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Flashcards in Genitourinary Deck (72):
1

signs of renal disease in utero

  • oligohyramnios
  • polyhydramnios
  • intrauterine growth retardation

2

oligohydramnios

reduced urine production

3

polyhydramnios

reduced swallowing of amniotic fluid /w

increased urine production

4

signs of renal disease in children

  • abnormal growth (small stature)
  • hypertension
  • dehydration
  • edema

5

physical features w/ potential

underlying renal defects

  • fetal alcohol syndrome
  • down syndrome
  • pre-auricular skin tags or pits
  • external ear deformities
  • eye abnormalities (cataracts, coloboma, aniridia)

6

name the condition

coloboma

("leaking pupil")

7

name the condition

aniridia

(absence of iris)

8

control of kidney filtration

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

products absorbed and produced

by proximal tube

  • 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

Role of Loop of Henle

determines urine concentration

11

components absorbed by distal tubule and collecting ducts

  • impermeable to water except if ADH present
  • active reabsorption of NaCl into bloodstream

 

  • collecting ducts are primary site of ADH production and aldosterone

12

urinary anion gap

causes of low and elevated gap

measured gap between serum anions and cations

  • low
    • increased renal acid secretion
    • increased NH4 production
  • elevated
    • caused by metabolic acidosis

13

causes of increased anion-gap

metabolic acidosis

MUDPILES

  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Iron, Inhalents (CO, cyanide, toluene), Isoniazid, Ibuprofen
  • Lactic acidosis
  • Ethylene glycol, ethanol ketoacidosis
  • Salicylates, starvation ketoacidosis, sympathomimetics

14

maturation of renal function

(urine concentration, GFR, tubular reabsorption)

  • 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

urinalysis

what dipstick checks for

pH, protein, glucose, ketones, blood leukocytes

16

urinalysis

what microscope checks for

pyuria, hematuria, casts, crystals

17

urinalysis

what spot calcium/creatinine checks for

renal stones, hematuria

18

renal imaging

what US used for

most utilized in peds

kidney size, dilation, assess cortex vs. medulla

19

used to evaluate bladder filling/function

position of ureters/urethra

reflux into kidneys/ureters

voiding cystourethrogram (VCUG)

20

what is nephrotic syndrome

heavy and persistent proteinuria

with protein losses (albumin)

21

signs of nephrotic syndrome

  • 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

2 sources of proteinuria

  • tubular
  • glomerular

23

tubular proteinuria

types of proteins seen

low molecular weight

24

tubular proteinuria

conditions

  • 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