Urology/ Nephro Flashcards by Vanessa Soetanto

most common cause of congenital obstructive uropathy

ureteropelvic junction (UPJ) obstruction

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Most common causes of UTIs in boys

vesiculoureteral reflux

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When is hypertonic 3% saline indicated

Serum sodium concentration < 120 mEq/L
patients with associated neurologic manifestations such as headaches, seizures, behavioral changes, obtundation, coma, and respiratory arrest

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Alport Syndrome
pathophys & clinical clues

Inherited disorder of basement membrane collagen

persistent microscopic hematuria (with RBC casts) with proteinuria
family history of renal disease and deafness
X-linked dominant AS

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Increased urinary excretion of ____, ___, ___ is associated with decreased risk of renal stone formation

citrate, magnesium, pyrophosphate

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Urinary metabolic evaluation process

24-hour urine collection, needs to be at home without IVF

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hyper_____ is the most commonly identified metabolic cause of renal stones

hypercalciuria

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Boy with proteinuria on UA x2 instances, 6 months apart. What is the next evaluative step?

First-Morning urinalysis
(Urine protein/Creatinine ratio >0.2 in first-morning sample is abnormal.)

Then Renal US if proteinuria is confirmed

(don’t really do 24-hour urine collection for proteinuria in adults or kids)

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Cut off for urine dipstick to make protein appear positive

300 mg/day
Normal

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What is benign proteinuria?

Orthostatic proteinuria (when active), and disappears when patient is supine/asleep for at least 2 hours (first-morning sample)

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Potter syndrome

Autosommal Recessive PKD
- oligohydramnios
- pulmonary hypoplasia
- facial appearance (pseudoepicanthus, flattened ears and nose, recessed chin)
- skeletal abnormalities (hemivertebrae, sacral agenesis)
- ophthalmologic malformations (cataracts, lens prolapse)
- limb abnormalities (club feet, hip dislocation)

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Ultrasonographic findings of Potter Syndrome

Large echogenic kidneys with decreased corticomedullary differentiation

hepatic echogenicity is possible

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Causes of asymptomatic gross hematuria in adolescent boys

Usually there is an obvious underlying cause
Trauma
Familial nephritis
HSP

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Ddx and Workup of gross hematuria in children

detailed H&P, urinalysis, workup of infection, renal US

Ddx: meatal/prineal irritation, calciuria (crystalluria), nephrolithiasis, cystitis, congenital renal anomalies, bladder mass

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Most common extra-renal manifestation of ADPKD, other manifestations, and pathophys

cerebral aneurysm

Others include: hepatic, pancreatic and seminal vesicle cyst; cardiac valve disease (MVP, Aortic Regurge); colonic diverticulal abd wall hernia

Pathophys: defective epithelial cell differentiation or extracellular matrix function associated with genetic abnormality in ADPKD

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First dx test to check if children have ADPKD (if they have positive family hx)

Renal US (to look for cysts): need 3 unilateral or bilateral kidney cysts. PPV 100%, sensitivity 82-96%.

If there is a murmur: need echo

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Most common manifestation of ARPKD and how to diagnose

liver abnormalities (congenital hepatic fibrosis, portal HTN, perilobular fibrosis and ‘Caroli Syndrome’)

Dx: antenatal US at 24wks gestation

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Causes of UTI in prepubertal girl >2yo

posterior urethral valves

+ foreign body or labial adhesions

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Most common pathogen causing lower urinary tract infections

E. Coli

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Bartter Syndrome

Syndrome caused by defect in NaCl reabsorption in medullary thick ascending limb of loop of Henle

Similar to chronic furosemide therapy

Presents as growth restriction, hypoK, metabolic alkalosis and polyuria

volume depletion from salt wasting

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Gitelman Syndrome

Syndrome cause by mutation in gene coding for thiazide-sensitive NaCl transporter in DISTAL TUBULE

Causes hypo K, polyuria, polydipsia

Presents in late in childhood or adulthood with muscle cramps

Reduced urinary calcium and hypomagnesemia

** volume depletion** from salt wasting

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Gordon Syndrome

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Syndrome causing pseydohypoaldosteronism (decrease Na reabsorption and K secretion) low Na, high K, high H+

in DISTAL TUBULE

Diminished renin secretion
metabolic acidosis

Liddle Syndrome

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Syndrome causing pseudoaldosteronism (increased Na reabsorption and K secretion) high Na, low K in COLLECTING TUBULES

Most likely cause of bilateral hydronephrosis, dilated bladder, thickened bladder wall, and dilated posterior urethra

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Posterior Urethral Valves

Initial serum creatinine concentration reflects maternal serum level. When does it normalize? (preterm vs. FT)

7-10 days FT 1 month preterm

Difference between ARPKD and multicystic dysplastic Kidney (MCDK)

MCDK = usually ONE kidney MCDK involves the whole kidney. On US shows unilateral multiple noncommunicating cysts of varying sizes with intervening dysplastic renal tissue. This kidney will not be functional. The other might have complications

Vesicoureteral reflux - age of presentation (dx) - complications

Dx and age: prenatally on maternal US screening, after episode of UTI (6-7yo) - can be secondary with high pressures in bladder (2/2 posterior urethral valves or closed urethral sphincter) - Increased risk of pyelonephritis

Management of VUR

- Abx ppx - surgical correction

Prognosis of Cesicoureteral reflux

- grade I-II have high rates of resolution grade III-IV only 10-20% self resolution Grade V rarely resolves spontaneously If dx before age 1 yo, favorable association with spontaneous resolution

FeNA formula

[Urine Na x serum Cr] / [Serum Na x urine Cr] x100

Winters formula (assess respiratory compensation for metabolic acidosis)

pCO2 = (1.5x HCO3) + 8 (+/- 2)

What is the delta-delta ratio and what does it assess?

Delta ratio = [measured AG - normal AG]/[normal bicrb - measured bicarb] If delta ratio >1 pure increased AG acidosis If delta ratio <1, mixed increased AG and normal AG metabolic acidosis

Tyle 1 RTA (location, channel effected, lab findings)

H+ problem (1st element in periodic table) Distal Inability to acidify urine Urine pH >5.5 Labs: Low K + Urine AG Hyper Ca + nephrolithiasis (phosphate kidney stones) (causes: Lithium, SLE, amphoterecin B)

Type 2 (location, channel effected, lab findings)

2 = bi = bicarbonate Problem reabsorbing bicarb in proximal tubule pH <5.5 Low to normal K May be associated with Fanconi syndrome, Multiple myeloma

Type 4 (location, lab findings)

4 (kind of looks like K) Distal Low aldosterone/ aldosterone insensitivity Labs: LOW K Causes: bactrim, Gordon sd, CAH

FSGS tx

ACE/ARB

Preventative care for patients with nephrotic syndrome

PPSV23

Difference between poststreptococcal GN and IgA GN

postreptococcal timing is at least 1wk post infection to 3-6wk post skin infection (**ASO negative in skin strep infection**) IgA GN is 2 DAYS after infection

MPGN Labs

low C3 *Normal C4 (type 2)* Low C4

Post GN after infective endocarditis complement levels

low C3, low C4

Painless gross hematuria concurrent with illness (URI). Dx and how to evaluate

Dx: IgA GN Biopsy to diagnose. C3 is normal, IgA can be elevated but not always. *key is concurrence*

Non-thrombocytopenic palpable purpura, arthritis, GI sx, nephritis. Dx and Tx?

HSP often self limited ACE/ARB if proteinuria >0.5g/day Steroids if nephritis continues on ARB/ACEi

Anti C1q ab in serum in patient with renal disease

think Lupus nephritis

Infectious association of membrenoproliferative GN

Hep B Hep C cryoglobulinemia lupus (not infective)

First line treatment for nephrotic syndrome

prednisolone/prednisone ACE-i is adjunctive No need to give furosemide unless clinically with HTN or crackles on lung exam

First line for Poststreptococcal GN

furosemide if HTN Supportive care If need be, CCB would be the preferred anti-hypertensive med (or nicardipine, nitro gtt, labetalol in hospital settings) - no steroids or ACE-i

When must you get a Renal US and VCUG

Renal US after UTI treated or >48h if no improvement for evaluation of renal abscess or pyonephrosis - urine with 50,000 or more cfu of single organism (suprapuic aspirate) - Voided urine sample or bag, >100,000 cfu - <24mo VCUG if there is hydronephrosis, scarring or other signs of urinary obstruction

FeNa and how to interpret

Urine Na x serum cr / serum Na x urine cr <1% prerenal >2% renal (also urine to plasma osm is <1.5, SG <1.010)

When do you repeat a BP for patients with elevated BP?

If >95th +112 mmHg (stage 2), in 1 week, then if still high, start diagnostic eval If > 95th percentile (stage 1), must be in 1-2 weeks, then if still high, in 3 mo for the 3rd If >90th percentile, in 6 mo, then 6 mo

Diagnostic evaluation of child with HTN

urinalysis CMP lipid profile renal ultrasound

When does maternal creatinine get cleared in term vs. preterm neonates

1-2 weeks Preterm: 1-2 mo

When does maternal creatinine get cleared in term vs. preterm neonates

1-2 weeks Preterm: 1-2 mo

When does GFR reach adult values

2 yo

Urology/ Nephro Flashcards

(53 cards)