Renal Flashcards
(421 cards)
1
Q
What is the definition of proteinuria?
A
Dipstick 1 + or 30 mg/dL is considered proteinuria
Proteinuria indicates the presence of excess protein in urine, often a sign of kidney disease.
2
Q
What does a dipstick reading of ‘negative’ indicate?
A
No proteinuria present
A negative result means that the urine does not contain detectable levels of protein.
3
Q
What does a trace dipstick reading correspond to in mg/dL?
A
10-20 mg/dL
A trace result indicates minimal protein presence, which may still warrant further investigation.
4
Q
What does a dipstick result of 1+ signify in terms of protein concentration?
A
30 mg/dL
This level indicates a low but significant presence of protein in the urine.
5
Q
What does a dipstick reading of 2+ indicate?
A
100 mg/dL
This level of proteinuria may suggest a more serious underlying condition.
6
Q
What is indicated by a dipstick result of 3+?
A
300 mg/dL
This level suggests a significant amount of protein in the urine, often requiring further medical evaluation.
7
Q
What does a dipstick reading of 4+ correspond to in mg/dL?
A
1000-1500 mg/dL
A 4+ reading indicates a very high level of proteinuria, which may indicate severe kidney issues.
8
Q
What should be done before going to sleep for a child with proteinuria?
A
Empty the bladder
This helps in obtaining accurate urine samples.
9
Q
When should the first morning urine sample be collected?
A
Immediately after waking up
This timing is crucial for accurate assessment of protein levels.
10
Q
What does a urine protein/creatinine ratio (UPr/UCr) of ≤ 0.2 indicate in a child over 2 years of age?
A
It is normal
This value helps in determining the presence of renal disease.
11
Q
What dipstick result or UPr/UCr value on a repeat morning sample suggests renal disease?
A
Dipstick > 1 + or UPr/UCr > 0.2
These findings warrant further investigation for potential kidney issues.
12
Q
What is the condition characterized by significant proteinuria in the upright position that resolves in the supine position?
A
Orthostatic proteinuria
This condition is often observed in adolescents and is typically benign.
13
Q
What body habitus is often associated with orthostatic proteinuria?
A
Tall, adolescent, active, slender body habitus
Individuals with this body type are more likely to experience this condition.
14
Q
What test should be ordered to assess protein levels in urine?
A
Order first morning urine protein and urine creatinine
This helps in determining the proteinuria status accurately.
15
Q
What U. protein/ U. creatinine ratio indicates significant proteinuria on a random urine sample?
A
U. protein/ U. creatinine ratio >0.2
A ratio greater than this threshold suggests significant proteinuria.
16
Q
What U. protein/ U. creatinine ratio on the first morning sample indicates benign conditions?
A
U. protein/ U. creatinine ratio < 0.2
This ratio suggests that the proteinuria is likely benign.
17
Q
How often should tests for proteinuria be conducted in benign conditions?
A
Test for proteinuria on annual basis
Regular monitoring is recommended for individuals with benign proteinuria.
18
Q
What should be done if Ur. Protein to Ur. creatinine ratio is < 0.2?
A
Repeat in 2 weeks
19
Q
What does a Ur. Protein to Ur. creatinine ratio > 0.2 indicate?
A
Persistent proteinuria
20
Q
What action should be taken for persistent proteinuria?
A
Refer
21
Q
What does a Ur. Protein to Ur. creatinine ratio < 0.2 when repeated after 2 weeks suggest?
A
Transient proteinuria
22
Q
What should be done for transient proteinuria?
A
Reassure → follow
23
Q
How often should a repeat UA in orthostatic protienuria be conducted for reassurance?
A
Every year
24
Q
Fill in the blank: Proteinuria < 3+ is determined from the _______.
A
First morning urine sample
25
What dipstick reading indicates proteinuria?
3 + or greater with associated signs and symptoms.
26
When dipstick +3 or more it means ___ in mg/m2/h
>40mg/m2/h
27
When dipstick +3 or more it means ___ in mg/m2/day
>1000 mg/m2/day
28
What is the total protein threshold in grams for a 24-hour urine collection to indicate proteinuria?
> 3-3.5 grams
29
What is the urine protein to urine creatinine ratio that indicates proteinuria in a random sample?
>2.5-3
30
What range is referred to as nephrotic range?
Defined by significant proteinuria >3-3.5 g.
31
What supports the diagnosis of orthostatic proteinuria?
Normal protein/creatinine ratio on the first morning urine
## Footnote
Orthostatic proteinuria is characterized by a normal protein level when measured in the first morning urine, as protein levels may increase when the patient is upright.
32
What is a typical finding in a urinalysis for a patient with significant proteinuria?
+3 protein or more
## Footnote
This level of protein indicates a significant amount of protein in the urine, which can be indicative of underlying kidney issues.
33
What is a normal blood pressure reading for the patient with +3 proteinuria ?
135/85 while sitting down, and 117/70 standing up
## Foot note
These readings suggest that the patient does not have orthostatic hypotension despite the presence of proteinuria.
34
What is a common finding on examination of the heart in a patient with proteinuria?
Normal heart sounds, no murmurs
## Footnote
This indicates that there are no immediate cardiac issues contributing to the patient's condition.
35
What does the absence of edema or signs of heart failure indicate in orthostatic proteinuria patient?
No fluid overload or heart failure
## Footnote
This finding can help differentiate between nephrotic syndrome and other causes of proteinuria.
36
Which diagnostic test is most appropriate for confirming the cause of proteinuria when it is associated with signs and symptoms ?
Urine protein collection for 24 hours
## Footnote
This test provides a more accurate measure of protein excretion over an entire day.
37
What is the relevance of microscopic hematuria with no casts in a repeat urine sample?
It may indicate a glomerular cause but not definitive for diagnosis
## Footnote
The presence of hematuria without casts can suggest various kidney conditions.
38
What imaging study could be considered if kidney issues are suspected?
Renal ultrasound
## Footnote
This imaging can help identify structural abnormalities in the kidneys.
39
What is the most common cause of nephrotic syndrome in children?
Minimal-Change Disease
## Footnote
Minimal-Change Disease is especially prevalent in children aged 2 to 6 years.
40
At what age range is Minimal-Change Disease most common?
Between 2 and 6 years of age
41
Enumerate primary causes of nephrotic syndrome.
1. Minimal change disease.
2. FSGS.
3. Membranous Nephropathy.
3. Membranoproliferative Glomerulonephritis.
42
What does effacement of podocytes refer to?
The flattening or loss of the foot processes of podocytes, leading to proteinuria
## Footnote
This is often observed in certain kidney diseases such as Minimal-Change Disease.
43
What is Minimal-Change Disease?
A kidney disorder that results in nephrotic syndrome, characterized by a minimal change in kidney appearance under a microscope
## Footnote
It is most commonly seen in children.
44
What is the most common cause of Minimal-Change Disease?
Idiopathic
## Footnote
This means that the cause is unknown in most cases.
45
With which oncogenic condition can Minimal-Change Disease be associated?
Hodgkin lymphoma
## Footnote
There is a noted correlation between Minimal-Change Disease and this type of cancer.
46
What is the primary characteristic of Minimal-Change Disease (MCD)?
Proteinuria (>3.5g/day)
## Footnote
MCD is primarily defined by the presence of significant protein in the urine.
47
What is a common serum protein level alteration in MCD?
Hypoalbuminemia
## Footnote
This condition results in low levels of albumin in the blood.
48
What type of edema is characteristic in MCD?
Facial edema → later in the day lower extremities → overtime → ascites and pleural effusion
## Footnote
Edema often begins in the face and progresses to other areas.
49
What immune deficiency is associated with MCD?
Hypogammaglobulinemia
## Footnote
This condition can increase susceptibility to infections.
50
What lipid abnormality is seen in patients with MCD?
Hypercholesterolemia
## Footnote
Elevated cholesterol levels are common in MCD.
51
What state is induced by MCD that affects blood clotting?
Hypercoagulable state
## Footnote
This is due to the loss of antithrombin III, protein C, and S.
52
What urinary finding may suggest a nephritic cause rather than MCD?
Hematuria and HTN
## Footnote
The presence of blood in urine may indicate a different underlying condition.
53
What are two conditions to consider when diagnosing MCD?
HTN and Hematuria.
## footnote:
Look for nephritic cause Or FSGS.
54
What is the primary characteristic observed in Minimal Change Disease under electron microscopy (EM)?
Effacement of podocytes
## Footnote
This refers to the flattening or loss of the foot processes of podocytes, which are critical for kidney filtration.
55
What is the first step in the treatment of Minimal-Change Disease (MCD)?
Empiric trial of corticosteroids
## Footnote
This is the standard initial approach for managing MCD.
56
What is the dosage of Prednisone for the first episode of MCD treatment?
60 mg/m2/day divided in two doses for 6 consecutive weeks
## Footnote
After the initial phase, it is followed by 6 weeks of alternate day therapy with 40 mg/m2/day.
57
What is the follow-up treatment after the initial 6 weeks of Prednisone for MCD?
6 weeks of alternate day therapy with 40 mg/m2/day
## Footnote
This follows the initial treatment phase.
58
What is the treatment protocol for a relapse of MCD?
Prednisone 60 mg/m2/day divided in two doses until urine is negative for protein on 3 consecutive days
## Footnote
After achieving negative urine tests, follow with 4 weeks of alternate day therapy with 40 mg/m2/day.
59
What is the follow-up treatment after achieving negative urine tests for relapse in MCD?
4 weeks of alternate day therapy with 40 mg/m2/day
## Footnote
This is to maintain remission after a relapse.
60
What test should be performed before starting steroid therapy for MCD?
Purified protein derivative (PPD)
## Footnote
This is important to rule out tuberculosis before initiating corticosteroid treatment.
61
When should cyclophosphamide be considered in the treatment of Minimal-Change Disease?
If the patient has multiple relapses a year or displays signs of steroid toxicity.
62
What supportive treatment should be implemented for patients with nephrotic range proteinuria?
Sodium restriction
63
What dietary restriction should be applied if a patient has hyponatremia in MCD?
Water restriction
64
What medication can be used for severe edema in patients with Minimal-Change Disease?
Diuretics
65
What should be monitored regularly in patients with Minimal-Change Disease?
Electrolytes
66
Fill in the blank: Sodium restriction is recommended as long as the patient has _______.
nephrotic range proteinuria
67
True or False: Cyclophosphamide is used as a first-line treatment for all patients with Minimal-Change Disease.
False
## Footnote
In steroid relapse and resistance.
68
Fill in the blank: Steroid resistance is defined as the lack of response to steroid therapy after _____ weeks of treatment.
4
69
Multiple Choice: Which of the following is a potential cause of steroid resistance in MCD?
A) Genetic factors
B) Viral infections
C) Both A and B
C) Both A and B
70
True or False: Relapse in MCD typically occurs within the first year after treatment.
True
71
Fill in the blank: Patients who are steroid-resistant may require alternative treatments such as _____
Cyclophosphamide
72
What are the complications associated with Minimal Change Disease?
Complications include:
* Spontaneous bacterial peritonitis
* Ascitis
73
What bacteria are commonly associated with spontaneous bacterial peritonitis in MCD?
Bacteria include:
* Streptococcus pneumoniae
* Escherichia coli
* Group B Streptococci
74
How can infection be prevented in patients with Minimal Change Disease?
By administering the pneumococcal vaccine if not previously immunized.
75
What action may be necessary for patients with complications of Minimal Change Disease?
Admission to the hospital.
76
Fill in the blank: The most common bacteria cause peritonitis in Minimal Change Disease is ______.
Streptococcus pneumoniae.
77
What is the typical response rate of patients with Minimal Change Disease (MCD) to steroid therapy within 2 weeks?
80-90%
## Footnote
This indicates that a significant majority of patients will show improvement with steroid treatment.
78
What percentage of patients with Minimal Change Disease resolves the condition as they grow?
> 80%
## Footnote
This suggests that many children with MCD outgrow the disease over time.
79
If a patient with Minimal Change Disease is not responsive to steroids or experiences recurrent relapses, what condition should be considered?
FSGS
## Footnote
FSGS stands for Focal Segmental Glomerulosclerosis, a more severe renal conditio often associated with HTN & Hematuria .
80
What is a potential progression of FSGS?
End stage renal disease (ESRD)
## Footnote
ESRD represents the final stage of chronic kidney disease where kidneys can no longer function.
81
What does FSGS stand for?
Focal segmental glomerulosclerosis
82
What is the usual cause of FSGS?
Usually idiopathic
83
What is a key characteristic of proteinuria in FSGS?
Proteinuria refractory to steroids and other immunosuppressive agents
84
What can FSGS progress to if untreated?
ESRD (End-Stage Renal Disease)
85
What are common associations with FSGS?
* Persistent proteinuria in older children or adolescents
* HIV
* Heroin abuse
* Sickle cell anemia
86
What histological feature is seen in FSGS on H&E staining?
Focal and segmental sclerosis
87
What is observed on electron microscopy (EM) in FSGS?
Effacement of foot processes
88
What is the common presentation for both MCD & FSGS?
* Massive proteinuria
* Hypoalbuminemia
* Hyperlipidemia
89
The typical age range for Minimal Change Disease is _____, while in FSGS is found in _____.
2-6 years of age , adult and adolescents
90
Which is excellent in response of steroids MCD or FSGS?
MCD
## Footnote
Steroids are often effective in 80-90% of MCD
91
If we want to differentiate between MCD & FSGS we use EM or H&E stain result?
H&E stain result as both has effacement of podocytes on EM
Although MCD has normal glomerulus on H&E, while there is segmental sclerosis in FSGS.
92
What is the typical progression of Focal Segmental Glomerulosclerosis?
Usually progresses to ESRD
## Footnote
End-stage renal disease is a common outcome
93
What are the age indications for renal biopsy in nephrotic syndrome at the time of diagnosis?
Age <1 year, > 12 years
## Footnote
These age groups are considered due to increased risk factors associated with nephrotic syndrome.
94
What is one indication for renal biopsy in nephrotic syndrome related to hematuria?
Persistent or gross hematuria
## Footnote
Hematuria can indicate underlying renal pathology that may require biopsy..
95
What blood pressure condition indicates a renal biopsy in nephrotic syndrome?
Hypertension
## Footnote
Hypertension may suggest secondary causes of nephrotic syndrome that need further evaluation.
96
What renal function condition is an indication for renal biopsy in nephrotic syndrome?
Renal insufficiency
## Footnote
Renal insufficiency may imply significant renal damage requiring a biopsy for diagnosis.
97
What complement value is an indication for renal biopsy in nephrotic syndrome?
Low C3 complement values
## Footnote
Low C3 levels can indicate certain types of glomerulonephritis that may necessitate a biopsy.
98
What is an indication for renal biopsy in nephrotic syndrome after diagnosis?
Persistent proteinuria (at the end of 4 weeks of daily prednisone therapy)
## Footnote
Steroid resistent.
99
Enumerate main indications for renal biopsy in nephrotic syndrome.
Two or more of the following:
* Age >1year Or >12 yrs.
* Persistent or gross hematuria.
* Hypertension
* Renal insufficiency.
* Low C3 complement values
* Persistent proteinuria ( steroid resistance)
100
What are the key laboratory findings for diagnosing Lupus Nephritis (LN)?
Positive ANA and anti-dsDNA antibodies, low C3 and C4 levels
## Footnote
These findings indicate an autoimmune process that is consistent with Lupus Nephritis.
Low C3 and C4 is more important
101
What is the definitive method for diagnosing Lupus Nephritis?
Renal biopsy
## Footnote
A renal biopsy is also needed to guide therapy.
102
What treatment is recommended for class IV Lupus Nephritis?
Immunosuppression, specifically pulse methylprednisolone and cyclophosphamide or mycophenolate mofetil
## Footnote
Aggressive treatment is indicated for class IV LN.
103
What are considered bad prognostic factors at presentation for Lupus Nephritis?
Presence of anemia, azotemia, and hypertension (HTN)
## Footnote
These factors can indicate a more severe disease course.
104
What inheritance pattern is associated with Congenital Nephrotic Syndrome?
Autosomal recessive
## Footnote
This indicates that both parents must carry a copy of the mutated gene for the child to be affected.
105
At what age does Congenital Nephrotic Syndrome typically present?
Between birth and 3 months of age
## Footnote
Symptoms can appear shortly after birth.
106
What is a key laboratory finding in urine for Congenital Nephrotic Syndrome?
Nephrotic-range proteinuria at birth
## Footnote
This indicates +3 or more protein loss in the urine.
107
What percentage of infants with Congenital Nephrotic Syndrome are born premature?
> 80%
## Footnote
This highlights a correlation between prematurity and this condition.
108
What is a notable feature of the placenta in cases of Congenital Nephrotic Syndrome?
Enlarged
## Footnote
This can be indicative of fetal distress or complications.
109
What is a characteristic finding in the kidneys of patients with Congenital Nephrotic Syndrome?
Enlarged kidneys
## Footnote
This may be due to increased filtration pressures and compensatory hypertrophy.
110
What is the primary method for diagnosing Congenital Nephrotic Syndrome?
Genetic testing
## Footnote
This helps confirm the diagnosis and identify specific mutations.
111
What infections need to be ruled out in the differential diagnosis of Congenital Nephrotic Syndrome?
TORCH and HIV infections
## Footnote
These can cause secondary nephrotic syndrome.
112
What is a significant symptom of Congenital Nephrotic Syndrome?
Severe intractable edema
## Footnote
This condition is characterized by persistent swelling due to fluid retention.
113
What nutritional deficiencies are commonly associated with Congenital Nephrotic Syndrome?
Iron and vitamin D deficiency
## Footnote
These deficiencies often arise due to the syndrome's effects on nutrient absorption.
114
What endocrine disorder is associated with Congenital Nephrotic Syndrome?
Hypothyroidism
## Footnote
This condition may complicate the overall health of patients with Congenital Nephrotic Syndrome.
115
What is a common consequence of Congenital Nephrotic Syndrome related to the immune system?
Frequent infections due to loss of IgG
## Footnote
The loss of immunoglobulin G can lead to increased susceptibility to infections.
116
What coagulation issue may arise in Congenital Nephrotic Syndrome?
Clots due to loss of antithrombin III
## Footnote
The loss of this protein increases the risk of thromboembolic events.
117
What is a temporary management strategy for Congenital Nephrotic Syndrome?
Daily substitution of albumin
## Footnote
This helps to manage the low protein levels in the blood.
118
What surgical procedure is considered 'curative' for Congenital Nephrotic Syndrome?
Bilateral nephrectomy
## Footnote
Following this procedure, patients typically require peritoneal dialysis.
Bad prognosis.
119
True or False: There is no role for steriod in management of congenital nephrotic syndrome.
True
120
What is the minimum number of RBCs in urinalysis to indicate hematuria?
≥ 5 RBCs
121
What does it indicate if there are red urine with no RBCs found in urinalysis?
Myoglobinuria
Hemoglobinuria
Medications
Food coloring
Urate crystals in newborn
122
What is a characteristic finding in glomerular hematuria differentiate it from non-glomerular hematuria regarding EM?
RBC casts present in glomerular hematuria only.
123
The color in urine typically founf in cases of non-glomerular hematuria is ______, while it is ______ in glomerular hematuria.
Red or pink, coca-colored or dark red
124
What is the protein level typically found to say it is glomerular hematoria?
Protein > +2
125
What can cause false-positive results for hematuria in urinalysis?
Medications, food coloring
126
What is a unique finding in urinalysis for newborns could mislead diagnosis of hematuria?
Urate crystals presence
127
What is the clinical approach to a child with hematuria?
Evaluate for non-glomerular and glomerular causes.
## Footnote
Non-glomerular hematuria includes conditions like UTI, trauma, and kidney stones, while glomerular hematuria involves conditions such as IgA nephropathy and lupus nephritis.
128
What are the characteristics of non-glomerular hematuria?
No RBC casts and eumorphic RBCs.
## Footnote
Non-glomerular hematuria can be caused by UTI, trauma, kidney stones, and other conditions.
129
What indicates glomerular hematuria?
Presence of RBC casts and dysmorphic RBCs.
## Footnote
Glomerular hematuria is often associated with kidney diseases like Alport syndrome and lupus nephritis.
130
List common causes of non-glomerular hematuria.
* UTI
* Trauma
* Sickle cell anemia (trait)
* Kidney stones
* Tumor
* Polycystic kidney disease
* Meatal stenosis
* Renal vein thrombosis (RVT)
## Footnote
These causes do not involve glomerular damage.
131
List common causes of glomerular hematuria.
* Postinfectious glomerulonephritis
* IgA nephropathy
* Lupus nephritis (LN)
* Alport disease
* MPGN
* Henoch-Schonlein purpura
* Hemolytic uremic syndrome (HUS)
## Footnote
These conditions involve glomerular damage and often present with dysmorphic RBCs.
132
True or False: Eumorphic RBCs are indicative of glomerular hematuria.
False.
## Footnote
Eumorphic RBCs are typically seen in non-glomerular hematuria.
133
What is a key characteristic of Nephritic Syndrome regarding protein levels?
Proteinuria (<3.5g/day)
## Footnote
Nephritic range proteinuria.
134
What condition is characterized by reduced urine output in Nephritic Syndrome?
Oliguria
## Footnote
Oliguria is defined as urine output that is less than 400 mL per day.
135
What is azotemia in the context of Nephritic Syndrome?
Azotemia refers to the accumulation of nitrogenous waste products in the blood due to impaired kidney function.
136
What symptom of Nephritic Syndrome is related to fluid retention?
Salt retention
## Footnote
Salt retention can lead to edema and hypertension due to excess fluid in the body.
137
What type of edema is commonly associated with Nephritic Syndrome?
Periorbital edema
## Footnote
Periorbital edema is swelling around the eyes and is often a visible sign of fluid retention.
138
Which cardiovascular condition may occur in Nephritic Syndrome?
Hypertension
## Footnote
Hypertension in Nephritic Syndrome is often due to increased blood volume from fluid retention.
139
What type of casts are typically found in the urine of patients with Nephritic Syndrome?
RBC Casts
## Footnote
RBC casts indicate the presence of red blood cells in the renal tubules, suggesting glomerular injury.
140
What is a notable feature of red blood cells in Nephritic Syndrome?
Dysmorphic RBCs
## Footnote
Dysmorphic RBCs indicate that the red blood cells have undergone alteration, often due to passage through damaged glomeruli.
141
What does Nephritic Syndrome involve in terms of kidney structure?
Inflammation of glomeruli
## Footnote
Inflammation in the glomeruli affects the kidney's ability to filter waste effectively.
142
Enumerate the most diagnostic criteria of Nephritic syndrome:
* Nephritic range proteiuria. (<3.5g/day)
* Oliguria.
* Azotemia.
* Salt retention.
* HTN.
* RMC Cast.
* Dysmorphic RBCs
* Periorbital edema.
143
What age group is most commonly affected by Acute Post-infectious Glomerulonephritis?
5 and 15 years of age
144
Acute Post-infectious Glomerulonephritis is example of :
Nephritic syndrome
145
What serious complications may develop from Acute Post-infectious Glomerulonephritis?
Encephalopathy and heart failure
146
How long does the acute phase of Acute Post-infectious Glomerulonephritis typically last?
6-8 weeks
147
When should proteinuria and hypertension normalize after the onset of Acute Post-infectious Glomerulonephritis?
4-6 weeks
148
How long may microscopic hematuria persist after Acute Post-infectious Glomerulonephritis?
Up to 2 years
## footnote
It is useful in follow up.
149
What type of bacteria is associated with nephritogenic toxins in Acute Post-infectious Glomerulonephritis?
Group A beta hemolytic streptococci
150
What is the virulence factor of group A beta hemolytic streptococci involved in Acute Post-infectious Glomerulonephritis?
M-protein
151
Which M-Types of streptococci are associated with skin infections leading to Acute Post-infectious Glomerulonephritis?
* 47
* 49
* 55
* 2
* 60
* 57
152
Which M-Types of streptococci are associated with pharyngeal infections leading to Acute Post-infectious Glomerulonephritis?
* 1
* 2
* 4
* 3
* 25
* 49
* 12
153
What is the typical time frame for the onset of symptoms in Acute Post-infectious Glomerulonephritis after skin infection?
3-6 weeks
154
What is the typical time frame for the onset of symptoms in Acute Post-infectious Glomerulonephritis after pharyngeal infection?
1-2 weeks
155
What type of immune response is involved in Acute Post-infectious Glomerulonephritis?
Immune complex
156
What is the difference between streptococcal infection in RF and APSGN?
Both cause immune coplex, but APSGN could caused by skin infection.
157
What is a key finding in urinalysis for Acute Post-infectious Glomerulonephritis?
Dysmorphic RBCs, RBC casts, Proteinuria
## Footnote
These findings indicate glomerular injury and inflammation.
158
What type of anemia is associated with Acute Post-infectious Glomerulonephritis?
Mild normochromic anemia
## Footnote
Anemia may occur due to chronic disease or inflammation.
159
What laboratory findings are typically observed in Acute Post-infectious Glomerulonephritis?
Low C3 and normal C4
## Footnote
This differentiate APSGN from Lupus Nephritis
160
How long does it typically take for low C3 levels to return to normal in Acute Post-infectious Glomerulonephritis?
6-8 weeks
## Footnote
Monitoring of C3 levels helps assess recovery from the condition.
161
What is a confirmation test for diagnosing Impetigo?
Positive antiDNase.
162
What serological test is positive in cases of Strep pharyngitis?
Positive ASO
## Footnote
ASO (Anti-Streptolysin O) titers indicate recent streptococcal infection.
163
What is the indications for renal biopsy in APSGN?
* Rapidly progressive glomerulonephritis (RPGN)
* C3 level not normalized beyond 8 weeks after the acute illness
* Persistent microscopic hematuria beyond 2 years duration
164
What is the primary treatment approach for Acute Post-infectious Glomerulonephritis?
Supportive treatment
## Footnote
This includes managing symptoms and complications.
165
What role do antibiotics play in the treatment of Acute Post-infectious Glomerulonephritis?
Early systemic antibiotics do not eliminate the risk of glomerulonephritis
## Footnote
Antibiotics are used to treat infections but do not prevent glomerulonephritis.
166
What is recommended for family members of a patient with Acute Post-infectious Glomerulonephritis?
Family members should be cultured and treated if positive
## Footnote
This helps to prevent the spread of nephritogenic strains.
167
What is the recommended duration of antibiotic treatment to limit the spread of nephritogenic strains?
10-day course
## Footnote
This is advised to effectively manage the infection.
168
Name two dietary restrictions recommended for patients with Acute Post-infectious Glomerulonephritis.
Salt and water restriction
## Footnote
These restrictions help manage fluid retention and hypertension.
169
Which class of medications is used to help manage blood pressure in Acute Post-infectious Glomerulonephritis?
ACE inhibitors
## Footnote
These medications help to lower blood pressure and reduce strain on the kidneys.
170
What is the prognosis for patients with Acute Post-infectious Glomerulonephritis?
95% recover completely
## Footnote
Most patients have a favorable outcome.
171
What type of medication is used in the management of edema caused by Acute Post-infectious Glomerulonephritis?
Diuretics
## Footnote
These help to reduce fluid overload.
172
What is IgA Nephropathy also known as?
Berger's Disease
## Footnote
IgA Nephropathy is commonly referred to as Berger's Disease.
173
What type of infections is IgA associated with?
Mucosal infections
## Footnote
IgA plays a significant role in mucosal immunity.
174
What is the most common chronic glomerular disease worldwide?
IgA Nephropathy
## Footnote
IgA Nephropathy is recognized as the most prevalent chronic glomerular disease globally.
175
What is the peak incidence age range for IgA Nephropathy?
Between 10 and 30 years of age
## Footnote
The disease typically manifests during adolescence and early adulthood.
176
In which populations is IgA Nephropathy more common?
Asians and Caucasians
## Footnote
The prevalence of IgA Nephropathy varies by ethnicity, with higher rates observed in these groups.
177
Where do IgA immune complexes accumulate in IgA Nephropathy?
Mesangium of glomeruli
## Footnote
The mesangial region of the kidneys is where these immune complexes are primarily found.
178
What is IgA Nephropathy characterized by?
Recurrent episodes of gross hematuria or persistent microscopic hematuria
## Footnote
Hematuria refers to the presence of blood in urine, which can be either visible (gross) or detectable only under a microscope (microscopic).
179
What type of casts are associated with IgA Nephropathy?
RBCs Casts
## Footnote
RBCs casts indicate the presence of red blood cells within the renal tubules and are typically associated with glomerular injury.
180
What is the level of proteinuria in IgA Nephropathy?
Less than 1g/24 hours
## Footnote
Proteinuria refers to the presence of excess proteins in urine, which can indicate kidney damage.
181
What are the levels of C3 and C4 in IgA Nephropathy?
Normal C3 and C4
## Footnote
C3 and C4 are complement proteins, and their normal levels suggest that the complement system is not significantly activated in this condition.
182
Role of serum IgA level in IgA Nephropathy?
Has no diagnostic value.
## Footnote
Serum IgA levels do not correlate with the severity or presence of IgA Nephropathy.
183
When can IgA Nephropathy occur after an infection?
1-2 weeks after infection
## Footnote
This timing is similar to post-infectious glomerulonephritis (PIGN), which can also develop after infections.
184
What condition is compared with IgA Nephropathy in terms of timing after infection?
PIGN
## Footnote
Post-Infectious Glomerulonephritis (PIGN) occurs after infections, particularly streptococcal infections, and has different clinical and laboratory findings compared to IgA Nephropathy.
185
What is the primary treatment approach for IgA Nephropathy?
Supportive treatment
## Footnote
Supportive treatment includes managing symptoms and preventing complications.
186
What is a key component of supportive treatment for IgA Nephropathy?
Blood pressure control
## Footnote
Managing blood pressure is crucial to reduce the risk of kidney damage.
187
When are corticosteroids used in IgA Nephropathy?
If nephrotic-range proteinuria is present
## Footnote
Corticosteroids can help reduce inflammation and protein loss.
188
What role do ACE inhibitors play in the treatment of IgA Nephropathy?
They reduce proteinuria
## Footnote
ACE inhibitors help lower the amount of protein in urine, which can protect kidney function.
189
Which supplement play a role in supportive treatment of IgA Nephropathy?
Fish oil cnoains anti-inflammatory Omega 3
## Footnote
It improves prognosis .
190
What is the diagnostic procedure for IgA Nephropathy?
Renal biopsy
## Footnote
A renal biopsy helps confirm the diagnosis by examining kidney tissue.
191
What is the prognosis for patients with IgA Nephropathy?
Progressive renal disease in 15-20 years from the onset
## Footnote
Many patients may experience gradual kidney function decline over time.
192
What percentage of Alport Syndrome cases are X-linked recessive?
85 %
## Footnote
This refers to X-linked Alport Syndrome (XLAS).
193
What gene is mutated in Alport Syndrome?
COL4A5
## Footnote
This mutation is responsible for the symptoms of Alport Syndrome.
194
What are the three main features of Alport Syndrome triad?
* Hematuria
* Sensorineural hearing loss
* Ocular abnormalities
## Footnote
These features are characteristic of the syndrome.
195
What is a common urinary finding in Alport Syndrome?
Progressive proteinuria
## Footnote
This condition indicates kidney damage over time.
196
What cardiovascular condition is associated with Alport Syndrome?
Hypertension
## Footnote
High blood pressure is often seen in patients with this syndrome.
197
What is the primary treatment approach for Alport Syndrome?
Supportive treatment
## Footnote
Management focuses on alleviating symptoms and monitoring kidney function.
198
Why is follow-up important in Alport Syndrome, even for carriers?
To monitor for potential progression of symptoms
## Footnote
Carriers may also experience health issues.
199
What characteristic finding is seen in the glomerular basement membrane (GBM) on electron microscopy for Alport Syndrome?
Thinning and splitting
## Footnote
This structural change is indicative of the disease.
200
What ocular abnormality is commonly associated with Alport Syndrome?
Anterior lenticonus
## Footnote
This refers to a conical shape of the anterior lens.
201
What is the prognosis of Alport Syndrome, particularly XLAS?
End-stage renal disease (ESRD)
## Footnote
XLAS has a higher risk of progressing to ESRD.
202
What is the condition characterized by palpable purpura and occurs 2 weeks after URTI?
Henoch-Schonlein Purpura (HSP)
## Footnote
HSP is a form of small-vessel vasculitis.
203
What type of complex is associated with Henoch-Schonlein Purpura?
IgA complex
## Footnote
The IgA complex plays a role in the pathogenesis of HSP.
204
Name two common symptoms of Henoch-Schonlein Purpura.
* Abdominal pain
* Arthritis or arthralgia
## Footnote
These symptoms are part of the clinical presentation of HSP.
205
What percentage of patients with Henoch-Schonlein Purpura experience hematuria?
30% to 50%
## Footnote
Hematuria is a common renal manifestation in HSP.
206
What is the risk of end-stage renal disease (ESRD) in patients with Henoch-Schonlein Purpura?
2-5%
## Footnote
This indicates a relatively low but significant risk of renal complications.
207
What is the recommended follow-up period for patients with Henoch-Schonlein Purpura?
At least 6 months
## Footnote
Follow-up is important to monitor for potential complications.
208
What is the typical platelet count in patients with Henoch-Schonlein Purpura?
Normal or high
## Footnote
This finding helps differentiate HSP from other forms of vasculitis.
209
True or False: Prednisone affects the renal involvement in Henoch-Schonlein Purpura.
False
## Footnote
Prednisone did not show efficacy in altering renal outcomes in HSP.
210
What type of vasculitis is Henoch-Schonlein Purpura classified as?
Small-vessel vasculitis
## Footnote
This classification is based on the size of the blood vessels affected.
211
What genetic inheritance pattern is associated with Familial Thin Basement Membrane Nephropathy?
Autosomal dominant
212
What is a key finding in the diagnosis of Familial Thin Basement Membrane Nephropathy?
Persistent microscopic hematuria
213
What type of casts may be observed in patients with Familial Thin Basement Membrane Nephropathy?
RBC casts
214
Is family history significant in Familial Thin Basement Membrane Nephropathy?
Yes, it discripe if other family member with same condition
and no family history of renal failure
215
What percentage of adults may experience proteinuria in Familial Thin Basement Membrane Nephropathy?
Up to 30%
216
What is the prognosis regarding long-term complications in Familial Thin Basement Membrane Nephropathy?
No long-term complications
217
What treatment may be required for proteinuria in Familial Thin Basement Membrane Nephropathy?
ACE inhibitor
218
What does light microscopy typically show in Familial Thin Basement Membrane Nephropathy?
Looks normal
219
What diagnostic test is recommended for affected first-degree family members?
Urinalysis and microscopy
220
Familial thin basement membrane nephropathy is _____ condition that diagnosed by _______.
Benign, exclusion
221
What is hypercalciuria?
A condition characterized by excessive calcium in the urine
## Footnote
Can be idiopathic or secondary
222
What is idiopathic hypercalciuria?
A type of hypercalciuria without a known cause
## Footnote
Commonly diagnosed in patients with kidney stones
223
What is secondary hypercalcemia?
Increased calcium levels in the blood due to other underlying conditions
## Footnote
Can result from disorders like hyperparathyroidism
224
What is the spot urine calcium to creatinine ratio for individuals over 8 years of age?
0.2
## Footnote
Indicates the threshold for diagnosing hypercalciuria
225
What is the spot urine calcium to creatinine ratio for infants under 7 months?
0.8
## Footnote
Higher threshold due to developmental factors
226
What is the 24-hour urine collection threshold for hypercalciuria?
> 4 mg/kg/day
## Footnote
Used to assess calcium excretion over a full day
227
Name a common cause of secondary hypercalcemia.
* Hyperparathyroidism
* Vitamin D intoxication
* Immobilization
* Sarcoidosis
## Footnote
These conditions can lead to increased calcium levels
228
What are common symptoms of nephrolithiasis?
* Abdominal pain
* Hematuria
## Footnote
Nephrolithiasis refers to kidney stones
229
Name a syndrome associated with hypercalciuria.
* Cushing syndrome
* William's syndrome
* Bartter syndrome
## Footnote
These syndromes may present with calcium metabolism abnormalities
230
What is the primary treatment for hypercalciuria?
Treatment of the underlying cause
## Footnote
May involve medication or lifestyle changes
231
What medication is commonly used to manage hypercalciuria?
Hydrochlorothiazide
## Footnote
A thiazide diuretic that helps reduce calcium excretion
232
What dietary restriction is recommended for managing hypercalciuria?
Sodium restrictions
## Footnote
Helps to reduce calcium loss in urine
233
What are the causes of normal anion gap metabolic acidosis?
Diarrhea
Renal tubular acidosis
Idiopathic fanconi syndrome
Oculocerebrorenal Dystrophy (Lowe Syndrome)
Uretroenteric fistula
Spironolactone
## Footnote
Diarrhea leads to loss of bicarbonate, resulting in acidosis.
234
What is Renal Tubular Acidosis?
Failure of the kidney to acidify the urine
## Footnote
Renal Tubular Acidosis (RTA) refers to a group of disorders characterized by the kidney's inability to properly acidify urine.
235
What is insufficiently reabsorbed in the Proximal Renal Tubule (PRT) in Renal Tubular Acidosis?
HCO3+
## Footnote
In RTA, there is a failure to adequately reabsorb bicarbonate (HCO3-) in the PRT.
236
What is the problem with acid excretion in the Distal Renal Tubule (DRT) in Renal Tubular Acidosis?
Insufficient acid excretion (H+)
## Footnote
The DRT is unable to excrete hydrogen ions (H+) effectively, contributing to acidosis.
237
What are the typical levels of HCO3 and H in Renal Tubular Acidosis?
Low HCO3 and High H
## Footnote
In RTA, bicarbonate levels are low, while hydrogen ion levels are elevated.
238
What type of metabolic acidosis is associated with Renal Tubular Acidosis?
Non-Anion gap metabolic acidosis
## Footnote
RTA is characterized by a non-anion gap form of metabolic acidosis, meaning that the anion gap remains within normal limits.
239
What is Renal Tubular Acidosis Type I (dRTA)?
A condition characterized by non-anion gap metabolic acidosis with specific renal tubular dysfunctions
## Footnote
dRTA affects the distal tubules and collecting ducts, leading to impaired hydrogen ion secretion.
240
Which part of the nephron is primarily affected in Renal Tubular Acidosis Type I?
Distal tubules
## Footnote
The distal tubules are responsible for the secretion of hydrogen ions (H+).
241
What is the urine pH in RTA Type I?
Urine pH > 6
## Footnote
This alkaline urine pH is a key diagnostic feature of dRTA.
242
What are the electrolyte imbalances associated with RTA Type I?
* Hypokalemia
* Hypocalcemia
* Hypercalciuria
## Footnote
These imbalances can lead to various complications, including kidney stones.
243
What is a common complication of RTA Type I?
Kidney stones
## Footnote
The presence of hypercalciuria increases the risk of calcium stone formation.
244
What type of metabolic acidosis is seen in RTA Type I?
Non-anion gap metabolic acidosis
## Footnote
This type of acidosis is characterized by a normal anion gap in the serum electrolyte profile.
245
Fill in the blank: RTA Type I is characterized by _______ metabolic acidosis.
non-anion gap
246
What is the effect of RTA Type I on calcium levels?
Hypocalcemia
## Footnote
This can lead to various skeletal and muscular issues.
247
What is the primary mechanism of acid-base imbalance in RTA Type I?
Impaired hydrogen ion secretion
## Footnote
This leads to retention of H+ in the blood, causing acidosis.
248
True or False: RTA Type I is associated with hyperkalemia.
False
## Footnote
RTA Type I is typically associated with hypokalemia.
249
Which nephron structure is responsible for water reabsorption that can also be affected in RTA Type I?
Collecting ducts
## Footnote
The collecting ducts play a role in urine concentration and can be affected by acid-base imbalances.
250
What is Renal Tubular Acidosis Type II also known as?
pRTA
## Footnote
pRTA stands for proximal renal tubular acidosis, a type of metabolic acidosis.
251
What substance is lost in urine in Renal Tubular Acidosis Type II?
HCO3
## Footnote
HCO3 is bicarbonate, which is critical for maintaining acid-base balance.
252
What is the primary site affected in Renal Tubular Acidosis Type II?
Proximal tubules
## Footnote
Proximal tubules are responsible for reabsorbing bicarbonate.
253
What is a common consequence of Renal Tubular Acidosis Type II?
Metabolic acidosis
## Footnote
This condition results from the loss of bicarbonate leading to acid accumulation.
254
Which syndrome is associated with Renal Tubular Acidosis Type II?
Fanconi syndrome
## Footnote
Fanconi syndrome includes defects in renal tubular function, leading to various renal losses.
255
What types of urine abnormalities are present in Fanconi syndrome?
* Phosphaturia
* Glycosuria
* Aminoaciduria
* Uricosuria
## Footnote
These abnormalities result from impaired tubular reabsorption.
256
What is the urine pH typically seen in Renal Tubular Acidosis Type II?
Urine pH is < 5
## Footnote
This low pH indicates the inability of the kidneys to excrete acids properly.
257
What part of the nephron is involved in the loss of HCO3?
Proximal tubules
## Footnote
The proximal tubules are crucial for bicarbonate reabsorption.
258
Fill in the blank: The loss of _______ in urine is characteristic of Renal Tubular Acidosis Type II.
HCO3
259
What are the components of the nephron involved in urine formation?
Proximal tubules, Distal tubules, Collecting ducts, Loop of Henle
## Footnote
These components play crucial roles in the reabsorption and secretion processes of the nephron.
260
What condition is characterized by a failure to secrete H+ in the kidneys?
Renal Tubular Acidosis Type IV
## Footnote
This condition leads to a buildup of acid in the body, resulting in metabolic acidosis.
261
Which hormone is primarily responsible for sodium reabsorption in the kidneys?
Aldosterone
## Footnote
Aldosterone promotes sodium retention and potassium excretion.
262
What is the typical urine pH in cases of renal tubular acidosis?
Urine pH is < 5
## Footnote
This acidic urine pH indicates a failure in acid excretion.
263
What can hyperkalemia in RTA type 4 lead to?
Can be life threatening
## Footnote
Hyperkalemia can cause serious cardiac issues and other complications.
264
List some causes of RTA Type 4.
* CAH
* Urinary tract obstruction
* Drugs e.g. NSAIDs, ACEi, Spironolactone
## Footnote
These factors can affect potassium levels in the body.
265
What ions are involved in the acid-base balance within the renal system?
* H+
* HCO3
## Footnote
Hydrogen ions and bicarbonate are crucial for maintaining the body's pH balance.
266
What is the formula to calculate the anion gap?
Na - (Cl + HCO3)
## Footnote
The anion gap helps determine the cause of metabolic acidosis.
267
What does an anion gap of < 12 indicate?
Absence of an anion gap
## Footnote
This suggests that the metabolic acidosis is not caused by a high anion gap condition.
268
What does an anion gap of > 20 suggest?
No renal tubular acidosis (RTA)
## Footnote
A high anion gap indicates other causes of metabolic acidosis rather than RTA.
269
What urine pH suggests proximal renal tubular acidosis (RTA) in the presence of acidosis?
Urine pH < 5.5
## Footnote
A low urine pH indicates impaired bicarbonate reabsorption typically seen in proximal RTA.
270
What urine pH indicates distal renal tubular acidosis (RTA) in the presence of acidosis?
Urine pH > 6.0
## Footnote
A higher urine pH suggests a defect in the ability to excrete hydrogen ions seen in distal RTA.
271
What type of genetic mutation is associated with cystinosis?
Autosomal recessive mutation in CTNS gene
272
What symptom of cystinosis is caused by crystal deposition in the cornea?
Photophobia
273
What is the typical IQ range for individuals with cystinosis?
Low-normal IQ
274
Which endocrine disorder is commonly associated with cystinosis?
Hypothyroidism
275
What syndrome characterized by failure to thrive is associated with cystinosis?
Fanconi syndrome
276
What urinary symptom is associated with cystinosis?
Microscopic hematuria
277
What type of transport is defective in cystinosis?
Transport of cystine from lysosomes
278
What is the name of the protein involved in the transport of cystine?
Cystinosin
279
What happens to cystine in individuals with cystinosis?
Cystine accumulation → cystine crystals
280
What central nervous system effects are associated with cystinosis?
Hypothyroidism, Photophobia, Fanconi Syndrome
281
What is the treatment for cystinosis?
Oral cysteamine
282
What is Nephrogenic Diabetes Insipidus (NDI)?
Insensitivity of the distal nephron to ADH
## Footnote
ADH stands for antidiuretic hormone, which helps regulate water balance in the body.
Diabetes = polyuria (urination).
Insipidus = tasteless
283
What percentage of Nephrogenic Diabetes Insipidus is X-linked recessive?
90 %
## Footnote
This genetic pattern primarily affects males due to the inheritance of X chromosome.
284
What are some secondary forms of Nephrogenic Diabetes Insipidus?
* Nephrotoxic drugs
* Chronic pyelonephritis
* Obstructive uropathy
* Sickle cell trait
285
What is the primary treatment for Diabetes Insipidus?
Vasopressin
## Footnote
DDAVP (Desmopressin) is a synthetic analog of vasopressin used in treatment.
286
What is the maximum amount of urine output per day in Nephrogenic Diabetes Insipidus?
Up to 20L
## Footnote
This condition results in excessive urination, known as polyuria.
287
What is the specific gravity of urine typically found in Nephrogenic Diabetes Insipidus?
Low urine SG
## Footnote
SG refers to specific gravity, which measures urine concentration.
288
What serum condition is commonly associated with Nephrogenic Diabetes Insipidus?
Hypernatremia
## Footnote
Hypernatremia indicates high sodium levels in the blood, often due to water loss.
289
What are the common laboratory findings in Nephrogenic Diabetes Insipidus?
* Polyuria
* High serum osmolality
* Low urine specific gravity
290
What is the clinical presentation of Nephrogenic Diabetes Insipidus (NDI)?
Failure to thrive (FTT), Constipation, Breast-fed infants
## Footnote
These symptoms can indicate potential underlying issues related to NDI.
291
What are some symptoms that may lead to a delayed diagnosis of NDI?
Irritability, Intellectual disability (ID), ADHD symptoms
## Footnote
These symptoms may confuse the diagnosis and lead to misinterpretation of the condition.
292
What are the red flags of Diabetes Insipidus (DI)?
* Inability to toilet train
* Frequent daytime accidents
* Constant thirst
* Dilated bladder
## Footnote
These signs can help in identifying potential cases of DI in patients.
293
What is the urine specific gravity threshold for diagnosing Nephrogenic Diabetes Insipidus?
< 1.015
294
What is the effect of the vasopressin test in Nephrogenic Diabetes Insipidus?
No effect on urine concentration
295
What blood test results are indicative of Nephrogenic Diabetes Insipidus?
Hypernatremia, high serum osmolarity > 300, normal or high plasma ADH levels
296
What is a key management strategy for patients with Nephrogenic Diabetes Insipidus?
Allow free access to water all the time
297
List two dietary recommendations for the treatment of Nephrogenic Diabetes Insipidus.
* Low Na diet
* Low protein diet
298
Name a medication used in the treatment of Nephrogenic Diabetes Insipidus.
Thiazide
299
What is another medication besides Thiazide that can be used to treat Nephrogenic Diabetes Insipidus?
Indomethacin
300
What is the urine specific gravity threshold for diagnosing Nephrogenic Diabetes Insipidus?
< 1.015
301
What is the effect of the vasopressin test in Nephrogenic Diabetes Insipidus?
No effect on urine concentration
302
What blood test results are indicative of Nephrogenic Diabetes Insipidus?
Hypernatremia, high serum osmolarity > 300, normal or high plasma ADH levels
303
What is a key management strategy for patients with Nephrogenic Diabetes Insipidus?
Allow free access to water all the time
304
List two dietary recommendations for the treatment of Nephrogenic Diabetes Insipidus.
* Low Na diet
* Low protein diet
305
Name a medication used in the treatment of Nephrogenic Diabetes Insipidus.
Thiazide
306
What is another medication besides Thiazide that can be used to treat Nephrogenic Diabetes Insipidus?
Indomethacin
307
What is Bartter Syndrome?
A disorder characterized by renal tubular dysfunction leading to electrolyte imbalances and metabolic alkalosis
## Footnote
Bartter Syndrome often presents with various clinical features and laboratory findings.
308
What is a common history noted in patients with Bartter Syndrome?
History of polyhydramnios
## Footnote
Polyhydramnios refers to an excess of amniotic fluid during pregnancy.
309
List three clinical features of Bartter Syndrome.
* Dysmorphic features
* Polyuria
* Polydipsia
* Failure to thrive (FTT)
## Footnote
These features indicate the impact of Bartter Syndrome on growth and hydration status.
310
What is the typical blood pressure finding in Bartter Syndrome?
Normal or low blood pressure
## Footnote
Blood pressure abnormalities reflect the underlying electrolyte imbalances.
311
What type of metabolic disturbance is associated with Bartter Syndrome?
Hypokalemic hypochloremic metabolic alkalosis
## Footnote
This disturbance is due to the loss of potassium and chloride in urine.
312
What is hypercalciuria?
High levels of calcium in the urine
## Footnote
Hypercalciuria can lead to complications such as kidney stones.
313
What laboratory findings are typically elevated in Bartter Syndrome?
* Renin
* Aldosterone
* Prostaglandin E
## Footnote
Elevated levels of these substances are part of the body's compensatory response to electrolyte imbalances.
314
What is often found at low levels in patients with Bartter Syndrome?
Low serum magnesium (Mg)
## Footnote
Hypomagnesemia can contribute to further complications in affected individuals.
315
What is a notable finding in urine analysis for Bartter Syndrome?
High level of urine chloride (Cl)
## Footnote
Increased urine chloride is a hallmark of renal tubular dysfunction.
316
What are the primary treatment goals for Bartter Syndrome?
* Prevention of dehydration
* Correction of hypokalemia
## Footnote
These goals help manage the symptoms and complications associated with the syndrome.
317
Name two medications used in the treatment of Bartter Syndrome.
* Spironolactone
* ACE inhibitors
## Footnote
These medications help manage electrolyte balance and blood pressure.
318
What is the role of indomethacin in Bartter Syndrome treatment?
It helps reduce renal prostaglandin production, therapy decreasing renal losses of sodium
## Footnote
Indomethacin can help mitigate some of the effects of the condition.
319
What type of supplement might be necessary for patients with Bartter Syndrome?
* Calcium (Ca) supplements
* Magnesium (Mg) supplements
## Footnote
These supplements address deficiencies that can arise due to the syndrome.
320
Fill in the blank: Bartter Syndrome is associated with _______ metabolic alkalosis.
hypokalemic hypochloremic
## Footnote
This indicates the type of metabolic disturbance commonly found in patients.
321
What is the alternative term for Acute Kidney Injury?
Acute Renal Failure
## Footnote
This term is often used interchangeably with Acute Kidney Injury.
322
What characterizes Acute Kidney Injury?
Rapid decline in renal filtration function
## Footnote
This decline leads to various metabolic abnormalities.
323
What are common laboratory findings associated with Acute Kidney Injury?
Increased serum creatinine, azotemia, and oliguria
## Footnote
These findings indicate impaired kidney function.
324
What does prerenal AKI refer to?
Decreased blood flow to the kidneys
325
What is the effect of decreased blood flow on GFR?
Decreased GFR
326
What happens to fluid and BUN reabsorption in prerenal AKI?
Increase reabsorption of fluid and BUN
327
What is the serum BUN to creatinine ratio indicative of prerenal AKI?
Serum BUN : Cr > 15
328
In prerenal AKI, what is the relationship between BUN and creatinine?
BUN = 1 BUN / Cr
329
What is the status of tubular function in prerenal AKI?
Tubular function is normal
330
What is the fractional excretion of sodium (FENa) in prerenal AKI?
FENa < 1%
331
What is the FENa threshold in neonates for prerenal AKI?
FENa < 2.5% in neonates
332
What is the urine osmolality in prerenal AKI?
Urine osm > 400 and > 350 in neonates
333
What is the urinary sodium level in prerenal AKI?
Low urinary Na < 10
334
What is the condition characterized by injury and necrosis of tubular epithelial cells?
Renal AKI
## Footnote
AKI stands for Acute Kidney Injury.
335
What is impaired in renal AKI?
Tubular function
## Footnote
Tubular function refers to the ability of the renal tubules to reabsorb and secrete substances.
336
What is the serum BUN to Cr ratio indicative of renal AKI?
Serum BUN : Cr < 15
## Footnote
BUN stands for Blood Urea Nitrogen and Cr stands for Creatinine.
337
What is the FENa percentage typically observed in renal AKI?
FENa > 2%
## Footnote
FENa refers to fractional excretion of sodium.
338
What is the FENa percentage observed in neonates with renal AKI?
FENa > 2.5-3% in neo
## Footnote
'neo' refers to neonates or newborns.
339
What is the urine osmolarity level in renal AKI?
Urine osm < 350
## Footnote
Urine osmolarity indicates the concentration of solutes in the urine.
340
What type of casts are typically found in renal AKI?
Granular, muddy, brown cast
## Footnote
These casts are indicative of tubular damage.
341
What is the urinary sodium level in renal AKI?
High urinary Na > 10
## Footnote
High urinary sodium levels can indicate impaired tubular reabsorption.
342
What does an increased BUN: Cr ratio > 20 indicate?
Pre-renal azotemia.
## Footnote
This suggests that the cause of kidney dysfunction is likely due to factors affecting blood flow.
343
What does a FENa < 1% indicate?
Pre-renal cause of acute kidney injury.
## Footnote
A low fractional excretion of sodium suggests that the kidneys are conserving sodium due to low blood volume.
344
What does an increased BUN: Cr ratio < 15 indicate?
Renal or post-renal cause of acute kidney injury.
## Footnote
This suggests that the kidneys are not able to concentrate urine properly.
345
What does a FENa > 2% indicate?
Renal cause of acute kidney injury.
## Footnote
A high fractional excretion of sodium suggests intrinsic kidney damage.
346
What does a urine osmolarity < 350 indicate?
The kidneys are unable to concentrate urine effectively.
## Footnote
This is typically seen in renal failure.
347
What are the signs of azotemia?
High serum creatinine and oliguria.
## Footnote
Azotemia refers to an accumulation of nitrogenous waste in the blood, indicating kidney dysfunction.
348
How does Urine Specific Gravity differ between prerenal AKI and renal AKI?
Pre renal: urine SG> 1.020
Renal AKI: urine SG <1.010
349
What is the primary method for diagnosing Acute Kidney Injury?
History and physical examination
## Footnote
This includes evaluating patient symptoms and medical history.
350
What is considered oliguria in the context of Acute Kidney Injury?
< 1mL/Kg/h
## Footnote
Oliguria indicates reduced urine output, which is a key symptom of kidney injury.
351
Which general labs are important for diagnosing Acute Kidney Injury?
* BUN/Creatinine
* Electrolytes
* Urinalysis
* Urine Na
## Footnote
These tests help assess kidney function and electrolyte balance.
352
What imaging study is used in the diagnosis of Acute Kidney Injury?
Renal Ultrasound
## Footnote
This imaging helps evaluate kidney structure and rule out obstructions.
353
What is the most important step in the management of Acute Kidney Injury?
Prevention
## Footnote
Prevention is key to avoiding the progression of Acute Kidney Injury.
354
List some management strategies for Acute Kidney Injury.
* Fluids
* Management of acidosis & Hyperkalemia
* Diuretics
* Renal replacement therapy
## Footnote
These strategies help to address the underlying issues in Acute Kidney Injury.
355
What are the indications for dialysis in children with Acute Kidney Injury?
* Anuria/Oliguria
* Volume overload - with hypertension or pulmonary edema that are diuretic resistant
* Persistent hyperkalemia
* Severe metabolic acidosis - resistant to medical treatment
* Uremia - encephalopathy, pericarditis, and neuropathy
* Hypocalcemic tetany due to calcium:phosphorus imbalance that is uncontrolled
* Inability to provide adequate nutrition - because of severe fluid restriction
## Footnote
These indications highlight critical situations where dialysis is necessary.
356
What condition must be present for dialysis if there is volume overload in AKI?
Hypertension or pulmonary edema that are diuretic resistant
## Footnote
These conditions indicate that fluid management is inadequate.
357
What type of casts are mostly diagnosed in Acute Tubular Necrosis?
Muddy brown granular casts
358
What is the typical timing of gross hematuria in IgA nephropathy after a URI?
1-3 days after URI
359
Which condition is characterized by arthritis, discoid rash, malar rash, photosensitivity, and serositis?
Lupus nephritis
360
Fill in the blank: Hematuria 2-3 weeks after URI is mostly indicative of _______.
post-infectious glomerulonephritis
361
True or False: Muddy brown granular casts are a key indicator of intrinsic AKI.
True
362
What is indicated by a progressive loss of renal function in a short time and crescents on RB?
Rapidly progressive glomerulonephritis
## Footnote
This condition is characterized by rapid decline in kidney function.
363
What symptoms are associated with allergic interstitial nephritis?
Fever, eosinophilia, and rash
## Footnote
Urinalysis (UA) may show eosinophils, WBC, and RBC casts.
364
What are the key indicators of diarrhea positive HUS?
Bloody diarrhea, anemia, thrombocytopenia, high LDH, schistocytes in PS
## Footnote
HUS stands for Hemolytic Uremic Syndrome.
365
What are the key indicators of diarrhea negative HUS?
Anemia, thrombocytopenia, high LDH, schistocytes in PS
## Footnote
This condition occurs without bloody diarrhea.
366
What is chronic kidney disease characterized by?
Progressive - Irreversible - Polyuria
## Footnote
Chronic kidney disease is a long-term condition that gradually worsens over time.
367
What are the most common causes of chronic kidney disease?
Kidney birth defects and genetic diseases
## Footnote
These are significant contributors to CKD, especially in younger populations.
368
From ages 5 to 14 years, what are the most common causes of chronic kidney disease?
Genetic diseases, nephrotic syndrome, and systemic diseases
## Footnote
These conditions are prevalent in the pediatric population within this age range.
369
From ages 15 to 19 years, what are the most common causes of chronic kidney disease?
Problems with the glomeruli, such as nephrotic syndrome and lupus
## Footnote
Glomerular issues become more prominent as children transition to adolescence.
370
What does a GFR > 90 indicate in chronic kidney disease?
No symptoms
## Footnote
This level of GFR suggests normal kidney function.
371
What does a GFR between 60 and 90 indicate?
Mild GFR decrease
## Footnote
At this stage, kidney function is still relatively preserved.
372
What does a GFR between 30 and 60 indicate?
Moderate decrease
## Footnote
This level indicates a more significant impairment in kidney function.
373
What does a GFR between 15 and 30 indicate?
Severe decrease
## Footnote
This level of GFR indicates advanced kidney disease, requiring close management.
374
What does a GFR < 15 indicate?
Replacement therapy
## Footnote
Patients at this stage typically require dialysis or kidney transplantation.
375
What are the indications for dialysis in children with chronic kidney disease?
* Fluid overload - diuretic resistant
* Failure to thrive/Poor linear growth
* Uncontrollable electrolyte abnormalities
* Uremia
* GFR=10-15 mL/min/1.73m2 - Dialysis should be considered
## Footnote
These indications highlight the critical situations where dialysis becomes necessary.
376
True or False: Indications for dialysis are the same between chronic kidney disease and acute kidney injury.
False
## Footnote
There are slight variations in the criteria for initiating dialysis between CKD and AKI.
377
What is the most common cause of urinary tract infections?
E-coli
## Footnote
E-coli is a type of bacteria that commonly causes infections in the urinary tract.
378
What condition is indicated by fever in urinary tract infections?
Pyelonephritis
## Footnote
Pyelonephritis is a kidney infection that typically presents with fever.
379
What condition is indicated by the absence of fever in urinary tract infections?
Cystitis
## Footnote
Cystitis is a bladder infection that usually does not cause fever.
380
What is the male to female ratio of urinary tract infections in uncircumcised boys under 18 years?
3:1
## Footnote
Uncircumcised boys are at a higher risk for urinary tract infections compared to females.
381
What is the male to female ratio of urinary tract infections in children over 1 year?
1:10
## Footnote
This ratio reflects the anatomical differences, particularly the shorter urethra in females.
382
What are some predisposing factors for urinary tract infections?
* Incomplete micturation
* Infrequent voiding
* Poor hygiene
* Uncircumcised boys
* Vulvitis
* Constipation
* Neuropathic bladder
* Obstructive uropathy
* Antibiotics
## Footnote
These factors can increase the risk of developing urinary tract infections.
383
True or False: Poor hygiene is a predisposing factor for urinary tract infections.
True
## Footnote
Maintaining good hygiene is important in preventing urinary tract infections.
384
Fill in the blank: In urinary tract infections, _______ can occur due to incomplete micturation.
infrequent voiding
## Footnote
Infrequent voiding can lead to urinary retention and increase the risk of infection.
385
What is a significant anatomical reason for the higher incidence of urinary tract infections in females?
Very short urethra
## Footnote
The short urethra in females increases the likelihood of bacteria reaching the bladder.
386
Identify one condition that can lead to obstructive uropathy.
Constipation
## Footnote
Constipation can lead to pressure on the urinary tract and cause obstruction.
387
What is the relationship between urinary tract infections and antibiotic use?
Antibiotics can predispose to urinary tract infections
## Footnote
Antibiotic use can disrupt normal flora and lead to infections.
388
What is a common complication of urinary tract infections in neonates and infants?
Septicemia
## Footnote
Septicemia can occur due to the spread of infection in young patients.
389
What are the symptoms of a urinary tract infection in older children?
According
If it is pyelonephritis it has : fever- rigor- hematuria- HTN- loin pain.
If it is cystitis: Dysuria- incontinence- frequency- urgency- 2ry enuresis
Suprs pubic pain.
## Footnote
These symptoms can vary in intensity and presentation.
390
What are two types of urinary tract infections common in older children?
* Pyelonephritis
* Cystitis
## Footnote
Pyelonephritis refers to a kidney infection, while cystitis is a bladder infection.
391
What type of pain is associated with urinary tract infections?
It differs according to the disease itself, pyelonephritis cause loin pain, while cystitis cause supra pubic pain.
## Footnote
This type of pain can be indicative of bladder irritation.
392
What are the investigations used for diagnosing urinary tract infections?
* Urine tests
* Blood tests
* Midstream urine collection
* Urine bag collection
* Bladder catheterization
* Suprapubic aspiration
## Footnote
Each method has its own indications and risks.
393
What is a risk associated with urine bag collection?
Risk of contamination
## Footnote
Contamination can lead to false results in urine tests.
394
What is the significance of a colony count greater than 100,000 of a single pathogen?
Diagnostic for UTI
## Footnote
This threshold is used to confirm the presence of a urinary tract infection.
395
What can cause pyuria without a urinary tract infection?
* Fever
* Nephritic syndrome
* Dehydration
## Footnote
Pyuria can occur in these conditions without an actual UTI.
396
What are the first-line treatments for cystitis in children?
* Amoxicillin
## Footnote
These antibiotics are typically prescribed for a duration of 5 days.
397
What are the recommended treatments for pyelonephritis?
* Ceftriaxone
* Cefotaxime
* 3rd generation Cephalosporin
## Footnote
Treatment can be oral or parenteral for a duration of 7-14 days.
398
What is a possible finding in urine tests indicating infection?
Pyuria with pus cells > 5/HPF
## Footnote
The presence of pus cells is a common indicator of infection.
399
What diagnostic test is used to identify vesicoureteral reflux (VUR)?
Voiding cystourethrogram
## Footnote
This imaging test helps assess the urinary tract's structure and function.
400
True or False: A UTI can occur without pyuria.
True
## Footnote
This can happen in cases of antibiotic use or closed infections like tuberculosis.
401
What are the common laboratory tests performed to evaluate urinary tract infections?
* ESR
* CRP
## Footnote
These tests help assess the inflammatory response associated with infections.
402
What is vesicoureteral reflux?
Urine is refluxing or getting backed up
## Footnote
Vesicoureteral reflux is a condition where urine flows backward from the bladder to the ureters.
403
What does 'vesico' refer to in the context of vesicoureteral reflux?
Bladder
## Footnote
'Vesico' is a prefix related to the urinary bladder.
404
What is the International Reflux Grading System used for?
To classify the severity of vesicoureteral reflux
## Footnote
The grading system helps determine the appropriate treatment plan.
405
What characterizes Grade I in the International Reflux Grading System?
Urine backs up into the ureter only
## Footnote
Grade I represents the least severe form of reflux.
406
What characterizes Grade II in the International Reflux Grading System?
Urine backs up into the ureter, renal pelvis, and calyces, without dilation
## Footnote
This indicates slight involvement of the renal structures.
407
What characterizes Grade III in the International Reflux Grading System?
The ureter and pelvis appear mildly dilated, and the calyces are mildly blunted
## Footnote
This grade indicates moderate concern for kidney damage.
408
What characterizes Grade IV in the International Reflux Grading System?
The ureter and pelvis appear moderately dilated, and the calyces are moderately blunted
## Footnote
This grade suggests a more significant risk of renal impairment.
409
What characterizes Grade V in the International Reflux Grading System?
The pelvis is severely dilated, the ureter appears tortuous, and the calyces are severely blunted
## Footnote
This is the most severe form of reflux and often requires surgical intervention.
410
What is the recommended treatment for Grade I reflux?
No treatment is necessary; periodic urine cultures
## Footnote
Monitoring is sufficient for Grade I reflux.
411
What is the recommended treatment for Grade II reflux?
No treatment is necessary; periodic urine cultures
## Footnote
Similar to Grade I, Grade II reflux is typically monitored.
412
What is the recommended treatment for Grade III reflux?
Prophylactic antibiotic with follow-up VURG to see if there is resolution
## Footnote
This treatment helps prevent urinary tract infections and monitor progress.
413
What is the recommended treatment for Grade IV reflux?
Surgical intervention is often necessary
## Footnote
Grade IV may require surgical correction to prevent kidney damage.
414
What is the recommended treatment for Grade V reflux?
Surgical correction is needed to resolve the problem
## Footnote
This is critical to prevent severe renal damage.
415
What is an indication for renal ultrasound in children under 2 years of age?
first febrile UTI
## Footnote
Renal ultrasound is recommended for young children presenting with their first urinary tract infection (UTI) accompanied by fever.
416
What are the indications for renal ultrasound in children of any age?
* Recurrent febrile UTIs
* Family history of renal or urologic disease, poor growth, or hypertension
* No expected response to appropriate antimicrobial therapy
## Footnote
These factors warrant further investigation using renal ultrasound to assess underlying issues.
417
What is VCUG and when is it indicated?
VCUG is indicated for:
* Children of any age with ≥ 2 febrile UTIs
* Children of any age with a 1st febrile UTI and:
* Any anomalies on RBUS
* Temp ≥39°C and a pathogen other than E. coli
* Poor growth or hypertension
## Footnote
VCUG (Voiding Cystourethrogram) is a radiological test used to visualize the urinary tract.
418
True or False: VCUG is indicated for children with a single febrile UTI.
False
## Footnote
VCUG is primarily indicated for children with multiple febrile UTIs or specific complications following a first febrile UTI.
419
Fill in the blank: VCUG is indicated for children with a first febrile UTI who have any ________ on RBUS.
[anomalies]
## Footnote
Anomalies detected on renal bladder ultrasound (RBUS) may necessitate further investigation with VCUG.
420
What combination of symptoms may indicate VCUG in children with a first febrile UTI?
* Temp ≥39°C
* Pathogen other than E. coli
## Footnote
This combination suggests a more complicated infection that may warrant further imaging.
421
What is a potential management approach for children with febrile UTIs who do not show expected improvement?
Watchful waiting (observe, do VCUG with recurrence)
## Footnote
Monitoring the child's condition before proceeding with further diagnostic tests can be a prudent approach.
