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Renal Flashcards

(90 cards)

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1
Q

stimulates the bone marrow to make red blood cell

A

erythropoietin

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2
Q

regulates blood pressure

A

renin

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3
Q

the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

A

calcitriol

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4
Q

problems in the glomerulus

A

allow proteins and RBC to be filtered though the basement membrane into urine

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5
Q

problems in kidney tubules

A

allow abnormal excretion of H+ , CL- , Bicarb , Na+, K+

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6
Q

What are the standard serum indicators of renal function?

A

BUN and Cr

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7
Q

What is the most reliable single indicator of glomerular function?

A

Cr

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8
Q

What radiographic study would you use to evaluate a patient for polycystic kidney disease?

A

renal ultrasound

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9
Q

most common abdominal mass on newborn exam

A

large kidney

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10
Q

unilateral renal agenesis can be associated with

A

IDM, VACTERL, Turner’s

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11
Q

most common type of PKD

A

autosomal dominant

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12
Q

clinically mild or insignificant renal abnormalities

A

unilateral renal agenesis, horseshoe kidney, pelvic or ectopic kidneys

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13
Q

renal parenchymal abnormalities (problematic)

A

dysgenesis or PKD

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14
Q

bilateral renal agenesis

A

Potter’s

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15
Q

PKD presents in infancy

A

recessive

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16
Q

PKD associated with other cysts

A

dominant

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17
Q

PKD characterized by marked enlargement of both kidneys

A

recessive

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18
Q

Marked bilat renal enlargement. Interstitial fibrosis and tubular atrophy. Renal Failure early childhood

A

ARPKD

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19
Q

Typically present in middle adulthood.

Assoc with other cysts : hepatic, pancreatic, ovarian and cerebral aneurysm

A

ADPKD

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20
Q

most common cause of bladder outlet obstruction in males. Male infant with anuria or poor stream

A

posterior urethral valves

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21
Q

treatment posterior urethral valves

A

urgent surgical drainage necessary

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22
Q

Reflux of urine from bladder to ureter during bladder contraction, or back up from bladder (ie neurogenic bladder)

A

vesicoureteral reflux

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23
Q

complications vesicoureteral reflux

A

recurrent UTI, renal damage, HTN, CKD

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24
Q

VUR prophylaxis

A

nitro or bactrim

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25
which grade of VUR should you consider surgically re-implanting the ureter
grade IV and up
26
Only occurs in males, account for 20% of all childhood end-stage renal failure
posterior urethral valves
27
this can be associated with posterior urethral valves. Can see cryptorchidism and absent abdominal musculature
Prune belly syndrome
28
dysplastic kidneys, dilated urinary tract, and malformed blasser
posterior urethral valves
29
hematuria- non glomerular
dysuria, associated back pain (pyelonephritis), colicky pain, bright red blood or clots
30
hematuria- glomerular (nephritis)
tea colored urine, smoky, RBC TNTC, +/-RBC casts, painless
31
most common cause of hematuria (gross or micro)
UTI
32
what makes you heavily suspect nephritis/nephropathy
proteinuria plus hematuria
33
common signs GN
high Cr, edema, HTN, hematuria
34
most common for of GN in childhood
acute post-streptococcal GN
35
History of culture + GAS , or +antistreptolysis O titer | Can have low complement (C3) levels
acute post-streptococcal GN
36
treatment acute post-strep GN
No specific treatment. Supportive. Antibiotics if GAS still present. Treat HTN
37
Presents as asymptomatic microscopic hematuria or gross hematuria during minor acute illness. Normal complement, no h/o strep
IgA nephropathy
38
treatment IgA nephropathy
steroids (chronic), anti-inflammatories promising (fish oil, vitamin E)
39
most common “chronic” form of GN in children (progress 50% to renal failure over 10 years)
membranoproliferative GN
40
Abnormal immune response with deposition in glomerular membrane Proteinuria, hematuria, hypocomplementemia, HTN
membranoproliferative GN
41
Type 1 membrano GN
responsive to steroids
42
Type II membrano GN
Rare, but Most common GN that progresses to Chronic Renal Failure (not very responsive to steroids)
43
how do you diagnose membrano GN
biopsy
44
What types of things can cause membrano GN
Autoimmune ( SLE, scleroderma, sjogrens) Cancer ( leukemia, lymphoma) Infections ( Hepatitis, endocarditis, malaria)
45
treat membrano GN
steroids, immunosupressants
46
Autoimmune vasculitis following viral infections | Microhematuria common with purpura
Henoch-Schonlein GN
47
treat HSP
steroids
48
are you worried about mild proteinuria in children?
NOPE. Most mild proteinuria in children is “normal” Vigorous exercise or febrile illness Orthostatic
49
most common nephrotic syndrome
minimal change disease
50
two big symptoms of nephrotic syndrome
excessive proteinuria, sudden onset of edema
51
this often follows flu like illness, presents with periorbital edema, vague malaise, oliguria
Idiopathic (minimal change disease) NS
52
this NS will present with lack of HTN, hematuria, renal insufficiency (you wont see Cr abnormalities)
minimal change disease
53
treat minimal change disease
``` prednisone (long taper) rarely diuretics (the patient already has low circulating volume) immunosuppressive drugs if relapsing ```
54
this usually follows a GI infection. Shiga toxin producing “verotoxin” which causes endothelial damage in glomeruli and interstitial vessel thrombosis. E. coli O157:H7 most common Less commonly salmonella or shigella
hemolytic-uremic syndrome
55
presents with renal failure, hemolytic anemia, and thrombocytopenia
hemolytic-uremic syndrome
56
blood smear shows schistocytes, burr cells, fragmented RBC
HUS
57
CBC- leukocytosis, low platelets Retic- high Coombs- negative UA- hematuria, proteinuria casts
HUS
58
treat HUS
Management – Primarily directed at renal failure (managing fluid and electrolytes ) No antibiotics: increases risk of HUS No antidiarrheals: increases exposure to VT toxins
59
mortality associated with HUS
CNS complications
60
most common cause of ARF in kids
Hypovolemia leads to underperfusion dehydration – most common in kids Hemorrhage burns
61
post renal causes ARF
usually obstructive
62
complications of ARF
Fluid overload Hyperkalemia +/- hyponatremia Metabolic acidosis Uremia
63
treatment ARF
furosemide | acute dialysis
64
causes of chronic RF in kids
Congenital/developmental abnormalities of kidneys < 10y (Nephritis/Nephrosis (membranoproliferative GN undx), Hemolytic uremic syndrome or other causes of acute renal failure that don’t resolve)
65
causes of HTN in kids
``` Renal Coarc of Aorta catecholamine excess endocrine essential HTN (diagnosis of exclusion) ```
66
when do you start screening kids for BP
3 years
67
gold standard for UTI diagnosis
urine culture
68
gold standard for UTI diagnosis infants
suprapubic aspiration
69
bugs for UTIs
e coli, klebsiella, proteus, enterobacter, staph saphrophyticus
70
treat complicated UTI
inpatient IV ampicillin and gentamicin (any child less than 3 months old is considered complicated)
71
treat uncomplicated UTI
cephalosporins, trimethoprim/sulfa, augmentin
72
who should have a RUS
all infants 2-24 months with first UTI
73
who should have a VCUG
infants who have had an abnormal RUS or if there is recurrence of febrile UTIs
74
What can renal US show us
kid size, number, position, hydronephrosis, hydroureter, dysplasia, renal scarring
75
what can VCUG show us
bladder anatomy, vesicoureteral reflux, and posterior urethral valves
76
what can you prescribe for voiding dysfunction, should you need to?
imipramine or DDAVP (desmopressin)
77
Malposition of the urethral opening | Not assoc with urinary tract anomalies
hypospadias
78
this condition can require complex surgical repair in males... DO NOT CIRCUMCISE
hypospadias
79
most frequent place for hypospadias
glanular
80
adherence of foreskin
phimosis
81
foreskin is retractable behind glands, then gets stuck: causing swelling and pain
paraphimosis
82
treat phimosis
topical steroids, gentle stretching, circumcision
83
treat paraphimosis
lubricant to reduce or emergent surgical circumcision
84
undescended testicle
crytporchidism
85
how do you locate the testies in cryptorchidism
milk around to find them | abdominal US if cant find
86
besides cryptorchidism, when may i not be able to find testies
Retractile testes, absent testes, ectopic testes
87
bulge in scrotum, blueish hue, transilluminates
hydrocele
88
Enlarged right testis, red Tender on palpation Cremasteric reflex absent Excruciating pain
testicular torsion
89
test for testicular torsion
doppler
90
major cause of acute scrotum in boys under six
testicular torsion

Pediatrics (15 decks)

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