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CPR II Exam 3 > Peds Renal > Flashcards

Peds Renal Flashcards

1
Q

Define Hematuria

A

The presence of 5 or more RBCs per high power field in 3 consecutive fresh centrifuged specimens obtained over the span of a few weeks

(either gross or microscopic)

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2
Q

What are some drugs that can cause red urine?

A

Rifampin

Nitrofurantoin

Pyridium

Sulfa drugs

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3
Q

What foods can turn urine red?

A

beets

rhubarb

fruit juices

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4
Q

Dehydration in newborns can cause urine changes that look like blood. What is the cause?

A

Uric acid crystals in the urine in newborns can cause a brick red color

Bilirubin can also cause red tint

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5
Q

While UAs are no longer recommended at annual well-child check-ups, when are they still often done?

A

5 year check up

pre-participation physicals

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6
Q

If you see reddish urine, how do you confirm that it’s blood?

A

UA or UA with micro

(You have to do this to make sure it’s blood and not a *red* herring lol)

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7
Q

Which is more ominous:

Hematuria alone or Hematuria with Proteinuria?

A

Hematuria and Proteinuria together

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8
Q

What are the sx of Post-Infectious Acute Glomerulonephritis (PIAGN)?

A

Recent strep throat followed by:

gross hematuria and proteinuria

HTN

swelling

elevated ASO

low serum C3

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9
Q

What is the pathology of PIAGN?

What is the treatment?

A

deposition of immune complexes in glomeruli

Supportive care, usually recover

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10
Q

In HSP, what is indicative of potential long-term renal damage?

A

proteinuria along with hematuria

Note: this condition is hard to diagnose and kids feel bad for a LONG time. Must f/u with regard to UAs and RBC and protein-until urine is clear

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11
Q

What will you see in asymptomatic (isolated) hematuria?

A
  • No gross blood, 25% will no longer demonstrate hematuria if followed for 5 years
  • rarely have significant renal disease
  • must be monitored for proteinuria and hypertension
  • ask Fmhx (benign familial hematuria)
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12
Q

what is the cause of asymptomatic microscopic hematuria?

How is it diagnosed?

A

hypercalcuria

urine Ca/Cr ratio is >0.2 indicating excess Ca excretion

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13
Q

What is March Hematuria?

What is the common presentation?

What to do about it?

A

after vigorous exercise, it is not unusual to see some RBCs in the urine

Likely presentation is a child/adolescent coming in for PE after sports practice

Repeat UA at a more sedentary time, like first thing AM

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14
Q

What are s/s of UTI in children?

A

Fever

decreased intake

strong smelling urine

dark urine

stomach pain

frequency/urgency/dysuria/incontinence

?emesis/diarrhea

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15
Q

How do you obtain a clean-catch urine specimen if a child is unable to void on command?

When are bag samples helpful?

A

catheterization

suprapubic aspiration

try to obtain before empiric abx given if they are indicated

Bag samples are only helpful if negative and are NOT appropriate for culture

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16
Q

What is the criteria to diagnose a UTI by clean catch?

A

presence of pyuria and at least 50,000 colonies per ml of a single uropathogenic organism

17
Q

What is the criteria for diagnosing UTI by catheter collection?

A

pyuria and colony count of 50,000 CPM or 10-50,000 CPM confirmed by repeat meets criteria

18
Q

What is the criteria for diagnosing UTI by suprapubic aspiration?

A

pyuria and ANY growth on culture meets criteria

19
Q

a high WBC count in urine indicating a UTI will have what positive test?

A

positive Leukocyte Esterase

20
Q

Nitrates present in urine likely indicate which pathogen?

A

E. coli

21
Q

What is the most common pathogen in UTIs in children?

A

E. coli

(others include Klebsiella, proteus, enterococcus, pseudomonas)

22
Q

What are some G+ bacteria that cause UTIs?

A

S. saphrophyticus

Enterococcus (catheters)

S. aureus (rare)

23
Q

How do you treat a UTI in a patient who is not acutely ill and is tolerating PO?

A

Cephalosporin like cefixime or cefdinir

resistance to amoxicillin and TMP/SMX is increasing

24
Q

How do you treat acutely ill pt’s or those not able to tolerate PO?

A

parenteral cefriaxone (3rd gen cephalosporin)

25
Q

When is imaging of the urinary tract indicated?

What modality?

A

after first UTI in boys and second UTI in girls

Renal and bladder US and may include VCUG if any abnormalities seen on US or if there is fever and pathogen other than E. coli or poor growth and HTN

26
Q

When a VCUG is done after the second UTI, what are we looking for?

A

evidence of vesicoureteral reflux, grade 1-5

notorious for causing renal scarring

27
Q

What is renal scarring?

What are some long term complications?

A

loss of renal parenchyma between the calyces and the renal capsule

  • HTN
  • Decreased renal function
  • Proteinuria
  • ESRD
28
Q

When will a PCP refer to a specialist?

A

dilating vesicoureteral reflux (grades III-V)

Obstructive Uropathy

Renal Abnormalities

Kidney function impairment

HTN

Bowel/Bladder dysfunction

CPR II Exam 3 (17 decks)

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