q

newborn renal fxn

A

produces dilute urine
2 mL/kg/hr
unable to reabsorb
glomerular filtration matures around 1-2 yrs

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3
Q

children renal fxn

A

shorter urethras
prone to UIT
complete bladder control at 4-5 yrs
ability to regain full renal fxn after ARF

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4
Q

aging renal fxn

A

(+)muscle thickness/(-)capacity/(+)frequency
(-)contractility and tone/(+)retention
(-)sphincter control (x2 for women)
(-)urethral length (affected by w/d of estrogen)
(+)prostate enlargement/(+)retention

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5
Q

hypospadias

A

opening on dorsal side (top)
more common
surgical correction 6-12 mos
should not be circumcised

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6
Q

epispadias

A

opening on ventral side (bottom)

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7
Q

VUR

A

vesicoureteral reflux

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8
Q

bladder extrophy

A

extrusion of bladder through defect in lower abdominal wall
may be associated with genital anomalies or anus defects
risk for kidney damage due to VUR s/p corrective surgery

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9
Q

MSRE

A

modern staged repair of extrophy

  1. bladder closure
  2. epispadias repair
  3. BNR (bladder neck reconstruction at 5 yrs
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10
Q

CPRE

A

complete primary repair of extrophy

bladder closure, epispadias repair, and BNR done simultaneously

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11
Q

primary VUR vs secondary VUR

A

congenital abnormality vs. acquired condition (UTI or obstruction)
graded I - V by how distended ureter is/how deep into nephrons

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12
Q

VUR management (stage I-II)

A

80% probability of spontaneous resolution

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13
Q

VUR management (less severe)

A

inject bulking agent (Deflux)

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14
Q

VUR management (stage IV-V)

A

surgical correction
ureter reimplantation
renal US to R/O obstruction

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15
Q

UTI

A 
-bacteria ascending through urethra:
E. coli (most common)
streptococci
S. saprophyticus
occasionally fungal or parasitic
-obstruction or void dysfunction
-reflux
-should be R/O in any presenting child with malaise or changed urinary habits
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16
Q

UTI (upper) involves:

A

renal parenchyma, pelvis, and ureters
>pyelonephritis
VUR
glomerulonephritis

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17
Q

UTI (lower) involves:

A

urinary tract
absent clinical manifestations
cystitis
urethritis

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18
Q

febrile UTI indicates:

A

pyelonephritis

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19
Q

kidney scarring from childhood UTIs cause concern regarding:

A

renal HTN and impaired fxn in adulthood

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20
Q

glomerulonephritis manifestations:

A 
hematuria, proteinuria
acute edema of eyelids/ankles (worse in AM)
pulmonary edema
proteinuria
HTN
renal insufficiency
fever fatigue
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21
Q

nephrotic syndrome (kinds)

A

primary (MCNS): minimal change
secondary: systemic disease (SLE, poisoning)
congenital

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22
Q

process of nephrotic syndrome:

A

glomerular membrane becomes permeable to albumin > hyperalbuminuria > hypoalbuminemia > fluid shift from plasma to interstitial spaces > hypovolemia/ascites

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23
Q

nephrotic syndrome s/s:

A 
proteinuria (frothy)
hypoalbuminemia/hyperalbuminuria
dependent edema (worsens through day)
hypovolemia/normotensive
pallor/fatigue
\++cholesterol/triglycerides
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24
Q

management of nephrotic syndrome:

A

reduce relapse:
high-dose prednisone, cytoxan, cyclosporine
manage fluid balance:
diuretics, albumin infusion
infection prevention:
PCN prophylaxis, pneumococcal vax, no live virus

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25
enuresis
inability to control voiding: most master by 5 yrs females often before males controlled by CNS; can be r/t delayed maturation
26
enuresis medications:
antidiuretics anticholinergics antidepressants/temporal therapy
27
osgood-schlatter disease:
most frequent cause of knee pain in kids usu ages 9-16 overuse associated w/running, twisting, jumping irritation of patellar ligament at its attachment to the tibial tuberosity
28
RICE interventions:
Rest Ice Compression Elevation
29
traction
pull/force exerted on one part of body in presence of counterforce
30
focus of traction on:
spine pelvis long bones of UE/LE
31
purpose of traction:
provide rest/immobilize prevent/improve contractures correct deformity treat dislocation
32
casts: plaster v. fiberglass
plaster: inexpensive, molds easy, but heavy, long drying time, and can't get wet fiberglass: quick-drying and water resistant, but more costly and not ideal for young children or sever breaks (don't mold easy)
33
treatment of compartment syndrome:
don't elevate above the heart (slows arterial perfusion, increases venous pressure) no ice (causes vasoconstriction) bivalve cast, loosen under layer loosen surgical dressings fasciotomy (surgical): removal of fascia decreases pressure and allows perfusion
34
compartment syndrome s/s:
myoglobinuria (protein from damaged muscle) precipitates like gel/blocks renal tubules dark reddish brown urine
35
types of traction:
manual (applied to body part by hand, usu during cast application) skin (applied to surface, indirectly to skeletal structures, like dunlop/humeral or buck/hip) skeletal (directly to skeletal via pin, wire, tongs)
36
scoliosis is:
lateral curvature of spine with vertebral rotation
37
types of scoliosis
adolescent idiopathic (occurs during growth spurt) congenital infantile/juvenile neuromuscular
38
scoliosis s/s:
prominent scapula/hip uneven shoulders/scapulae spinous process misaligned uneven fit/hem of clothing
39
osteomyelitis is:
bacterial infection of bone that involves cortex or marrow cavity
40
etiology/epidemiology of osteomyelitis:
``` S. aureus most common organism exogenous (from penetrating wound) or hematogenous (preexisting infection) boys/girls 2:1 commonly at 5-14 yrs ```
41
osteomyelitis s/s:
``` hx of trauma at affected area leukocytosis ++ESR irritability elevated temp local tenderness/swelling/pain +bone culture ```
42
osteomyelitis treatment:
immobilization (prevents spread of infection) antibiotics (3-4 weeks usu, up to 6) surgical intervention if necessary
43
juvenile arthritis is:
``` autoimmune disease, cause unknown peak ages of onset 1-3 yrs and 8-10 yrs occurs before age 16 girls/boys 2:1 30% of children suffer long term limitations ```
44
types of juvenile arthritis:
50% pauciarticular (onset of fewer joints) 40% polyarticular (onset of 5+ joints) 10% systemic (variable arthritis/systemic)
45
juvenile arthritis s/s:
swelling/stiff/loss of fxn in affected joint warm/erythematous leukocytosis during flares synovial thickening systemic: maculopapular rash, fever, hepatosplenomegaly, pericarditis, lymphadenopathy
46
pharmacological management of JA:
corticosteroids NSAIDS cytotoxic drugs
47
``` DM1: age at onset: inheritance: nutritional status: insulin: sulfonylurea therapy: symptoms: onset: ```
``` insulin-dependent DM any age, usu before 30 yrs recessive usually nonobese dependent none polyuria/polydipsia/polyphagia, weight loss, fatigue and irritability abrupt ```
48
``` DM2: age at onset: inheritance: nutritional status: insulin: sulfonylurea therapy: symptoms: onset: ```
``` non insulin-dependent DM usu starts in 40s/peaks in 50s, but increasing incidence in childhood and adolescences dominant 60-80% patients obese insulin required in 20-30% of cases sulfonylurea therapy effective none, OR DM1 similar (thirst/fatigue), OR vascular/neural/visual complications, frequent infections (esp skin, gums, bladder), slow healing cuts/bruises, tingling/numbness in hands or feet gradual onset ```
49
gestational diabetes:
develops during pregnancy detected at weeks 24-28 Bg usually returns to normal 6 weeks postpartum increased risk for C-section, prenatal complications increased risk for development of DM2 treatment: nutrition, insulin
50
secondary diabetes:
``` *resulting from: cushing syndrome hyperthyroidism pancreatitis parenteral nutrition cystic fibrosis hemochromatosis *results from treatment with: corticosteroids thiazides phenytoin atypical antipsychotics like clozapine *usu resolved w/resolution of above ```
51
DM methods of diagnosis:
HbA1c > 6.5% Fasting Bg > 126 random Bg > 200 + s/s 2hr OGTT > 200 w/glucose load of 75g
52
rapid-acting insulin (aspart)
onset: 15 min peak: 60-90 min duration: 3-4 hr
53
short-acting insulin (regular, ending in -R)
onset: 30-60min peak: 2-3 hr duration: 3-6 hr
54
intermediate-acting insulin (NPH, ending in -N)
onset: 2-4 hr peak: 4-10 hr duration: 10-16 hr
55
long-acting insulin (glargine)
onset: 1-2 hr NO PEAK duration: 24+ hr
56
somogyi effect
overabundance of insulin overnight > hypoglycemia > rebound hyperglycemia
57
dawn phenomenon
``` waning insulin (+growth hormone surge?) > hyperglycemia not rebound, unlike somogyi ```
58
sick day rules:
``` call PCP Bg Q4h test for ketonuria when Bg >240 drink 8-12 sugar free fluids Qh when awake observe for changes in n/v or fever ```
59
hypoglycemia:
mild: 40-70 moderate: 20-40 s/s: diaphoresis, tremor, tachycardia, palpitations, moves to tachypnea, cold/clammy skin, pallor, change in mood tx with CHO, fruit juice/soft drink/hard candy/skim milk/saltines/graham crackers
60
pelvic floor exercises
kegels (10 reps 3-5xday 4-8 weeks) | vaginal weights/cones
61
urge control technique
be still, squeeze x5, distract, walk, then bathroom
62
most common cause of incontinence in women:
fecal impaction
63
most common cause of incontinence in men:
prostate enlargement
64
PVR is:
post void residual tested 10 min post void 50-100cc normal >200cc abnormal
65
surgical interventions for urinary retention:
BPH reduction TURP bladder sling/suspension
66
BPH is:
noncancerous enlargement of prostate 50% of men will have BPH by age 50 90% of men will have BPH by age 80 AA men develop at a younger age
67
BPH s/s:
``` void hesitancy unsteady stream nocturia frequency vesical tenesmus intermittent starting and stopping ```
68
TURP is:
transurethral resection of prostate correction of BPH removal of prostate tissue using resectoscope inserted through urethra
69
``` AKI: onset: nephrons involved: duration: reversible? mortality: urine status: most common cause: ```
``` acute kidney injury sudden 50% 2-4 weeks, < 3 mos yes high oliguria to polyuria ATN ```
70
``` CKD: onset: nephrons involved: duration: reversible? mortality: urine status: most common cause: ```
``` chronic kidney disease gradual 80-90% permanent no poor diagnosis w/o HD/transplant polyuria to oliguria diabetic nephropathy ```
71
common abnormalities cause by renal failure:
fluid disturbances electrolyte imbalance accumulation of nitrogenous waste/toxin neurologic disorders
72
prerenal AKI:
``` 55-60% of cases results from decreased perfusion pathology doesn't reach parenchyma caused by hypovolemia, heart failure, hypotension, shock, hepato-renal syndrome, cyclosporin/tacrolimus resolved with resolution of cause ```
73
intrarenal AKI:
35-40% of cases results from damage to glomeruli, interstitium, or tubules pathology reaches parenchyma caused by ischemia, immune complexes (lupus), RBC waste (sickle cell), nephrotoxins (aminoglycosides, contrast dye)
74
postrenal AKI:
``` <5% of cases results from obstruction to urine flow can move backward into parenchyma cased by obstruction: calculi, stone, tumor, fibrosis, clot, prostate resolved with resolution of cause ```
75
clinical manifestations of AKI:
* oliguria ( HF, pulm edema, effusions * metabolic acidosis (buildup of H+) * decreased sodium excretion, hyponatremia * decreased potassium secretion, hyperkalemia
76
prerenal AKI urine:
SG > 1.015 Na+ < 10-20 Os > 500
77
intrarenal AKI urine:
SG < 1.010 Na+ > 40 Os < 350 RBC/WBC, casts

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