Peds: T3: Kidney & Urinary Tract
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73 terms
Terms | Definitions |
|---|---|
 U/S | What can detect structural abnormalities of the kidneys & urinary tract at birth? |
| UTI, vesicoureteric reflux, & urinary obstruction | These things can potentially damage growing kidney at birth... |
| 25% | Glomerular filtration rate at 28 weeks gestation is only __% of that at term. |
| Doubles | Over the first 2 weeks of life GFR ___________. |
| 6-fold | GFR increases by how much from birth to a year of age to adult rate? |
| Renal agenesis (Potter's syndrome) | Absence of both kidneys... |
| Oligohydramnios | This occurs from a lack of fetal urine which causes facies such as large & low set eats, lung hypoplasia, postural deformities, severe talipes, stillborn... |
| Multicystic kidney | Nonfunctioning structure due to failure of union of the uretic bud (which forms the ureter, pelvis, calyces & collecting ducts) with the nephrogenic mesenchyme (Large fluid-filled cysts) |
| Recessive | The infantile polycystic kidney disease is autosomal __________. |
| Dominant | The adult-type polycystic kidney disease is autosomal __________. |
| Tuberous sclerosis | Autosomal dominant deletion on chromosome 9 which is responsible for tumor suppression... |
| Pelvic kidney or horseshoe kidney | This occurs due to abnormal caudal migration, abnormal position, predisposed to infx or obstruction to urinary drainage... |
| Premature division of the uretic bud | This is a duplex system where it ranges from bifed renal pelvis to complete division of 2 ureters presenting with abnormal drainage... |
| Prune-Belly syndrome | Absent abdominal musculature with a large bladder & dilated ureters (megacystis-megaureters) & cryptorchidism)... |
| Pelviuretic junction, Vesicouretic junction, bladder neck | Obstruction to urine flow may occur at what three places? |
| Nerve supply to neuropathic bladder or posterior urethra due to mucosal folds or a membrane | Bladder neck obstruction occurs due to disruption of what? |
| Forming a scar and predisposing to HTN & CRF if scarring is bilateral | A UTI can damage a growing kidney how? |
| Vulvitis, Balanitis | Dysuria without a fever may be due to _________ in girls or _________ in boys instead of UTI. |
| Suprapubic aspiration | What might some consider the method of choice in severely ill infants <1 y/o for collection of urine? |
| Midstream sample (Clean-Catch method) | In older children, what method of urine collection is usually used? |
| E.Coli | Virulence varies with this bacteria and cell wall antigens & presence of endotoxin... |
| Proteus | This bacteria that causes UTI's is more common in boys and predisposes to formation of phosphate stones... |
| Pseudomonas | This bacteria often indicates structural abnormality in the urinary tract affecting drainage... |
| Infrequent voiding, vulvitis, hurried micturition, obstruction by a loaded rectum from constipation, neuropathic bladder | Contributing factors to incomplete bladder emptying... |
| Vesicoureteric reflux | Ureters are displaced laterally & enter directly into the bladder rather than at an angle... |
| Neuropathic bladder, urethral obstruction, temporarily after UTI | Vesicoureteric refleux can also occur with what? |
| UTI | Evaluate all children with 1st confirmed what? |
| Structural abnormalities & urinary obstruction, renal scars, vesicoureteric reflux | The aim of evaluating children with 1st confirmed UTI is what? |
| U/S, X-Ray, Static radioisotope scanning, Cystography | How are children evaluates with 1st UTI? |
| 3 | Cystography & Functional scans can be deferred for about __ months after a UTI to avoid missing a newly developed scar. |
| Daytime enuresis | Lack of bladder control during the day in child old enough to be continent... |
| Bladder training, pelvic floor exercises, tx constipation, pad in pants with alarm, anticholinergic or adrenergic drugs to decrease bladder contractions, Ephidrine | Tx of daytime enuresis includes... |
| Increases tone at bladder neck | What does Ephidrine do? |
| Emotional upset, UTI, Polyuria from osmotic diuresis | Loss of previously achieved urinary continence may be due to what? |
| An early morning sample | Measure urine protein/creatinine ratio when? |
| 0.2 | A protein to creatinine ratio of more than _____ is abnormal. |
| Orthostatic proteinuria | Common cause of proteinuria is what? |
| Nephrotic syndrome | Heavy proteinuria with low plasma albumin & edema is what syndrome? |
| Henoch-Schonlein purpura, Vasculitis, Infx, Allergy | Systemic nephrotic syndromes include... |
| Periorbital edema, scrotal, leg, & ankle edema, ascites, breathlessness due to pleural effusions & ascites | What are some clinical signs of nephrotic syndrome? |
| Resolve directly, Infrequent relapses, frequent relapses (steroid dependent) | Prognosis of steroid-sensitive nephrotic syndrome is what? |
| Congenital nephrotic syndrome | Presents in the first 3 months of life associated with early end-stage renal failure with high mortality... |
| RBC casts, brown urine, deformed RBCs, proteinuria | Glomerular hematuria presents with what? |
| Red urine, occurs at end of urinary stream, NOT accompanied by proteinuria, NO casts | Lower urinary tract bleed presents with what? |
| UTI | What is the most common cause of hematuria? |
| Recurrent macroscopic hematuria, familial nephritis suspected, renal fx abnormal, proteinuria, complement levels are abnormal persistently | Renal bx for hematuria if what? |
| Acute nephritis | In childhood, this usually follows a streptococcal sore throat or skin infx where increased glomerular cellularity restricts glomerular blood flow and therefore filtration is decreased... |
| Decreased urine output & volume overload, HTN (can cause seizures), Edema (Usually around eyes), Hematuria & Proteinuria | Acute nephritis leads to what? |
| Henoch-Schonlein Purpura | Characteristic skin rash with arthralgia, periarticular edema, abdominal pain, and glomerulonephritis... |
| winter, URI, 3-10 | Henoch-Schonlein purpura occurs in the ________, often preceded by _____, and usually occurs between the ages of __-__ y/o. |
| IgA Nephropathy | Presents with episodes of macroscopic hematuria commonly associated with upper respiratory tract infx, similar to henoch-schonlein purpura... |
| Alport's | Most common familial nephritis is __________ syndrome. |
| Henoch-Schonlein purpura | Most common vasculitis to involve the kidney is what? |
| Fever, malaise, weight loss, skin rash, arthropathy | What are some symptoms of vasculitis? |
| HTN, hepatic fibrosis, progression to chronic renal failure | autosomal recessive polycystic kidney diseases are associated with what? |
| Fanconi syndrome | Generalized proximal tubular dysfunction with excessive urinary loss of amino acids, glucose, phosphate, bicarbonate, sodium, calcium, potassium, urate... |
| Polyuria, polydipsia, salt depletion & dehydration, hyperchloremic metabolic acidosis, rickets & osteoporosis, failure to thrive | Fanconi syndrome presents with what? |
| Acute renal failure | Sudden reduction in renal function with oliguria... |
| Prerenal, Renal, and Post-Renal | Acute renal failure can be classified as... |
| Prerenal | What is the most common cause of acute renal failure in children? |
| hypovolemia | Prerenal failure is suggested by what? |
| Failure of conservative management, hyperkalemia, severe hypo or hypernatremia, pulmonary edema, HTN, Severe acidosis, multisystem failure | When do you use dialysis for acute renal failure? |
| Peritoneal dialysis | What is the most common choice for children for acute renal failure? |
| Acute renal failure, Microangiopathic hemolytic anemia, Thrombocytopenia | What is the triad of Hemolytic Uremic Syndrome (HUS)? |
| Hemolytic Uremic Syndrome (HUS) | This is the most common cause of acute renal failure in childhood and is believed to be due to activation of neutrophils which damage vascular endothelium usually secondary to GI infx with toxin-producing E. Coli O157:H7... |
| Renal origin (Usually due to renal parenchymal disease from scarring following reflux nephropathy) | Symptomatic HTN in children is usually due to what? |
| Coarctation of the aorta | What is another important cause of HTN in children? |
| Vomiting, H/A, Facial palsy, HTN retinopathy, Convulsions, Proteinuria, Failure to thrive & cardiac failure most common features in infants | What are some symptoms of HTN? |
| Pheochromocytoma | This can cause paroxysmal palpitations & sweating... |
| Nephrectomy for unilateral scarring, Angioplasty for renal artery stenosis, surgical repair or coarc., resection of a pheo. | Some causes of HTN are correctable. What are they? |
| twice/year | Any child with renal scarring should have BP checked how often? |
| anorexia & lethargy, polydipsia & polyuria, failure to thrive, Bony deformities, HTN | What are some clinical features of CRF? |
| Protein | What should be sufficient to maintain growth & normal albumin, but low enough to prevent accumulation of toxic metabolic by-products? |
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