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SD: Peds > Peds: Renal & GU > Flashcards

Peds: Renal & GU Flashcards

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1
Q

What is hemoglobinuria?

A

presence of hemoglobin FREE from red blood cells

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2
Q

When does hemoglobinuria occur?

A

occurs with rapid disintegration of red blood cells, exceeding the ability of blood protein to bind with hemoglobin

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3
Q

What is the most common cause of hemoglobinuria?

A

hemolytic anemia

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4
Q

What is the cause of myoglobinuria?

A

skeletal muscle injury

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5
Q

What else is likely to be elevated with myoglobinuria?

A

CK (fivefold increase)

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6
Q

What is benign familial hematuria?

A

isolated asymptomatic hematuria without renal abnormalities in multiple family members

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7
Q

What is the most common bacteria that causes UTIs?

A

E coli

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8
Q

What is pyelonephritis?

A

bacterial involvement of upper urinary tract

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9
Q

What are some S/S of pyelonephritis?

A

abdominal pain

flank pain

fever

lethargy

N/V

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10
Q

What is cystitis?

A

bacteria involvement of bladder

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11
Q

What are some S/S of cystitis?

A

dysuria

frequency

urgency

sometimes odor

abdominal pain

incontinence

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12
Q

What is asymptomatic bacteriuria?

A

positive culture without symptoms

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13
Q

When should imaging be done in kids with their first UTI?

A

before the age of 5

febrile UTI

recurring UTI

male with UTI

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14
Q

What is the imaging tool of choice for UTIs?

A

voiding cystourethrogram (VCUG)

*should be done with child IS NOT sick*

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15
Q

What should be done if proteinuria is found on dipstick with absence of other findings or concerns?

A

repeat the dipstick on 2-3 other occasions

(preferable first AM urine)

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16
Q

What should be done if their is persisting proteinuria?

A

a 24 hour collection is the test of choice

upper limit of normal protein excretion is 150mg/24 hour

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17
Q

What is the most common cause of persisting proteinuria in kids?

A

orthostatic proteinuria

(normal to low levels of protein are excreted in the supin position but higher levels are excreted in the upright position)

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18
Q

What are the 3 diseases of primary nephrotic syndrome?

A
  1. minimal change disease (most common)
  2. mesangial proliferation
  3. focal segmental glomerulosclerosis
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19
Q

What is minimal change disease?

A

glomeruli (capillary network) generally appear normal, or minimal incrase in mesangial cells (support cells for glomeruli)

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20
Q

What is mesangial proliferation?

A

increase in mesangial cells

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21
Q

What is focal segmental glomerulosclerosis?

A

mesangial proliferation & segmental scarring, leading to sclerosis

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22
Q

Initial episodes of primary nephrotic syndrome usually follow what?

A

illness

infections

allergic reactions

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23
Q

What are some S/S of primary nephrotic syndrome?

A

facial & lower extremity edema (often overlooked as an allergic reaction)

abdominal pain

diarrhea

irritability

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24
Q

How is primary nephrotic syndrome diagnosed?

A

3-4+ proteinuria on dipstick (persisting)

urinary protein exceeds 150mg/24 hour

serum creatinine is normal to minimally elevated

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25
What is the treatment for primary nephrotic syndrome?
children with generalized edema should be hospitalized diuretics may be used very cautiously close monitoring complications: volume overload, electrolyte imbalance, HTN, cardiac, renal failure
26
If an initial episode of primary nephrotic syndrome occurs between ages 1-8, what is it most likely to be & what is the treatment?
minimal change disease generallly considered safe to initiate steroids without a biopsy
27
What is secondary nephrotic syndrome?
occurs as a secondary feature of many forms of glomerular disease consider in patients \> 8 yrs, HTN, persisting hematuria, renal dysfunction, rash, and/or arthalgia
28
When does congenital nephrotic syndrome develop?
first 3 months of life
29
What are some S/S associated with congenital nephrotic syndrome?
premature birth respiratory trouble poorly defined sutures are common
30
What is Tubulointerstitial Nephritis (TIN)?
caused by interstitial inflammation with sparing of vessles & glomeruli
31
What is the main triad of symptoms for acute TIN?
fever rash arthralgia w/ steadily rising creatinine
32
How is the diagnosis made for acute TIN?
presentation & lab findings (UA, renal function) ## Footnote **pay attention to timing as symptoms appear 1-2 weeks following exposure**
33
What is the treatment for acute TIN?
supportive watch for complications (volume overload, electrolyte imbalance) consider steroids
34
What are some etiologies of acute TIN?
PCN, cephalosporins, sulfa, drugs, fluoroquinolones, EES, anti-convulsants, diuretics, allopurinol, cimetidine, cyclosporine, NSAIDs streptococcal infections, pyelonephritis, Hep B, EBV, HIV, adenovirus sarcoid, SLE, idiopathic
35
What are some etiologies of chronic TIN?
analgesics, cyclosprin, lithium, heavy metal exposure sickle cell disease, polycystic kidney disease, Alport syndrome, SLE ureteropelvic junction abnormality, urinary reflex, radiation, idiopathic
36
What is Alport syndrome?
congenital condition characterized by deafness, large thrombocytes, cataracts
37
What is the treatment for Alport syndrome?
no cure dialysis or transplant may be beneficial
38
What is the most common etiology of chronic TIN?
underlying renal disease
39
What will the kidneys look like on imaging & biopsy in chronic TIN?
imaging- kidneys will appear small biopsy- tubular atrophy
40
What are some S/S of chronic TIN?
non-specific fatigue poor growth polyuria polydipsia anemia
41
How is the diagnosis made for chronic TIN?
escalating creatinine level ultrasound revealing small kidneys history of chronic disease or exposure
42
What is the treatment for chronic TIN?
supportive maintain fluids, electrolytes, avoid nephrotoxins prognosis dependent on underlying disease
43
When do S/S appear in post-streptococcal glomerulonephritis & what are the most common ages for this?
sxs appear 1-2 weeks following a throat infection or 3-6 weeks following a skin infection most common between ages 5-12
44
What are the S/S of post-streptococcal glomerulonephritis?
sudden onset hematuria edema HTN renal insufficiency
45
How will the kidneys appear on imaging in post-streptococcal glomerulonephritis?
kidneys appear large on imaging glomeruli are enlarged with mesangial cell proliferation
46
What strep titer will be elevated & can determine a recent throat infection (but not skin infection)?
anti-streptolysin O titer
47
What can be checked to determine/confirm a recent skin infection?
deoxyribonuclease B anti-streptococcal
48
What is the treatment for post-streptococcal glomerulonephritis?
control effects of renal failure & HTN sodium restriction ACEIs, CCBs, vasodilators tx infection w/ appropriate antibiotics
49
What glomerulonephritis disorder typically presents as an **isolated disease** but can be secondary to autoimmune disease, malignancies, syphilis, or Hep B infections?
membranous glomerulopathy
50
What is membranous glomerulopathy?
thickening of basement membrane without proliferative changes thought to be from visceral epithelial cell deposits
51
How is the diagnosis made for membranous glomerulopathy?
biopsy usually done in cases of persisting hematuria & proteinuria & lack of other explanation
52
What is the most comon cause of acute renal failure in kids?
hemolytic-uremic syndrome (HUS)
53
What are the 3 main S/S of HUS?
hemolytic anemia uremia (toxic levels of nitrogen in the blood) thrombocytopenia
54
\_\_\_\_\_ ___ illness precedes 80% of cases of HUS
acute GI illness (E. coli)
55
What might the physical exam of someone with HUS reveal?
dehydration edema petechiae hepatosplenomegaly
56
How is the diagnosis made for HUS?
supported by clinical findings, hx, CBC, renal panel CBC may show **helmet & burr cells**
57
What is the treatment for HUS?
supportive with attention on HTN, nutrition, fluid, & electrolyte balance
58
What is Henoch-Schonlein Purpura Nephritis and what is it characterized by?
small vessel vasculitis purpuric rash, arthralgia, abdominal pain & glomerulonephritis
59
When do symptoms of Henoch-Schonlein Purpura Nephritis usually occur?
usually 1-3 weeks following illness, usually URI
60
What are some causes of toxic nephropathy?
medications diagnostic agents (dyes) chemicals **usually reversible if offending agent is removed**
61
What age should routine BP screenings start?
3
62
What are some S/S associated with pediatric hypertension?
HA blurry vision UTI edema rash DOE
63
What are some pharm & non-pharm treatments for pediatric hypertension?
exercise, salt restriction, weight loss CCB, diuretics, ACEI, B-blockers
64
What is vesicouretal reflex?
retrograde flow of urine from bladder to ureter & pelvis
65
What does vesicoureteral reflex cause?
causes urine to 'back up' leading to infection, inflammation, scarring
66
What is the leading cause of HTN in children?
vesicoureteral reflex
67
How is vesicoureteral reflux diagnosed?
VCUG
68
What is the treatment for vesicoureteral reflux?
toileting habits should be monitored proper wiping technique for girls watch for straining with stools treat constipation surgical therapy if recurring UTIs or signs of renal damage
69
What is hypospadius?
urethral opening located on ventral surface of penis
70
What is the treatment for hypospadius?
circumcision should be avoided because the foreskin may be used in surgical repair surgical repair is advised between 6-12 months
71
What is phimosis?
inability to retract the foreskin
72
What is the definitive treatment of phimosis?
circumcision
73
What is paraphimosis?
occurs when foreskin is retracted beyond the glans penis, & cannot be pulled forward again leads to strangulation of glans penis due to venous congestion
74
What is the treatment for paraphimosis?
surgical repair is often needed ## Footnote **this is a medical emergency**

SD: Peds (11 decks)

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