Renal - Pediatric Uti/hematuria

Front 1

Definitions:
cystitis:
pyelonephritis:
bacteriuria:
pyuria:
UTI:

Back 1

cystitis - bladder
pyelonephritis - anything above bladder
bacteriuria - duh
pyuria - RBC casts in urine
UTI - duh

Front 2

Clinical manifestations:
urethritis:
cystitis:
pyelonephritis:

May be only sign in kids < 2 y/o of UTI:

Some long-term complications of UTI's:

UA/Cx: + in UTI's:

Back 2

dysuria, frequency
dysuria, frequency, suprapubic tenderness
above + flank pain, N/V/systemic S/S

fever

HTN, renal scarring, impaired renal growth/fxn

leukocytes, nitrites
proteins, blood

Front 3

Major pathogen of UTI's:

Are bagged urines OK for UA/Cx to R/O UTI?

Most accurate method to get urine?

Gold standard for UTI's?

Most accurate rapid indicator of UTI's in children?

Back 3

E. Coli

No - contamination

suprapubic tap

Urine Cx

Nitrites

Front 4

Pyuria = ___ WBC's per high-powered field

Bacteriuria = _____ bacteria per high-powered field:

Urine Cx - # cfu's for clean catch + test? for cath? for suprapubic?

Back 4

>5

Any

clean catch - >100,000
cath - >50,000
suprapubic - any G-, >5,000 G+

Front 5

Common Abx for UTI's?

Risk factors for pediatric UTI's?

UTI evaluation guidelines for kids?

Back 5

Amox, Bactrim, Nitrofurantoin, Cefixime, Cephalexin

female, uncircumcised, white race, genetic, urinary obstructions, chronic caths

fever of unknown origin, <1 y/o, white, fever for days, temp >39C

Front 6

Gross hematuria:

Microscopic hematuria:

Some medications that cause heme-negative red urine?

foods that cause red urine?

common causes of gross hematuria? (3)

Back 6

increased RBC's in urine, visible to naked eye

common finding, 3-4% schoolchildren have it, mostly benign causes

ibuprofen, iron sorbitol, *rifampin*

beets, blackberries, food coloring

UTI, local irritation, trauma

Front 7

Common causes of gross hematuria in peds urology?

Common causes in peds nephrology?

What should you evaluate on PE in kids?

Back 7

urethral trauma/irritation, UTI, congenital

IGA nephropathy, Alport syndrome, hypercalciuria

BP, edema/weight gain, skin, direct visualization of genitals, close eval of abdomen (Wilm's tumor)

Front 8

Do you normally see clots in glomerular disease?

How do the RBC's look in glomerular disease?

Color of urine?

Is protein elevated?

Back 8

No

Dysmorphic- not normal
RBC casts

brown

Yes - >100 mg

Front 9

Test to order for:
trauma:
flank pain:
dysuria/fever:

What are S/S of glomerular disease?

Test ordered for strep Ab's?

Back 9

trauma - CT
flank pain - U/S
UAC, G stain

Proteins, RBC casts, HTN, edema

ASO titer

Front 10

A Ca+/creatinine ratio >0.2 suggests:

3 etiologies for persistent microscopic hematuria?

Back 10

hypercalciuria

IGA nephropathy, Alport's syndrome, thin basement membrane
hypercalciuria
Nutcracker syndrome

Front 11

Describe IGA nephropathy:

Thin basement membrane disease:
(benign familial hematuria)

Back 11

Hx of gross hematuria,URI/AGE 1-5 d. prior, Most common form of glomerulonephritis, recurrent hematuria common

autosomal dominant, thinned glomerular membranes on EM

Front 12

Classic Alport syndrome:

Back 12

Recessive X-linked
hearing loss
ocular abnormalities progressive renal failure affects A-5 Type 4 collagen chains
thickened membranes in kidney

Front 13

Post infectious glomerulonephritis:

What drugs can decrease hematuria in hypercalciuria?

Nutcracker syndrome?

Back 13

post-streptococcal
10-21 days post infection
rarely recurrent hematuria
most resolve <6 mo.

Thiazide diuretics

L renal vein compression between aorta, sup mesenteric a.; common in Asians (damn!)

Front 14

Most common presentation of hematuria in kids?

When should you refer an asymptomatic micropic with proteinuria kid?

Back 14

asymptomatic isolated

1st void urine protein > 0.2 mg creatinine
>4 mg protein/hr.
elevated serum creatinine

Front 15

Symptomatic microscopic hematuria:
1. new onset dysuria/frequency/urgency:
2. recent URI/skin infection (1-2 d., 2-3 wks)
3. flank pain radiating to groin:
4. flank pain, no radiation, fever, dysuria, urinary S/S:
5. deafness:

Back 15

1. UTI
2. 1-2 d: IGA nephropathy
2-3 wks: post strep glomerulonephritis
3. kidney stone
4. acute pyelonephritis
5. Alport's syndrome

Front 16

Symptomatic microscopic hematuria:
6. family hx of hematuria, renal disease:
7. weight loss, mass/tumor in abdomen:
8. extrarenal manifestations:

Back 16

6. Alport's, thin basement membrane, kidney stones
7. Wilm's tumor
8. Lupus, Henoch-Schonlein purpura