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Clin Med Lab Final 2nd Semester > Case 5 > Flashcards

Case 5 Flashcards

1
Q

What is the most common cause of acute nephritis in kids worldwide?

A

post streptococcal glomerulonephritis

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2
Q

How much more common is PSGN in males than females ?

A

twice as common

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3
Q

PSGN develops how many weeks after pharyngitis ?

A

1-3 weeks

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4
Q

what are the 3 most common presenting symptoms of PSGN?

A
  • generalized edema
  • gross hematuria
  • HTN
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5
Q

What are some of the other presenting symptoms of PSGN?

A

red/brown urine, proteinuria, elevated serum creatinine, headache, malaise, anorexia, and flank pain

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6
Q

UA results for PSGN?

A

RBCs, red cell casts, proteinuria

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7
Q

Will serum complement be low or high in PSGN?

A

LOW, because complement components (part of the innate immune system) are being consumed

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8
Q

which two serology tests will show evidence of a recent streptococcal infection?

A

ASO and anti-DNAse

-of note: a streptozyme test can also be used

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9
Q

What other lab value might you see increased in PSGN?

A

BUN/Cr

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10
Q

What is needed to make the PSGN diagnosis?

A
  • clinical finding of acute nephritis PLUS

- demonstration of a recent GAS infection (+ throat, skin culture or serology test)

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11
Q

How would you treat mild volume overload in children with PSGN?

A

sodium and water restriction

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12
Q

Which medication would you use to reduce BP and edema in children if severe?

A

loop diuretics, usually furosemide

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13
Q

When is dialysis indicated in management of PSGN?

A
  • life threatening fluid overload (ex. pulmonary edema, heart failure, severe HTN) refractory to meds
  • hyperkalemia > 6.5 unresponsive to meds
  • uremia with BUN between 89-100
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14
Q

What are the criteria for admission of patients with PSGN?

A
  • severe renal dysfunction
  • oliguria
  • severe HTN
  • CHF
  • significant volume overload
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15
Q

Which antibiotics would be used to treat PSGN?

A

1st line: penicillin
2nd line: amoxicillin
3rd line: for PCN allergy, cephalexin
-if they cant take cephalosporins –> azithromycin

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16
Q

How long does it take for hematuria to resolve after PSGN?

A

3-6 months

17
Q

When does creatinine usually return back to baseline ?

A

by 3-4 wks

18
Q

What is the most common cause of heart disease in kids in developing countries?

A

rheumatic fever

19
Q

When do rheumatic fever symptoms usually start?

A

10 days - several weeks after GAS infection

20
Q

S/S of rheumatic fever?

A

acute febrile illness with joint manifestations and or carditis, neurologic and behavioral manifestations with chorea

21
Q

Fever is present in what percent of RF cases?

A

> 90% of cases

22
Q

Describe the joint pain in RF.

A
  • generally larger joints
  • migratory
  • dramatic response to NSAIDS/salicylates
23
Q

Describe the rash in RF.

A

erythema marginatum:

  • non pruritic
  • non painful
  • evanescent
  • usually on the trunk
  • may have central pallor
24
Q

How many of the Jones Criteria are needed to diagnose ?

A

-2 major OR
-1 major + 2 minor
AND evidence of strep infection

25
Q

Name the major jones criteria.

A
  • carditis and valvulitis
  • arthritis (migratory usually)
  • CNS involvement (chorea usually)
  • subcutaneous nodules
  • erythema marginatum
26
Q

Name the minor jones criteria.

A
  • arthralgia
  • fever
  • elevated acute phase reactants
  • prolonged PR on EKG
27
Q

Name the 3 main cardiac/EKG findings in RF.

A
  • PR prolongation (AV block)
  • mitral valve most commonly effected valvulitis
  • mitral regurgitation

*there are others to on the slides, but Paulson pointed out these 3 specifically

28
Q

Treatment of acute rheumatic fever ?

A
  • PCN for the strep infection
  • NSAIDs for arthritis (aspirin 1st line)
  • carditis management
  • prophylaxis bc they are at risk for recurrence
29
Q

What type of hypersensitivity reaction is rheumatic fever?

A

type II –> antibody directed against antigen on cells or extracellular materials

30
Q

What type of hypersensitivity reaction is Postreptococcal glomerulonephritis?

A

type III –> immune complexes promote tissue damage through complement activation

Clin Med Lab Final 2nd Semester (2 decks)

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