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SD- Pediatrics > Renal and GU Disorders Lecture > Flashcards

Renal and GU Disorders Lecture Flashcards

1
Q

Heme positive urine is caused by:

A

Hemoglobin or Myoglobin

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2
Q

Heme negative urine is caused by:

A

Drugs
Dye
Foods

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3
Q

What type of evaluation is needed to determine hemoglobinuria or myoglobinuria?

A

Microscopic evaluation

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4
Q

The presence of hemoglobin FREE from red blood cells

*Occurs with rapid disintegration of RBCs, exceeding the ability of blood protein to bind with hemoglobin

(ie. hemolytic anemia)

A

Hemoglobinuria

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5
Q

Caused by skeletal muscle injury

*if present, there is a fivefold increase in serum CK being increased

SEEN IN RHABDOMYOLYSIS

(can be seen after trauma or even exercise)

A

Myoglobinuria

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6
Q

Best time of day to get UA?

A

Early morning

(if later in day, after exercise, could have myoglobinuria)

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7
Q

Urine culture
Renal ultrasound
Renal panel
CBC
Must rule out sickle cell

A

If hematuria persists!

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8
Q

Isolated asymptomatic hematuria without renal abnormalities in multple family members

presence of persistent microscopic hematuria, often initially seen in childhood

*May be intermittent
*No treatment

A

Benign familial hematuria

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9
Q

MC cause:
E. Coli**
Klebsiella
Proteus
Staph

A

UTIs

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10
Q

Often peaks during toilet training

More often in uncircumcised boys

A

UTIs

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11
Q

Bacteria involvement of upper urinary tract

Presents with:
abdominal pain, flank pain, fever, lethargy, N/V, ill appearing

A

Pyelonephritis

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12
Q

Dx by:
Urinalysis
Urine culture
PE findings
Renal ultrasound may be helpful, but not necessary (enlarged kidney)

abx therapy depends on bacteria that is cultured

A

Pyelonephritis

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13
Q

DOC for pyelo (to start on, may change when culture comes back)

A

Nitrofurantoin

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14
Q

Bacteria involvement of bladder

Presents with:
Dysuria
Frequency
Urgency
Sometimes odor
Abdominal pain
Incontinence in older kids

A

Cystitis

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15
Q

How is a dx of cystitis made?

A

History
PE
Urinalysis
Urine culture

(do not need imaging)

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16
Q

Positive urine culture without symptoms
Almost exclusive to girls
Often seen with long term catheter use

A

Asymptomatic bacteriuria

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17
Q

True or false….

You should only treat a UTI if culture confirms and symptoms are present

A

TRUE

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18
Q

What population can you use sterile collection bags

A

Infants

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19
Q

If a urine collection is obtained at home, what instructions do you need to tell the parent?

A

Keep the sample cold until processed!!!

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20
Q

First UTI before age 5
Febrile UTI
Recurring UTI
Male with UTI

what must be done?

A

IMAGING

(voiding cystourethrogram (VCUG)= image of choice)

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21
Q

Image of choice for kids wth UTI problems that need imaging?

A

Voiding cystourethrogram (VCUG)

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22
Q

if a kid has an indication to get a voiding cystourethrogram (VCUG), when should you do this?

A

2 weeks after the UTI

(the kid should be healthy)

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23
Q

In addition to voiding cystourethrogram (VCUG), this type of imaging may also be helpful in determining size, shape, and renal abnormalities

A

Renal ultrasound

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24
Q

As many as 10% of routine urine dipstick screenings will be positive for protein in ages ________

A

8-15 years old

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25
Q

If proteinuria is found on dipstick with absence of other findings or concerns, repeat the dipstick on…..

A

2-3 other occasions (early AM)

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26
Q

With persisting proteinuria, what is the test of choice?

A

24 hour collection

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27
Q

If a child with a repeat normal dipstick or a normal 24 hour excretion level, is further work up required?

A

NO

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28
Q

MC cause of persisting proteinuria in kids?

A

Orthostatic proteinuria

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29
Q

In orthostatic proteinuria….

  • *low levels of protein** are excreted in the ________ position
  • *higher levels** of protein are excreted in the ________ position
A

Low protein= supine position

High protein= upright position

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30
Q

MC type of primary nephrotic syndrome (loss of protein)

A

Minimal change disease

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31
Q

MC primary nephrotic syndrome

Glomeruli generally normal or minimal increase in mesangial cells (support cells for glomeruli)

Excellent response to corticosteroids

A

Minimal change disease

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32
Q

Least common primary nephrotic syndrome

Increase in mesangial cells
~50% of patients respond to corticosteroid therapy

A

Mesangial Proliferation

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33
Q

Most severe form of Primary Nephrotic Syndrome

Mesangial proliferation and segmental scarring, leading to sclerosis

only ~20% of pts respond to corticosteroids
condition is progressive, leading to end stage renal failure usually

A

Focal segmental glomerulosclerosis

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34
Q

Loss of protein

Nephrotic or Nephritic?

A

Nephrotic

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35
Q

MC in males, 2:1
Generally appears between ages 2-6 (but can be seen in infancy or adulthood)

Initial episode often follows illness, infections, or allergic reaction

A

Primary nephrotic syndrome

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36
Q

Presentation typical of:
facial and lower extremity edema
*edema becomes progressive and generalized over time
can lead to pleural effusions

addominal pain, diarrhea, irritability

A

Primary nephrotic syndrome

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37
Q

3-4+ proteinuria on dipstick (persisting)

Urinary protein exceeds 150mg/24 hour

Serum creatinine is normal to minimally elevated

A

Primary nephrotic syndrome

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38
Q

In primary nephrotic syndrome and child had generalized edema (including pleural effusion, ascites, etc)

what should happen?

A

HOSPITALIZATION!

(diuretics should be used cautiously in children
close monitoring of volume status is a MUST)

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39
Q

If initial renal episode occurs between ages 1-8, it is likely to be….

A

Minimal change disorder

40
Q

Can you start steroids in Minimal change disorder without getting a biopsy first?

A

YES

41
Q

If initial renal episode occurs prior to age 1 or after age 8

OR

Findings of hematuria or HTN

…what should be done before giving steroids?

A

Renal biopsy

42
Q

For primary nephrtoic syndrome…

Initial treatment of prednisone at 60 mg/day (BID or TID) for 4-6 weeks

..should see negative urine dips within ___days

A

10!

43
Q

In primary nephrotic syndrome, if proteinuria persists beyond 8 weeks (despite steroid tx), what is the next step?

A

Renal biopsy

44
Q

Cyclophosphamide
Cyclosporine

Tx for primary nephrotic syndrome in kids who cannot tolerate…

A

Steroids

45
Q

Occurs secondary to other forms of glomerular disease

Must consider if the pt is GREATER THAN 8
HTN
Persisting hematuria
Renal dysfunction
Rash
Arthralgias

A

Secondary nephrotic syndrome

46
Q

Membranous nephropathy

Membranoproliferative glomerulonephritis

Postinfectious glomerulonephritis

Henoch-Schonlein purpura nephritis

..these are examples of?

A

Secondary Nephrotic Syndrome

47
Q

Congenital Nephrotic Syndrome develops within…

A

first three months of life

48
Q

VERY RARE
Caused by mutation in the NPHS1 gene on chromosome 19

A

Congenital Nephrotic Syndrome

49
Q

In utero findings of:

Significant proteinuria
Large placenta and edema

Premature birth, respiratory trouble, poorly defined cranial sutures

A

Congenital Nephrotic Syndrome

50
Q

ACE inhibitors and unilateral nephrectomy may be helpful

Treatment of most benefit is bilateral nephrectomy, dialysis, nutritional support and ultimately kidney transplant

A

Congenital Nephrotic Syndrome

51
Q

Characterized by interstitial inflammation with sparing of vessels and glomeruli

A

Tubulointerstitial Nephritis (TIN)

52
Q

Caused by lymphocytic infiltration of the tubulointerstitium, tubular edema and tubular damange

traid= FEVER, RASH, ARTHRALGIA with steadily rising creatinine

A

Tubulointerstitial Nephritis (TIN)

53
Q

Triad:
Fever
Rash (maculopapular or urticarial)
Arthralgia

N/V, fatigue, weight loss
NO hematuia and/or proteinuria
May see WBCs or casts in urine

A

Tubulointerstitial Nephritis (TIN)

54
Q

Causes of acute:

PCN, cephalosporins, sulfa drugs, fluoroquinolones, EES
Anti-convulsants, diuretics, allopurinol, cimetidine, cyclosporine, NSAIDs

Strep infections, pyelonephritis, Hep B, EBV, HIV, adenovirus

Sarcoidosis, SLE, idiopathic

A

Tubulointerstitial Nephritis (TIN)

55
Q

Causes of chronic:

Analgesics, cyclosporin, lithium, heavy metal exposure

Sick cell, polycystic kidney dz, Alport syndrome, SLE

Ureteropelvic junction abnormality, urinary reflux, radiation, idiopathic

A

Tubulointerstitial Nephritis (TIN)

56
Q

A congential condition characterized by:
deafness
large thrombocytes
cataracts

*NO CURE
*Can cause chronic TIN

A

Alport Syndrome

57
Q

MC etiology is underlying renal disease

Sxs are non specific:
Fatgue, poor growth, polyuria, polydipsia, anemia

A

Chronic TIN

chronic TIN is seen in ALL forms of progressive renal disease

58
Q

True or False…

Chronic TIN is seen in ALL progressive renal disease

A

TRUE

59
Q

Glomerulonephritis can occur after _________ infections

A

Strep

60
Q

Sudden onset:
hematuria
edema
HTN
renal insufficiency

follows a strep infection (group A beta hemolytic)

A

Glomerulonephritis

61
Q

Kidneys appear enlarged on imaging
Glomeruli are enlarged with mesangial cell proliferation

MC ages 5-12

A

Glomerulonephritis

62
Q

MC ages are 5-12

Symptoms appear 1-2 weeks following a throat infection or skin infection

acute phase can last 6 weeks
hematuria may persist for years

A

Glomerulonephritis

63
Q

Anti-streptolysin O titer can confirm a recent….

A

Throat infection

64
Q

Deoxyribonuclease B anti-streptococcal can be used to confirm a recent…

A

skin infection

65
Q

In glomerulonephritis, complete recovery occurs in most cases within….

A

2 months

66
Q

Typically presents as isolated disease, but can be secondary to autoimmune disease, malignancy, syphilis, or Hep B infections

thickening of basement membrane without proliferative changes

*diagnosis made by biopsy

A

Membranous glomerulopathy

(type of glomerulonephritis)

67
Q

Most pts have spontaneous recovery

Salt restriction and diuresis can be helpful
Steroids may be helpful in prolonged cases

A

Membranous glomerulopathy

68
Q

How is diagnosis of Membranous Glomerulopathy made?

A

Biopsy

69
Q

MC cause of acute renal failure in kids

A

Hemolytic-Uremic Syndrome (HUS)

70
Q

MC cause of acute renal failure in kids

characterized by:
Hemolytic anemia
Uremia
Thrombocytopenia

A

Hemolytic-Uremic Syndrome (HUS)

71
Q

Acute GI illness (E.Coli) precedes about 80% of cases

(can be associated with other bacterial infections, viral illnesses, OCPs, and cyclosporin)

A

Hemolytic-Uremic Syndrome (HUS)

72
Q

Glomerular changes seen include thickening of capillary walls, narrowing of capillary lumens

syndrome starts due to epithelial cell injury, leading to clotting

  • *anemia results** as RBCs pass thru narrowed vasculature
  • *platelet drop** due to damage and possible adhesion
A

Hemolytic-Uremic Syndrome (HUS)

73
Q

Seen usually in kids under age 4

Initial illness includes:
Fever
Abdominal pain
Bloody diarrhea
Vomiting

5-10 days later, sudden onset:
Weakness, leathargy, pallor, irritability and oliguria

A

Hemolytic-Uremic Syndrome (HUS)

74
Q

PE may show:

Dehydration
Edema
Petechiae
Hepatosplenomegaly

A

Hemolytic-Uremic Syndrome (HUS)

75
Q

CBC may show:
Fragmented RBC
HGB low range of 5-9
may seem helmut cells and burr cells
low platelets

A

Hemolytic-Uremic Syndrome (HUS)

76
Q

How do you treat HUS?

A

Supportive! (with attention to HTN, nutrition, fluid and electrolytes)

77
Q

Schistocytes/Helmet cells on blood smear

what must you think?

A

Hemolytic-Uremic Syndrome (HUS)

78
Q

Small vessel vasculitis characterized by
purpuric rash, arthralgia, abdominal pain and glomerulonephritis

Sx occur 1-3 weeks following illness, usually URI

A

Henoch-Schonlein Purpura Nephritis

79
Q

Do kids normally have essential HTN or HTN due to underlying dz?

A

usually secondary to underlying disease

80
Q

Routine BP screenings should be done on all children starting at age….

A

3

81
Q

Defined as average systolic and/or diastolic reading greater than 90th percentile for age, gender, hgt and wgt.

A

Pediatric HTN

82
Q

High normal BP is between what percentiles?

Significant BP is greater than what percentile

Severe BP is greater than what percentile

A

High normal= betwene 90 and 95th percentile

Significant= over 95th percentile

Severe= over 99th percentile

83
Q

Defined as retrograde flow of urine from bladder to ureter and renal pelvis

this occurs when the tunnel between the bladder mucosa and detrusor muscle is absent, causing the flap-valve to malfunction
(may resolve as child grows)

(grades I –V)

A

Vesicoureteral reflex

84
Q

this condition causes urine to “back up”, leading to infection, inflammation and scarring

this is the leading cause of HTN in children!

A

Vesicoureteral reflex

85
Q

What is the leading cause of HTN in children?

A

Vesicoureteral Reflex

86
Q

Usually found during the work up of a UTI
80% are female
Typically under age 5

  • *diagnosed by VCUG**
  • *Catheterization is required**
A

Vesicoureteral Reflex

87
Q

Cornerstone treatment in Vesicoureteral reflux

A

Antibiotic prophylaxis

DOC: Sulfamethoxazole-trimethoprim
or nitrofurantoin

88
Q

Prophylaxis with: Sulfamethoxazole-trimethoprim
​or nitrofurantoin

A

Vesicoureteral Reflex

89
Q

Toilet training begins at age….

A

2-3

(most kids are dry thru the night by age 5)

90
Q

By age _____, control of micturation is expected

A

5

91
Q

For nocturnal eneursis. avoid pharm treatments until after age….

A

7 yo

Tx should just be reassurance before this

92
Q

Urethral opening located on ventral surface of penis.
Due to incomplete development of the dorsal hood.

Occurs in 1 in 250 males.

A

Hypospadius

93
Q

Treatment : circumcision should be avoided because the foreskin may be used in surgical repair.

Surgical repair is advised between 6-12 months of age.
These children should be evaluated by a pediatric urologist.

A

Hypospadius

94
Q

Inability to retract the foreskin.

In 90% of uncircumcised males, the foreskin should be retractable by age 3.

Accumulation of epithelial debris collects under the foreskin, and hygiene is critical.

If foreskin is not retractable, application of topical steroid TID for 3 weeks may help to loosen the skin.
Circumcision is definitive treatment.

A

Phimosis

95
Q

Occurs when foreskin is retracted beyond the glans penis, and cannot be pulled forward again.

Leads to strangulation of glans penis due to venous congestion

Lubrication may help you to push the glans penis back thru the phimotic ring and relieve the pressure, but surgical repair is often needed.
This is a medical emergency!!

A

Paraphimosis

SD- Pediatrics (11 decks)

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