Pediatrics - Renal Emergencies

Question 1

History of strep suggests

Answer 1

PSGN

Question 2

Hx of bloody diarrhea suggests

Answer 2

HUS (CBC shows thrombocytopenia)

Question 3

Organomegaly on PE in young children may suggest

Answer 3

Fluid overload

Question 4

Hematuria, casts, proteinuria suggest

Answer 4

GN

Question 5

Proteinuria alone suggests

Answer 5

Nephrotic syndrome

Question 6

Hyaline casts may be seen in

Answer 6

ATN

Question 7

Urine SG is often high (>1.025) in what renal failure?

Answer 7

Prerenal

Question 8

CBC shows eosinophilia, what renal dx suggested?

Answer 8

Interstitial nephritis

Question 9

In prerenal failure, treat dehydration and hypovolemia with a 10-20ml/kg bolus of

Answer 9

NS

Question 10

How are RBC transfused in kids in the setting of hemorrhagic shock?

Answer 10

10 ml/kg

Question 11

Diagnostics for Nephrotic syndrome

Answer 11

Hypoproeteinemia
Low albumin
Protein:Creatinine ratio >2 in 1st am void
Hypercholesterolemia
Generalized edema
PE to assess for pulmonary effusion, edema, facial swelling (anasarca)

Question 12

Tx for volume overload in children

Answer 12

1-2 mg/kg furosemide

Question 13

Children with nephrotic syndrome are at high risk for:

Answer 13

Bacterial peritonitis from strep pneumo

Question 14

GN is often associated with

Answer 14

HTN

Question 15

Most common serologic markers of PSGN in kids

Answer 15

Anti-streptolysin titer

Low C3

Question 16

Tx for PSGN

Answer 16

Supportive
Renal bx not indicated
F/U with Nephropathy

Question 17

Tx for Berger’s/IgA Nephropathy

Answer 17

Bx is diagnostic
ACE inhibitors or ARBs for HTN (esp w/ proteinuria)
Refer to Outpt Nephropathy

Question 18

Tx focuses for HSP

Answer 18

Rest, analgesics, hydration

Consult Nephrology

Question 19

Triad of HUS

Answer 19

Microangeiopathic hemolytic anemia
AKI
Thrombocytopenia

Question 20

Complications of E. Coli enteritis/Shiga toxin

Answer 20

HUS
Acute gastroenteritis
DM
Acidosis
Colitis
Intussusception
HTN
Heart failure

Question 21

Peripheral smear in microangiopathic hemolytic anemia

Answer 21

Schistocytes
Helmet cells
Burr cells

Question 22

Diagnostic to do for HUS

Answer 22

Get stool sample
CBC w/ diff
UA

Question 23

Contraindications for tx of suspected HUS in peds

Answer 23

Do not give abx
Do not give antiperistaltics
Do not give platelets

Question 24

Most common signs of primary HTN in children (4)

Answer 24

HA
Sleep disturbances
Chest pain
Abd pain

Question 25

Medication causes of HTN in children

Answer 25

OCT
Steroids
Drugs of abuse

Question 26

Lower BP in legs vs arms, or left vs right suggests

Answer 26

Coarctation of the aorta

Question 27

Diagnostics to order in children with HTN

Answer 27

CXR
EKG
\+/- head CT if neuro findings present
Renal U/S +/- CT/MRI
\+/- Echocardiogram

Question 28

Tx hypertensive emergency peds

Answer 28

ABCs

Reduce MAP by 25% over 8 hours

Question 29

Tx hypertensive urgency

Answer 29

Oral antihypertensives

D/C with outpatient F/U

Question 30

Medication causes of hematuria

Answer 30

NSAIDs
Anticonvulsants
Warfarin
Diuretics
Penicillin
Chlorpromazine

Question 31

Imagine choice for macroscopic hematuria

Answer 31

US to rule out structural defects and malignancy

Question 32

What is an avoidable risk factor for development of hemolytic uremic syndrome?

Answer 32

Antibiotic use during infection with E. Coli O157:H7