What is the other name for Berger’s disease ?

IgA nephropathy

What seems to be the trigger for Berger’s disease?

A viral infection

(mainly URIs with activation of mucosal defenses)

What is the usual long-term outcome in Berger’s disease?

Spontaneously resolves

Which post-infectious nephropathy has low complement levels?

Post-strep has low C3

What do you see in the kidney of a post-strep nephritis patient?

“Humps” on the basement membrane

If a nephritis patient has sensorineural deafness and cataracts, what should you suspect is the cause?

Alport syndrome

What is the long-term outcome for Alport nephritis?

Usually end-stage renal failure in teens or 20s

If a patient has microscopic or gross hematuria and nephrolithiasis, what should you suspect?

Idiopathic hypercalciuria

(although the blood could be due to a stone that formed for another reason)

What medication should you avoid in a hypercalciuria patient?

Furosemide (Lasix ^® ) – it increases calcium excretion further

What medication is helpful for a hypercalciuria patient?

Thiazide diuretic

(increases calcium retention)

What dietary modifications are helpful in hypercalciuria?

Decrease oxalate-containing foods (chocolate, nuts, tea) –

Do not decrease calcium-containing foods

(Decreasing high-salt foods is also helpful, because increased Na intake promotes increased calcium excretion)

Which kidney problem is associated with loss of “foot processes” on the glomerulus?

Minimal change disease

What accounts for 80 % of the nephrotic syndrome cases seen in children?

Minimal change disease

What is the triad of nephrotic syndrome?

Edema

Proteinuria/low albumin

Hyperlipidemia

What is the description of the typical minimal change disease patient?

Male aged 2–8 years

How is minimal change disease treated?

Steroids & cyclophosphamide, if needed

How is nephrotic syndrome treated, if the patient’s condition requires it?

25 % albumin fluids & furosemide

  &

Often steroids

(it may also be necessary to tap the ascites, but usually not)

ACE inhibitors & angiotensin II receptor blockers are frequently used in patients with nephrotic syndrome. What are the two main purposes for using them?

To manage hypertension

  &

Decrease proteinuria

What is the classic presentation for children with renal dysfunction ?

Periorbital edema

Alport nephritis, hypercalciuria, IgA nephropathy, and post-infectious glomerulonephritis all commonly present with what finding?

Gross or microscopic hematuria

(post-infectious glomerulonephritis includes post-strep glomerulonephritis)

Which type(s) of RTA produces acidosis and a urine anion gap?

Type 4

(also causes hyperkalemia)

What is distal RTA ?

Failure to excrete hydrogen

If there is metabolic acidosis, but no anion gap (normal anion gap, in other words), what are the likely causes?

Diarrhea or an RTA

Which RTA is characterized by severe bicarb wasting?

Proximal

(also known as RTA type 2)

If the kidney is wasting a lot of bicarb, what other problems develop?

Wasting of glucose, phosphate, and amino acids

Which type of RTA often accompanies congenital disorders and inborn errors of metabolism?

Proximal RTA

(also known as RTA type 2)

A low urine chloride (<10 mEq) suggests what possible underlying problems?

Gastric fluid losses

Diarrhea

Cystic fibrosis

A high urine chloride (>10 mEq) in a patient with high blood pressure suggests what two diagnoses?

Cushing’s syndrome or

Hyperaldosteronism

If the urine chloride is high, and blood pressure is normal, what are the most likely causes?

Acute diuretic use

Bartter’s syndrome

Which psychiatric medication sometimes causes DI?

Lithium

Normal urine output for an infant?

1–2 cc/kg/day

How can you calculate an approximate “ bladder capacity ?”

(in ounces)

Child’s age + 2

For metric results use:

7 × weight in kg = mL in infants

Age in years × 30 + 30 = mL in children

How is proteinuria diagnosed?

Either a 24-h urine or

A spot urine

When can proteinuria be a normal finding?

Alkaline urine

Concentrated urine

(high specific gravity)

How does the urine protein/creatinine ratio help you diagnose proteinuria in kids?

Urine protein/urine creatinine >0.2 diagnoses proteinuria

(However, nephrotic range proteinuria is >2.0)

How can you use the urine protein-creatinine ratio to diagnose proteinuria in an infant older than 6 months?

Same process, but >0.5 is considered proteinuria in infants (6–24 months)

Which aspects of history are especially important to pay attention to in renal questions?

Edema

UTI history

Toxin exposure

Hearing loss

(Hearing loss is associated with certain causes like Alport syndrome, or drug side effects, and is also a tip-off to possible renal dysfunction in newly presenting patients, because renal patients have an unusually high rate of sensorineural hearing loss)

If a question states that urine has both protein and bacteria in it, which is probably more important?

The bacteria

What is a common presenting complaint for hypercalciuria – even if no kidney stones have formed?

Abdominal pain and dysuria

What is the main underlying problem that leads to the nephrotic syndrome?

The glomerulus is too leaky

(Podocyte dysfunction and loss of basement membrane negative charge are involved)

Patients with nephrotic syndrome appear to be fluid overloaded, because they are edematous. What is their main fluid or electrolyte issue?

Intravascular fluid depletion

(It’s all leaked out!)

What are the immune consequences of nephrotic syndrome?

Poor immune function – IgG & complement are low

(they leak out, also)

What infection are nephrotic syndrome patients at special risk of developing?

Encapsulated organisms

(such as Strep pneumo and H. flu )