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Flashcards in BRS Renal Deck (109):
1

Total body fluid requirements =

maintenance fluid needs +
prior loss +
ongoing losses

2

Two types of fluid losses

sensible (urine, etc. measurable)
insensible (sweat, skin etc...not measurable)

3

Maintenance fluid requirements for children

1500 mL/m^2/day
or.....
100ml/kg/day for first 10 kg
50ml/kg/day for second 10 kg
20 ml/kg/day for any additional 10 kg

4

How much should maintenance fluids be increased during fever?

12% for every degree increase in temp above 38

5

Normal sodium range + relevance to dehydration

130-150
above= hypernatremic dehydration, correct over 48 hours
below/equal= hypo/isonatremic, correct over 24 hours

6

Three severities of dehydration

3-5%: mild
7-10%: moderate
12%+: severe

7

Typical bolus amount

20ml/kg normal saline for all dehydrated patients What

8

Composition of oral rehydration salts

glucose + electrolytes
(coupled cotransport mechanism)

9

Define microscopic hematuria (#)

more than 6 RBCs per HPF

10

Cause of false negative urine dipsticks

vitamin C

11

Shape of RBCs from upper vs lower urinary tract

upper: dysmorphic, blebs in membrane
lower: normal biconcave discs

12

Three hematologic causes of hematuria

sickle cell
thrombocytopenia
thrombosis

13

Four glomerular diseases leading to hematuria

-bergers
-HSP
-PSGN
-Alports

14

Proteinuria level considered pathologic

more than 100mg/m^2/day

15

What causes incorrect measures of protein in urine

high concentration = false +
low concentration = false -

16

Typical test for urine protein in children + normal levels

TP/CR
6-24 months, less than 0.5 normal
2+ years, less than 0.2 normal

17

Dipstick + for blood but no RBS on U/A... cause?

hemoglobinuria, myoglobinuria

18

Orthostatic proteinuria, protein is excreted when?

when upright but not supine

19

Cause of glomerular proteinuria

increased permeability of the glomerular capillaries

20

Cause of tubular proteinuria

decreased reabsorption due to injury

21

Marker for tubular vs glomerular proteinuria

tubular: B(two)macroglobulin
glomerular: microalbumin

22

Two types of glomerulonephritis

primary vs secondary

23

Signs of acute nephritic syndrome

-gross hematuria
-hypertension
-fluid overload

24

Signs of acute nephrotic syndrome

-heavy proteinuria
-hypercholesterolemia
-edema

25

Labs for glomerulonephritis (6)

-U/A
-TP/CR
-blood chem
-complement levels
-antibodies (DNAB, ASO)
-IgA

26

How long after GAS infection does PSGN onset?

8-14 days

27

PSGN assc labs

-low complement
-ASO+ 90%, ADB + for all

28

When is renal biopsy indicated for PSGN

within 8 weeks if kidney function isn't normalized

29

Most common acute glomerulonephritis worldwide? chronic?

acute: PSGN
chronic: IgA Nephropathy (Bergers)

30

Recurrent bouts of gross hematuria assc with URI:
cause

IgA Nephropathy (Bergers)

31

Histo findings assc with PSGN + Bergers

mesangial cell proliferation + increased mesangial cell matrix for both + IgA deposition in Bergers

32

Prognosis PSGN vs Bergers

PSGN- usually full recovery
Bergers- 20-40% ESRD

33

In addition to purpura, abdominal pain, what signs are assc with HSP ?

-arthritis
-hematuria

34

What type of disease is HSP?

IgA mediated vasculitis

35

When is renal biopsy indicated for HSP?

heavy or nephrotic range proteinuria

36

Histo findings assc with MPGN

-lobular mesangial hypercellularity
-thickening of GBM

37

Prognosis MPGN

almost all = ESRD

38

Labs assc with MPGN

75% have low complement

39

Most common cause nephrotic syndrome in US adults?

Membranous Nephropathy
(=heavy proteinuria --> renal insufficiency)

40

Definition of nephropathy

heavy proteinuria greater than 50mg/kg/day

41

In addition to proteinuria, what labs are assc with nephropathy?

-hypoalbuminemia
-hypercholesterolemia
-edema

42

Most common cause primary nephropathy

minimal change disease

43

Two systemic diseases that cause nephrotic syndrome

SLE
HSP

44

Physiologic cause of nephrotic syndrome

loss of normal charge and size glomerular barrier

45

When does edema occur in nephrotic syndrome?

following URI

46

Two risks assc with nephrotic syndrome?

thrombosis
infection with encapsulated bacteria
(COD in 5%)

47

CBC changes assc with nephrotic syndrome?

-elevated hematocrit
-hemoconcentration

48

Nephrotic syndrome:
biopsy?

only if creatinine clearance is impaired/ corticosteroids don't work

49

Treatment of widespread edema in nephrotic syndrome

25% albumin IV
no added salt in diet
steroids

50

Cause of ESRD in NS

FSGS

51

Abx treatment for HUS?

NO!
and... abx treatment of hermorrhagic colitis= ^^ risk HUS

52

E coli strain responsible for HUS ?

0157:H7

53

Key to pathogenesis in HUS

injury to endothelial cells by shiga toxin

54

Causes of death in HUS

toxic megacolon
CNS infarctions

55

Poor prognostic signs in HUS

high WBC count
prolonged oliguria

56

Alports:
inheritance pattern
defect

XD
type 4 collagen in basement membrane

57

Three manifestations of alports

cant see
cant pee
cant hear high C

58

Most common cause of a renal mass in the newborn

multicystic renal dysplasia

59

Adult vs infantile polycystic kidney diseases

ARPKD (infantile)
ADPKD (adult)

60

Two organ systems effected by ARPKD in addition to renal:

pulmonary hypoplasia
liver involvement= constant (portal HTN, cirrhosis)

61

Prognosis of ARPKD/ ADPKD:

most = severe HTN + renal insufficiency and require transplant

62

Define:
-normal HTN
-significant HTN
-severe HTN
-malignant TN

-normal 90-95th %ile
-significant 95th%ile+
-severe above 99th%ile
-malignant: end organ damage

63

Most hypertension in childhood is _____ HTN

secondary

64

Three secondary causes of HTN in newborn

-renal artery embolus/ stenosis
-coarctation
-renal disease

65

2 most common causes of HTN in kids 1-10

coarctation
renal disease

66

2 most common causes of HTN in adolescents

renal disease
essential

67

Consequences of chronic HTN in kids

growth retardation
poor school performance

68

Initial evaluation of HTN in peds

-CBC/BMP/UA/BUNCr/renin
-CXR/RUS

69

Signs of RTA

-calculi
-weakness/ myalgias
-FTT
-vomiting

70

Drug that may cause acquired RTA

amphotericin

71

Classic electrolyte presentation of RTA

hypercholermic acidosis + normal serum anion gap

72

How to calculate urine anion gap

Na+K-Cl

73

hypokalemia
hypophosphatemia
aminoaciduria
+RTA
=suggestive of

Fanconis

74

Defect assc with:
Type 1 vs Type 2 RTA

Type 1= distal= failure to excrete H+
Type 2= proximal= failure to absorb bicarb

75

Type III RTA defect

variant of type I but = proximal bicarb wasting in babies

76

Hallmark of Type IV RTA

transient acidosis + hyperkalemia

77

Treatment of all RTAs

oral alkali

78

Treatment of Type IV RTA

oral alkali + furosemide

79

Which type RTA is assc with:

Fanconis
amphotericin/nephrotic syndromes
obstructive uropathy
aldo def

-Fanconis= type II
-amp/nephrotic syndromes (acquire)= Type I
-obstructive/aldo def= Type IV

80

Type RTA assc with stones

Type I

81

Define oliguria

less than one ml/kg/hr

82

Renal failure management

-restore volume
-electrolyte intake to match losses
-protein restriction
+/-dialysis

83

Disease that manifests SECONDARY TO renal failure

renal osteodystrophy

84

BUN/Cr and FeNa in prerenal ARF

^^^ BUNCR move than 20
low FeNa less than 1

85

Renal Tubular ARF assc FeNa + marker

high B2 microglobuin
FENA above 1

86

ARF due to glomerular damage causes ____ and _____

hematuria and proteinuria

87

Interstitial nephritis marker

eosinophilia/uria

88

post renal ARF findings

renal dilation on US

89

Vascular related ARF findings

decreased renal blood flow on nuclear renal scan

90

Two types of ureteral obstruction

ureteropelvic
ureterovesical

91

Cause of bladder outlet obstruction in males

posterior urethral valve obstruction

92

Absence of rectus muscles + bladder outlet obstruction + cryptorchidism=

prune belly syndrome

93

Most common newborn abdominal mass

multicystic dysplastic kidney +atretic ureter

94

Most common anomaly assc with UTIs + inheritance pattern

vesicoureteral reflux =AD

95

How to Dx VUR

voiding cystourethrogram

96

Px treatment of VUR

low dose abx to prevent UTI until it is outgrown

97

Grade 1-2 VUR

1: reflux into distal ureter only
2: reflux into pelvis without dilation

98

Grade 3-5 VUR

3: into calyces + dilation
4: into calyxes + dilation + clubbing
5: gross dilation of entire collecting system + tortuosity of ureters

99

Workup for any kid with renal stones

rule out metabolic disorders

100

What UTI type is assc with stones

proteus

101

Three common stone components

calcium
oxalate
uric acid

102

When are UTIs most common in boys?

more common in boys before 6 months
girls after 6 months

103

Most common pathogenesis of UTI

ascending infection

104

Sign of pyelo

fever + systemic illness

105

gold standard dx of UTI

more than 10k colones on catherized sample
any bacteria on suprapubic sample
more than 50k colonies on clean catch

106

When is imaging needed in case of UTI ?

pyelo
recurrent UTI
all males
girls younger than 4 with cystitis

107

Two options of treatment for empiric uti

TMP-SMX
cephalexin

108

Neonate UTI treatment

amp & gent

109

How to prevent renal scarring in infants

3 months px antibiotics after pyelo episode