Renal/GU

Question 1

Urinary tract infection common organisms

Answer 1

E. Coli (50-60% of all infections)*
Enterococcus species
Enterobacter*
Pseudomonas aeruginosa*
Klebsiella pneumoniae*
Proteus mirabilis*
Staphylococcus aureus
*gram negative organism

Question 2

Urosepsis

Answer 2

Febrile illness or nosocomial infection
Immediate evaluation and therapy
Fluid resuscitation and management of
shock symptoms and/or renal failure.
14 days of therapy

Question 3

Common UTI Treatment IV

Answer 3

IV:
* Cephalosporins
* First generation
* Third or fourth
generation for recent
hospitalization or
infection
* Gentamicin
* Allergy to cephalosporins

Question 4

Common UTI Treatment

Answer 4

Oral:
Cephalosporins
* -First generation
TMP/SMX (Bactrim)
Amoxicillin-clavula

Question 5

Pyelonephritis

Answer 5

Bacterial invasion upper parenchyma of the kidney
Symptoms: high fever, lethargy, ill appearance, poor feeding, pain, vomiting,
irritability, Renal scarring
Diagnostics: Urinalysis and culture, CBC, CRP, ESR, chemistry.
Imaging – renal ultrasound and VCUG
Management: Inpatient vs outpatient, Hydration, pain control, IV vs PO antibiotics

Question 6

Testicular Torsion

Answer 6

Acute twisting of the spermatic cord, which disturbs blood supply to the testicle and surrounding structures within the
Symptoms:
* Sudden onset of severe pain in one testicle
* Enlarged testes
Emergent Surgical referral is appropriate management.
* 4- 8 hours reversible window
* Doppler US and labs

Question 7

Hydronephrosis

Answer 7

Distension of renal calyces
and pelvis due to
obstruction of urinary
outflow
Congenital Obstructive pathology
Scar Tissue (UTI)
Tumor, Kidney stone

Question 8

Hydronephrosis evaluation

Answer 8

Renal ultrasound*
* VCUG
* DMSA scan

Question 9

Renal Tubular Acidosis (RTA)

Answer 9

Renal tubular defect:
Metabolic acidosis with normal anion gap,
presents as lab abnormalities
Most common types in children:
Distal: genetic or acquired; results from
medications, autoimmune disorders, sickle
cell disease, autoimmune, obstructive uropathy
Proximal: less common, occurs with Fanconi
syndrome, vitamin D deficiency, some
medications and metabolic disorders
Management:
Replace bicarbonate, fluid management,
prevention of renal failure
Referral to nephrology, genetics

Question 10

Renal Failure

Answer 10

AKI: kidney function ceases to secrete water, regulate electrolytes, and acid-base balance.
* Pre-renal failure – most common, caused by
decreased blood flow, hypovolemia
* Intrinsic Renal failure – HUS, pyelonephritis, vasculitis, high levels of calcium, phosphorous, uric acid, medications
* Post-renal failure – structural defects, posterior
urethral valves, neurogenic bladder, trauma

Question 11

Pre-renal Failure Causes

Answer 11

Gastroenteritis
* GI damage
* Diabetes
* Ketoacidosis
* Hypo-proteinuria
* Hemorrhage
* Impaired Cardiac output
* Bilateral renal vessel
occlusion
Medications:
* Prostaglandin
* ACE Inhibitors
* Cyclosporine
* Diuretics

Question 12

Pre-renal Failure S/S

Answer 12

Hypotension
* Urine osmolarity of > 500, urine Na < 20 meq/L
* Fractional excretion of Na (FeNa) <1%
* Metabolic acidosis
* Hyperkalemia
* Hyperphosphatemia
* Hypocalcemia

Question 13

Intrinsic Renal Failure Causes

Answer 13

Injury of the renal
parenchyma
* Causes:
* Acute Glomerulonephritis
* Acute Tubular Necrosis
* Pyelonephritis
* Hemolytic Uremic Syndrome
* Vasculitis
* Hyper-calcemia,
phosphatemia, uricemia

Question 14

Intrinsic Renal Failure S/S

Answer 14

Hypertension
* Metabolic acidosis
* Hyperkalemia
* Hyperphosphatemia
* Hypocalcemia
* Urine Na > 20 meq/L
* FeNa > 2-3%
* Proteinuria - moderate

Question 15

Post-Renal Failure Causes

Answer 15

Occluded urinary catheter
* Posterior urethral valves
* Neurogenic bladder
* Surgical Accident
* Nephrolithiasis
* Ureterocele
* Tumors
* Trauma

Question 16

Post-Renal Failure S/S

Answer 16

Anuria
Increased BUN and Creatinine
Low calcium, high K+
Other electrolyte disorders

Question 17

Acute Renal Failure Evaluation

Answer 17

Serum electrolytes with BUN and Creatinine
* Renal ultrasound
* Urine electrolytes, osmolarity
* FeNa vs FeUrea

Question 18

Acute Renal Failure Indications for dialysis

Answer 18

Acid-base imbalance
* Electrolyte derangements
* Ingestions/toxins
* Fluid Overload
* Uremia

Question 19

Nephrotic Syndrome

Answer 19

Kidney filtration disorder
* Albuminuria, proteinuria, and edema. intravascular volume loss.
* Primary vs Secondary
* Treatment: High dose steroids, Cyclophosphamides,
Supportive care, Blood pressure control, 25% albumin, Diuretics, Sodium restriction

Question 20

A 9-year-old with septic shock is severely dehydrated. Initial labs indicate BUN of 24 and Creatinine of 1.4. Urine specific gravity is 1.025. The most likely explanation for these findings is:
1.Pre-renal failure
2.Intrinsic renal failure
3.Post renal failure
4.Chronic renal failure

Answer 20

1.Pre-renal failure
Dehydration and septic shock predisposes child to pre renal injury.
Elevated BUN/creatinine & SG are consistent with pre-renal injury.

Question 21

A 10-year-old, recently treated for strep throat, presents today with edematous face and ankles, and complains of a headache and flank pain. BP is 142/86, he has been oliguric for the past 3 hours, with 3+ proteinuria. His FENa is 2%.
What is the first treatment?
A.Emergent dialysis
B.Corticosteroids
C.Fluid bolus of 20ml/kg
D.Continued antibiotic therapy

Answer 21

B. Corticosteroids.
Consistent with 2nd nephrotic syndrome. Initial tx is steroids.

Question 22

A 5-year-old, who is potty-trained, presents with fever to 100 F, bedwetting and urinary frequency. A urine dipstick indicates
eukocytes, nitrites and a small amount of blood in urine. She is drinking as usual and appears well. Which of the following is the
most appropriate initial management?
A.Obtain Renal Ultrasound
B.Start Corticosteroids
C. Start Vancomycin
D. Start Cephalexin

Answer 22

D. Cephalexin
Presentation consistent with UTI. Initial management is abx.
Renal US indicated for < 5 yrs.

Question 23

A male infant is born with posterior urethral valves. Which of the following is the MOST concerning problem this infant is at risk of
developing?
A. Pre-renal failure
B.Testicular torsion
C.Post renal failure
D.Urinary tract infection

Answer 23

C.Post renal failure
Most common with posterior urethral valves.
Most common cause of obstructive uropathy that leads to kidney failure in males.

Question 24

A 4-year-old is seen in urgent care with complaints of dysuria. UA reveals the presence of leukocyte esterase and nitrites. What
anticipatory guidance should be provided to the family?
A.Hospital admission is necessary
B.A VCUG will be scheduled
C.A renal US should be completed
D. Urology referral once resolved

Answer 24

C.A renal US should be completed.
1st time uncomplicated UTI for < 5 yrs old should have renal US
VCUG if UTI’s are frequent or if vesicoureteral reflex present on renal US.

Question 25

Post-streptococcal glomerulonephritis

Answer 25

prior beta-hemolytic strep A infections.

Question 26

Post-streptococcal glomerulonephritis S/S

Answer 26

Sudden onset gross hematuria, edema, HTN, proteinuria,

Question 27

Post-streptococcal glomerulonephritis Evaluation

Answer 27

UA: rbc, protein, wbc ASO titer: elevated Complement C3: decreased. Throat culture: positive for GAS.

Question 28

Post-streptococcal glomerulonephritis Management

Answer 28

PCN: 10 days Cephalosporin or macrolide. Lasix for renal insufficiency. Na restriction & BP meds for HTN.