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pediatrics > Urology/ Nephro > Flashcards

Urology/ Nephro Flashcards

1
Q

most common cause of congenital obstructive uropathy

A

ureteropelvic junction (UPJ) obstruction

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2
Q

Most common causes of UTIs in boys

A

vesiculoureteral reflux

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3
Q

When is hypertonic 3% saline indicated

A
  1. Serum sodium concentration < 120 mEq/L
  2. patients with associated neurologic manifestations such as headaches, seizures, behavioral changes, obtundation, coma, and respiratory arrest
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4
Q

Alport Syndrome
pathophys & clinical clues

A

Inherited disorder of basement membrane collagen

persistent microscopic hematuria (with RBC casts) with proteinuria
family history of renal disease and deafness
X-linked dominant AS

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5
Q

Increased urinary excretion of ____, ___, ___ is associated with decreased risk of renal stone formation

A

citrate, magnesium, pyrophosphate

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6
Q

Urinary metabolic evaluation process

A

24-hour urine collection, needs to be at home without IVF

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7
Q

hyper_____ is the most commonly identified metabolic cause of renal stones

A

hypercalciuria

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8
Q

Boy with proteinuria on UA x2 instances, 6 months apart. What is the next evaluative step?

A

First-Morning urinalysis
(Urine protein/Creatinine ratio >0.2 in first-morning sample is abnormal.)

Then Renal US if proteinuria is confirmed

(don’t really do 24-hour urine collection for proteinuria in adults or kids)

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9
Q

Cut off for urine dipstick to make protein appear positive

A

300 mg/day
Normal

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10
Q

What is benign proteinuria?

A

Orthostatic proteinuria (when active), and disappears when patient is supine/asleep for at least 2 hours (first-morning sample)

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11
Q

Potter syndrome

A

Autosommal Recessive PKD
- oligohydramnios
- pulmonary hypoplasia
- facial appearance (pseudoepicanthus, flattened ears and nose, recessed chin)
- skeletal abnormalities (hemivertebrae, sacral agenesis)
- ophthalmologic malformations (cataracts, lens prolapse)
- limb abnormalities (club feet, hip dislocation)

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12
Q

Ultrasonographic findings of Potter Syndrome

A

Large echogenic kidneys with decreased corticomedullary differentiation

hepatic echogenicity is possible

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13
Q

Causes of asymptomatic gross hematuria in adolescent boys

A

Usually there is an obvious underlying cause
Trauma
Familial nephritis
HSP

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14
Q

Ddx and Workup of gross hematuria in children

A

detailed H&P, urinalysis, workup of infection, renal US

Ddx: meatal/prineal irritation, calciuria (crystalluria), nephrolithiasis, cystitis, congenital renal anomalies, bladder mass

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15
Q

Most common extra-renal manifestation of ADPKD, other manifestations, and pathophys

A

cerebral aneurysm

Others include: hepatic, pancreatic and seminal vesicle cyst; cardiac valve disease (MVP, Aortic Regurge); colonic diverticulal abd wall hernia

Pathophys: defective epithelial cell differentiation or extracellular matrix function associated with genetic abnormality in ADPKD

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16
Q

First dx test to check if children have ADPKD (if they have positive family hx)

A

Renal US (to look for cysts): need 3 unilateral or bilateral kidney cysts. PPV 100%, sensitivity 82-96%.

If there is a murmur: need echo

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17
Q

Most common manifestation of ARPKD and how to diagnose

A

liver abnormalities (congenital hepatic fibrosis, portal HTN, perilobular fibrosis and ‘Caroli Syndrome’)

Dx: antenatal US at 24wks gestation

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18
Q

Causes of UTI in prepubertal girl >2yo

A

posterior urethral valves

+ foreign body or labial adhesions

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19
Q

Most common pathogen causing lower urinary tract infections

A

E. Coli

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20
Q

Bartter Syndrome

A

Syndrome caused by defect in NaCl reabsorption in medullary thick ascending limb of loop of Henle

Similar to chronic furosemide therapy

Presents as growth restriction, hypoK, metabolic alkalosis and polyuria

volume depletion from salt wasting

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21
Q

Gitelman Syndrome

A

Syndrome cause by mutation in gene coding for thiazide-sensitive NaCl transporter in DISTAL TUBULE

Causes hypo K, polyuria, polydipsia

Presents in late in childhood or adulthood with muscle cramps

Reduced urinary calcium and hypomagnesemia

** volume depletion** from salt wasting

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22
Q

Gordon Syndrome

A

Syndrome causing pseydohypoaldosteronism (decrease Na reabsorption and K secretion) low Na, high K, high H+

in DISTAL TUBULE

  • Diminished renin secretion
    metabolic acidosis
23
Q

Liddle Syndrome

A

Syndrome causing pseudoaldosteronism (increased Na reabsorption and K secretion) high Na, low K in COLLECTING TUBULES

AD

24
Q

Most likely cause of bilateral hydronephrosis, dilated bladder, thickened bladder wall, and dilated posterior urethra

A

Posterior Urethral Valves

25
Q

Initial serum creatinine concentration reflects maternal serum level. When does it normalize? (preterm vs. FT)

A

7-10 days FT
1 month preterm

26
Q

Difference between ARPKD and multicystic dysplastic Kidney (MCDK)

A

MCDK = usually ONE kidney

MCDK involves the whole kidney. On US shows unilateral multiple noncommunicating cysts of varying sizes with intervening dysplastic renal tissue. This kidney will not be functional. The other might have complications

27
Q

Vesicoureteral reflux
- age of presentation (dx)
- complications

A

Dx and age: prenatally on maternal US screening, after episode of UTI (6-7yo)
- can be secondary with high pressures in bladder (2/2 posterior urethral valves or closed urethral sphincter)
- Increased risk of pyelonephritis

28
Q

Management of VUR

A
  • Abx ppx
  • surgical correction
29
Q

Prognosis of Cesicoureteral reflux

A
  • grade I-II have high rates of resolution
    grade III-IV only 10-20% self resolution
    Grade V rarely resolves spontaneously

If dx before age 1 yo, favorable association with spontaneous resolution

30
Q

FeNA formula

A

[Urine Na x serum Cr] / [Serum Na x urine Cr] x100

31
Q

Winters formula (assess respiratory compensation for metabolic acidosis)

A

pCO2 = (1.5x HCO3) + 8

(+/- 2)

32
Q

What is the delta-delta ratio and what does it assess?

A

Delta ratio = [measured AG - normal AG]/[normal bicrb - measured bicarb]

If delta ratio >1 pure increased AG acidosis

If delta ratio <1, mixed increased AG and normal AG metabolic acidosis

33
Q

Tyle 1 RTA (location, channel effected, lab findings)

A

H+ problem (1st element in periodic table)
Distal
Inability to acidify urine
Urine pH >5.5

Labs:
Low K
+ Urine AG
Hyper Ca + nephrolithiasis (phosphate kidney stones)

(causes: Lithium, SLE, amphoterecin B)

34
Q

Type 2 (location, channel effected, lab findings)

A

2 = bi = bicarbonate
Problem reabsorbing bicarb in proximal tubule

pH <5.5
Low to normal K
May be associated with Fanconi syndrome, Multiple myeloma

35
Q

Type 4 (location, lab findings)

A

4 (kind of looks like K)

Distal
Low aldosterone/ aldosterone insensitivity

Labs:
LOW K

Causes: bactrim, Gordon sd, CAH

36
Q

FSGS tx

A

ACE/ARB

37
Q

Preventative care for patients with nephrotic syndrome

A

PPSV23

38
Q

Difference between poststreptococcal GN and IgA GN

A

postreptococcal timing is at least 1wk post infection to 3-6wk post skin infection (ASO negative in skin strep infection)

IgA GN is 2 DAYS after infection

39
Q

MPGN Labs

A

low C3
Normal C4 (type 2)
Low C4

40
Q

Post GN after infective endocarditis complement levels

A

low C3, low C4

41
Q

Painless gross hematuria concurrent with illness (URI). Dx and how to evaluate

A

Dx: IgA GN
Biopsy to diagnose.

C3 is normal, IgA can be elevated but not always.
key is concurrence

42
Q

Non-thrombocytopenic palpable purpura, arthritis, GI sx, nephritis. Dx and Tx?

A

HSP

often self limited
ACE/ARB if proteinuria >0.5g/day

Steroids if nephritis continues on ARB/ACEi

43
Q

Anti C1q ab in serum in patient with renal disease

A

think Lupus nephritis

44
Q

Infectious association of membrenoproliferative GN

A

Hep B
Hep C
cryoglobulinemia
lupus (not infective)

45
Q

First line treatment for nephrotic syndrome

A

prednisolone/prednisone
ACE-i is adjunctive
No need to give furosemide unless clinically with HTN or crackles on lung exam

46
Q

First line for Poststreptococcal GN

A

furosemide if HTN
Supportive care

If need be, CCB would be the preferred anti-hypertensive med (or nicardipine, nitro gtt, labetalol in hospital settings)
- no steroids or ACE-i

47
Q

When must you get a Renal US and VCUG

A

Renal US after UTI treated or >48h if no improvement for evaluation of renal abscess or pyonephrosis
- urine with 50,000 or more cfu of single organism (suprapuic aspirate)
- Voided urine sample or bag, >100,000 cfu
- <24mo

VCUG if there is hydronephrosis, scarring or other signs of urinary obstruction

48
Q

FeNa and how to interpret

A

Urine Na x serum cr /
serum Na x urine cr

<1% prerenal
>2% renal (also urine to plasma osm is <1.5, SG <1.010)

49
Q

When do you repeat a BP for patients with elevated BP?

A

If >95th +112 mmHg (stage 2), in 1 week, then if still high, start diagnostic eval

If > 95th percentile (stage 1), must be in 1-2 weeks, then if still high, in 3 mo for the 3rd

If >90th percentile, in 6 mo, then 6 mo

50
Q

Diagnostic evaluation of child with HTN

A

urinalysis
CMP
lipid profile
renal ultrasound

51
Q

When does maternal creatinine get cleared in term vs. preterm neonates

A

1-2 weeks

Preterm: 1-2 mo

52
Q

When does maternal creatinine get cleared in term vs. preterm neonates

A

1-2 weeks

Preterm: 1-2 mo

53
Q

When does GFR reach adult values

A

2 yo

pediatrics (26 decks)

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