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Renal/GU Flashcards

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1
Q

How do you calculate an anion gap?

A

Na - (Cl + bicarb) = 12 +/- 2

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2
Q

What is a normal pH, Pco2 and O2 sat?

A

pH = 7.4

Pco2 = 40

sat = 98%

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3
Q

What can cause a respiratory acidosis?

A

Sedative OD

Hypoxemia

Pneumonia

Pulmonary edema

Airway obstruction/Bronchospasm

Brain stem injury

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4
Q

What causes a metabolic acidosis?

A

Increase in exogenous acid = MUDPILES

Inc. in endogenous acid = sepsis/lactic acid

Decrease in bicarb = diarrhea

Decreased acid elimination

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5
Q

What causes a metabolic alkalosis?

A

Loss of H+ = vomiting

Contractions of extracellular fluid volume

excessive bicarb (licorice, Cushings, hyperaldo)

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6
Q

A 6-week old child has a 2-week history of projectile vomiting that is not bile-stained. He is dehydrated and slightly jaundiced.

Na 138, K 3.0, Cl 88, HCO3 35 pH 7.52

A

Hypochloremic Metabolic Alkalosis

Give IVF!

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7
Q

An asthmatic in respiratory distress has a normal pH and normal Pco2 - what are you concerned about?

A

Impending respiratory failure

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8
Q

Failure H+ secretion in the distal tubule and collecting duct

A

Distal RTA

Hypercaliuria

Nephrocalcinosis

Nephrolithiasis

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9
Q

Decreased reabsorption of bicarb in the proximal tubule

A

Type 2: Proximal RTA

Isolated vs. Fanconi’s Syndrome

Rickets 2/2 phosphate wasting

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10
Q

Inadequate production or reduced response to aldosterone in the distal tubule

A

Type 3: Mineralocorticoid deficiency RTA

Adrenal problem or decreased renin production from JGA (interstitial damage)

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11
Q

Signs and Symptoms of RTA

A

Polyuria & dehydration

Anorexia, vomiting, constipation

Hypotonia

**Children often present with growth failure

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12
Q

Of the three RTAs which is lifelong and can lead to renal failure?

A

Distal - inc H+ secretion, stones

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13
Q

What is the most common cause of ARF in toddlers?

A

HUS

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14
Q

What can cause renal ARF?

A

GN

ATN

Interstitial nephritis

Small-vessel thrombosis -HUS or renal vein thrombosis

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15
Q

What are signs/symptoms of acute renal failure?

A

Oliguria

Edema

HTN

CHF

Seizures

Uremic encephalopathy

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16
Q

What metabolic derangements are seen with Acute Renal Failure

A

Hyper K

Hypo Ca and Hyper Phos

Anemia

Hyponatremia

Metabolic Acidosis

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17
Q

What causes the metabolic acidosis seen in patients with renal failure?

A

Decreased excretion of H+ and ammonia

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18
Q

What is the most common cause of CRF in children < 5 yo?

A

Anatomic anomalies

Renal hypoplasia, dysplasia, or malformation

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19
Q

Most patients with chronic renal failure are weak and have ____.

A

HTN

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20
Q

What is the expected BUN/Cr ratio in patients with prerenal acute renal failure?

A

BUN/Cre > 20

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21
Q

What are indications for emergent dialysis?

A

Acidosis

Electrolytes

Ingestion - toxins

Overload - fluid

Uremia

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22
Q

When do you treat kids with CKD with transfusion?

A

Hgb < 6

Use epo

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23
Q

How do you treat hypertensive emergencies in kids with CKD?

A

Salt restrict

ACE

β-blocker

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24
Q

On a routine exam, a 10 yo girl has HTN confirmed by repeated BP measurements. BP 160/90 in the right arm, and similar in L arm and R leg. What is the next most appropriate diagnostic step?

A

Renal Disease

UA

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25
What are the most common causes of HTN in children?
**Renal | 75%** Infection GN HUS Obstructive uropathy
26
**Wilms tumor** is associated with what mutations on what chromosome?
p53, Ch 11
27
How do you treat a CKD patient who presents with bleeding due to defective platelets 2/2 uremia
Dialysis Desmopressin
28
How does **Wilms Tumor** usually present? (4)
**Age \< 3** Abdominal/flank **mass** **Vomiting** **HTN** - obstruction of renal artery
29
How do you diagnose Wilms Tumor?
US and CT
30
How do you treat a Wilm's Tumor
**Non-hematogenous** extension into abdomen = _nephrectomy_ and _chemo_ +/- radiation **Hematogenous mets** or **bilateral renal mets** = _Nephrectomy_, _3 drug chemo_, _pulmonary irradiation_
31
WAGR Syndrome
**W**ilms' Tumor **A**niridia **G**U malformation Mental **R**etardation - del. @ 11p13
32
AD vs AR **PKD**
**AR =** Infant, dilated collecting ducts + cirrhosis/portal HTN **AD =** 4th/5th decade, dilated tubules, present with hematuria/pain/mass/HTN
33
What is the leading cause of ESRD in the first decade?
Renal Hypoplasia Fewer calyces and nephrons
34
A 1-week old male has wrinkled abdomen w/o abdominal musculature. He also has clubfeet and is in respiratory distress. His _bladder is distended and easily palpable_ and _neither testis is in his scrotum_. BUN 30, Cr 2, Hco3 15.
Prune Belly Syndrome
35
Who gets horseshoe kidney?
7% are associated with **Turners Syndrome** 4x more common with **Wilms' Tumor**
36
Nephrotic Syndrome
Proteinuria \> 3.5g/24 hr Hypoproteinemia Hyperlipidemia Edema, periorbital edema
37
What is the most common cause of _nephrotic syndrome_ in kids?
**Minimal change disease** Mesangial Proliferation Focal sclerosis
38
How do you diagnose nephrotic syndrome?
**Clinically** Confirmatory biopsy - fusion of epithelial foot processes EM
39
How do you treat nephrotic syndrome in kids?
**Steroids** - most will respond **Salt restrict** to dec. edema
40
Patients losing protein in the urine are at risk for what?
Hypercoagulable state Nephrotic loss of Antithrombin III
41
Post-Strep GN
**Immune complex disease** from Group A β-hemolytic strep 10-14 days post strep infection
42
How do you diagnose post strep GN?
Light microscopy - Enlarged glomeruli w/ mesangial proliferation and exudation of neutrophils IF microscopy: **Granular** pattern EM: E**lectron-dense humps on epithelial side**
43
How do you treat post strep GN?
**Penicillin for 10 days** **Peritoneal dialysis** for fluid overload \*\*Microscopic hematuria can take 1 year to resolve
44
What is the underlying abnormality in **rapidly progressive GN?**
**Crescents** in the majority of glomeruli \*\*Can progress thru several forms of GN\*\*
45
What are the crescents in RPGN made of?
Proliferative _epithelial cells_ of the capsule _Fibrin_ _Macrophages_
46
What is the prognosis of RPGN? What can you try for treatment?
Poor prognosis May respond to steroids of cyclophosphamide
47
What is the most common cause of GN in older children?
Membranoproliferative GN
48
**Lobular**, split glomeruli **Lobular** **C3** deposits Immune complex deposits in **mesangial** and **subendothelial** **regions**
Membranoproliferative GN Nephrotic Syndrome, Hematuria, HTN Poor prognosis
49
How does Membranous GN present?
**Nephrotic syndrome** +/- hematuria **Immune complex** disease of kidney Spike and dome on epithelial side of GBM \*\*Uncommon in children, most common in adults
50
Do you treat membranous GN in children
Most cases spontaneously resolve
51
What is the most common cause of gross hematuria in children?
IgA nephropathy
52
**Diffuse thickening** of GBM w/o proliferative change **Granular** IgG and C3 on epithelial side
Membranous
53
How is "nephrotic syndrome" best controlled
Salt restriction Diuretics
54
A patient presents with hemoptysis, sinusitis, and GN
Wegener's granulomatosis
55
A patient presents with hemoptysis, dyspnea and ARF.
Goodpastures Syndrome
56
What are 3 types of "normal" proteinuria?
Up to 150 mg/day **Postural** (supine to standing) **Febrile** - fever \> 101˚ **Exercise**
57
What are causes of **Acute Interstitial Nephritis**? (5)
Drugs, infection, sarcoid, GN, transplant rejection ## Footnote **PCN**, cephalosporins, sulfonamides, rifampin Phenytoin, **thiazides**, **furosemide**, allopurinol, amphotericin B, **NSAIDS**
58
How do patients with AIN present?
**ARF** or generalized tubular dysfxn
59
How do you diagnose AIN?
**Renal** **bx****:** _interstitial_ lymphocytes/plasma cells/Eφ/Nφ Edema present Normal glomeruli
60
How do you treat AIN?
Remove inciting agent - kids often recover
61
What causes **Chronic Interstitial Nephritis**? (3)
**Drugs** = analgesics, lithium ## Footnote **Infections** **Vesicoureteral reflux**
62
How do kids with chronic interstitial nephritis present?
_Symptoms of CKD_ Nausea/vomiting HA, fatigue HTN Growth failure
63
How do you diagnose CIN?
Lymphocytes and plasma cells in interstitium Fibrosis Sclerosed glomeruli 2/2 ischemia
64
What is the most common manifestation of SLE in childhood?
Lupus nephritis
65
How does a renal vein thrombosis in infancy present?
Acute gross hematuria Flank mass and pain
66
How do you diagnose RVT?
US = enlarged kidnesy Doppler = little renal function
67
Which infants get RVT?
Dehydration Shock Sepsis
68
What older kids get RVT? (4)
**Nephrotic syndrome** (membranous) **Cyanotic heart disease** **Hypercoagulable states** **Contrast**
69
What are the s/sx of neurogenic bladder (3)
**Urinary incontinence** (retention, overflow, frequency, urge) ## Footnote **UTIs** **Upper tract deteriorations**
70
How do you diagnose urolithiasis?
Plain X-ray = Calcium and struvite (90%) Abdominal CT = better for stones and hydronephrosis
71
Struvite stones normally come from what?
**Urease** containing bugs, most commonly **Proteus** [Mag, phosphate, ammonium]
72
When do you see Uric Acid stones? (5) How do you treat?
Hyperuricosuria Lesch-Nyhan Post-chemo Myeloproliferative disorders IBD **\*\*Radiolucent\*\*** **Allopurinol & Alkalinize Urine**
73
Where do you see Cystine stones? How do you treat?
**Cystinuria, AR** Renal epithelial cells **can't absorb** _cystine_, lysine, arginine, ornithine **D-penicillamine**
74
How do you treat calcium stones?
Thiazide Potassium Citrate Dietary Ca Fluids
75
When do you need to intervene?
\> 5-6 mm via stent or lithotripsy \*\*obstruction or hydronephrosis
76
What are predisposing factors to UTIs?
Female or uncircumcised male VUR Toilet training Bubble baths _Tight_ clothes _Nylon_ panties/bathing suit
77
What are the most common UTI pathogens?
E. coli Klebsiella Proteus Enterococci Staph saprophyticus
78
Does cystitis cause fever?
No! Pyelonephritis
79
7 yo girl with urinary urgency, frequency, suprapubic pain, and no flank pain or mass. UA shows many leukocytes, 2-5 RBCs, and no protein or casts. What is the next step?
Urine Culture
80
How might an infant or a kid \< 2 yo present with a UTI?
**Neonate**: FTT, feeding irregularities, diarrhea, vomiting, fever, hyperbili 1 month - 2 yo: Colic, irritability, GI complaints
81
How do you diagnose UTI
\> 100k colonies of single bacteria \> 10k colonies in symptomatic child Any bacterial growth from properly obtained urine **Leukocytes \> 5** **Hematuria** **White cell casts**
82
How do you treat a UTI?
2 mo- 2 years: 10-14 days of IV abx Older: 5-7 days PO abx Pyelo = 2 wks IV β-lactam/cephalosporin
83
What kids with UTIs get renal US?
Children \< 5 yo All male children \*\*R/o hydronephrosis, dilation of distal ureter, bladder hypertorphy
84
What kids with UTIs get a voiding cytourethrogram?
Kids \< 5 yo \*\* Looking for VUR\*\*
85
How do you treat VUR?
**Low dose antibiotic** **ppx**, **UA + culture** q 3-4 months **Surgery** if breakthrough UTI, unresolving or severe reflux
86
Cryptorchidism
Failure of testes to descend by 6 months of age **Infertility**, **seminoma** (regardless of treatment), **hernia**, **torsion**
87
If testes are not palpated in the inguinal canal?
Orchiopexy after 12 months
88
If testes are palpated in the inguinal canal?
LHRH therapy controversial
89
Choriocarcinoma
Malignant tumor of **syncytiotrophoblasts** and **cytotrophoblasts** ## Footnote **High hCG** **Surgery + chemo + radiation**
90
What is the most common germ cell tumor?
Seminoma
91
Seminoma
High β-hCG Radiation = good prognosis
92
Dysgerminomas are associated with \_\_\_\_\_\_\_\_\_\_\_.
XY gonadal dysgenesis Y-DNA probes are important in diagnosis
93
Yolk sac tumor
**High α-fetoprotein**, malignant _germ cell tumor_ Peak during infancy and childhood
94
Sertoli Cell Tumors
Malignant sex cord stroma tumors Produce Estrogen - **feminization and precocious puberty** Dx: CT and horomone **Surgery + chemo**
95
What causes painful ulcers?
**Chancroid** - ducrei ## Footnote **Herpes**
96
What STDs cause painless ulcers?
Lymphogranuloma venereum (LGV) Syphilis
97
What STDs causes urethral discharge?
Gonorrhea Chlamydia Trichomonas
98
How do you diagnose BV?
Fishy odor Clue Cells pH \> 4.5
99
How do you treat gonorrhea?
IM ceftriaxone

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