Genitourinary Flashcards
(72 cards)
1
Q
signs of renal disease in utero
A
- oligohyramnios
- polyhydramnios
- intrauterine growth retardation
2
Q
oligohydramnios
A
reduced urine production
3
Q
polyhydramnios
A
reduced swallowing of amniotic fluid /w
increased urine production
4
Q
signs of renal disease in children
A
- abnormal growth (small stature)
- hypertension
- dehydration
- edema
5
Q
physical features w/ potential
underlying renal defects
A
- fetal alcohol syndrome
- down syndrome
- pre-auricular skin tags or pits
- external ear deformities
- eye abnormalities (cataracts, coloboma, aniridia)
6
Q
name the condition
A
coloboma
(“leaking pupil”)
7
Q
name the condition
A
aniridia
(absence of iris)
8
Q
control of kidney filtration
A
glomeruar filtration
- rate of blood flow through glomerulus controlled by arteriolar tone
- renin
- hormone prod. in juxtaglomerlar apparatus
- responds to glomerular flow and perfusion
- sensitive to low blood flow and low serum sodium
- renin-angiotensin-aldosterone axis
9
Q
products absorbed and produced
by proximal tube
A
- reabsorbs
- 2/3 of filtered volume
- Na+ and Cl-
- glucose
- amino acids, K+, PO4 almost completely reabsorbed
- NaHCO3 reabsorption set by bicarb threshold
- produces
- calcitriol (Vit D analog)
10
Q
Role of Loop of Henle
A
determines urine concentration
11
Q
components absorbed by distal tubule and collecting ducts
A
- impermeable to water except if ADH present
- active reabsorption of NaCl into bloodstream
- collecting ducts are primary site of ADH production and aldosterone
12
Q
urinary anion gap
causes of low and elevated gap
A
measured gap between serum anions and cations
- low
- increased renal acid secretion
- increased NH4 production
- elevated
- caused by metabolic acidosis
13
Q
causes of increased anion-gap
metabolic acidosis
A
MUDPILES
- Methanol
- Uremia
- Diabetic ketoacidosis
- Iron, Inhalents (CO, cyanide, toluene), Isoniazid, Ibuprofen
- Lactic acidosis
- Ethylene glycol, ethanol ketoacidosis
- Salicylates, starvation ketoacidosis, sympathomimetics
14
Q
maturation of renal function
(urine concentration, GFR, tubular reabsorption)
A
- max. urine concentration - infants cannot concentrate urine (produce same amount even if dehydrated)
- GFR - reaches adult levels by 1-2 years old
- tubular reabsorption - adult levels by 1-2 y-o
15
Q
urinalysis
what dipstick checks for
A
pH, protein, glucose, ketones, blood leukocytes
16
Q
urinalysis
what microscope checks for
A
pyuria, hematuria, casts, crystals
17
Q
urinalysis
what spot calcium/creatinine checks for
A
renal stones, hematuria
18
Q
renal imaging
what US used for
A
most utilized in peds
kidney size, dilation, assess cortex vs. medulla
19
Q
used to evaluate bladder filling/function
position of ureters/urethra
reflux into kidneys/ureters
A
voiding cystourethrogram (VCUG)
20
Q
what is nephrotic syndrome
A
heavy and persistent proteinuria
with protein losses (albumin)
21
Q
signs of nephrotic syndrome
A
- pitting edema and/or ascites
- anorexia, malaise, abdominal pain
- increased BP (25%)
- shock d/t sudden albumin decline and fluid loss
- NO gross hematuria or renal insufficiency
22
Q
2 sources of proteinuria
A
- tubular
- glomerular
23
Q
tubular proteinuria
types of proteins seen
A
low molecular weight
24
Q
tubular proteinuria
conditions
A
- acute tubular necrosis
- pyelonephritis
- polycystic kidney
25
tubular proteinuria
causes
tubular toxins:
antibiotics
chemotherapy
26
glomerular proteinuria
type of protein seen
large and small
27
glomerular proteinuria
evidence of disease
* hematuria
* casts
* HTN
28
MC but least severe nephrotic syndrome
minimal change disease
29
least common but most severe nephrotic syndrome
IgA nephropathy
30
primary nephrotic syndrome
minimal change disease characteristics
* MCC nephrotic syndrome in children (80% in children \< age 7)
* MC in males
* most respond to steroids within 4 weeks
* treat with oral steroids x12 weeks
31
primary nephrotic syndrome
focal segment glomerulosclerosis characteristics
* 10-20% of kids w/ NS
* no specific tx - less steroid responsive
* may need nephrectomy, dialysis, transplant
32
primary nephrotic syndrome
membranoproliferative glomerulonephritis characteristics
* 5-10% of kids w/ NS
* caused by hypocomplementemia (immune complex deposits)
* tx is to stop deposition of immune complexes
33
what is secondary nephrotic syndrome
protein losses from kidney occur secondary to other diseases
* vasculitis
* chronic infections (hepatitis, malaria, HIV)
* diabetes
* renal vein thrombosis
* amyloidosis
* heart disease
* malignancies
* drug reactions
34
when/what to check for proteinuria
* first morning urine - r/o orthostatic or transient proteinuria which are not significant
* presence of 1+ or higher protein on dipstick 2 or more times
35
nephrotic syndrome treatment
* steroids
* loop diuretics for edema
* B-blockers or Ca+ channel blockers for HTN
36
complications of nephrotic syndrome
* peritonitis and bacteremia
* side effects of high dose steroids
* hypovolemia from diuretics or diahhrea
* loss of coagulation factors -
* hypercoagulable state
* DVT
37
general presentation of glomerulonephritis
gross hematuria
38
acute vs. chronic glomerlonephritis
* acute
* post streptococcal (PSGN) MC
* chronic
* IgA neuropathy MC
39
presentation of acute glomerulonephritis
* ages 2-12
* MC in boys
* HTN most serious problem
* 10 days after strep infection (PSGN)
- OR-
* 4-6 weeks after impetigo (undiagnosed)
40
S/s of glomerulonephritis
* variable presentation
* asymptomatic microscopic hematuria
* or more acute
* often assoc. w/ concurrent URI
* rapidly progressing
* can quickly progress to renal disease
* observe emergently until no blood
* glomerular blood brownish
* casts and dymorphic RBCs
41
x-lined disorder of collagen defect in glomerular basement membrane
(name, s/s)
Alport syndrome
* hearing and vision problems
(can't see, can't hear)
* renal failure in males
42
non-glomerular causes of hematuria
* painless gross hematuria
* sickle cell
* Wilms tumor
* strenuous exercise
* kidney trauma
* urolithaisis
* hypercalcemia
43
Tx of gomerulonephritis
* sick or not sick
* observation if not sick
* recheck urine and BP weekly
* refer to nephrology if becoming chronic or BP elevated
* Na+ restrictions, diuretics, antihypertensives for BP
* treat underlying cause
* ACE inhibitors reduce glomerular HTN
* post-step usually self limited and benign
* others w/ higher risk of chronic disease
44
hemolytic uremic syndrome (HUS)
triad/cause
* microangiopathic hemolythic anemia
* thrombocytopenia
* renal injury secondary to syndrome
* assoc. w/ shigatoxin and diarrheal illnesses
* E. coli - verotoxin (VT)
* important cuase of kidney injury in children
* typically \< 5 y/o
* non-diarrheal more severe
* HIV, complement defects, medications, malignancy, pregnancy
45
hemolytic uremic syndrome (HUS)
S/s
* verotoxin causes hemorrhagic enterocolitis
* bloody stools
* 7-10 days after stools - lethargy, oliguria
* irratability, pallor, petechiae
* HTN from volume overload and renal injury
* seizures (25%)
* rare: pancreatitis, dysfunction, colonic perf.
46
HUS
laboratory findings
* CBC- anemia, thrombocytopenia
* peripheral smear- schistocytes, burr cells, helmet cells
* elevated LDH, AST, reticulocytes, bilirubin
* decreased haptoglobin
"chewed up" RBCs
47
HUS treatment
* supportive care
* volume repletion
* RBC transfusion
* HTN management
* dialysis
48
categories of renal failure
* pre-renal
* renal
* post-renal
49
cause/sign of pre-renal failure
* glomerular hypoperfusion
* MC dehydration
* others:
* cardiac failure
* hemorrhage
* cirrhosis
* shock
* sign: very concentrated urine
50
causes/sign of renal failure
* usually tubular injury
* hypoxic ischemic tubular injury
* infection (sepsis)
* nephrotoxic agents
* (myoglobin, meds, contrast medium)
* inflammation
* Interstitial nephritis
* sign: mild hematuria/proteinuria, SG \< 1.015
51
causes/sign of post-renal failure
* urinary tract obstructions
* sign: reduced urine volume
52
MCC chronic kidney disease
greater than/less than 10 y/o
* \< 10 y/o
* congenital anomalies:
agenesis, duplication, polycystic, ureteral implantation, kidney parenchyma
* \> 10 y/o
* focal glomerulosclerosis
53
signs of kidney failure / CKD
* growth failure
* fractures and bone deformities
* delayed puberty
* HTN
* renal osteodystrophy
* hormonal abnormalities
* uremia
54
Tx of CKD
* nutritional supplements / tube feeding
* treat acidosis - NaHCO3, Na+ citrate
* dialysis
* address salt needs based on Na+ excretion
* anemia - supplement erythropoietin and iron
* renal ostedystrophy - PO4 restriction, Vit D
* renal transplant
55
2 types of pediatric HTN
* essential
* leading cause in children and adults - obesity
* secondary
* typically renal
56
at what age do you begin
routine measurements of BP
3 y/o
57
correct cuff size
"2 fingers under the cuff"
58
effect of too large/small cuff on BP measurement
too large - low BP
too small - high BP
59
diagnosis of HTN in children
3 measurements over 95 %tile
* UA, electrolytes, Ca+, BUN, Cr tests
* renal US
* cardiac evaluation
60
Tx of HTN in children
* address underlying cause (esp. renal)
* anti-hypertensives (like adults)
* Ca+ blockers
* ACE inhibitors
* B-blockers
* diet and exercise
61
backward flow of urine from bladder up ureter
vesicoureteral reflux
62
causes/risks of vesicoureteral reflux
* junction of ureter and bladder congenitally malformed - can be familial
* incomplete emptying leading to kidney infections and scarring (reflux nephropathy)
* increased pressure of urine in renal pelvis -\> decreased renal function and failure
* neurologic bladder in 50% w/ VUR
* significant incontinence and bladder training difficulties
63
Dx of VUR
* ususally unnoted until UTI
* voiding cystourethrogram (VCUG)
* bladder filled w/ contrast - allows grading
* radionucleotide cystogram
* renal US to ID abnormalities
64
vesicoureteral reflux Tx
* antibiotics to prevent recurrent UTI
* teach good bladder/bowel habits to minimize urinary retention
* deflux procedure - produce a valve at entry of ureter in to bladder
* surgical reimplantation of ureters into bladder
65
congenital kidney abnormalities
renal agenesis assoc. w/ this
diabetes during pregnancy
66
congenital kidney abnormalities
renal hypoplasia/dysplasia assoc. w/ this outcome
eventual kidney failure
67
congenital kidney abnormalities
polycystic kidney disease assoc. w/ this
genetic defect in structure - possible kidney failure
68
congenital kidney abnormalities
posterior uretheral valves MC patient
#1 DDx when 3 mo male w/ UTI
69
when childhood urinary incontinence unacceptable
after age 5
70
potty training characteristics
* age varies by child and parent
* daytime dryness preceeds nighttime
71
issues preventing daytime dryness
* poor habits
* UTI undiagnosed
* structural problem
72
issues preventing nighttime dryness
* age
* bladder size
* ADH production (DDAVP)
* behavioral
