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66 Cards in this Set

  • Front
  • Back
secondary HTN in infants and kids, cause
umbilical artery cath, Renal art thrombosis, renal disease (HUS, glomerulonephritis), coarct, endo
secondary HTN in older kids
renal scarring from recurrent pyelo, fibromuscular dysplasia(nonatherosclerotic blockage of renal a by tunical hyperplasia) (many of whom are nft)
first course of action with HTN essential and obese
weight reduction
Fanconi S
prox tubule dysfunction.: everything lost in urine: aa, glycogen, phs, bicarb, Na, K, Ca, uric acid
Fanconi S causes
inborn erros: cystinosis, tyrosinemia, galactosemia, Wilsons
Renal: renal vein thrombosis, medulary cysts, renal transplant, intersitial nephritis
drugs: onco drugs
RTA labs
normal anion gap met acidosis. inability of kidney to reclaim bicarb or excrete acid. distal I, proximal II, hyperkalemic IV.
RTA type I, explain
distal. reduced H+ secretion from distal nephron. cannot lower pH below 5.5 despite acidosis. hi Ca, low K is common.
RTA type II, explain
proximal tubular reabsorption of filtered bicarb is deficient. spill bicarb. able to lower pH below 5.5 (differentiates from type I)
differentiate norm anion gap acidosis: GI loss fo bicarb from distal RTA
Na+K-Cl as measured in urine.
(-) = kidney able to make ammonia: not RTA
(+) = kidney not able to make ammonia: RTA possible
differentiating renal abscess from pyelo
Only entertain renal abscess if treatment for pyelo is not going wel. Must follow sepsis or pyelo.
most common fetal renal anomaly with common causes
obsrtuctive uropathy: post urethral valve, UPJ obsrtuction, ectopic ureterocele. all dx by fetal ultrasound.
AD polycystic kidney disease
adult polycystic kidney. common cause o RF in adults. 20-30s presents with HTN, hematuria, UTI. can be dx eariler. Potter S is worset, asx renal cyst is best.
AD polycystic renal disease associations
more UTIs
hepatic cysts
heart valve disease
cerebral berryt aneurysms
diff dx of single renal cyst on US
ADPCKD, TS, von Hippel-Lindau
autosomal recessive polycystic renal diseas
infantile polycysitc. rare. birth presentation with bilat renal masses. in uero dx by US. cysts in liver, req. transplant or dialysis
GFR development
21cc/m2/min at birth
doubles by 2 weeks
4x by 6 mo
adult rate by 2yrs.
most common cause of congenital hydronephrosis
UPJ obstruction.
how to evaluate proteinuria, asx in healthy teen
orthostatic urine collection (first void of AM while supine). and midday normal void. Compare protein. should be more in midday if orthostatic proteinuria is present.
most common cause of bladder outlet obstruction
post urethral valves.
when to do VCUG
all boys with UTI. all girls under 10, all patients with pyelo.
pheochromocytoma med management
secrete norepi, epi, dopa. VMA or all catecholamines in urine is dx. If HTN present need lpha-adrenergic blocker to lower BP prior to surgery.
when to use and not use suprapubic tap
best source for cx <1yr old. CI if coagulopathy is present.
medullary cystic disease associations
*ophthalmologic: coloboma, strabismus. do slit lamp
renal: end stage renal failure
growth retardation
lab findings nephrotic s
proteinuria, hypoproteinemia, hyperlipidemia.
most common cause of asx unilat renal mass in infant
multicystic dysplastic kidney. look for VATER
sickel cell trait renal complication
painless gross hematuria. usually L.
idiopathic hypercalciuria
common. urinary Ca is too high based on Ca-Cr ratio > 0.2. serum Ca is normal. causes dysurea and stones, hematurea (microstones) treat with thiazide diuretic.
evaluation of urethral injury
retrograde urethrography. Insert tube just inside meatus and inject contrast. Suspect when trauma to abdomen, CNS, or fractures. meatal blood = urethral trauma
frequency, hesitancy, frequent enuresis otherwise heatlhy with nl UA and cx
unstable bladder, search for neuro cause,
nonneurogenic neurogenic bladder (Hinman S)
inability of detrusor muscle to relax during void. diurnal and nocturnal enuresis, recurrent UTI, reflux
multicystic kidney disease how to eval
perfusion scan 99Tc. shows fxn and flow
Ig A nephropathy (Berger D)
glomerulonephritis 1-2 days after illness. (quicker than post strep), nephritic-nephrotic syndrome. normal compliment (unlke post strep). recurrent hematuria. elevated IgA.
alport hereditary nephritis
inherited illness. progressive nephritis. sensorineural hearing loss. dx by renal bx
familial benign hematuria
thin glomerular basement membrane nephropathy. microscopic hematuria without proteinuria. nl hearing and renal fxn.
prune belly syndrome
absence of abd muslces. bilat cryptorchidism. nonobstructed urinary tract. VUR, scoliosis, malrotation, volvulus more common.
renal osteodystrophy
CRF and rickets
malabsorption of Ca, phosphate retention, secondary hyperparathyroidism.
1,25 dighyfroxyvit D low
parathryoid horm hi
25 hydroxy D nl
normal causes of isolated proteinurea
postural changes (orthostatic)
CLD + furosemide, microscopic hematuria think
hypercalciurea. do Ca:Cr ratio >0.25 is suggestive of hypercalciurea.
normal K in <2mo old
signs of progressive glomerular disease
HTN, persistant proteinurea, rising Cr.
presentation of UPJ
painless hematuria caused by minor trauma. Brings to attention but kidney is already hydronephrotic.
UPJ workup
CT or US reveals hydronephrosis
99Tc scan shows renal blood flow and fxn.
do VCUG to make sure 2nd kidney has no VUR
drugs causing bladder obstruction
medullary cystic disease associations and genetics
ar, polyuria, enuresis, polydipsia. short stature, ophthalmologic problems
dx: normochromic, normocytic anemia, renal salt wasting, hyposthenuria (low specgrav), polyuria, renal failure.
persistant flank pain with all else nl, think
UPJ. sx may be worsened by diuretics.
most likely cause of abdominal mass in newborn
hydronephrosis. often due to multicystic dysplasia of kidney. 50% will have VUR in the one good kidney for do VCUG.
etiology of prune belly s
urethral obstruction early in fetal life. bladder gets too big, muscles don't form, testes cant descend
ureteroceles, associations, problems
associated with duplicated ureters.
most common cause of urinary retention and urethral prolapse in girls.
cystic dilitation of ureter just before emptying in to bladder
Alport S and genetics
hearing loss and nephropathy
frequency and enuresis with nl labs 9yr girl
baldder instability (dyssnergy). unbalanced parasympathetic stimuli. check for ocult spina bifida. treat with oxybutinin (anticholinergic)
differentiating cystic kidney diseases
ADPKD polystic (can be ar or AD)usually presents in adults but more seriously affecteds in kids. hematuria, HTN, abdominal pain. always bilateral, always enlarged kidneys.
MCKD, TS, benign cystic disease are a ll nl sized kidneys. alll unilateral
ar polycystic kidney disease associations
congenital hepatic fibrosis causing portal HTN and hematemesis
prognosis following correction of congenital post urethral valves
ends tage renal failure by age 10.
treatment for asx bacterurea in girl with hx of previous UTI and nl imaging
observation. No benefit to treating, clears on it's own.
labs in acute postinfectious glomerulonephritis
UA: RBC and casts, electrolytes nl, Cr may rise (consult nephrologist), C3 low. If C3 and C4 low think membranoproliferative GN or lupus. anti-DNAse B is abnormal always in post strep/
diagnoses if nephrotic syndrome does not respond to steroids
focal segmental glomerulosclerosis.
complications of nephrotic syndrome
venous thrombosis, peritonitis, acute renal failure, hypercholsesterolemia
nephrotic syndrome complication thrombosis
loss of AT-III a fibrinolytic protein in urine causes hypercoag state. renal vein thrombosis causes abd pain, hematuria
Rx of recurrent cysitis with sx with no radiologic abnormalities
3 day course of amox, nitro, or bactrim
recurrent gross hematuria in older kid soon after illnesses
IgA nephropathy. Post strep is usually not recurrent and occurs weeks after illness
nephropathic cystinosis
abnormal cystine storage. infantile (hi cystine in WBC or fibroblasts leads to CRF. ar polyuria, polydipsia, FTT, hyperchloremic met acidosis, rickets.
Rx for renal dysplasia
cauased by PUV, UPJ, hydronephrosis.
look for cause with imaging
liberal fluids and salt.
common Se of tacrolimus
Bartter syndrome
renal K wasting. hypoK, nl BP, pressors don't work, hi renin and aldosterone. present with weakness or spasms, and hypoK
renal manifestations of TS
plycystic kidney disease, asymptomatic cysts
Fabry d
dermal telangietctasias over trunk, HTN, proteinuria, hematuria, progressive renal failure. x linked. prenatal dx with alpha galactosidase in amniotic fluid cells. lysosomal storage disease. affects kidney, heart, skin, nervous sys.