Renal and allergy and immunology Flashcards
(27 cards)
absent irises and genitourinary symptoms (cryptorchidism, hypospadias) patient is at increased risk for what condition?
wilms tumor!!!
patient likely has WAGR/11P deletion syndrome
serial abdominal ultrasounds to detect wilms
chronic granulomatous disease. on prophylaxis with TRIMETHORPRIM!! and ITROCONAZOLE (learn). however has break through chest infection but stable. blood cultures obtained. next step in management?
cgd diagnosis is made using?
obtain biopsy culture via bronchoscopy!!!
done prior to antibiotics administration.- because breakthrough infection may involve resistant bacteria and fungi
dihydroamine flow cytometry test, nitroblue tetrazolin, oxidative burst test
intercostal retractions and bilateral lungs have decreased aeration (pulmonary hhypoplasia), flattened facies, club feet or hip dislocation (limb deformities)
abdominal distention and suprapubic mass
most likely underlying cause of presentation?
posterior urethral valves!!
abdominal distention consistent with bladder disstention from Urinary tract obstruction
patient has potters sequence caused by PUV. other causes = renal agenesis, PCKD, prom
investigation for vesicoureteral reflux?
voiding cystourethrogram
joint pain and puritic rash and fever after completing co amoxiclav 10 days ago
most likely outcome of condition?
complete resolution without episodes
serum sickness like reaction!!- triggered by antibiotics = penicillin, sulfa drugs
UTI in children treatment?
Cefixime!!!!! or ceftriaxone = basically A 3rd generation cephalosporin.
NOT ciprofloxacin!
Low Iga and IgM + Low T cell counts = SCID
NOT common variable immune deficiency as T and B cell counts will be normal!!
5 yo boy, still bedwetting and no previous nightime consistent drynesss
fatigue
history of urinary tract infection
urinalysis shows no infection but proteinuria.
next step in management?
check serum creatinine level!!!
findings concerning for chronic kidney disease!! -> posterior urethral valves may be the cause
hypertension,!! weight loss and hematuria may also be present
severe dehydration and hypernatremia in child. high sodium. what fluid do you give to replace?
0.9% saline!!
then slowly correct sodium
to prevent cerebral edema
long distance runners can experience hematuria due to
- collision of bladder wall and base during running - increased RBCs in urine
- rhabdo - normal rbcs, raised CK
- march hemoglobinuria = rbcs crunched in feet -> normal rbcs level in urine
when a glomerular souce of hematuria is suspected in a child, next step in workup?
complement workup!!
dysuria and pyuria (elevated wbcs in urine) = diagnostic of UTI
nitrites and leukocyte esterase may not always be present. hematuria may be present
asymptomatic hematuria in child. next step in workup?
renal ultrasound!! -> may be atypical presentation of nephrolithiasis
NOT ct abdomen is only used to investigate hematuria if trauma is suspected
failure to thrive + metabolic acidosis (low bicarb - this type of metabolic acidosis is normal anion gap but you can also calculate it). no diarrhea. most likely diagnosis?
anion gap = Na+ - (chloride + bicarb)
normal = 10–14
renal tubular acidosis!!!
other causes of normal anion gap metabolic acidosis
= diarrhea, excessive saline infusion
newborn with 1 single wet diaper in first 48 hours of life. next step in investigation?
RBUS!!
neonatal AKI!!
normal = at least 1 void per day of life
4 month old boy
was in nicu at birth due to hypoglycemia
now examination shows
enlarged tongue (macroglossia)
99th percentile for weight (macrosomia)
right leg circumference significantly larger than left (hemihyperplasia)
next step in management
abdominal ultrasound!! - serial screening
Beckwith Weiddeman syndrome!!!
= overgrowth disorder with predisposition to neoplasms = wilms tumor!! and hepatoblastoma!!
alpha-fetoprotein levels should also be screened for hepatoblastoma
other findings:
abdominal wall defects = omphalocele, hernia
18 year old, polyuria, nocturia.
serum sodium is normal
urinalysis shows low urine specific gravity!!!
birth mother died from sickle cell stroke
most likely cause of polyuria?
hyposthenuria!!! = inability of kidneys to concentrate urine. can occur in sickle cell disease and sickle cell trait
Negative urine glucose so NOT T1 OR T2DM
gross hematuria following URTI 3 days ago. sensorineural hearing loss and family history of kidney transplant (renal failure)
complement levels normal
what will renal biopsy show?
longitudinal splitting of glomerular basement membrane!!!
=alport syndrome. can also cause htn
NOT igA nephropathy as renal insufficiency rarely seen and not associated with hearing loss or HTN
greatest risk factor for primary nocturnal enuresis?
family history of bedwetting!
2 days old. only 1 wet diaper. and 1 stool. abdomen distended. diminshed lung sounds and CXR shows diminished lung volumes.
weight also went up
next step in evaluation
RBUS - for posterior urethral valves!!!!
oligohydramnios and pulmonary hypoplasia
anaphylaxis, unstable neurological disorders and encephalopathy (coma, decreased consciousness, prolonged siezures) are contraindications to future administration of pertussis containing vaccines.
uncomplicated siezure is not a contraindication
severe atopic dermatitis and recurrent absecces on buttocks. eosinophils was raised on blood work.
most likely diagnosis?
hyperIgE syndrome. eosinophilia classic and wbc normal despite infection.
note LAD, neutrophilia would be seen
not chediak higashi syndrome as causes infections + oculocutaneous albinism.
essentially learn the immune deficiency syndromes
PSGN can present with brown urine 2 weeks after URTI. Don’t psyche yourself out -> complement testing
