nephrology part I

Question 1

What are the maintenance Na and K requirements in kids?

Answer 1

• Na: 2-3 mEq/kd/day

- K: 2 mEq/kg/day

Question 2

emergency fluid repletion in kids

Answer 2

usually begins with 20 mL/kg boluses with a high enough oncotic load (NS or LRs)

Question 3

What kinds of diseases cause acute hemorrhagic cystitis?

Answer 3

bacterial infections, adenovirus infections, cyclophosphamide or ifosphamide

Question 4

What are benign causes of proteinuria?

Answer 4

benign transient proteinuria
orthostatic proteinuria- esp. in athletes. increased urinary protein excretion while upright but not while supine. compare total protein:creatinine rations in morning vs. afternoon.

Question 5

tubular proteinuria: definition, causes, tests

Answer 5

• caused by decr. reabsorption of low molecular weight proteins by tubular epithelial cells
• may involve ATNl, interstitial nephritis
• look for elevated urinary beta 2 microglobulin (should be completely resorbed)
• may also see glucosuria and aminoaciduria

Question 6

What labs are suggestive of post-strep glomerulonephritis?

Answer 6

• ASO titer (esp. after strep pharyngitis)
• anti-DNase B titer (esp. after skin infections)
• biopsy shows mesangial cell proliferation and increased mesangial matrix, but is not usually needed because this may be diagnosed clinically
• transient reduction in serum complement

Question 7

IgA nephropathy

Answer 7

• most common chronic glomerulonephritis worldwide
• recurrent bouts of gross hematuria associated with resp infections
• renal biopsy shows mesangial proliferation

Question 8

henoch schonlein purpura characteristics

Answer 8

IgA mediated vascultis with:

• palpable purpura
• abd pain
• arthritis or arthalgias
• hematuria

Question 9

What is membranoproliferative glomerulonephritis?

Answer 9

one term for 3 forms of histiologically distinct glomerulonephritis

• lobular mesangial hypercellularity and thickening of glomerular basement membrane
• HTN is common, as is low serum complement

Question 10

type 1 vs. type 2 membranoproliferative glomerulonephritis

Answer 10

type 1: subendothelial. associated with HBV and HCV

type 2: C3 nephritic factor. intramembranous depositis

Question 11

membranous nephropathy

Answer 11

subepithelial depositous with spike and dome appearance

associated with HBV and HCV, tumors, SLE, NSAIDs

Question 12

features of nephrotic syndrome

Answer 12

• edema, often following URI
• thrombotic disease due to hypercoagulability, esp. stroke, renal vein thrombosis, saggital sinus thrombosus
• incr. risk of infection ,esp w/ encapsulated organisms (SBP, PNA, sepsis)
• hypercholesterolemia

Question 13

HUS definition/features

Answer 13

acute renal failure in the presence of microangiopathic hemolytic anemia and thrombocytopenia, usually related to shiga toxin (E coli O157:H7, or some types of shigella)

Question 14

pathogenesis of HUS

Answer 14

vascular endothelial injury by the shiga toxin. endothelial injury, esp. in the renal vasculature, causes platelet thrombi formation and renal ischemia

Question 15

atypical HUS

Answer 15

HUS NOT caused by shiga toxin
may be caused by drugs (OCP, cylopsorine, tacrolimus), or may be inherited
looks like shiga-induced HUS excep no diarrhea