Nephro/GU Flashcards by A A

An 18 month old girl has periorbital swelling. Her albumin is 26. Her urine is negative for protein. What do you do for diagnosis?

a) Serum trypsin
b) Stool alpha anti-trypsin
c) Urine creatinine excretion
d) ECHO

b) Stool alpha anti-trypsin

Other potential causes of hypoalbuminemia include liver disease (reduced production) and inadequate protein intake. Very rarely hypoalbuminemia can result from an extensive skin disorder causing protein loss via the skin. Measurement of stool α1-antitrypsin is a useful screening test for protein-losing enteropathy.

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What is important to know in order to determine if BP is within normal range?

a) Weight
b) Ethnicity
c) Height
d) Age

age, sex, and height percentile.

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11 year old boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management?

a. Alarm
b. Imipramine
c. DDAVP
d. Oxybutynin

DDAVP
Synthetic analogue of ADH. Not curative. Desmopressin acetate’s greatest value may be for short-term treatment, in settings such as camp or sleepovers, rather than as an attempt at a cure

Alarm - Alarm therapy requires a commitment from parents and other siblings because the alarms are sufficiently loud that often all members of the household are wakened when the alarm goes off. Alarms are impractical for ‘sleepovers’ and camp.

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A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it?
Today
1 month
6 months
11 months

today
NON LIVE
Inactivated vaccines and toxoids can be administered to all immunocompromised patients in usual doses and schedules, although the response to these vaccines may be suboptimal.

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16 year old girl comes to your office. Her BMI is 27 and she has stage 1 hypertension. No protein present on urinalysis. What is the next step in managing her high blood pressure?

1) Beta blocker
2) Calcium channel blocker
3) Lifestyle
4) ACEi

lifestyle
The mainstay of therapy for children with asymptomatic mild hypertension without evidence of target-organ damage is therapeutic lifestyle modification with dietary changes and regular exercise. Weight loss is the primary therapy in obesity-related hypertension.

Indications for pharmacologic therapy include symptomatic hypertension, secondary hypertension, hypertensive target organ damage, diabetes (types 1 and 2), and persistent hypertension and STAGE 2 HTN (>99th) -despite nonpharmacologic measures.

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Which of the following is seen in distal RTA?

a. Hyperkalemia
b. Hyponatremia
c. Hypophosphatemia
d. Hypercalciuria

d. Hypercalciuria
can also get hypokalemia
Renal tubular acidosis is characterized by non-anion gap (hyperchloremic) metabolic acidosis in the setting of normal GFR. There are 4 types:
Type I - classic distal RTA- cant secrete H
Type II - proximal RTA - cant absorb bicarb
Type III - combined proximal and distal
Type IV - hyperkalemic RTA

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Most common renal stone in children

a) Calcium oxalate
b) Cystine
c) Urate
d) Struvite

calc oxalate

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4 year old girl with glomerulonephritis, hypertension, and vomiting x3 days. Most probable test to determine diagnosis

a) C3
b) Renal Biopsy

C3
GN with Low C3:
Systemic diseases: Lupus nephritis, subacute bacterial endocarditis, shunt nephritis, essential mixed cryoglobulinemia, visceral abscess
Renal disease: Acute post-infectious GN, membranoproliferative GN type I

GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)

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15 yo with 3+ proteinuria.

a) Check Protein twice each am

check three times in a row

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What is the result when you have a diagnosis of central DI post water deprivation test?

a) Decreased Urine osmolality
b) Increased urine osmolality
c) Decreaed Serum osmolality
d) Increased serum osmolality

increased serum osmolality

and urine will stay LOW as u keep spilling water

with ADH deficiency, high serum osmolality and low urine osmolality

this just diagnosis DI- next step give DDAVP to determine central vs peripheral

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Boy with enuresis, what is a good non pharm way to treat it

a) Positive reinforcement
b) Bed Alarm
c) Ddavp
d) Bladder training

bed alarm

DO not reward them

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Children with turners have which renal abnormality at rates higher than healthy population?
a -horseshoe kidney
b -MCDK
c -Vesicoureteral reflux

A horseshoe kidney

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What glomerular disease is associated with a low C3?

          	a. Membranous nephropathy
          	b. Alports
          	c. IgA nephropathy
          	d. Membranoproliferative glomerulonephritis

MPGN
GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture, Alports (hematuria, sensorineural hearing loss)
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)

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A child presents with hypertension, urine dip shows blood and protein, creatinine and urea are elevated, C3 and C4 are normal. What is the most likely diagnosis?

a. SLE
b. Membranoproliferative glomerulonephritis
c. Post-infectious glomerulonephritis
d. IgA nephropathy

d. IgA nephropathy

LOW C3- SLE, MPGN, Post infectios

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4 year old child with nephrotic syndrome on steroids. Presents with a swollen and tender abdomen. Looks septic. What test would give you the diagnostic:
a. Paracentesis
b. CT scan
c. MRI
D. Laparotomy

parecentesis

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Child with distal RTA who doesn’t take his meds. 2 months after last visit, presents with bilateral leg weakness and doesn’t want to walk. What does he have?

a. Chronic acidosis
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia

hypokalemia - gives bilat weakness

severe metabolic acidosis, urine pH cannot be reduced < 5.5, hyperchloremia (because of loss of HCO3-), hypokalemia (because of inability to secrete H+), hypercalciuria, hypocitraturia (chronic metabolic acidosis leads to impaired urinary citrate excretion, which worsens hypercalciuria)

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7 y.o boy presents with left-sided night time flank pain. An US reveals left-sided hydronephrosis. what do you do next?

a. VCUG
b. Nuclear scan with lasix washout
c. DMSA scan
d. CT abdomen with contrast

nuclear scan with lasix washout

MAG-3 administered with lasix - looks at differential renal function to assess for obstruction

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chool aged child with pH 7.15, HCO3 9, Na 138, Cl 121, PO4 0.7, K 3.0. Also has urine pH of 5 and glucose in urine. What do you check? Which test is most likely to reveal the diagnosis?

a. Leukocyte for cystine
b. Urine ca/cr ratio

leukocyte for cysteine

metabolic acidosis, non-aniongap
either RTA or diarrhea
distal RTA DO NOT have acidic urine.

RTA with pH <5.5, glucosuria = proximal RTA
Proximal RTA almost always = fanconi
Most common cause of fanconi = cystinosis

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RTA proximal vs distal

proximal - acidic urine,
distal
pRTA presents with polyuria, dehydration, anorexia, vomiting, constipation, hypotonia and FTT in first year of life. Non-anion gap metabolic acidosis, normal urinalysis (except in Fanconi), urine pH < 5.5 because distal acidification mechanisms are intact, +/- renal failure.

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You are asked to assess a 10 day old baby with weak abdominal muscles and cryptorchidism. The baby is also found to have bilateral flank masses. What is the most likely association with this picture to explain the flank masses?

a. polycystic kidneys
b. multicytic dysplastic kidneys
c. hydronephrosis
d. bilateral wilms tumors

hydronephrosis

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Shows picture of genitalia (looks labial adhesions) in an 18mo girl. What to do?

Estrogen cream to the affected area

b. Abdo US
c. Call CAS
d. Refer to urology

estrogen cream to affect area

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6 yr American African girl presented with blood in underwear. She has some trouble urinating, no fever, no other symptoms. On exam there is a red mass coming out of vagina..

a. Urethral prolapse
b. Cancer

black + blood spotting
it is URETHRAL PROLAPSE
and give estrogen cream 2-3 times daily

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Patient presents with edema, abdominal distension, and proteinuria. Patient also has fever and is found to have spontaneous bacterial peritonitis. What is the MOST likely pathogen causing the SBP.

a. Steptococcal pneumoniae
b. E. Coli
c. Enterococcus
d. Listeria

strep pneumo

e coli #2

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Patient with history of sore throat. Urine shows microscopic hematuria. What is the natural course?

a. It will resolve over time
b. Progress to chronic renal disease
c. microscopic hematuria
d. proteinuria and hypertension

resolve over time

Progress to chronic renal disease - very rare

c. microscopic hematuria - can last up to a year
d. proteinuria and hypertension - in acute phase

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Antenatal diagnosis of hydronephrosis. What to do before d/c? a. VCUG b. MAG scan c. Ultrasound

ultrasound at 48 hours if persistent then VCUG and nephro referal

A 14 year old boy presents with an acutely painful scrotum. You suspect testicular torsion. Which of the following is true? a. absence of the cremasteric reflex is common b. blue discoloration of the scrotum is pathognomonic c. you have 36 hours to treat before losing the testes

absence of crem reflex ommon non viable after 24 hours

he reason we do orchidopexy? a. reduce the chance of testicular cancer b. allow better testicular examination c. increase fertility potential - JELD says best as per their lecture ALL technically correct

increase fertility

A 10 month old boy comes to ER. Acute onset of scrotal swelling. Parents have noted on and off swelling in the past few days. Today a bit irritable. VSS stable. On exam, swollen scrotum, does not reduce; transilluminates well, testicle palpable separately. Likely diagnosis? a. epididmytis b. testicular torsion c. acute hydrocele d. incarcerated hernia

acute hydrocele not super upset

Smooth, firm, tubular mass in scrotum that transilluminates, not febrile, irritable for a week. Discomfort with examination, testes palpable and are distinct from this mass. Not reducible, no vomiting. a. incarcerated inguinal hernia b. acute non-communicating hydrocoele c. epididymitis d. testicular torsion

acute non-communicating hydrocoele as it transilluminates

3 mo baby boy with right inguinal mass. Anorexia and irritabiliy x 3days. Mass transilluminates, soft and separate from testes. Diagnosis: a. acute non-communicating hydrocele b. incarcerated inguinal hernia c. Tumor d. torsion of testes

INCARCERATED INGUINAL HERIA - could also be hydrocele tunica vaginalis communicates, maybe they have hydrocele and inguinal hernia

Which of the following is important in measuring blood pressure: a. height b. weight c. Tanner stage

height BP varies with age, sex, and height in children ABPM uses a portable automated device that records blood pressure (BP) over a specific time period (usually 24 hours).

Kid with hypertension confirmed by ambulatory blood pressure monitoring. Has BP 121/86. What do you do? a. start him on captopril b. observe and repeat an ambulatory blood pressure test c. renal ultrasound

renal u/s ABPM if positive over 24 hours that is diagnostic if its by visits 3x consider starting amlodipine DONT do ace inhibitor/pril - with renal artery stenosis, causes hyperK, aki, and inc cr

Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do? a. reassure b. check for proteinuria c. start antibiotics

check for proteinuria

tests for hypertension?

RENAL lytes and renal function uurinalysis, renal ultrasound HEART fasting glu and lipids END ORGAN echo, acr, retinal exam

Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do? a. reassure b. check for proteinuria c. start antibiotics

check proteinuria

Which of the following is a presentation of HUS? a. Coombs + anemia b. Thrombocytopenia c. Myoglobinuria

thromboycypeona Characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia and renal insufficiency. 2 major categories of disease: Infection associated (E. coli O157:H7, Shigella dysenteriae type 1, HIV, neuraminidase producing Strep pneumo) Genetic (atypical HUS)

Recurrent hematuria in a young male with a speech delay a. IgA nephropathy (usu occurs within 2 days of getting ill) b. Alport syndrome c. PSGN d. MPGN

alport hematuria often associated with sensorineural hearing loss and ocular abnormalities C3 normal xlinked IF a GIRL - consider IgA nephropathy

6 y.o. girl with a history of bilateral VUR and recurrent UTIs, including two febrile illnesses. Has been off antibiotics and infection-free for two years. Repeat u/s and VCUG show normal kidneys, but grade 1-2 reflux bilaterally. What do you recommend: a. consider operative repair b. repeat cystogram every 2 years c. restart prophylactic antibiotics d. continue non-interventional observation

continue non-interventional observation if put on abx, reasses 3-6 mo

12y old with diabetes Type I since the age of 5 with microalbuminuria despite optimum control of his diabetes. What should you start him on : a. hydrochlorothiazide b. nifidepine c. enalapril

enalapril

Diabetic with microalbuminuria. What would you prescribe? a. Enalapril b. Hydrochlorothiazide c. Nifedipine d. Salt and water restriction

enalapril

14 year old boy in office for pre-camp physical, 3+ protein in urine x2, exam is normal, what is most likely cause? a. exercise induced - b. IgA nephropathy - c. nephritic syndrome - d. Orthostatic

a. exercise induced - also possible but less common b. IgA nephropathy - persistent microscopic hematuria more common c. nephritic syndrome - would have other symptoms d. Orthostatic

Patient to ER with following labs: Na 135, K 2.3, Cl 116, Bicarb 9, pH 7.14, most likely cause? a. RTA b. DKA c. lactic acidosis d. Vomiting

RTA Non- anion gap metabolic acidosis, hypokalemia, normal sodium, hyperchloremia Anion gap = Na - HCO3 - Cl = 10 (normal) RTA: RTA is a disease state characterized by a normal anion gap (hyperchloremic) metabolic acidosis

RTA 1

DISTAL Impaired distal acid secretion Severe metabolic acidosis with high urine pH (>5.5) Loss of bicarb → hyperchloremia Hypokalemia from inability to secrete H+ Hypercalciuria + nephrocalcinosis usually present

RTA 2

PROX Impaired proximal bicarbonate reabsorption Usually occurs as part of global proximal tubular dysfunction or Fanconi syndrome Non-anion gap hyperchloremic metabolic acidosis Urine pH <5.5 because distal H+ secretion intact Glucosuria, aminoaciduria, phosphaturia Hypophosphatemia (can cause rickets), hypokalemia Patients can have FTT, polyuria, anorexia, vomiting, constipation

A child with recent Group A strep infection, normal C3, C4, slightly increased creatinine, Platelets and low hemoglobin, with blood in the urine a. HSP - b. HUS - c. Post strep GN - d. IgA nephropathy -

HUS usu caused by strep pneumo NOT GAS a. HSP - need other sx to make diagnosis b. HUS - if they meant both Plts and Hgb low, but no diarrhea? c. Post strep GN - C3 would be low d. IgA nephropathy - possible, but no anemia usually

Teenager found to have struvite stone. What would be next investigation? a. Urine calcium/Po4 b. Urine culture c. 24 hour urine ca

urine culture klebsiella ecoli and pseudomonas

130. Asymptomatic renal cyst 2 cm

monitor

Distal RTA (type 1), what is the electrolyte abnormality? a. Glycosuria - b. Hypercalciuria c. Increased anion gap

HYPERCALCURIA a. Glycosuria - this is proximal RTA w/ Fanconi syndrome b. Hypercalciuria c. Increased anion gap acidosis - anion gap is normal

7 year old girl with BP 140/80 with sx of ?PSGN & no signs given in history of end-organ damage. Management? a. IV labetolol b. PO nifedipine c. Salt/H2O restriction

salt h20 restrict

Which is a factor in determining what a child’s mean BP should be: a. Height b. Weight c. Tanner stage d. Ethnicity

height age, sex and height.

6 yo female with prior history of recurrent UTI, 2 of them afebrile, known bilateral reflux. Last VCUG shows ongoing low grade reflux. She has been off antibiotics and infection free for 2 years. What to do next? a. Restart antibiotics b. Observe only c. VCUG every 2 years

observe

15 yo female with 2+ protein on routine exam. What to do? a. 24 hr urine protein b. first morning urine analysis x 2 c. Renal function tests

FIRST MORRNING URINE X2

11 year old girl with gross hematuria. She has a history of 3 prior episodes, all associated with upper respiratory infections. Her gross hematuria resolves in one day, but she continues to dip positive for microscopic hematuria. What test would give you the diagnosis? a. C3, C4 b. ASOT c. Immunoglobulins

C3 AND C4 if normal then it would be IgA

``` 6mm pelicalviceal dilatation noted on antenatal and postnatal u/s. What should be done next? start prophylactic antibiotics VCUG DMSA repeat U/S in 2 months ```

rpt in 2 mo likely uou would do nothing

Description of testicular torsion. How can this diagnosis be confirmed? a. testicular ultrasound b. nuclear scan

testicular u/s

What is the most common etiology of hypertension in adolescents? a. essential hypertension b. renal artery stenosis c. congenital renal disease d. coarctation of the aorta

essential

5 day old infant in nursery has low urine output. Creatinine is 120. Renal ultrasound shows absent left kidney. The right kidney is at the low end of normal for size, and has consistent/uniform echodensity throughout. Which of the following is most likely? a. Prognosis depends on liver and lung status b. Likely will progress to end stage renal disease in childhood c. Likely will progress to end stage renal disease in mid adulthood d. He will have normal renal function

likely progress to ESRD When one kidney absent/nonfunctioning, other should compensate by hypertrophy. The fact that this one is normal for size and already showing signs of renal failure (ie low U/O, high Cr) would think he will progress to ESRD -

3 month old boy with UTI and grade 2 VUR on Right side. Which is the most clinically relevant way to detect renal scarring. a. IV pyelography b. nuclear renal scan (MAG or DMSA) c. Renal excretion scan (DTPA) d. VCUG

MAG nuclear renal scan

All of the following about Alport's are true except: a. Girls have worse prognosis b. Bad prognosis is with gross hematuria in childhood c. Progressive sensorineural hearing loss in childhood d. 15% have end stage renal disease before age 15 e. 2-3% of all end stage renal disease is due to Alport's

girls have worst prognosis

7 year old with microscopic hematuria most likely dx? a. IgA nephropathy b. alports c. idiopathic

idiopathic

Child with HUS following E coli enteritis, admitted in renal failure. How do you treat/screen her two siblings who are having bloody diarrhea? a. admit them, do CBC, BUN/Cr, start antibiotics b. do CBC, BUN/Cr, follow them clinically c. do CBC, BUN/Cr, start antibiotics d. do nothing unless they develop signs or symptoms of HUS

b. do CBC, BUN/Cr, follow them clinically abx not recommended

What is true about primary nephrogenic DI a. female predominance b. mental retardation c. growth deficiency

``` growth def are cause of DI defect in receptors for ADH - so resistant to ADH - AVPR2 gene gene for receptors is X linked - so more likely in males present with: massive polyuria (very wet diapers) volume depletion hyperNatremia hyperthermia irritability crying constipation poor weight gain multiple episodes of hypernatremic dehydration causes developmental delay and mental retardation ```

A child with multicystic dysplastic kidney. What is the likely association? a. severe hypertension b. vesico-uretero reflux c. cataracts d. brain aneurysm

VUR Contralateral hydronephrosis is present in 5-10% and 15% have contralateral VUR, of patients with MCDK

Previously well 10yo boy presents with microscopic hematuria. Renal ultrasound reveals 1 cm stone in pelvic basin. Likely: a. oxaluria b. idiopathic hypercalciuria c. aminoaciduria d. cystinuria

idiopathic hypercalciuria is most common cause of stones most common metabolic urine abnormality found in kids: Hypercalciuria, 50 % Hyperoxaluria, 10 to 20 % Hyperuricosuria, 2 to 8 % Cystinuria, 5 % Hypocitraturia, 10 % Most urinary calculi are either calcium oxalate and/or calcium phosphate.

What is the management of 10 yo male with nocturnal enuresis (normal u/a)? a. conditioning alarm b. DDAVP c. TCA d. diapers

conditioning alarm

In SIADH you DO NOT have: a. serum hypouricemia b. urine hyperkalemia c. high urine sodium excretion d. urine/serum osm ratio >1.5

urine hyperkalemia urine/serum osm ratio >1.5 - expect really low serum osm with high ADH

Patient with HSP. What would you monitor a. urinalysis b. IgA c. stool for O/P d. AXR

urinalysis

What condition is not associated with low complement levels? a. MPGN b. HSP c. Shunt nephritis d. Lupus nephritis e. Post strep GN

HSP - shunt and lupus causes secondary MPGN Low complement GN: Systemic: SLE, endocarditis, cryoglobulinemia, shunt nephritis Isolated renal: post-infectious GN, MPGN Normal complement GN: Systemic: HSP, ANCA-associted (Wegener’s, PAN), Goodpasture’s syndrome, hypersensitivity vasculitis Isolated renal: IgA nephropathy, anti-GBM disease, RPGN

51/2 boy with recent URTI, now has respiratory distress and BP150/110, most likely a. anxiety b. pneumonia c. Henoch-schonlein purpura d. post strep GN

post strep GN

11y old presents with a 4 day hx of tea colored urine. He had an upper respiratory tract infection 10 days ago. There is no hx of urgency or dysuria. Normal PE. Blood pressure 110/75 (not hypertensive). Urine analysis: red blood cells, 0-2 WBC and 1+ protein. a. cystitis b. Hypercalcuria c. IGA nephropathy d. Post infectious GN

post infectious GN ``` nephritis proteinrua Hemuatira Azotemia Renal inusff Oliguria HTN ``` ystitis - ?could they mean hemorrhagic cystitis, could be secondary to adenovirus, should present with LUTS. b. Hypercalcuria - idiopathic hypercalciuria can cause gross hematuria, should have pain, LUTS, diagnosed by 24 hour urine calcium excretion > 4mg/kg, spot calcium/creatinine ratio. c. IGA nephropathy - shorter latency period, should be 1-2 days after URTI, M>F d. Post infectious GN - would be helpful to distinguish from IgA nephropathy if C3 levels were given. Low C3 in post infectious GN and normal C4 in IgA nephropathy.

A 17 y adolescent male complains of several weeks of swelling above his left testicle. He does not have any pain in the area. He is sexually active and states that he uses condoms. On PE: he has a mass along the spermatic cord that feels like a bag of worms. Which of the following is the most effective management? a. ceftriaxone and doxycyclin po b. Doppler flow studies of testis c. Radionucleide scan of testis d. reassurance and education only at that time

reassurance and education only at that time ultrasound - only if R side to r/o abdo mass

During the first year of infant’s life, which of the following remains essentially unchanged? a. GFR b. nephron number c. renal blood flow d. Ability to concentrate urine

nephron #

5 yo male with fever and rhinorrhea presents with gross hematuria one day later. He has had a previous similar episode 3 months ago. What is the most likely diagnosis? a. chronic glomerulonephritis b. post-Strep GN c. postinfectious GN d. IgA nephropathy e. nephrotic syndrome

IgA nephropty

14 mos male with FTT and vomiting, labs pH 7.31, bicarb 17, K3.5, Na 140, Cl 118, and urine pH 6.3. a. distal RTA b. Bartter’s syndrome c. organic acidopathy d. nutritional deprivation

distal RTA Renal tubular acidosis = non-anion gap hyperchloremic metabolic acidosis if urine pH >5.5 + potassium is NOT high = type 1 RTA; distal RTA Bartter syndrome = hypochloremic metabolic alkalosis Organic acidopathy = anion-gap metabolic acidosis

A newborn infant has a left sided abdominal mass. A renal ultrasound demonstrates multicystic kidney disease. Which of following would this be associated with: a. ipsilateral hydroureter b. posterior urethral valves c. sensorineural hearing loss d. cataracts e. risk of malignancy

risk of malignancy for life The risk of associated hypertension is 0.2-1.2%, and the risk of Wilms tumor arising from an MCDK is approximately 1 in 1,200. Because neoplasms arise from the stromal rather than the cystic component, even if the cysts regress completely, the likelihood that the kidney could develop a neoplasm is not altered. you get CONTRAlateral hydroureter

Which of the following is associated with a low C3: a. Alport’s syndrome b. nephrotic syndrome c. post-streptococcal glomerulonephritis d. hemolytic uremic syndrome e. Henoch-Schonlein purpura -

post strep glomerulopehritis

An 8-year-old boy has recurrent episodes of asymptomatic gross hematuria triggered by intercurrent illnesses. Between illnesses, dipstick shows microscopic hematuria. Best test to determine etiology: ***Q a. immunoglobulins (as per Consensus) b. C3 and C4 levels (as per Nelson’s) c. 24-hour urine protein d. abdominal ultrasound e. DMSA scan

c3 c4

6-year-old girl with incidental finding of a 2 cm renal cyst. Appropriate management: a. observe b. CT abdomen c. ultrasound liver d. urology consult e. full nephrologic workup

observe Isolated renal cysts are commonly observed within the general population, and the prevalence rises with increasing age. For both affected adults and children, the principle clinical concern is accurately distinguishing simple renal cysts from complex renal cysts that are associated with malignancy. if complex CT

A 6-year-old child has hypertension and persistent hypokalemia. Most likely diagnosis: a. hyperaldosteronism b. Bartter syndrome c. Addison’s disease d. renal vein thrombosis e. aortic coarctation

hyperaldosterosnims Primary hyperaldosteronism: excessive aldosterone secretion causes hypertension, hypokalemia. Also high Na, low Cl, low Mg. Urine is neutral or alkaline. High urine potassium Aortic coarctation = hypertension, without hypokalemia Addison’s disease = hypocortisolism, hypoaldosteronism = hyperkalemia, hypotension Renal vein thrombosis = hypertension, without hypokalemia Bartter syndrome = hypotension, metabolic alkalosis, hypokalemia

Child presents with failure to thrive, polydipsia, polyuria, and hypokalemic metabolic alkalosis. a. hyperaldosteronism b. Bartter syndrome c. cystinosis d. renal tubular acidosis e. congenital adrenal hyperplasia

Bartter syndrome - like being on lasix all the time hypokalemic hypochloremic metabolic akalosis with hypercalciuria, salt wasting can manifest antenatally, perinatally, in infancy, or in childhood with FTT and history of recurrent dehydration type4 is HYPOaldosteronisn

5½-year-old child with a recent upper respiratory tract infection, now has respiratory distress and BP 150/110. Most likely: a. anxiety b. pneumonia c. myocarditis d. Henoch-Schonlein purpura e. post-streptococcal glomerulonephriti

post strep glomeuerlonephritis pulm edema cause resp distress

The following are shared by cystinosis and renal tubular acidosis (distal) EXCEPT: a. hypokalemia b. nephrolithiasis c. concentrating defect d. aminoaciduria e. hyperchloremic metabolic acidosis

b. aminoaciduria -The main cause of fanconi syndrome is cystinosis -Clinical features of proximal renal tubular acidosis (Type 2) include Polyuria, polydipsia and dehydration, Growth failure Hyperchloremic metabolic acidosis Hypokalemia Fanconi syndrome (other features) Glycosuria Proteinuria/aminoaciduria Hyperuricosuria

Infant post cardiac surgery with poor urine output. BUN 25, Cr 177, urine (low Na, concentrated) a. ATN b. prerenal failure c. anaesthetic injury to kidney d. obstructive uropathy e. renal vein thrombosis

pre renal Urine Na <20 = prerenal Urine Na >20 = renal

In a newborn found to have a multicystic-dysplastic kidney, the following is likely: a. hematuria b. hypertension c. ureteropelvic reflux

ureteropelvic reflux

Child with nephrotic syndrome admitted with edema. Na=125. Best fluids: a. D5W/0.2% saline b. D5W/0.45% saline c. normal saline d. 3% saline e. Nothing

Treatment of Nephrotic Syndrome: · sodium restriction <1500mg daily · water/fluid restriction

An 8 year old female presents with microscopic hematuria. She has no symptoms. The most likely diagnosis is: a. Alport's b. Wilms' tumour c. IgA nephropathy d. nephrocalcinosis e. post streptococcal glomerulonephritis

IgA neprhopathy

A child is brought to the emergency department after an MVA. There has been a period with prolonged hypotension/hypovolemia. His urine output is now 0.3 ml/kg/hr. His mother states that he was evaluated for hematuria and proteinuria 1 year ago and was told that the child may have renal disease. What is the best way to detect parenchymal kidney disease: a. Increased tubular reabsorption of urea b. Decreased urinary creatinine c. Urinary sodium <10 mmol/L d. Fractional excretion of Na <3% e. IVP

urinary sodium <10mmol/L

You are assessing a 3 week old infant. The weight is 4 kg, the birth weight was 3.6 kg, the blood pressure is 90/55 (high). The mother states that the infant is feeding well. The labs show: Na 142 (Normal), K 3.6 (low), Cl 113 (high), Cr normal, pH 7.25 (acidotic), urine pH 5.0. What is the most likely etiology a. hyperaldosteronism b. RTA, proximal c. CF d. Psychosocial failure to thrive

RTA a. Hyperaldosteronism - should have hypokalemia, hypertension, high urine potassium, metabolic alkalosis due to H excretion (when K leaves too) b. RTA, proximal - urine with pH < 5.5, non metabolic gap metabolic acidosis + hyperchloremic c. CF - should have hypochloremic, hyponatremic metabolic alkalosis d. Psychosocial failure to thrive - gained ~ 20g/day

Photograph of Prune Belly Syndrome. Which of the following is a consistent association: a. Posterior urethral valves b. Progression to renal failure c. Sex-linked inheritance d. Polyhydramnios

progression to renal failure in 50% and ESRD 30% more common in males usu oligohydramnios

A 14 year old boy has hypertension. He is at the 99th percentile for height and weight. What are the THREE investigations you need to do to assess for effects of his hypertension, and what would you be testing for? (3 points)

ECHO - looking for LVH Fundoscopy - looking for papilledema, retinal changes ACR (albumin to Cr - renal function

A boy with family history of renal stones, presents with 24-48h right flank pain. Passed a 5 mm stone determined to be calcium oxalate. Name 4 dietary interventions you would recommend to decrease the risk of further stones.

hydration low Na diet Low fat diet limiting animal diet

nephrotic syndrome | what vaccine they should get

Because children with nephrotic syndrome are at increased risk for serious complications and potentially death from pneumococcal infection, they should receive 23-valent polysaccharide (PPSV23) pneumococcal vaccine if not previously immunized. Pneumococcal vaccine is effective even in children receiving high doses of steroids and it is not associated with an increased risk of relapse

What are four other possible causes of his testicular pain?

Epididymitis Incarcerated inguinal hernia Scrotal trauma Orchitis

What are 3 reasons to refer to a nephrologist?

``` Failure to respond to steroids Gross hematuria Hypertension Renal insufficiency <1 year >12 years ```

Child with hemolytic uremic syndrome (you are told it is HUS) What are the 3 characteristic laboratory features of HUS?

Microangiopathic hemolytic anemia Thrombocytopenia Renal insufficiency

5yo nausea and confuse, then seizue 12 hours post tonsillectomy labs Na 121 serum osm 260 a) urine osm higher than serum osm

SIADH

child sick with vomitting and diarrhea feeding sugar water Na 108 Cr 95 urea 13 correct to 118/120 over 24 hours 3% correct over 4-6 hours fluid restric correct to 135-140 in 24 hurs

correct to 118/120 over 24 hours

4 mo with FTT gas 7.24, co2 30, HCO3 16 BW- Na 138, Cl 111, K5, P04 2.1, glu 4

RTA Fanconi causes low p04 (its normal here)

Distal RTA a. hypercalcuria b. hypokalemia

hpyercalcuria

child with unilat gr 4 VUR, and has had resistance with 2 abx, what to do next

stop prophylaxis

``` 7yo M left sided night time flank pain, u/s L sided hydro whats next a-vcug b-nuc scan with lasix washout c-dmsa scan d- CT with contrast ```

nuc scan with lasix as this diagnosis obstrcution

four intervention decrease stones

low salt high urine more citrate - lemonade more pho4 and magneisum

14yo recurrent, painless hematuria, best test a) IgA level b) C3 c) renal us d) hearing test

IGA level no pain so not ultrasuond for stone C3- recurrent so not PIGN hearing test= males alport

12 yo with 2 w fever, artharglia an dmaalgia well but pale blood and proitein urine ESR 50 WBC 5, normal platelet acute rheumatic fever SLE wegeners granulmatosis JRA

SLE

12 yo with 2 w fever, artharglia an dmaalgia well but pale blood and proitein urine ESR 50 WBC 5, normal platelet acute rheumatic fever SLE wegeners granulmatosis JRA

SLE | usu pancytopenic

3 ft of HUS

MAHA thrombocytpenoa renal abn NO abx in HUS, do CBC BUN cr and follow clinically

most common cause of htn in newborn

renovascular

Nephro/GU Flashcards

(107 cards)