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Flashcards in peds44 Deck (52):
1

repletion phase for hyponatremic or isonatremic dehydration

replace fluids over 24 hours

2

repletion phase for hypernatremic dehydration

replace more slowly over 48 hours to minimize risk of cerebral edema

3

oral rehydration salt salotions

balanced mixtures of glucose and electrolytes (since glu co-transport still works in secretroy diarhhea, whereas other pways of Na absorption are impaired)

4

when is ORT inapprop

severe life-threatening dehydration, paralytic ileus, or GI obstruction, patients with extremely fast stool losses or repeated severe emesis losses

5

microscopic hematuria

greater than 6 RBCs per HPF, detected on 3 or more consec samples

6

urinary dipstick for hamturia

detects hemoglobin or myoglobin in the urine

7

false neg on urine dipstick for hematuria

vit C ingestion

8

RBC casts

glomerular bleeding (acute or active glomerulonephritis)

9

dymorphic RBCs

originating in the glomerulus, ofetn have blebs

10

RBCs that look normal

originate in the lower urinary tract

11

large numbers of RBCs (esp in the presence of dysuria)

may indicate acute hemorrhagic cystitis (due to bacterial or viral infection or chemotherapeutic agents like cyclophosphamide)

12

proteinuria

more than 100 mg/m2/day

13

how to screen for proteinuria

urine dipstick; it detects albumin

14

false pos on urine dipstick for protein

if urine is very concentrated (sg>1.025) or alkaline (pH > y) or If patient received certain meds (peniccilin, aspirin, oral hypoglycemic agents)

15

false neg on urine dipstcik for protein

if the urine is very dilute

16

most accurate way to detect proteinuria

24 hour protein collection ; normal Is less than 100 mg/m2

17

random spot urine

protein to creatinine ratio; early morning sample is ideal;

18

normal urine TP/CR for 6-24 months

<0.5

19

normal urine TP/CR for > 2 years is <0.2

right

20

benign transient proteinuria

may be associated with vigorous exercise, fever, dehydration, and CHF

21

wht if dipstick is pos for blood but no rbcs on microscopic U/A

hemoglobinuria or myoglobinura

22

RBC casts

glomerulonephritis; if no casts, can be glomerular or lower urinary source

23

examples of tubular proteinuria

interstitial nephritis, ischemic renal injury (ATN), and tubular damage due to nephrotoxic drugs

24

marker for tubular proteinuria (as opposed to glomberular)

urinary B2 microglobulin

25

glucosuria and aminoaciduria

accompany tubular proteinuria

26

nephritic syndrome

gross hematuria, htn, fluid overload from renal insuff

27

most common form of acute glomerulonephritis in school aged kids

psotstrep glomerulonephritis; but rare before age 2

28

when does post strep glomerulonephritis develop relative to infection

8-14 days after infection of skin or pharynx with group A beta hemolytic strep

29

low serum complement (C3)

transient in post-strep GN

30

prognosis of post strep GN

usually normalizes in 6-8 weeks; severe renal failure is rare

31

diagnosis of poststrep GN

ASO titer, ADB titer

32

bx in post-strep gn?

not typically indicated but if you were to do it, youd see mesangial cell proliferation

33

does antibiotic tx of strep reduce the risk of post strep GN?

no, but it does reduce the risk of rheumatic fever

34

bergers diseaes

aka IgA nephopathy

35

most common type of chronc glomerulonephritis world wide

bergers disease

36

when does bergers disease usually present?

second or third decade of life

37

bergers diseae more common in what races?

asia, australian, and in native americans; rare in african american

38

clinical features of bergers

recurrent bouts of hematuria assoc with resp infections

39

diagnosis of iga nephropathy (bergers)

renal biopsy shows mesangial prolif and incr mesangial matrix

40

treatment for iga nephropathy

mainly supportive; meds only recommended for patients with associated pathologic proteinuria or renal insuff

41

henoch-schonlein purpura nephritis

igA mediated vasculitis with palpable purpura on the butt and thigh, abdominal pain, arthritis and hematuria

42

prognosis

in majority of patients, the renal featurs of HSP are self-limited with recovery in 3 months; 1 to 5% develop chronic renal failure

43

membranoproliferative glomerulonephritis

mesangial hypercellularity and thickened glomerular basement membrane

44

prognosis for membranoproliferative glomerulonephritis

variable, but most patients ultimately develop end stage renal disease

45

managmeent of membranoproliferative glomerulonephritis

some patients repsond to steroids; ace inhib may slow progression

46

membraneous nephropahty

more common in young kids; heavy proteinuria and often progresses to renal insuff

47

most common cause of nephrotic syndrome in the US

membraneous nephopathy

48

nephrotic syndrome characterisitics

heavy proteinuria (>50 mg/kg/day), hypoalbuminemia, hypercholesterolemia, and edema

49

when does nephrotic syndrome present?

2/3 present before 5 years

50

types of nephrotic syndrome

primary (most common), NS that results from other primary glomerular diseases; NS that results from systemic diseases

51

most common cause of primary NS

minimal change disease

52

systemic diseases that can cause NS

SLE and HSP