Nephro

Question 1

positive urine culture without signs or symptoms; can become symptomatic if untreated; almost exclusive to girls

Answer 1

Asymptomatic bacteriuria

Question 2

Urine culture considered postive for UTI

Answer 2

Positive if >50,000 colonies/mL (single pathogen) plus pyuria

Question 3

Tx of UTI

Answer 3

Lower-urinary tract infection (cystitis) with amoxicillin, trimethoprim-sulfamethoxazole,
or nitrofurantoin (if no fever)

Question 4

Dxtics of UTI

Answer 4

Obtain voiding cystourethrogram (VCUG) in recurrent UTIs or UTIs with complications
or abnormal ultrasound findings

Question 5

Etiology of VUR

Answer 5

Occurs when the submucosal tunnel between the mucosa and detrusor muscle is
short or absent

Question 6

Grades of VUR

Answer 6

– Grade I: into nondilated ureter (common for anyone)
– Grade II: upper collecting system without dilatation
– Grade III: into dilated collecting system with calyceal blunting
– Grade IV: grossly dilated ureter and ballooning of calyces
– Grade V: massive; significant dilatation and tortuosity of ureter; intrarenal reflux
with blunting of renal pedicles

Question 7

Dx of VUR

– ________for diagnosis and grading
–________ for renal size, scarring and function; if scarring, follow creatinine

Answer 7

VCUG

Renal scan

Question 8

Palpable abdominal mass in newborn; most common cause is hydronephrosis

Answer 8

OBSTRUCTIVE UROPATHY

Question 9

Obtain VCUG in all cases of congenital hydronephrosis and in any with ureteral
dilatation to rule out _______

Answer 9

posterior urethral valves

Question 10

Otheir etiology for OBSTRUCTIVE UROPATHY

– __________—drains outside bladder; causes continual incontinence and UTIs

–______—cystic dilatation with obstruction from a pinpoint ureteral orifice; mostly in girls

– Posterior urethral valves

Answer 10

Ectopic ureter

Ureterocele

Question 11

° Most common cause of severe obstructive uropathy; mostly in boys
° Can lead to end-stage renal disease

Answer 11

Posterior urethral valves:

Question 12

OBSTRUCTIVE UROPATHY Dx

Answer 12

voiding cystourethrogram (VCUG)

Question 13

OBSTRUCTIVE UROPATHY Tx

Answer 13

– Decompress bladder with catheter
– Antibiotics (intravenously)
– Transurethral ablation or vesicostomy

Question 14

OBSTRUCTIVE UROPATHY

If lesion is severe, may present with _______

Answer 14

pulmonary hypoplasia (Potter sequence)

Question 15

Acute Poststreptococcal Glomerulonephritis usually follows?

Answer 15

Follows infection with nephrogenic strains of group A beta-hemolytic streptococci
of the throat (mostly in cold weather) or skin (in warm weather)

Question 16

Pathology of PSGN

Answer 16

Diffuse mesangial cell proliferation with an increase in mesangial matrix; lumpybumpy
deposits of immunoglobulin (Ig) and complement on glomerular basement
membrane and in mesangium

Question 17

SSx of PSGN

1–2 weeks after _______ or 3–6 weeks after ______

Answer 17

strep pharyngitis

skin infection (impetigo)

Question 18

Triad of PSGN

Answer 18

Edema, hypertension, hematuria (classic triad)

Question 19

UA findings of PSGN

Answer 19

Urinalysis—RBCs, RBC casts, protein 1–2 +, polymorphonuclear cells

Question 20

Complement levels low in PSGN

Answer 20

Low C3 (returns to normal in 6–8 weeks)

Question 21

Dx of PSGN

Answer 21

Need positive throat culture or increasing antibody titer to streptococcal antigens;
best single test is the anti-DNase antigen

Question 22

When to do biopsy in PSGN

Answer 22

Consider biopsy only in presence of acute renal failure, nephrotic syndrome, absence
of streptococcal or normal complement; or if present >2 months after onset

Question 23

Most common chronic glomerular disease worldwide

Answer 23

IgA Nephropathy (Berger disease)

Question 24

SSx of IgA Nephropathy (Berger disease)

Answer 24

– Most commonly presents with gross hematuria in association with upper respiratory infection or gastrointestinal infection
– Then mild proteinuria, mild to moderate hypertension

Question 25

Complement levels of IgA Nephropathy (Berger disease)

Answer 25

Normal C3

Question 26

Most important primary treatment for IgA Nephropathy (Berger disease) is ____

Answer 26

blood pressure control

Question 27

* Hereditary nephritis (X-linked dominant); renal biopsy shows foam cells * Asymptomatic hematuria and intermittent gross hematuria 1–2 days after upper respiratory infection

Answer 27

Alport's syndrone

Question 28

Association of Alport's syndrome

Answer 28

``` Hearing deficits (bilateral sensorineural, never congenital) females have subclinical hearing loss ``` Ocular abnormalities

Question 29

Ocular abn associated with ALport

Answer 29

pathognomonic is extrusion of central part of lens into anterior chamber

Question 30

* Small vessel vasculitis with good prognosis | * Present with purpurie rash, joint pain, abdominal pain

Answer 30

Henoch-Schönlein Purpura

Question 31

• Most common cause of acute renal failure in young children

Answer 31

Hemolytic Uremic Syndrome (HUS)

Question 32

Etiology of HUS

Answer 32

Most from E. coli O157:H7 (shiga toxin–producing)

Question 33

Pathophysiology of HUS 1 2 3

Answer 33

− Mechanical damage to RBCs as they pass through vessels − Intrarenal platelet adhesion and damage (abnormal RBCs and platelets then removed by liver and spleen) − Prothrombotic state

Question 34

SSx of HUS

Answer 34

5–10 days after infection, sudden pallor, irritability, weakness, oliguria occur; mild renal insufficiency to acute renal failure (ARF)

Question 35

Dx of HUS

Answer 35

Labs— hemoglobin 5–9 mg/dL, helmet cells, burr cells, fragmented cells, moderate reticulocytosis, white blood cells up to 30,000/mm3, Coombs negative, platelets usually 20,000–100,000/mm3, low-grade microscopic hematuria and proteinuria

Question 36

Plasmapheresis or fresh frozen plasma—may be beneficial in HUS not associated with _______

Answer 36

diarrhea or with severe central nervous system involvement

Question 37

HUS Prognosis:

Answer 37

—more than 90% survive acute stage; small number develop ESRD (end-stage renal disease

Question 38

* Most common hereditary human kidney disease * Both kidneys enlarged with cortical and medullary cysts * Most present in fourth to fifth decade

Answer 38

ADPKD

Question 39

UTZ of ADPKD

Answer 39

Renal ultrasound shows bilateral macrocysts

Question 40

How to Dx ADPKD

Answer 40

Diagnosis—presence of enlarged kidneys with bilateral macrocysts with affected first-degree relative

Question 41

_______ is the most common nephrotic syndrome seen in children

Answer 41

Steroid-sensitive minimal change disease

Question 42

SSx of MCD

Answer 42

− Proteinuria (>40 mg/m2/hour) − Hypoalbuminemia (<2.5 g/dL) − Edema − Hyperlipidemia (reactive to loss of protein)

Question 43

preferred initial test for MCD

Answer 43

is a spot urine for protein/creatinine ratio >

Question 44

COmplement levels in MCD

Answer 44

N

Question 45

Tx of MCD

Answer 45

Start prednisone for 4–6 weeks, then taper 2–3 months without initial biopsy

Question 46

MCD ``` Consider biopsy with 1 2 3 4 ```

Answer 46

hematuria, hypertension, heart failure, or if no response after 8 weeks of prednisone (steroid resistant)

Question 47

MCD TX Re-treat relapses (may become steroid-dependent or resistant); may use alternate agents__________ renal biopsy with evidence of steroid dependency

Answer 47

(cyclophosphamide, cyclosporine, high-dose pulsed methylprednisolone);

Question 48

MCD Infection is the major complication; make sure immunized against ________

Answer 48

Pneumococcus | and Varicella and check PPD

Question 49

Most frequent CX

Answer 49

Most frequent is spontaneous bacterial peritonitis (S. pneumoniae most common

Question 50

• Most common disorder of sexual differentiation in boys (more in preterm)

Answer 50

Undescended Testes

Question 51

Testes should be descended by ____ of age or will remain undescended

Answer 51

4 months

Question 52

Prognosis in terms of fertility of undescended testes

Answer 52

Treated: bilateral (50–65% remain fertile), unilateral (85% remain fertile

Question 53

Malignancy asstd with undescendes testes

Answer 53

Untreated or delay in treatment: increased risk for malignancy (seminoma most common)

Question 54

* Most common cause of testicular pain age >12 years | * Clinical presentation—acute pain and swelling; tenderness to palpitation

Answer 54

Testicular Torsion

Question 55

Testicular Torsion TX

Answer 55

``` emergent surgery (scrotal orchiopexy); if within 6 hours and <360-degree rotation, >90% of testes survive ```

Question 56

Most common cause of testicular pain age 2–11 years − Gradual onset − 3–5 mm, tender, inflamed mass at upper pole of testis − Naturally resolves in 3–10 days (bed rest, analgesia)

Answer 56

Torsion of Appendix Testes

Question 57

Clinical sign of Torsion of Appendix Testes

Answer 57

Clinical—blue dot seen through scrotal skin

Question 58

• Ascending, retrograde urethral infection → acute scrotal pain and swelling (rare before puberty) • Main cause of acute painful scrotal swelling in a young, sexually active male

Answer 58

Epididymitis

Question 59

UA of Epididymitis

Answer 59

Urinalysis shows pyuria (can be N. gonorrhoeae [GC] or Chlamydia, but organisms mostly undetermined