MedU Clipp 31

Question 1

(5) DDx of Periorbital Swelling?

Answer 1

• Seasonal / Pernnial Allergic Conjunctivitis
• URI
• Sinusitis (Ethmoid, Frontal, or Maxillary)
• Acute allergic Reactin
• Cellulitis

Question 2

An S3 gallop and Edema is a sign of what?

Answer 2

Heart Failure

Question 3

Signs of Nephrotic Syndrome?

Answer 3

• Edema is most prominant
• Periorbital edema that improves when upright
• Generalized Edema
• Pitting Edema, Ascites
• Weight Gain
• A/w interstitial fluid accumulation rather than intravascular fluid overload (as in acute glomerulonephritis)
• Severe cases –> Hypotensive

Question 4

Most common cause of Nephrotic Syndrome in Children?

Answer 4

Minimal Change Disease ( 90% cases under 10 y.o.)

• Characteristic finding is:
  
  • Fusion and Diffuse effacement of the epithelial cell foot processes on electron microscopy
  • Nephron appears relatively normal on Light Microscopy

Question 5

Benign Causes of Proteinuria?

Answer 5

• Children may excrete 1+ to 2+ ( 30 - 100 mg/dL) of protein during a Fever or after Significant Exertion
• Clears after Resolution of the Fever or on Cessation of exertion
• Orthostatic Proteinuria - frequent finding in adolescents and does not signify Renal disease
  
  • As much as 1500 mg/1.73 m2 may be excreted in a 24 hour collection, but protein occurs while standing, not recumbent
  • First morning uring should be negative

Question 6

(3) Causes of Proteinuria in Nephrotic Syndrome?

Answer 6

• Loss of the Polyanion Charge - loss of negative charge due to Proteoglycans such as Heparin Sulfate
• -> leak large negatively charged proteins
• Shift in the Capillary Wall Pore Size - toward permitting increased leaking of Large molecules
• Change in the Hemodynamic Characteristic of Capillary Flow - greater filtration of larger molecules

Question 7

What is seen on Urinalysis w/ Pyelonephritis?

Answer 7

• WBC and WBC casts would be seen w/ Urinary Tract Infection
• -> cause a Positive Leukocyte Esterase Test on dipstick

Question 8

What is in the Urine of Poststreptococcal Glomerulonepthritis?

Answer 8

• Varying degrees of Proteinuria
• RBCs and RBC casts
• Postive Heme Test
• -> Acute Glomerulonephritis

Question 9

What is seen in the Urine of Interstitial Nephritis?

What causes it?

Answer 9

• RBC and WBC casts
• Rare in Children
• Methicillin (ABX)
• NSAIDs
• Penicillins
• Cephalosporins
• Rifampin
• Sulfonamids
• Infection

Question 10

Hypo____ and Hyper____ are a/w Nephrotic Syndrome?

Answer 10

• Hypoalbuminemia - major loss of albuin in urine
• -> decreased protein sysnthesis in Liver
• Hyperlipidemia - rxn to decreased Albumin, Liver makes Lipoproteins as well as Albumin
• -> decreased Lipid Clearance from the Circulation

Question 11

What does Proteinuria result in?

Answer 11

• Lowered Osmotic Pressure
  –> Fluid moves into interstitial space
• Intravascular Hypovolemia –> activates sensors and extrarenal neurohumoral and hemodynamic mechanisms that signal the Kidney
• Kidney retains Salt and Water through increased
  Renin-angiotensin-aldosterone catecholamines, ADH, and Depressed Natriuretic factor
• Retention of Salt and Water Leads to Edema

Question 12

(5) Risk Factors Predisposing to Venous Thrombosis?

Answer 12

• Urinary Loss of Proteins that inhibit Coagulation
  (Antithrombin III)
• Increased Fibrinolysis
• Destabilization of Platelets by Hyperlipidemia
• Increased Fibrinogen levels
• Increased Blood Viscosity due to rise in Hematocrit
  (use of diuretics are used without Albumin replacement)
• Increasd / Prolonged use of Corticosteroids
  –> risk of Thrombosis for pts. w/ Nephrotic Syndrome

Question 13

(3) Groups of pts. classified w/ Nephrotic Syndrome?

Answer 13

• 95%
  
  • Steroid Responsive
  • Relapsing / Steroid-dependent
• 5%
  
  • Steroid Resistant

Question 14

Where is Generalized-Edema seen best
in a Male and Female?

Answer 14

• Males –> Scrotal Region
• Females –> Labia

Question 15

(6) DDx of
Fatigue, Periorbital Edema, Abdominal Distention?

Answer 15

• Nephrotic Syndrome
• Allergic Rxn
• Acute Glomerulonephritis
• Congestive Heart Failure
• Sinusitis
• Hepatic Failure

Question 16

(4) Main causes of Ankle Swelling?

Answer 16

• Arthritis Involving the Ankles
• Systemic Allergic Reaction
• Serum Sickness
• Henoch-Schonlein Purpura

Question 17

(3) Diseases a/w Hypocomplementemia?

Answer 17

• Membranoproliferative Glomerulonephritis
• Post-streptococcal Glomerulonephritis
• Systemic Lupus Erythematosus

Question 18

(3) Tx of Primary Nephrotic Syndrome?

Answer 18

• Corticosteroids
• Sodium Restriction
• Combination of IV Furosemide and Albumin to Treat Symptomatic Edema

Question 19

(7) Increased Risks of Infection A/w Nephrotic Syndrome?

Answer 19

• Decreased Immunoglobulin lvls
• Edema fluid acting as a Culture Medium
• Protein Deficiency
• Decreased Leukocyte Bactericidal Activity
• Immunosuppression from Steroids
• Decreased Splenic Perfusion due to Hypovolemia
• Urinary Loss of a Complement Factor that Opsonizes Certain Bacteria
  
  • Properdin Factor B

Question 20

Common Infectious Complications of Nephrotic Syndrome?

Answer 20

• Spontaneous Peritonitis
  
  • Streptococcus pneumoniae (most common)
  • Gram-negative Bacteria
• Pneumonia
• Cellulitis
• Urinary Tract Infection