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125 Cards in this Set
- Front
- Back
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What is usually the first test to assess fxn of urinary tract/
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UA
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Proteinuria means there is damage to what?
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parenchmal damage
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GFR broadly reflects what?
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function
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Cr is synthesized predominately where?
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in skeletal muscle and excreted in kidney
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What is the final product of metabolism of proteins?
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BUN
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BUN is freely filtered by the glomerulus, but reabsorbed where?
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renal tubules
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What are some things that cause an increase in BUN?
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-bleeding
-dehydration -increased protein intake |
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What are some things that cause a decreased BUN?
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-protein intake
-malnutrition -liver dz |
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What is normal CrCl for males and females?
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males is 20 mg/kg
females is 15 mg/kg |
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How is renal concentration capacity commonly assessed?
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measuring specific gravity
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What is the more accurate test for assessing renal concentrating capacity?
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urine osmolality
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Excretion of NH4 should be assess by what?
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urine net charge (urinary anion gap)
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What is a useful parameter in teh evaluation of oliguria and can help differentiate between prerenal and renal causes of acute renal faliure?
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fractional excretion of sodium
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What is prerenal oliguria?
ATN? |
<1%
>2% |
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Urinary tract US can't detect what?
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VUR (vesicoureteral reflux)
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What is a VCUR?
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fluroscopic study in which the contrast media is injected into the bladder via an indwelling catheter
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In VCUR die above the bladder indicates what?
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VUR
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Radionuclide renal imaging is used to assess what?
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glomerular filtration
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Why is Tc-DTPA one of the most used agents in radionuclide scan?
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b/c it is only excreted by GF
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Tc-MAG-3 measures effective renal plasma flow and is more useful in who?
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young children
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What is the agent of choice for the evaluation of renal scarring and acute inflammation?
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TcDMSA
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What test is useful for the evaluation of the anatomy of the kidney and collecting system?
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IVP
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Proteinuria is only a problem if it occurs how many times?
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4 or more
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Nephritic Syndrome is characterized by what things?
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-massive proteinuria
-hypoalbuminemia edema -hyperlipidemia |
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What is the MC presenting sx of Nephritic syndrome?
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edema
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Why is there increased glomerular permeability in Nephritic Syndrome?
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b/c of immunologically mediated decrease in anionic charge
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In Nephritic syndrome, what is the protein loss?
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usually 40mg/hr/m2 and mostly comprised of albumin
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50% of Nephritic syndrome protein consists of what type of protein?
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Hamm Horsfall protein
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What is the best predictor of prgressive renal damage in children with proteinuric renal dz?
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increasing levels of proteinuria
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Severe persistant proteinuria may be a risk factor for what in kids?
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atherosclerosis
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In Nephritic syndrome, edema usually appears when?
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when serum albumin falls below 2/5 g/dL
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What are the 2 mechanisms for edema in Nephritic SYndrome?
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-transduction of fluid from the intravascular space into the interstitium 2nd to hypoalbuminemia
-increased renal tubular rabsorption of sodium and water |
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What is seen on hx in Nephritic syndrome?
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-impaired growth and development
-unexplained polydipsia and polyuria, hearing loss, or visual problems -oligohydraminos -bladder dysfunction, frequency or dysuria -HA, edema, and joint pain |
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NephrOtic syndrome has a hx of what?
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mild puffiness around eyes, esp in the morning
-confusion with allergy -ascites, pleural effusions, and scrotal or labial edema |
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What is the most commonly used tool to test for proteinuria?
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urine dipstick
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When can proteinuria testing have a false positive?
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-w/ concentrated or very alkaline uring, gram neg bacteria, detergents, and skin cleansers
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What is the most accurate screening tool for proteinuria?
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24 hr urine specimen
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What is the most common method to quantify proteinuria in children?
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spot urine and protein and Cr
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What children should ge a renal sonogram?
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those with hx of persistent proteinuria
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What is renal biopsy not required for intial dx of nephrotic syndrome?
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b/c most have minimal change dz
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When is a bx for nephrotic syndrome indicated?
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if renal function, HTN, gross hematuria or hypocomplementemia are present
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What is the ruine protein: Cr ratio in kids iwth nephrotic syndrome?
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less than 2.0
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What are some causes of transient proteinuria?
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-fever
-dehydration -stress -exercise |
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What is orthostatic protienuira?
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elevated protein in upright position, but norma in recumbancy that is usually benign
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What is primary nephrotic syndrome?
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when only the kidneys are involved
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What is the most common form of nephrotic syndorme?
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minimal change dz?
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What is the DOC for children with nephrotic syndrome?
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cortidosteroids
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What is treatment for steroid resistant nephrotic syncrome?
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IV pulse steroids and you can also use ACE ihibitors in steroid resistant pts
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What drugs can be used for long periods of remission in nephrotic syndrome?
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Cyclophosphamide or Chlorambucil
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What can you use to tx severe edema in renal dz?
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-IV albumin though there is a risk of HTN, fluid overload, and pulmonary edema
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Children lose which Ig in nephrotic syndrome?
What does this put them at risk for? |
IgG
puts them at risk for cellulitis, peritonitis, pneumonia |
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What is an important cause of hematuria?
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GN
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What are some causes of GN?
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-immunologic causes (MC)
-coagulation distrubances -biochemical defects -direct toxic insults |
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Hematuria presents in what 3 ways?
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1-onset of gross hematuria
2-onset of urinary or other sx with indicental finding of microscopic hematura 3indicental finding of microscopic hematuria |
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How does acute GN present?
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with hematuria, edema, and HTN with or without oliguria
ps-edema is presenting sign in may pts |
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What are 4 other things that may accompany GN?
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-fever
-anorexia -weakness -HA |
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What are some signs that point to a systemic dz in GN?
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-purpuric rash
-joint involvement -GI bleeding -pleuritis |
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What is the first step in PE of hematuria and GN?
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blood pressure and determination of growth pattern
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HTN and failure to thrive point to what?
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chronic renal dz
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What is the most common test for the detection of RBCs in urine?
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urine strip tests
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What casts are found in GN?
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RBC casts
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What happens in the first week of PSGN?
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serum C3 and total serum hemolytic complement are decreased
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IF hypocomplementemia lasts longer thatn 8 weeks in PSGN, what diseases should be considered?
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-membranoproliferative GN
-lupus nephritis |
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What is the most common type of GN in children?
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PSGN
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In PSGN there is gross hematuria when?
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2 weeks after infection
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What is the MC variety of primary GN?
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IgA nephropathy
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IgA nephropathy has recurrent episode of what that occurs when?
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episodes of gross hematuria 1-2 days post viral resp or GI infection
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What is Alport's syndrome?
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familial nephritis with neurosensory hearing loss and slow pregresion to renal insufficiency
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How is Familial bening hematuria different from Alport's syndrome?
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it doesn't progress to renal failure
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What are the 4 groups of hematuria?
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-gross hematuria
-microscopic hematuria with clinical sx -asymptomatic microscopic hematuria (isolated) -asymptomatic microscopic hematuria with protenuria |
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What drugs are inticated in the tx of severe lupus nephritis?
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steroids and cyclophosphamide
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What is the most common vasculitis in children?
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HSP
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What is HSP?
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inflammation and damge to blood vessels, resulting in compromise of the vessel lumen and ischemic hcanges in tissues
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HSP effects which sex more?
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males
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HSP is regulated by what Ig?
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IgA
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What are the most typical findings of HSP?
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-purpuric rash, arthritis, abdominal pain, and nephritis
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GI sx in HSP result in what?
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edema of the bowel wall and hemorrhage owing to vasculitis
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What is the most common complaint in HSP?
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abdominal pain
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What is the most common sx complication in HSP?
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intussusception
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What is the clinical hallmark of HSP nephritis?
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gross hematuria
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Is there a relationship btw the severity of extrarenal organ involvement and severity of nephritis?
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NO
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The rash in HSP may be what?
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urticarial, maculopalaple, purpuric lesions
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Where can edema be seen in HSP?
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scalp, extremities, back and eyelids
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What is the most common lab finding in HSP?
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hematuria with or without proteinuria
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In HSP if urine is abnromal, what needs to be done next?
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SCr level and BUN
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What does bx show in HSP?
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IgA
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ANA and ANCA are usually what in HSP?
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negative
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When do you need to admit to hospital in HSP?
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if ARF, HTN or nephrotic syndrome present (watch for ESRF)
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What helps GI manifestations associated with HSP?
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steroids
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What is the most common cause of UTI?
what bug is common in adolesence? |
E.coli
-S. saprophyticus |
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What virus is associated with acute hemorrhagic cystitis?
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adenovirus
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VUR can lead to what?
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UTI
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Hematuria plus dysuria or pain most likely is due to what?
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lower UTI
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What can be used to collect a urine sample in children who can't void on request?
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catheterization or suprpubic aspiration
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What are the 3 most important components of UA in eval of UTI?
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-leukocyte esterase
-nitrate test -urine micrsocopy |
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What is sensitive and specific in dx of pyelonephritis in children?
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Tc-labeled DMSA
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What is normal BP in children?
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below 90th percentile for age, sex and height
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Adolescents with primary HTN are more likely to have elevated ________ and normal what?
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-elevated CO
-normal systemic vascular resistance |
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What lab findings are seen in Renal Parenchymal disease?
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abnormal UA or elevated BUN and Cr
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What is seen on labs for Renovascular disease?
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elevated plasma renin activity
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What are some tx used in HTN emergencies in children?
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NA nitroprusside, labetalol, and nicrdipine
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What is RTA?
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clinical biochemical syndrome characterized by impaired renal acidification
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RTA involves the reabsorbtion of what or the excretion of what?
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-reabsorption of HCO3
-secretion of H+ |
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What are the 3 kinds of RTA?
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Proximal RTA type 2
Distal RTA type1 Hyperkalemic RTA type 4 |
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What are the 2 steps in the acidification of urine?
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-reabsorption of filtered bicarb in the proximal tubule
-excretion of fixed acids through the titration of urinary buffers and the excretion of NH4 in the distal tubule |
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In Proximal or Type 2 RTA there is an impairment of what/
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bicarb reabsorption in the proximal tubule
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Distal RTA or Type 1 is characterized how?
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the inability to maximally lower uirne pH (<5.5) under the stimulus of systemic academia
aka impairment in distal acidification |
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How is hyperkalemic or Type 4 RTA characterized?
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normal ability to acidify urine after an acid load
it involves acidification defect that is primarly caused by impaired renal genesis of ammonia |
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What are some things in a child that point to dx of RTA?
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-failure to thrive
-repeated dehydration, vomiting, anorexia, constipation, and hx of kidney stones |
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What is the 1st step in the eval of a child with metabolic acidosis?
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calc of plasma anion gap
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If plasma anion gap is normal, what should be considered?
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possible GI losses of bicarb or RTA should be considered
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The normal response to metabolic acidosis in urine is an increase in excretion of what?
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NH4
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A negative urine anion gap reflects an increased excretion of what?
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NH4
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What is the only type of RTA in which urine pH can't decrease below 5.5-6?
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Distal or Type 1 RTA
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RTA type 2 is most commonly observed in kids with what?
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Fanconi SYndrome
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RTA type 1 is almost always observed as what?
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a primary inherited entity
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RTA type 4 is associated with low what?
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aldosterone states
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What is ARF defined as?
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rapid deterioration of renal funciton associated with accumulation of nitrogenous waste products
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Chronic renal failure is definded as what?
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slow and progressive dexease in kidney function over time
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ESRF is a GFR less than what?
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10
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UA with renal tubular casts, tubular cells, and cellular depris suggests what/
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ARF
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Absence of cellular elements and protein is most compatible with what?
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prerenal or postrenal azotemia
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What is prerenal azotemia?
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diminished blood flow to a well functioning kidney
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What is postrenal azotemia?
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generally 2nd to an obstruction to urine flow
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Dx of ARF is a dx of what?
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exclusion
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