nephrology Flashcards
(90 cards)
1
Q
avg. newborn systolic BP
A
70-75
2
Q
avg 1 yr old systolic BP
A
90
3
Q
avg 5 yr old systolic BP
A
95
4
Q
avg 12 yr old systolic BP
A
100-105
5
Q
HTN is BP > than 95th percentile for what?
A
age
gender
ht
6
Q
HTN is more often_________than_________in CH
A
secondary than primary (“essential”)
7
Q
HTN in CH, consider what types of dz first
A
renal dz
endocrine dz
8
Q
early HTN in CH is a precursor to what?
A
serious adult HTN
9
Q
HTN in CH DDx
A
renal dz endocrine neurologic psychologic causes vascular causes drugs other
10
Q
renal dz that may cause HTN in CH
A
pyelonephritis renal parenchymal dz congenital anomalies reflux nephropathy acute glomerulonephritis Henoch-Schonlein purpura renal trauma hydronephrosis hemolytic-uremic syndrome renal stones nephrotic syndrome Wilms tumor hypoplastic kidney polycystic kidney dz
11
Q
endocrine dz that may cause HTN in CH
A
hyperthyroidism congenital adrenal hyperplasia Cushing syndrome primary aldosteronism primary hyperparathyroidism DM hypercalcemia pheochromocytoma
12
Q
neurologic dz that may cause HTN in CH
A
increased ICP
Guillain-Barre syndrome
13
Q
psychologic causes in HTN in CH
A
mental stress
anxiety
14
Q
vascular causes of HTN in CH
A
renal artery abnormalities renal vein thrombosis coarctation of the aorta patent ductus arteriosus arteriovenous fistula
15
Q
some drugs that may cause HTN in CH
A
anabolic steroids
corticosteroids, OCPs
PCP, cocaine
16
Q
other causes of HTN in CH
A
pain
collagen vascular dz
neurofibromatosis
17
Q
Henoch-Schonlein purpura pneumonic
NAPA
A
Nephritis
Abdominal pain
Purpura-non blanching rash over buttocks & calves/ankles
Arthralgias
test urine initially weekly, then monthly to monitor for kidney failure
18
Q
Hx taking in eval of HTN in CH
A
CNS- HA, seizures hearing impairment CV- palpitations renal- edema, UTI, urine output meds neonatal hx- hx of central cath early CV dz
19
Q
eval of HTN cause
A
intracranial HTN Alport syndrome catecholamine nephropathy (HUS, SLE, GN, tumor, ADPKD, etc) OCPs renal artery or aortic stenosis obesity, essential HTN
20
Q
Labs for evaluation of HTN in CH
A
BP measurements w/ approp. cuff size
electrolytes, BUN, cretinine, UA, urine cx
consider: CBC, uric acid, C3 level, FBG, lipid levels, urine catecholamines, renal ULS, echocardiogram & EKG
21
Q
HTN tx in CH
A
treatable causes must 1st be r/o- much more common to have a treatable cause in CH than adults
exercise
diet changes to address obesity & co-morbidities
medical therapy- diuretics, ACEi, B-blockers, CCB
22
Q
Hematuria DDx in CH
DOGSHIT
A
Drugs Oncologic Glomerulonephritis Stones Hematologic Infection Trauma
23
Q
Fever in a neonate
A
blood
CSF
urine
24
Q
UTI labs in kids <2yo in addition to basics, like CBC
A
renal ULS- visualizes upper UT
VCUG (voiding cystourethrogram)- visualizes lower UT
25
what clinches the dx of kidney stones in CH
UA w/ micro to get WBC & RBC count (elevated)
| the clincher is....CT w/o contrast
26
what are some of the causes of red urine w/o urinalysis evidence of blood
red dye
food
meds
chemicals excreted in urine
27
causes of red urine w/ urinalysis evidence of blood but no RBC on microscopy
free Hgb- hemolysis, DIC
| free myoglobin-crush injury, burns, myositis, asphyxia
28
red urine w/ urinalysis & microscopy evidence of blood but no RBC casts
bleeding from urinary tract distal to renal tubules
29
red urine w/ blood & casts in urine
glomerular dz
- immunologic dz (e.g. post-streptococcal glomerulonephritis)
- inherited dz (e.g. Alport syndrome)
- vascular injury (e.g. ATN, cortical necrosis)
30
hematuria work up
hx & PE
confirm true hematuria
-if microscopic w/ benign H&P=>recheck
-if repeatedly + or +H&P=>workup
31
hematuria DDx
```
UTI/cystitis/urethritis
hypercalcemia
urolithiasis
trauma
post-streptococcal glomerulonephritis
IgA nephropathy
Henoch Schonlein purpura (HSP)
SLE
nephrotic syndrome
membranoproliferative glomerulonephritis
Alport syndrome- sensorineural deafness, progressive renal failure
sickle cell trait/dz
structural abnormality
renal/urinary tract tumor
```
32
hematuria benign DDx
benign familial hematuria
| post exercise
33
phase I workup for hematuria
```
UA w/ microscopic exam
CBC
urine cx
chem 8 (including BUN, Cr)
24 hr urine collection for Cr, protein, Ca2+
serum C3 level
renal ULS
```
34
phase II workup for hematuria
```
ANA titer
throat culture for Step pyogenes
ASO titer or DNAse B titer or streptozyme
urine erythrocyte morphology
coagulation studies
sickle cell screen
VCUG (voiding cystourethrogram)
```
35
hematuria & when a renal bx is indicated
persistent high grade microscopic hematuria;
| microscopic hematuria & diminished renal function, proteinuria exceeding 150 mg/ 24 hrs, 2nd episode of gross hematuria
36
post streptococcal glomerulonephritis clinical presentation
```
5-21 days (avg 10) post streptococcal infxn
gross hematuria (65% of cases)
edema (75% of cases)
HTN (HA, visual changes) 50% of cases
```
37
post streptococcal glomerulonephritis labs
elevated ASO titer
group A B-hemolytic streptococcal infxn
decreased C3 level
38
tx of post-streptococcal glomerulonephritis
```
Abx for streptococcus pyogenes
supportive care for renal function
-reduce salt intake
-tx w/ diuretics
-anti-HTN drugs
```
39
IgA Nephropathy pathogenesis
glomerulonephritis w/ IgA immunoglobulin in mesangial deposits
absence of systemic dz
40
IgA nephropathy clinical manifestations
episode of gross hematuria 1-2 days after a viral upper respiratory infxn
may be picked up by UA showing microscopic hematuria
41
IgA nephropathy tx
usually resolves w/ minimal intervention in CH. some progress to have HTN, diminshed renal function, proteinuria. 25% of adults progress to end-stage renal dz
42
clinical manifestations of SLE
```
malar rash
discoid rash
photosensitivity
oral ulcers
arthritis
serositis
renal d/o-variable: minimal to end-stage
neurologic d/o
hematologic d/o
immunologic
+ANA
```
43
proteinuria
nml CH exretion <4 mg/m2/hr
| proteinuria is a urinary protein loss of 50 mg/kg per 24 hrs
44
proteinuria may be the result of normal activity such as
exercise
febrile illness
upright posture
45
some non-renal causes of proteinuria
Fanconi syndrome
drug & heavy metal intoxication
processes that increase glomerular filtration such as physical damage, abnormal hemodynamics
46
Clinical diagnostic criteria for nephrotic syndrome
generalized edema
hypoproteinemia ( 1g/m2/24 hrs
hypercholesterolemia (>250 mg/dL)
47
pathophysiology of nephrotic syndrome
loss of basement membrane sialoproteins (loss of nml neg. charge)
allows glomerular permeability to proteins
protein loss in urine
48
complications of protein loss in urine
hypoalbuminemia
loss of plasma oncotic pressure- fluid shifts from vascular to interstitial compartment
increases risk of thromboembolism
hepatic lipoprotein synthesis stimulated by hypoproteinemia
49
most common presentation of nephrotic syndrome
sudden onset of pitting edema, wt gain or ascites
| onset < 6 yo
50
DDx of nephrotic syndrome
```
transient proteinuria
postural (orthostatic) proteinuria
glomerular proteinuria
glomerular proteinuria
minimal change dz (typical nephrotic syndrome)
congenital nephrotic syndrome
focal segmental glomerulosclerosis
meangial nephropathy
membranous nephropathy
```
51
transient proteinuria (w/ fever, dehydration, etc.)
protein to creatinine ratio reveals mild proteinuria, ratio <1
52
postural (orthostatic) proteinuria
benign condition of moderate proteinuria while upright
| rationale for 1st morning samples
53
glomerular proteinuria
associated w/ acute illnesses involving kidney
54
clinical findings of nephrotic syndrome
edema
periorbital swelling
oliguria
fluid shifts- ascites, pleural effusion, scrotal/ labial edema
55
labs in nephrotic syndrome
low albumin
UA (proteinuria)- 1+ proteinuria on 2+ random specimens warrants quantitative measure or proteinuria (1st a.m. void spot protein/Cr ratio, ratio>0.5 prompts lab & radiographic workup)
C3 level
renal bx
56
C3 level in nephrotic syndrome
a low C3 level is the most sensitive & specific test to imply a presence OTHER than minimal change dz
57
renal bx in nephrotic syndrome
generally unremarkable
| foot processes of glomerular basement membrane fused
58
nephrotic syndrome tx
corticosteroids (80% of pts respond)
low Na+ diet to prevent massive fluid shifts
can try immunosuppressive agents
renal bx if no response to either above (this would typically preced steroids if C3 level was low- implying dz other than minimal change dz)
59
complications of nephrotic syndrome
infection (peritonitis, bacteremia/sepsis- S. pneumoniae, E. coli), cellulitis
hypercoagulability
pleural effusion
renal insufficiency- BP instability
60
what accounts for renal cysts as well as tuberous sclerosis
ADPKD (1:1000)
ARPKD (1:10k-40k)
ADPKD can present in infancy & CH
61
urinary tract obstructions that can lead to nephropathy
```
ureteropelvic junction (UPJ) obstruction
posterior urethral valves
```
62
clinical manifestations of posterior urethral valves
poor urine stream
urethra dilates, VUR may develop, kidneys swell & become dysplastic
rupture of the renal pelvis may cause urinary ascites
hopefully caught on fetal ULS (as obstruction)
63
what is the MCC of newborn ascites
rupture of the renal pelvis d/t posterior urethral valves
64
hypospadias
ventral malposition of urethral meatus
| 10% have undescended testes
65
severe cases of hypospadias prompt suspicion of what?
congenital adrenal hyperplasia & masculinization of female genotype
66
hypospadias is often associated w/ what?
chordee (ventral curve in penile shaft)
67
phimosis
unretractable foreskin
90% can retract by 16 yo
tx w/ serial stretching/ steroid cream
circumcision in severe cases
68
paraphimosis
trapped retracted foreskin in coronal sulcus
foreskin becomes swollen, red, painful
reduce manually w/ lubrication & plenty of analgesia
rarely proceeds to circumcision
69
testicular torsion
torsion of the testis twists the spermatic cord, causing vascular compromise of involved testicle
70
S&S of testicular torsion
```
acute onset of severe scrotal & testicular pain
n/v
swelling & color change of scrotum
transverse lie to testicle
vascular flow absent in scrotal ULS
```
71
tx of testicular torsion
address in 1st 6 hrs of symptoms & 90% of testes will survive
surgical- detorsion, orchiopexy
72
torsion of the appendix testis
appendix of the epididymis may torse & undergo vascular compromise
73
S&S of torsion of the appendix testis
insidious onset of pain
n/v
"blue dot" sign- pain at upper pole of testicle w/ appearance of blue dot
point tenderness at epididymis
minimal swelling
torsion of testis needs to be r/o if pain is moderate or severe
74
epididymitis
inflammation of the epididymis usually 2/2 infxn or inciting agent- STI, UTI/structural anomaly, trauma, chemical inflammation, often w/ antecedent sexual activity or UTI
75
clinical presentation of epididymitis
pain & swelling of the epididymis
frequency, dysuria, urethral d/c
fever
76
PE of epididymitis
normal vertical lie of testis
normal cremasteric reflex
scrotal edema, redness
77
labs for epididymitis
UA, urine cx
urine nucleic acids for N. gonorrhoeae, C. trachomatis
gram stain & cx of urethral d/c
consider screening for other UTIs in high risk pts
78
tx of epididymitis
Abx to address UTI/STI
| further work up if age or circumstances suggest a structural anomaly- scrotal or renal ULS, VCUG
79
hydrocele
trapped fluid around the testis located in the tunica vaginalis
80
what are the 2 types of hydrocele
communicating- precursor to inguinal hernia
| non-communicating
81
tx of hydrocele
observation 1st 2 years of life
| earlier if underlying problem (adj. testis becomes inflamed), not resolving, compromise to the testicle
82
varicocele
tortuous collection of veins around the spermatic cord
83
clinical sx's of varicocele
fullness
may be asymptomatic
"bag of worms"
84
tx of varicocele
tx to preserve function of testes
observation- testicular vol., LH, FSH levels
surgical intervention- embolization, ligation
85
spermatocele
sperm-containing cyst distinct from the testis. may arise from epididymis, rete testis, or ductulis efferentes
86
dx of spermatocele
transilluminates
| ULS
87
tx of spermatocele
surgical excision for comfort
88
undescended testes
more common in premies
present in 3.4% of newborns, remains in 0.7% at 1 yo
if no descent by 1 yo, testes are located (if present) & surgically corrected/removed
89
retractile testes
retract from scrotum when cold
| present in scrotum by parent's report
90
testes retained in the abdomen are at higher risk for what
progression to testicular cancer. rates higher for infertility & torsion
