Pediatrics > Genitourinary > Flashcards

Genitourinary Flashcards

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1
Q

signs of renal disease in utero

A
  • oligohyramnios
  • polyhydramnios
  • intrauterine growth retardation
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2
Q

oligohydramnios

A

reduced urine production

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3
Q

polyhydramnios

A

reduced swallowing of amniotic fluid /w

increased urine production

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4
Q

signs of renal disease in children

A
  • abnormal growth (small stature)
  • hypertension
  • dehydration
  • edema
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5
Q

physical features w/ potential

underlying renal defects

A
  • fetal alcohol syndrome
  • down syndrome
  • pre-auricular skin tags or pits
  • external ear deformities
  • eye abnormalities (cataracts, coloboma, aniridia)
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6
Q

name the condition

A

coloboma

(“leaking pupil”)

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7
Q

name the condition

A

aniridia

(absence of iris)

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8
Q

control of kidney filtration

A

glomeruar filtration

  • rate of blood flow through glomerulus controlled by arteriolar tone
  • renin
    • hormone prod. in juxtaglomerlar apparatus
    • responds to glomerular flow and perfusion
    • sensitive to low blood flow and low serum sodium
  • renin-angiotensin-aldosterone axis
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9
Q

products absorbed and produced

by proximal tube

A
  • reabsorbs
    • 2/3 of filtered volume
    • Na+ and Cl-
    • glucose
    • amino acids, K+, PO4 almost completely reabsorbed
    • NaHCO3 reabsorption set by bicarb threshold
  • produces
    • calcitriol (Vit D analog)
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10
Q

Role of Loop of Henle

A

determines urine concentration

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11
Q

components absorbed by distal tubule and collecting ducts

A
  • impermeable to water except if ADH present
  • active reabsorption of NaCl into bloodstream
  • collecting ducts are primary site of ADH production and aldosterone
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12
Q

urinary anion gap

causes of low and elevated gap

A

measured gap between serum anions and cations

  • low
    • increased renal acid secretion
    • increased NH4 production
  • elevated
    • caused by metabolic acidosis
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13
Q

causes of increased anion-gap

metabolic acidosis

A

MUDPILES

  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Iron, Inhalents (CO, cyanide, toluene), Isoniazid, Ibuprofen
  • Lactic acidosis
  • Ethylene glycol, ethanol ketoacidosis
  • Salicylates, starvation ketoacidosis, sympathomimetics
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14
Q

maturation of renal function

(urine concentration, GFR, tubular reabsorption)

A
  • max. urine concentration - infants cannot concentrate urine (produce same amount even if dehydrated)
  • GFR - reaches adult levels by 1-2 years old
  • tubular reabsorption - adult levels by 1-2 y-o
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15
Q

urinalysis

what dipstick checks for

A

pH, protein, glucose, ketones, blood leukocytes

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16
Q

urinalysis

what microscope checks for

A

pyuria, hematuria, casts, crystals

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17
Q

urinalysis

what spot calcium/creatinine checks for

A

renal stones, hematuria

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18
Q

renal imaging

what US used for

A

most utilized in peds

kidney size, dilation, assess cortex vs. medulla

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19
Q

used to evaluate bladder filling/function

position of ureters/urethra

reflux into kidneys/ureters

A

voiding cystourethrogram (VCUG)

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20
Q

what is nephrotic syndrome

A

heavy and persistent proteinuria

with protein losses (albumin)

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21
Q

signs of nephrotic syndrome

A
  • pitting edema and/or ascites
  • anorexia, malaise, abdominal pain
  • increased BP (25%)
  • shock d/t sudden albumin decline and fluid loss
  • NO gross hematuria or renal insufficiency
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22
Q

2 sources of proteinuria

A
  • tubular
  • glomerular
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23
Q

tubular proteinuria

types of proteins seen

A

low molecular weight

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24
Q

tubular proteinuria

conditions

A
  • acute tubular necrosis
  • pyelonephritis
  • polycystic kidney
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25
tubular proteinuria causes
tubular toxins: antibiotics chemotherapy
26
glomerular proteinuria type of protein seen
large and small
27
glomerular proteinuria evidence of disease
* hematuria * casts * HTN
28
MC but least severe nephrotic syndrome
minimal change disease
29
least common but most severe nephrotic syndrome
IgA nephropathy
30
primary nephrotic syndrome minimal change disease characteristics
* MCC nephrotic syndrome in children (80% in children \< age 7) * MC in males * most respond to steroids within 4 weeks * treat with oral steroids x12 weeks
31
primary nephrotic syndrome focal segment glomerulosclerosis characteristics
* 10-20% of kids w/ NS * no specific tx - less steroid responsive * may need nephrectomy, dialysis, transplant
32
primary nephrotic syndrome membranoproliferative glomerulonephritis characteristics
* 5-10% of kids w/ NS * caused by hypocomplementemia (immune complex deposits) * tx is to stop deposition of immune complexes
33
what is secondary nephrotic syndrome
protein losses from kidney occur secondary to other diseases * vasculitis * chronic infections (hepatitis, malaria, HIV) * diabetes * renal vein thrombosis * amyloidosis * heart disease * malignancies * drug reactions
34
when/what to check for proteinuria
* first morning urine - r/o orthostatic or transient proteinuria which are not significant * presence of 1+ or higher protein on dipstick 2 or more times
35
nephrotic syndrome treatment
* steroids * loop diuretics for edema * B-blockers or Ca+ channel blockers for HTN
36
complications of nephrotic syndrome
* peritonitis and bacteremia * side effects of high dose steroids * hypovolemia from diuretics or diahhrea * loss of coagulation factors - * hypercoagulable state * DVT
37
general presentation of glomerulonephritis
gross hematuria
38
acute vs. chronic glomerlonephritis
* acute * post streptococcal (PSGN) MC * chronic * IgA neuropathy MC
39
presentation of acute glomerulonephritis
* ages 2-12 * MC in boys * HTN most serious problem * 10 days after strep infection (PSGN) - OR- * 4-6 weeks after impetigo (undiagnosed)
40
S/s of glomerulonephritis
* variable presentation * asymptomatic microscopic hematuria * or more acute * often assoc. w/ concurrent URI * rapidly progressing * can quickly progress to renal disease * observe emergently until no blood * glomerular blood brownish * casts and dymorphic RBCs
41
x-lined disorder of collagen defect in glomerular basement membrane (name, s/s)
Alport syndrome * hearing and vision problems (can't see, can't hear) * renal failure in males
42
non-glomerular causes of hematuria
* painless gross hematuria * sickle cell * Wilms tumor * strenuous exercise * kidney trauma * urolithaisis * hypercalcemia
43
Tx of gomerulonephritis
* sick or not sick * observation if not sick * recheck urine and BP weekly * refer to nephrology if becoming chronic or BP elevated * Na+ restrictions, diuretics, antihypertensives for BP * treat underlying cause * ACE inhibitors reduce glomerular HTN * post-step usually self limited and benign * others w/ higher risk of chronic disease
44
hemolytic uremic syndrome (HUS) triad/cause
* microangiopathic hemolythic anemia * thrombocytopenia * renal injury secondary to syndrome * assoc. w/ shigatoxin and diarrheal illnesses * E. coli - verotoxin (VT) * important cuase of kidney injury in children * typically \< 5 y/o * non-diarrheal more severe * HIV, complement defects, medications, malignancy, pregnancy
45
hemolytic uremic syndrome (HUS) S/s
* verotoxin causes hemorrhagic enterocolitis * bloody stools * 7-10 days after stools - lethargy, oliguria * irratability, pallor, petechiae * HTN from volume overload and renal injury * seizures (25%) * rare: pancreatitis, dysfunction, colonic perf.
46
HUS laboratory findings
* CBC- anemia, thrombocytopenia * peripheral smear- schistocytes, burr cells, helmet cells * elevated LDH, AST, reticulocytes, bilirubin * decreased haptoglobin "chewed up" RBCs
47
HUS treatment
* supportive care * volume repletion * RBC transfusion * HTN management * dialysis
48
categories of renal failure
* pre-renal * renal * post-renal
49
cause/sign of pre-renal failure
* glomerular hypoperfusion * MC dehydration * others: * cardiac failure * hemorrhage * cirrhosis * shock * sign: very concentrated urine
50
causes/sign of renal failure
* usually tubular injury * hypoxic ischemic tubular injury * infection (sepsis) * nephrotoxic agents * (myoglobin, meds, contrast medium) * inflammation * Interstitial nephritis * sign: mild hematuria/proteinuria, SG \< 1.015
51
causes/sign of post-renal failure
* urinary tract obstructions * sign: reduced urine volume
52
MCC chronic kidney disease greater than/less than 10 y/o
* \< 10 y/o * congenital anomalies: agenesis, duplication, polycystic, ureteral implantation, kidney parenchyma * \> 10 y/o * focal glomerulosclerosis
53
signs of kidney failure / CKD
* growth failure * fractures and bone deformities * delayed puberty * HTN * renal osteodystrophy * hormonal abnormalities * uremia
54
Tx of CKD
* nutritional supplements / tube feeding * treat acidosis - NaHCO3, Na+ citrate * dialysis * address salt needs based on Na+ excretion * anemia - supplement erythropoietin and iron * renal ostedystrophy - PO4 restriction, Vit D * renal transplant
55
2 types of pediatric HTN
* essential * leading cause in children and adults - obesity * secondary * typically renal
56
at what age do you begin routine measurements of BP
3 y/o
57
correct cuff size
"2 fingers under the cuff"
58
effect of too large/small cuff on BP measurement
too large - low BP too small - high BP
59
diagnosis of HTN in children
3 measurements over 95 %tile * UA, electrolytes, Ca+, BUN, Cr tests * renal US * cardiac evaluation
60
Tx of HTN in children
* address underlying cause (esp. renal) * anti-hypertensives (like adults) * Ca+ blockers * ACE inhibitors * B-blockers * diet and exercise
61
backward flow of urine from bladder up ureter
vesicoureteral reflux
62
causes/risks of vesicoureteral reflux
* junction of ureter and bladder congenitally malformed - can be familial * incomplete emptying leading to kidney infections and scarring (reflux nephropathy) * increased pressure of urine in renal pelvis -\> decreased renal function and failure * neurologic bladder in 50% w/ VUR * significant incontinence and bladder training difficulties
63
Dx of VUR
* ususally unnoted until UTI * voiding cystourethrogram (VCUG) * bladder filled w/ contrast - allows grading * radionucleotide cystogram * renal US to ID abnormalities
64
vesicoureteral reflux Tx
* antibiotics to prevent recurrent UTI * teach good bladder/bowel habits to minimize urinary retention * deflux procedure - produce a valve at entry of ureter in to bladder * surgical reimplantation of ureters into bladder
65
congenital kidney abnormalities renal agenesis assoc. w/ this
diabetes during pregnancy
66
congenital kidney abnormalities renal hypoplasia/dysplasia assoc. w/ this outcome
eventual kidney failure
67
congenital kidney abnormalities polycystic kidney disease assoc. w/ this
genetic defect in structure - possible kidney failure
68
congenital kidney abnormalities posterior uretheral valves MC patient
#1 DDx when 3 mo male w/ UTI
69
when childhood urinary incontinence unacceptable
after age 5
70
potty training characteristics
* age varies by child and parent * daytime dryness preceeds nighttime
71
issues preventing daytime dryness
* poor habits * UTI undiagnosed * structural problem
72
issues preventing nighttime dryness
* age * bladder size * ADH production (DDAVP) * behavioral
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