Renal Flashcards
(290 cards)
1
Q
What is the definition of microscopic hematuria?
A
5+ RBCs/hpf in 3 centrifuged samples of freshly voided urine obtained over several weeks
2
Q
True or False: The urine is not discolored when there is microscopic hematuria?
A
True
3
Q
4 RBCs/hpf is considered microscopic hematuria?
A
FALSE (5+)
4
Q
What are 3 things that can cause a transient hematuria?
A
- Minor trauma
- Exercise
- Fever
5
Q
What is an important part of evaluating hematuria?
A
Family history
6
Q
If a patient with hematuria has a family history of hematuria without complications, what could the diagnosis be?
A
Benign familial hematuria
7
Q
In benign familial hematuria, is it typically microscopic or macroscopic?
A
Microscopic
8
Q
What is the management for benign familial hematuria?
A
Monitoring for HTN and proteinuria
9
Q
What is the next step after you get a urine dipstick positive for blood?
A
Obtain a urinalysis with microscopy
10
Q
What are 3 things that a dipstick positive for blood could be positive for?
A
- Hemoglobin
- Myoglobin
- Porphyrins
11
Q
What are 2 additional findings in patients with hemoglobinuria?
A
- Jaundice
- Anemia
-No RBCs in urine so no hematuria
12
Q
Kid who was vigorously active and has gross hematuria, otherwise asymptomatic, 0-2 RBCs on microscopic urinalysis… most likely diagnosis?
A
Myoglobinuria… 0-2 RBCs/hpf isn’t hematuria
13
Q
What are 5 things to know in a patient presenting with hematuria?
A
Is there…
- Proteinuria
- HTN
- Abdominal pain
- Dysuria
- Family history of kidney disease
14
Q
What % of school-aged children is microscopic hematuria seen normally in?
A
2-3%
15
Q
After following a school-age child with hematuria for 6 months, what % remain + for hematuria?
A
1%
16
Q
If you have a kid with hematuria and no other symptoms, what is next step?
A
Repeat urinalysis in a few weeks
17
Q
If a repeat UA is positive for hematuria, what is the next step?
A
Check a urine Ca/Cr ratio (look for hypercalciuria)
18
Q
What is a common cause of microscopic hematuria?
A
Hypercalciuria
19
Q
What should be done if you have persistent hematuria with a calcium/creatinine ratio greater than 0.25?
A
Check 24 hour total calcium excretion
20
Q
What value for 24 hour total calcium excretion confirms hypercalciuria?
A
> 4.0 mg/day
21
Q
If you have confirmed hypercalciuria after a 24 hour total calcium excretion, what should b done next?
A
Renal US to rule out a renal stone
22
Q
What should be done if you have persistnet hematuria with a calcium/creatinine ratio less than 0.25?
A
Obtain serum BUN, creatinine, and electrolytes
-Other labs to consider based on history would be C3, C4, ANA, ds-DNA, CBC, sed rate, urine protein:creatinine ratio, ASO titers, ANCA, and renal/bladder US (to look for UPJ obstruction)
23
Q
What is a hematological condition you should keep in mind with hematuria?
A
Sickle cell disease
24
Q
True to False: A child with sickle cell trait (Hgb AS) can develop hematuria?
A
True
25
When is cystoscopy indicated in a pediatric patient?
Never (bladder CA is very unlikely)
26
What is a red/pink discoloration in the diaper of a newborn likely due to?
Urate crystals (not hematuria)- No treatment needed once UA is normal
27
What is the finding of RBCs in a urine sample that is discolored?
Gross hematuria
28
Name 12 things that can result in gross hematuria.
1. Glomerulonephritis (post infectious- strep, membranoproliferative)
2. HSP
3. IgA nephropathy
4. Hereditary nephritis
5. Alport syndrome
6. Benign familial hematuria
7. Sickle cell disease
8. UPJ obstruction
9. Stones
10. Bleeding disorders
11. Crystals in the urine
12. Trauma
29
How do kids with kidney stones present?
1. Hematuria
2. Abdominal/flank oain
3. Urinary frequency
4. Dysuria
5. Fever
30
What medication can turn urine (along with tears and sweat) orange?
Rifampin
31
Painless tea or coke-colored urine with RBC casts and deformed RBCs, but without clots?
Glomerular disease
32
Bright red urine with clots?
Non-glomerular disease (lower urinary tract below level of kidneys)
-Could be structural anatomical abnormality- kidney stones, Wilms tumor, cystic kidney disease
33
True or False: Kids with kidney stones should undergo a full metabolic workup?
True
34
What imaging study is needed for kids with kidney stones?
US- to evaluate for stone burden and renal/urological abnormalities
35
What is the most common type of kidney stones in children?
Calcium
36
What kids are at increased risk for calcium renal stones?
1. Distal RTA
2. Hypercalciuria- Hyperparathyroidism/hypercalcemia
3. Loop diuretics
37
What is the initial diagnostic study when you suspect renal stones?
Plain XR or US
38
What size stones usually pass on their own?
Smaller than 5mm
39
What procedure might be required for kidney stones >5mm?
Percutaneous nephrolithotomy
40
What are some long-term treatment options for kids with kidney stones?
1. Increase fluid intake
2. Restrict salt intake
3. Thiazide (if above don't work)
41
True or False: Proteinuria in the absence of hematuria or other clinical findings is likely benign?
True
42
What two settings might you see a benign proteinuria?
1. Alkali urine
| 2. Concentrated urine
43
What is having proteinuria present during the day, but disappearing when lying down (asleep)?
Orthostatic proteinuria
44
How is othostatus proteinuria confirmed?
First void spot urine right after waking (this should show no proteinuria, even though later in the day there may be preoteinuria)
45
If a first void spot urine right after waking shows no proteinuria (but there is protinuria later in the day), what is done next?
Check serum creatinine
46
If a kid with suspected orthostatic proteinuria has a normal serum creatinine, when can you follow-up?
3 months
47
Kid with proteinuria that doesn't disappear on first morning specimen, what do you check next?
Urine protein/creatinine ratio
48
A urine protein/creatinine ratio >2 suggests what?
Renal disease
49
What are 3 things that can cause temporary proteinuria?
1. Fever
2. Exercise
3. Dehydration
50
What are 3 things in the history that would point you away from just benign transient proteinuria?
1. Edema
2. History of UTI
3. Exposure to toxins
51
True or False: A 24 hour urine collection is the gold standard for proteinuria in children?
False- Serial spot checks are standard
52
What is another name for Familial Nephritis?
Alport syndrome
53
How is Alport syndrome inherited?
X-Linked Dominant
54
Do males or females get Alport syndrome more frequently?
Males
55
What are findings with Alport syndrome?
1. Hematuria
2. Bilateral sensorineural hearing loss
3. Ocular defects
4. Renal failure
56
Are males or females with Alport syndrome more likely to develop end-stage renal disease?
Males
57
True or False: Most females with Alport syndrome are asymptomatic carriers?
True
*Variability in severity in females from degree of random inactivation of mutated X chromosome due to lyonization
58
What are the 2 most commonly palpated masses in infants?
1. Hydeonephrotic kidneys (UPJ obstruction)
| 2. Multicystic dysplastic kidneys
59
Child with microscopic hematuria after an MVA or sports injury?
UPJ obstruction
60
Newborn with hydronephrosis on prenatal US or palpable flank mass (with confirmation of the unilateral flank mass)
UPJ obstruction
61
What is an enlarged kidney with non-communicating cysts along with thin/no parenchyma and dysplasia?
Multicystic dysplastic kidney disease
62
Is the kidney functional in Multicystic dysplastic kidney disease?
No
63
Is there any treatment for multicystic dysplastic kidney disease?
No
64
What is a unilateral flank mass a clue to?
Renal dysplasia
65
Diagnosis of multicystic dysplastic kidney disease can be suspected prenatally with what 2 things?
1. Oligohydramnios
| 2. Minimal fluid in bladder
66
Is multicystic dysplastic kidney disease typically unilateral or bilateral?
Unilateral
67
What % of the time does multicystic dysplastic kidney disease occur with other urinary tract anomalies?
50%
68
Name 4 urinary tract anomalies that can be seen with multicystic dysplastic kidney disease.
1. UPJ obstruction
2. Vesicoureteral reflux
3. Posterior urethral valves
4. Megaureter and duplication
69
What is necessary to confirm diagnosis of multicystic dysplastic kidney disease?
Renal US
70
What imaging besides renal US is needed in multicystic dysplastic kidney disease?
VCUG- rule out comorbid anomalies
71
What is the typical presentation of ARPKD in infants?
Bilateral flank masses, history of oligohydramnios
72
What is the typical presentation of ARPKD in older kids?
Bilateral kidney masses, signs of chronic portal HTN (due to congenital hepatic fibrosis)
73
What are signs of portal HTN?
1. Hematemesis
2. Palpable liver
3. Thrombocytopenia
4. Splenomegaly
74
What imaging should the workup for ADPKD include?
Renal US
75
What brain abnormality is ADPKD associated with?
Intracranial aneurysms
76
What is typical in family history for ADPKD?
Death from renal disease and/or cerebral aneurysms
77
How does a ureterocele present?
Symptoms mimic UTI: Dysuria, hematuria, abdominal pain
78
What is the most common cause of urinary retention in females?
Ureterocele
79
Name 2 ways ureterocele can present on exam/imaging.
1. Mass protruding from the urethral meatus
| 2. Round filling defect on IVP
80
What can a ureterocele lead to?
Urinary tract obstruction
81
The earlier a UTI presents in life, the more likely what is a contributing factor?
Reflux
82
How is diagnosis of vesicoureteral reflux confirmed?
VCUG
83
What 2 things does management of vesicoureteral reflux depend on?
1. Grade
| 2. Fact that reflux improves with time
84
What are the 2 main goals of management in vesicoureteral reflux?
1. Avoid HTN
| 2. Avoid renal insufficiency/renal failure
85
True or False: Prophylactic antibiotics are routinely recommended for vesicoureteral reflux?
False
*May be indicated for some kids with high grade VUR- urology should decide
86
What is important for kids with VUR who are febrile?
Get urine evaluation ASAP to rule out/treat UTI
87
What are urethral strictures usually the result of?
Uretheral trauma (don't forget placement of catheter can do this- watch for any recent surgery)
88
Besides uretheral trauma, what else can cause urethral strictures?
Infections (like GC)
89
When is insertion of a urinary catheter contraindicated?
In a patient who is experiencing gross urethral bleeding following trauma
90
What should you think with a newborn who has a palpable bladder and weak urinary stream?
Posterior urethral valves
91
What 2 things would a prenatal US in a kid with PUV show?
1. Bilateral hydronephrosis
| 2. Reduced renal parenchyma
92
What is next step in an infant with a palpable bladder and no urine output?
Pass a urine catheter
93
What should be done once PUV is suspected/confirmed?
Consult urology for surgical correction immediately
94
True or False: Renal failure can occur even after surgical correction of posterior valves?
True- Long term followup of bladder function is important
95
True or False: PUV can occur in males and females?
False- only in males
96
What 3 things are kids with prune belly syndrome prone to?
1. Chronic UTIs
2. Dilated ureters
3. Large bladders
97
What is another name for Eagle Barrett syndome?
Prune Belly Syndrome
98
What is the cause of the problems with chronic UTI, dilated ureters, and large bladders in kids with prune belly syndrome?
Posterior uretheral valves
99
What is the typical triad presentation of prune belly syndrome?
Newborn with...
1. Bilateral hydronephrosis
2. Undescended testicles
3. Poor anterior abdominal wall musculature
100
What does the presentation of males with bilateral hydronephrosis warrant?
Immediate VCUG (rule out posterior uretheral valves)
101
What is something that is very important to pay attention to in a patient presenting with dysuria?
Age
102
What are 4 possible causes of dysuria in a pre-adolescent female?
1. Pinworms
2. Poor hygiene
3. Trauma
4. Vaginitis
103
What is 1 possible cause of dysuria in an adolescent female who isn't sexually active?
UTI
104
What are 2 possible causes of dysuria in an adolescent female who is sexually active?
1. UTI
| 2. Chlamydia/gonoccoal infection
105
What is a possible cause of dysuria in an adolescent male?
Chlamydia/gonococcal infection
106
Teenage girl treated empirically for UTI still experiencing dysuria, best next step?
Additional history, PE, or lab tests (like a pelvic exam)
*Don't pick additional treatment (like a new abx)
107
What are 3 causes of urinary frequency and incontinence?
1. UTI
2. Ectopic urethral opening in females
3. Unstable bladder
108
Girl who has had a thorough workup that is negative and continues to wet her pants?
Ectopic urethral opening
109
When do kids with an unstable bladder experience symptoms?
Daytime (urinary frequency) and are usually okay at night
110
What behaviors might kids with unstable bladders do to compensate?
Cross legs or squat
111
What can unstable bladder lead to?
UTI (from urine retention)
112
What are 2 ways to help manage unstable bladder?
1. Timed urination
| 2. Anticholinergic agents
113
How is a UTI diagnosed?
>50,000 colonies of a SINGLE organism from a reliable sample (cath or bladder tap)
114
What virus can cause UTI?
Adenovirus (but most UTI are caused by bacteria)
115
What is the most common but with UTI?
E. Coli
116
What are two other bugs besides E. Coli that can cause UTI?
1. Klebsiella
| 2. Enterococcus
117
Kids with what other problem are more likely to get a UTI?
Constipation
118
During the first 3 months of life, who is at higher risk for UTI, boys or girls?
Boys (especially if uncircumcised)
119
After 3 months of life, who is at higher risk for UTI, boys or girls?
Girls
120
What 2 demographic groups are UTIs more common in during adolescence?
1. Sexually active females
| 2. Homosexual males
121
A positive leukocyte esterase is diagnostic for UTI?
False- only suggestive, need a positive urine culture to make diagnosis (even though we often treat empirically)
122
True or False: Asymptomatic bacteruria requires no further intervention
True
123
True or False: Most kids with febrile UTI can be treated with oral antibiotics?
True
124
When do you treat kids with IV antibiotics for febrile UTI?
If they appear toxic or have persistent emesis
125
How long do you treat for UTI?
7-14 days
126
Name 5 antibiotics that can be used for oral treatment of UTI.
1. Amoxicillin-clavulanate
2. Trimethoprim-sulfamethoxazole
3. Cephalexin
4. Cefizime
5. Cefuroxime
(Narrow with sensitivities)
127
Name 5 antibiotics that can used for parenteral treatment of UTI.
1. Ceftrixone
2. Cefotaxime
3. Gentamivin
4. Tobramycin
5. Piperacilin
(Narrow with sensitivites)
128
What 3 antibiotics can be used for UTI prophylaxis if indicated?
1. Amoxicillin (especially for infants)
2. Trimethoprim-Sulfamethoxazole
3. Nitrofurantoin
129
What needs to be done after the first febrile UTI?
Renal and bladder US... if normal wait and see if they get another UTI
130
When is a VCUG indicated in setting of UTI?
1. After 2nd febrile UTI
| 2. Is the US obtained after 1st febrile UTI is abnormal in any way
131
What is the triad of nephrotic syndrome?
1. Hypoproteinemia
2. Proteinuria
3. Edema
132
Are most cases of nephrotic syndrome in kids primary or secondary?
Primary
133
What 5 things can lead to secondary nephrotic syndrome?
1. Infections
2. Drugs
3. Malignancies
4. Lupus
5. Diabetes
*Several glomerulopathies can also be associated with nephrotic syndrome
134
Most cases of nephrotic syndrome in kids are due to what?
Minimal change disease
135
What age group is minimal change disease typically seen in?
2-8
136
Is minimal change disease more common in males or females?
Males (2:1)
137
Name 4 findings seen with minimal change disease.
1. Decreased urine output
2. Abdominal pain
3. Diarrhea
4. Weight gain
138
True or False: Renal function is normal in minimal change disease
True
139
How are edema, hypoproteinemia, and proteinuria related?
Protein spills to urine causing low serum protein which causes low oncotic pressure which causes edema
140
What 2 things happen to the liver when there is low oncotic pressure?
1. High LDL/HDL ratio
| 2. Hypercoagulability
141
What causes a high LDL/HDL ratio seen in the setting of low oncotic pressure?
VLDL production increases
142
What causes hypercoagulability seen in the setting of low oncotic pressure?
Fibrinogen, Facor V, and Factor VII increase, decreased volume, and increased platelet count
143
What three things result from lost protein in the setting of proteinuria?
1. Immunodeficiency
2. Hypocalcemia
3. Functional hypothyroidism
144
What causes immunodeficiency in the setting of proteinuria?
Immunoglobulins lost by the kidneys in addition to decreased complement levels
145
What causes hypocalcemia in the setting of proteinuria?
Albumin is lost by the kidneys (Low albumin decreases bound and available calcium)
146
What cases functional hypothyroidism in the setting of proteinuria?
Thyroxine binding globulin is lost in the urine
147
What are 3 complications of nephrotic syndrome?
1. Hyponatremia
2. Vascular thrombosis
3. Peritonitis
148
What should be suspected in a kid with minimal change disease who has hematuria?
Vascular thrombosis
149
When is hospitalization necessary in minimal change disease?
Severe edema or infection
150
What two things are done as initial treatment of minimal change disease?
1. Sodium restriction
| 2. Prednisone
151
True or False: Fluid restriction is important in the management of minimal change disease?
False: Only necessary in severe edema
152
Name 5 things that result in worse prognosis and need for renal biopsy in setting of minimal change disease.
1. Age >10
2. Persistent or gross hematuria
3. HTN
4. Renal insufficiency
5. Low C3 complement levels
*If there are 2+ of these
153
After how long on daily prednisone is a renal biopsy indicated in minimal change disease if there is still proteinuria?
4 weeks
154
What 2 drugs might be needed in minimal change disease if there is proteinuria after 4 weeks of daily prednisone?
1. Cyclophosphamide
| 2. Cyclosporine
155
True or False: Relapses are uncommon in minimal change disease?
False: 1-2 relapses per year are not uncommon
156
When do replaces stop during minimal change disease?
Usually during adolescence
157
What is prognosis in nephrotic syndrome often based on?
Response to treatment (steroids)
158
What is suggested by the presence of RBC casts?
Glomerular disease
159
Name 7 things that are important to note in nephropathies/nephritidies.
1. ASO
2. C3
3. BP
4. Electrolytes
5. BUN
6. Creatinine
7. Albumin
160
Name 5 buzz phrases to help with cause of hematuria.
1. Positive family history
2. Recent trauma
3. Abdominal pain/mass
4. Recent strep infection
5. Sickle cell disease
161
Name 4 symptoms of nephritic syndrome.
1. Red urine (hematuria)
2. Oliguria
3. Proteinuria
4. Elevated BP and BUN (azotemia)
"ROPE"
162
Hematuria + Proteinuria indicates what?
Glomerulonephritis (Either one by themselves can be benign, but together, no)
163
What is the first division you should think of with causes of glomerulonephritis?
Low or normal complement levels
164
What 5 things does nephritic syndrome consist of?
1. Hematuria
2. Proteinuria
3. Edema
4. HTN
5. Azotemia
165
What causes glomerulonephritis with normal complement?
1. HSP
2. IgA nephropathy
3. Idiopathic vasculitis
4. FSGS
5. Rapidly progressive glomerulonephritis
166
What age group is FSGS typically seen in?
Teens
167
How can FSGS present?
Nephrotic syndrome (edema)
168
What does FSGS typically lead to?
Progressive renal failure
169
What happens to serum albumin and C3 levels in FSGS?
Albumin is low
| C3 is normal
170
What happens to C3 in membranoproliferative glomerulonephritis?
It is low
171
Why is aggressive treatment needed in MPGN?
To prevent renal failure
172
What is a nonsuppurative sequelae of an infection with a nephritogenic strain of group A beta hemolytic strep?
Post Strep Glomerulonephritis
173
True or False: Only throat infections can lead to PSGN?
False: Throat and skin infections can lead to PSGN
174
What is due to the deposition of immune complexes in the kidney?
PSGN
175
True or False: PSGN typically doesn't lead to renal failure?
True
176
Triad for PSGN?
1. HTN
2. Edema
3. Hematuria
*Look for hints of recent illness
177
Where is the edema typically located in PSGN?
Eyelids and/or face
178
Tea or cola-colored urine?
PSGN (may also be described as rusty or smoky)
179
What 3 things cause glomerulonephritis with low complement?
1. Post strep
2. Membrano-proliferative
3. Systemic lupus
180
In PSGN what causes low serum albumin levels?
Hemodilution (not proteinuria)
181
How long are C3 levels low in PSGN?
Up to 2 months, then return to normal
182
If there is documentation that C3 returns to normal after being low, what glomerulonephritis is differentiated?
It is PSGN (vs. Lupus and membranoproliferative where C3 stay low for longer)
183
What is treatment for PSGN?
Supportive: Fluids and BP control
184
True or False: Long term outcome for PSGN is poor
False- Excellent long term outcome
185
If you see recurrent gross hematuria, what should you think of?
IgA nephropathy (not PSGN)
186
What is another name for Berger's Disease?
IgA nephropathy
187
What is associated with elevated serum IgA with IgA deposits noted on renal biopsy?
IgA nephropathy (Berger's Disease) and HSP
188
IgA nephropathy rarely occurs in a child under what age?
10
189
What is the typical presentation of IgA nephropathy?
Gross painless hematuria with (or days after) a URI. Can see mild abdominal pain.
190
Glomerulonephritis with a pharyngitis?
IgA nephropathy
191
Glomerulonephritis 1-3 weeks after a pharyngitis?
PSGN
192
Name 5 instances where a renal biopsy would be indicated.
1. Gross hematuria > 8 weeks
2. Low serum compliment levels
3. HTN over 2 weeks
4. Proteinuria over 6 months
5. Abnormal renal function
193
What finding correlates with worsening disease in IgA nephropathy?
Persistent proteinuria
194
What is the classic triad for HUS?
1. Hemolytic anemia
2. Renal failure (elevated BUN)
3. Thrombocytopenia
195
What are the usual initial signs in HUS?
Anemia and pallor
196
What typically follows anemia and pallor seen in HUS?
Abdominal pain and decreased urine output
197
What skin findings will be described in HUS?
Purpura and ecchymoses
198
What neuro and cardio findings might be a part of HUS presentation?
Seizures, lethargy, coma, HTN
199
What is HUS often contracted from?
Contaminated food or water- E. Coli
200
Question noting decreased urine output and exposure to poorly cooked meat, unpasteurized apple cider/cow milk/goat milk?
HUS
201
What can HUS be mistaken for?
Leukemia- Anemia, thrombocytopenia, variable white count, elevated BUN/creatinine can happen in both
202
What 2 things in history will point towards HUS v. new-onset leukemia?
Presence of diarrhea and hematuria
203
What is the treatment for HUS?
Supportive
204
When are antimicrobials given in HUS?
Never- they can actually worsen the course
205
What happens to the serum complement levels and Coombs test in HUS?
Complement levels are normal
| Coombs test is negative
206
What is the definition of acute renal failure?
Rapid worsening of renal function along with an increase in BUN/creatinine, often hyperkalemia, metabolic acidosis, and HTN
207
What are the 3 categories of acute renal failure?
1. Pre-renal
2. Intrinsic
3. Post-renal
208
What is the most common cause of acute renal failure?
Pre-renal
209
In pre-renal acute renal failure, what happens to the urine sodium concentration and FeNa?
They are both low (FeNa <1%)
210
In pre-renal acute renal failure, what happens to the urine osmolality?
It is high (>350mOsm)
211
What happens to the FeNa in renal causes of acute renal failure?
FeNa is high (>1%)
212
What happens to urine osmolality in renal causes of acute renal failure?
Low (<350mOsm)
213
What is the equation for FeNa?
(Urine Na/Serum Na)/(Urine Cr/Plasma Cr)
214
Name 2 causes of pre-renal acute renal failure
1. Blood/fluid loss
| 2. Cardiac disease
215
Name 5 causes of intrinsic acute renal failure
1. Acute tubular necrosis
2. Interstitial nephritis
3. HUS
4. Glomerulonephritis
5. Nephrotoxic drugs
216
Name 1 cause of post-renal acute renal failure
1. Urologic obstruction
217
What electrolyte abnormality is a problem with acute renal failure, regardless of the cause?
Hyperkalemia
218
Name 3 ways you can treat hyperkalemia in the setting of acute renal failure
1. Calcium gluconate
2. Insulin and glucose
3. Sodium polystyrene sulfonate
219
What do you have to do for a kid in renal failure who is taking medications metabolized by the kidneys?
Adjust the dose
220
What happens to the GFR when the creatinine level is 2x normal?
It is cut in half
221
What do you typically do to the loading dose and dosing interval for kids in acute renal failure for meds metabolized by the kidney?
Keep loading dose same
| Increase dosing interval of drug
222
Name some things that are part of treatment of acute renal failure.
1. Correct underlying problem (hypovolemia, meds, ect)
2. Manage HTN
3. Manage acidosis
4. Manage electrolytes
5. Vit D supplementation
6. Nutrition/fluid intake
7. Dialysis
223
In a kid with pre-renal acute of acute renal failure, what type of fluids are given and why?
Isotonic, maintain intravascular volume
224
What is another word for renal failure?
Azotemia
225
What 2 common medications are contraindicated in patients with renal disease?
1. ASA
| 2. NSAIDs
226
Name the 2 most common causes of chronic kidney disease in kids
1. Urologic abnormalities
| 2. Glomerulopathies
227
What should always be on the differential for a kid with FTT or growth failure?
Chronic kidney disease
228
What causes FTT/GF in kids with chronic kidney disease?
Multi-factorial: Acidosis, poor nutrition, issues with bone mineralization
229
What causes anemia seen in chronic kidney disease?
Decreased EPO production by kidney
230
What type of anemia is seen in chronic kidney disease?
Normocytic
231
What is treatment with exogenous EPO indicated in kids with chronic kidney disease?
When Hgb drops below 8
232
Name 6 drugs that are nephrotoxic
1. Amnioglycosides
2. Cyclosporine
3. Tacrolimus
Chemo- 4. Cisplatin, 5. Carboplatin, 6. Ifosfamide
233
What side effect can EPO therapy have?
Polycythemia
234
Polycythemia with EPO therapy is associated with what 2 things?
1. HTN
| 2. Thrombosis
235
What 3 things cause the metabolic acidosis seen in chronic kidney disease?
1. Bicarb loss
2. Decreased production of bicarb by renal tubules
3. Decreased acid excretion
236
What happens to the BUN in renal failure or obstructive uropathy?
Increases (uremia)
237
What is a big part of management of uremia and elevated BUN in chronic kidney disease?
Restricted protein intake
238
What causes HTN seen in renal failure?
Salt and water retention, sometimes increased renin levels
239
What neurological problems can be manifestations of kidney disease?
Changes in mental status, seizures, peripheral neuropathies
240
What causes secondary hyperparathyroidism in chronic kidney disease?
Decreased production of 1,25-dihydroxyvitamin D3 (this is active metabolite made in kidneys), leads to decreased calcium absorption, hypokalemia, and elevated PTH
241
What causes increased serum phosphorous in chronic kidney disease?
Kidney's can't excrete phosphorous
Increases in serum suppresses calcitriol
Increased calcium loss
Increased PTH (snowballs)
242
What dermatological findings are seen in chronic kidney disease?
Dry skin
Pruritus
Easy bruisability
243
What do serum creatinine levels correlate with?
Muscle mass (thus creatinine increases with age in kids as they get more muscle mass)
244
After adolescence, do males or females have a higher creatinine?
Males- more muscle mass
245
What happens to creatinine in the newborn period and why?
Elevated- Reflects Mom's creatinine level
246
Do pre-term or full-term babies have higher creatinine levels?
Pre-term
247
What is one unique reason it is very important to keep kids with chronic kidney disease UTD on their immunizations?
They may not qualify for transplant if not up to date
248
What is one set of vaccines that is very important to give prior to a kidney transplant any why?
Live- Can't get them once on immunosuppressive therapy
249
What titers do kids undergoing dialysis need checked regularly?
Hepatitis B (antibodies can be removed by dialysis)
250
What are 2 complications that can happen after kidney transplant?
1. Rejection
| 2. Infection
251
True or False: Prognosis after kidney transplant is good?
True
252
What is one big problem with kids who have gotten a kidney transplant?
Compliance with daily meds
253
Why might kids that have gotten a kidney transplant qualify for growth hormone?
They are at risk for poor growth
254
What is the definition for HTN?
BP > 95% for age and sex, taken on 3 separate occasions
255
When should routine BP screening start?
No later than age 3
256
What should you take note of before getting worried about a high BP?
If the right cuff size was used
257
What 2 organs are the main suspects in HTN in kids?
1. Heart
| 2. Kidneys
258
What should be checked with HTN in a kid?
1. 4 extremity pulses
2. 4 extremity BP
3. UA
4. BUN/Creatinine
5. Thyroid (hyperthyroidism)
259
Children who are obese are how many more times likely to develop HTN than kids who aren't?
3 times more likely
260
Are older or younger kids more likely to have primary (essential) HTN?
Older- Younger the kid, harder you look for cause of HTN
261
Name 10 causes of HTN in kids... mneumonic?
POUNND HARD
- Polycystic kidney disease
- 0 Enzyme (11 hydroxylase deficiency)
- Urinary reflux nephropathy
- Neonatal problem (renal artery stenosis)
- Neurofibromatosis
- Deficiency (17 hydroxylase deficiency)
- Heart (coarctation of aorta)
- Adrenal (pheochromocytoma)
- Rheum (Lupus)
- Due to endocrine (Cushings, hyperthyroidism)
262
Name 5 medications that can cause HTN
1. Albuterol
2. Contraceptives
3. Corticosteroids
4. Decongestants
5. Illicit drugs
263
What should you think with "family history of HTN" in a kid with HTN?
Renal or endocrine problems that run in families
264
What should you think with "prematurity" in a kid with HTN?
Renal artery stenosis (secondary to umbilical catheterization)
265
What should you think with "Joint pain/swelling" in a kid with HTN?
Connective tissue disorder like lupus
266
What should you think with "Flushing, palpitations, fever, weight loss" in a kid with HTN?
Pheochromocytoma
267
What should you think with "Muscle cramps, weakness" in a kid with HTN?
Hypokalemia secondary to hyperaldosteronism
268
What should you think with "Onset with sexual development" in a kid with HTN?
Enzyme deficiency
269
What ortho circumstance can cause HTN in kids?
If they are placed in prolonged traction after an orthopedic procedure
270
What should you think with "Pale color, edema" in a kid with HTN?
Kidney disease (pale from poor EPO production)
271
What should you think with "Pale color, increased sweating even at rest, flushing, abdominal mass" in a kid with HTN?
Pheochromocytoma
272
What should you think with "Wide spaced nipples, webbing of the neck" in a kid with HTN
Turner Syndrome- Coarctation of the aorta
273
What should you think with "Elfin facies, high serum calcium, and friendly" in a kid with HTN?
Williams Syndrome- Supravalvular aortic stenosis
274
What should you think with "Decreased femoral pulse or low BP in leg v. arms" in a kid with HTN?
Coarctation of the aorta
275
What is the most important non-pharmacological intervention for HTN in obesity is an issue?
Weight Loss
276
Name 7 categories of meds for HTN
1. CCB
2. Vasodilator
3. ACEi
4. ARBs
5. BB
6. Alpha 2 Agonists
7. Diuretics
277
What 2 CCB will be use for kids with HTN?
Nifedipine or amlodipine
278
What 2 vasodilators can be used for kids with HTN?
Hydralazine or minoxidil
279
What 2 ACEi can be used for kids with HTN?
Enalapril or lisinopril
280
What ARB can be used for kids with HTN?
Losartan
281
What 2 BB can be used for kids with HTN?
Propranolol or atenolol
282
What is an Alpha 2 agonist that can be used for kids with HTN?
Clonidine
283
What are 3 diuretics that can be used for kids with HTN?
Thiazides, furosemide, spironolactone
284
What has to be done before a kid with a pheochromocytoma can have a surgical resection?
BP has to be under control
285
What has to be given first for BP control in the setting of a pheochromocytoma?
Alpha blocker (phenoxybenzamine)
286
Why is initial treatment with beta blockers contraindicated in kids with a pheochromocytoma?
It would lead to unopposed alpha effect and cause increase in BP (have to give alpha blocker first)
287
Short obese patient with HTN?
Cushing syndrome
288
When you suspect a renal cause of HTN, what is the next step?
Get a renal arteriography with differential central venous renin determination
289
What happens to renin levels in the setting of renal stenosis causing HTN?
Renin is higher in renal vein of the involved kidney
290
What can renal scars result in?
HTN
