Brandau Pediactric 1 Flashcards Preview

RENAL II Exam 3 > Brandau Pediactric 1 > Flashcards

Flashcards in Brandau Pediactric 1 Deck (41):
1

gross hematuria

bright red blood, clots in urine or tea colored urine

2

microscopic hematuria

>5 RBCs per higher power field on MORE THAN two occasions

-so check on second occasion before working up further

3

DDx for gross hematuria

kidney stones
trauma
AV malformation
renal vein thrombosis
acute tubular necrosis
IgA nephropathy
Alport nephritis
glomerular nephritis

4

renal vein thrombosis

primary in neonates
-hemoconcentration and reduced renal blood flow
-abdominal mass and tenderness, hematuria, oligria, thrombocytopenia (low platelets - used in clot)

-ULTRASOUND will show enlarged kidneys with hyperechogenicity

5

renal AV malformations

congenital or acquired
-complication of renal biopsy

-gross hematuria and decreasing renal function

6

complication of renal biopsy

renal AV malformation**

7

acute tubular necrosis

ischemia or toxins

critically ill child - nephrotoxic or ischemic insult
-tubular cell necrosis

8

meds cause acute tubular necrosis

aminoglycosides
cyclosporine
oncologic drugs
heavy metals

9

aminoglycosides

good against gram negative
-but damage kidney

10

IgA nephropathy

most common chronic glomerular disease worldwide
-IgA mesangial deposits
-absence of systemic disease

-gross hematuria following respiratory infection

mild proteinuria

C3 levels are normal**

11

alport nephritis

mutations in type IV collagen
-proteinuria - more in males
-hearing loss
-ocular abnormalities
-leiomyomatosis of esophagus and bronchial

12

acute post-strep GN

gross hematuria, edema, HTN, renal insufficiency

-follows group A beta hemolytic streptococci
-skin or throat

children age 5-12

C3 levels depressed**

13

approach to hematuria

urinanalysis
-no Hg or cell elements - look for causes of red urine
-Hg but no cell elements - causes of Hg-uria or Mg-uria (muscle breakdown)
-cellular elements - casts - suggest glomerular cause

14

RBC casts

suggests glomerular pathology

15

low C3

suggest SLE

16

normal C3

henoch schonlein
HUS
wegeners granulomatosis
goodpastures syndrome
polyarteritis nodosa

17

common organism with HUS

e. coli

18

atypical HUS

alternate complement overactivation

19

low C3

PSGN
MPGN
SBE
HIV
Hep B

20

normal C3

IgA nephropathy
alports
thin glomerular basement membrane
idiopathic progressive GN

21

non-glomerular hematuria

interstitial nephritis
sickle cell trait
polycystic kidney disease
tumors
renal vein thrombosis
A/V malformation

22

most common renal tumor in kidneys

wilms

23

von willebrands disease

can cause hematuria

24

child with post-strep GN

-likely HTN and headache

normal systolic <94 in child

25

IgA nephropathy in child

aka bergers
-several episodes of hematuria

26

lab studies to confirm post-strep GN

urinanalysis-RBC casts

-complement level decrease

-ASO titer

27

post-strep GN prognosis

-majority get better
-rare - to renal failure

28

hematuria, mild proteinuria, difficulty swallowing

do barium swallow
-lymphoma
-wilms tumor?

scope - see mass

biopsy

Dx - alport syndrome with leiomyomatosis

29

wilms tumor metastasis

most to lungs

30

alport

mutation in type IV collagen alpha 3, 4, 5 chains

also possible leiomyomatosis

31

vesicoureteral reflux

UTIs

-urine reflux to kidney

grade 3 - dilation of ureter
grade 4 - worse than 3
grade 5 - even worse

32

imaging for VUR

voiding cystourethrogram

33

dimercaptosiccinic acid renal scan

DMSA
-can show scarring in kidney

34

VCU

bladder filled - child voids

-checks for reflux to ureter
-lots of radiation exposure

can do as nuclear (less exposure), easier to do
-done after initial study

35

reflux

inflammatory process
-cytokines reaks havoc
-typically bilateral

36

prophylactic antibiotics for reflux

possible attempt to get rid of reflux

37

chronic renal disease in child

will not grow
-failure to thrive

always monitor growth over time

38

chronic VUR

options:
-careful watching
-antibiotic prophylaxis
-surgery repair for VUR

39

VUR watchful waiting

-inherited - goes away with time
-patients that develop ESRD - most damage in utero
-antibiotics can cause resistance

40

VUR continuous prophylaxis

-grade 3 VUR - 4-6x more likely to develop renal scarring
-chance of recurrent infection

study looking at >grade 3 VUR nothing vs. prophylaxis vs. surgery
-prophylaxis most effective
-what stat design appropriate?

41

surgical repair VUR

-children with UTI - can get again - ESRD
-prophylaxis - nonadherence
-surgery - turns cost and morbidity of VUR into cure