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Nephrology Flashcards

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1
Q

Nephritic

A

OHH

Oliguria
Hypertension
Hematuria
Azotemia

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2
Q

Nephrotic

A

PALE (EPHAL)

Proteinuria (nephrotic range)
Albumin low
Lipid high
Edema

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3
Q

Grossly red urine

A

LOWER URINARY TRACT

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4
Q

brown, cola, tea, burgundy colored urine

proteinuria >100 mg/dL

RBC casts

dysmorphic EBCs (acanthocytes)

A

GLOMERULAR

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5
Q

leukocytes or renal tubular casts

A

TUBULAR SYSTEM

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6
Q

Documentation of prior strep infection

A

ASO - throat

DNAse B antigen - skin

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7
Q

Serotype ff throat infection

A

1,2,4,12,18,25

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8
Q

Serotype ff THROAT infection

A

49,55,57,60

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9
Q

Patient develops nephritic syndrome how many weeks after throat infection

A

1-2 weeks

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10
Q

Patient develops nephritic syndrome how many weeks after skin infection

A

3-6 weeks

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11
Q

Poststreptococcal Glomerulonephritis

5-12 y/o
RARE before 3 y/o

A

LM: diffuse proliferation

IF: granular IgG, C3

EM: subepithelial humps

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12
Q

Laboratory findings Poststreptococcal Glomerulonephritis

A

INCREASED ASO titers
(+) streptozyme
decreased C3-C9; normal C1,C4

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13
Q

When will the abnormalities resolve

A

urinary protein excretion and HPN - 4-8 weeks

acute phase - 6-8 weeks
C3 level - 6-8 weeks

microscopic hematuria - 1-2 years

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14
Q

The only causes of renal insufficiency that cause DECREASED C3

A

PSGN
MPGN
Lupus Nephritis

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15
Q

Indications for Renal Biopsy in APSGN

A 
acute renal failure
nephrotic syndrome
(-) evidence of strep infection
normal complement level
hematuria and proteinuria
low C3 that persists > 2 mos
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16
Q

Bilateral sensory hearing loss

Anterior lenticonus (pathognomonic)

macular flecks, corneal erosions

A

Alport Syndrome (Hereditary Nephritis)

(+) hematuria
2 of the ff
*macular flecks
*recurrent corneal erosions
*GBM thickening or thinning
*sensorineural deafness
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17
Q

(+) hematuria, HPN
signs of renal insufficiency

history of hemoptysis and severe RDS

A

Goodpasture syndrome

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18
Q

(+) hematuria, HPN
signs of renal insufficiency

(+) SVI 3 weeks ago

purpuric rash (buttocks)
pain in the joints
A

Henoch Schonlein Purpura (HSV)

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19
Q

(+) hematuria, HPN
signs of renal insufficiency

vomiting, bloody diarrhea and fever
history of eating hamburger

dehydrated hepatosplenomegaly

A

hemolytic uremic syndrome (HUS )

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20
Q

Sudden onset of gross hematuria

febrile with LRTI or GIT infection

normal C3

A

IgA nephropathy

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21
Q

Sudden onset of gross hematuria

History of strep throat or pyoderma

severely depressed C3

A

APSGN

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22
Q

asymptomatic microscopic hematuria

wears thick glasses and hearing aid

has uncles with the same condition

A

Alport Syndrome (Hereditary Nephritis)

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23
Q

IgA nephropathy

10-35 y/o

follows viral syndrome

INCREASED serum IgA

A

LM: focal proliferation

IF: diffuse mesangial IgA

EM: mesangial deposits

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24
Q

Goodpasture syndrome

15-30

pulmonary hemorrhage; IDA

(+) anti GBM antibody

A

LM: focal –> diffuse proliferation w/ crescents

IF: linear IgG, C3

EM: (-) deposits

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25
Idiopathic Rapidly Progressive Glomerulonephritis adults (+) ANCA (in some)
LM: crescentic GN IF: (-) immune deposits EM: (-) deposits
26
3 mechanisms of proteinuria
Glomerular proteinuria -- ineffective filtration Tubular proteinuria -- ineffective reabsorption Increase plasma protein -- i.e. rhabdomyolysis
27
Urine dipstick
3+ - 300 mg/dL | 4+ - >2g/dL
28
Nonpathologic causes of proteinuria
Postural Febrile (>38 C) Exercise - resolves after 48 h
29
24 hr urine protein determination
NEPHROTIC RANGE > 40 mg/m2/hr
30
Urine protein: Creatinine ratio
NEPHROTIC RANGE >2
31
Causes of Transient Proteinuria
``` Fever Exercise Dehydration Cold Exposure CHF Seizure Stress ```
32
Idiopathic Nephrotic Syndrome
MInimal Change Disease Focal Segmental Glomerulosclerosis Mesangial Proliferation
33
Glomerular Diseases
Membranous Nephropathy | Membranoproliferative Glomerulonephritis
34
3+ or 4+ proteinuria urine protein/ creatinine ratio >2 urinary protein excretion > 3.5 h/24 hr in adults and 40 mg/m2/hr in children normal C3 and C4
Nephrotic Syndrome (Minimal Change Disease) increased permeability of glomerular capillary wall -- proteinuria and hypoalbuminemia PODOCYTES -- EFFACEMENT of foot process, decrease number of podocytes and altered slit diaphragm -- LEAKY MEMBRANES
35
Remission attained w/n initial 4 weeks
RESPONSE
36
UPCR <0.2 or < +1 protein on dipstick for 3 consecutive days
REMISSION
37
UPCR > 2 or > 3 dipstick for 3 consecutive days
RELAPSE
38
Relapse w/n 28 days of stopping prednisone therapy
NON RESPONDERS Steroid Dependent
39
Patient who respond well to prednisone therapy but relapse 4 or more tie in a 12 mo period
NON RESPONDERS Frequent relapser
40
Children who fail to respond to prednisone therapy w/n 8 weeks
NON RESPONDERS Steroid dependent
41
Children who continue to have proteinuria (+2 or greater) after 8 weeks of steroid therapy
NON RESPONDERS Steroid resistant
42
Major complication of nephrotic syndrome
Infection
43
The most frequent type of infection in nephrotic syndrome
Spontaneous bacterial peritonitis
44
The MC organism causing peritonitis
Pneumococcus
45
LM: Diffuse thickening of glomerular capillary walls IF: granular IGG and C3 EM: subepithelial deposits of electron dense material SPIKE AND DOME APPEARANCE
Membranous Glomerulonephritis
46
LM: normal EM: effacement of epithelial foot processes, (-) deposits
MInimal Change Disease
47
LM: Large hypercellular glomeruli Increased mesangial matrix DOUBLE CONTOUR OR TRAM TRACK APPEARANCE
Membranoproliferative Glomerulonephritis
48
LM: focal segmental sclerosis and hyalinosis EM: loss of foot process, epithelial denudation
Focal Segmental Glomerulosclerosis
49
Prevalence of UTI
1st year of life - MALE | beyond 1-2 y/o - FEMALE
50
3 basic forms of UTI
Pyelonephritis Cystitis Asymptomatic bacteriuria
51
Colonic bacteria that cause UTI
E. coli Klebsiella Proteus
52
abdominal, back or flank pain, fever, malaise, nausea, vomiting and diarrhea (occasional)
Pyelonephritis
53
(-) fever (-) permanent renal damage dysuria, urgency, frequency, suprapubic pain, incontinence and malodorous urine
Cystitis
54
(+) urine culture (-) manifestation of infection
Asymptomatic Bacteriuria
55
Recurrent UTI
2 or more acute pyelonephritis/presumptive UTI OR 3 or more cystitis OR 1 pyelonephritis + 1-2 cystitis
56
Presumptive UTI
Clinical symptoms + urinalysis findings suggestive of UTI not supported by urine culture
57
Indications of urine culture in UTI
significant urinalysis findings complicated UTI seriously ill children recurrent UTI
58
Gold standard in a properly collected sample
Urine Culture
59
Collection of urine
< 2 y/o - clean catch urine collection > 2 y/o - mid-stream sample
60
Indications for KUB Ultrasound with post void study
Culture proven pyelonephritis Febrile presumptive UTI Recurrent UTI
61
Nitrite + | Leukocyte +
Urine CS Treat as UTI
62
Nitrite + | Leukocyte -
Urine CS Treat as UTI
63
Nitrite - | Leukocyte +
Urine CS Treat if with symptoms
64
Nitrite - | Leukocyte -
NOT UTI
65
Pyuria
CENTRIFUGED >5 /HPF UNCENTRIFUGED >10/uL
66
Bacteriuria + | Pyuria +
Urine CS Treat as UTI
67
Bacteriuria + | Pyuria -
Urine CS Treat as UTI
68
Bacteriuria - | Pyuria +
Urine CS Treat if with symptoms
69
Bacteriuria - | Pyuria -
NOT UTI
70
Management of CYSTITIS
Co-trimoxazole and Amoxicillin – high rate of resistance Nitrofurantoin
71
Management of ACUTE PYELONEPHRITIS
Ceftriaxone Cefotaxime Ampicillin + Aminoglycoside
72
Management of PSEUDOMONAS
Aminoglycoside | Fluoroquinolone (Ciprofloxacin)
73
DOH RECOMMENDATION (UTI) ``` E. coli Klebsiella Enterobacter Enterococcus Group B Strep ```
< 2 mos - Cefotaxime PLUS Amikacin - 10-14 days > 2 mos - 18 y/o (7-10 days) Oral Co-Amoxiclav Cefuroxime Nitrofurantoin Ampicillin Sulbactam
74
DOH RECOMMENDATION (UTI) Recurrent UTI Catheter related comorbidities
Ceftriaxone and/or Amikacin for 7-14 days
75
DOH RECOMMENDATION (UTI) Antibiotic Switch
If culture shows different sensitivity pattern and/or poor response after 48-72 hrs
76
Acute Kidney Injury
Abrupt loss of kidney function -- rapid decline in the glomerular filtration rate (GFR), accumulation of waste products such as BUN and CREA, and dysregulation of extracellular volume and electrolyte homeostasis
77
KDIGO (Kidney Disease Improving Global Outcomes) Definition of AKI
INCREASE in CREA by >/= 0.3 mg/dL from baseline w/n 48 hrs INCREASE in CREA by >/= 1.5 mg/dL from baseline w/n the prior 7 days URINE VOLUME = 0.5 ml/kg/hr for 6 hrs
78
Categories of AKI
Pre renal Intrinsic Post renal
79
Diminished effective circulating arterial volume -- inadequate renal perfusion
PRERENAL ``` dehydration sepsis hemorrhage hypoalbuminemia cardiac failure ```
80
Renal parenchymal damage including sustained hypoperfusion and ischemia
INTRINSIC glomerulonephritis acute tubular necrosis ENDOGENOUS - myoglobin, hemoglobin EXOGENOUS - medications, poisons, radioactive materials
81
Obstruction of urinary tract
POST RENAL congenital conditions - posterior urethral valve, uteropelvic junction obstruction urolithiasis, tumors
82
Chronic Kidney Injury (NKF KDOQI)
Kidney damage for >3 mo - structural or functional abnormalities of the kidney w/ or w/o decreased GFR manifested by one or more of the ff features * abnormalities in the composition of the blood or urine * abnormalities in imaging tests * abnormalities on kidney biopsy GFR <60 mL/min/1.73 m2 for 3 mo w/ or w/o the other signs of kidney damage described above
83
One of the MCC of acute renal failure in young children Caused by infection, genetics, drugs (calcineurin inhibitors, cytotoxic agents, clopidogrel, ticlopidine, quinine) SLE, HELLP
Hemolytic Uremia Syndrome (HUS) sudden onset of pallor, irritability, weakness, lethargy and oliguria usually occurs 5-10 days after the initial gastroenteritis or respiratory illness dehydration, petechiae, hepatosplenomegaly, marked irritability
84
RAT Renal insufficiency Anemia (microangiopathic) Thrombocytopenia
Hemolytic Uremia Syndrome (HUS)
85
MC form of HUS
EHEC
86
Characteristic of all forms of HUS
Microvascular with endothelial cell damage
87
Laboratory criteria for diagnosis of HUS
anemia (acute onset) with microangiopathic changes - schistocytes, burr cells, helmet cells renal injury evidenced by hematuria, proteinuria, or elevated creatinine level
88
Presents similarly with PSGN but the throat infection coincides with appearance of renal symptoms
IgA Nephropathy
89
Triad of HUS
Renal insufficiency Anemia (microangiopathic) Thrombocytopenia
90
HSP Tetrad
Palpable purpura Arthritis Abdominal pain Glomerulonephritis
91
Pathognomonic for Alport Syndrome
Anterior lenticonus
92
Clinical Manifestations that differentiate TTP from HUS
CNS Involvement | Fever
93
HPN for children 1-13 y/o
elevated BP >90th to <95 OR 120/80 mmHg (whichever is lower) Stage 1 >95th to <95th + 12 mmHg OR 130/80 mmHg - 139/89 mmHg (whichever is lower) Stage >95th + 12 mmHg OR >140/90 mmHg (whichever is lower)

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