Paediatrics Marrow Pg 161-170 (Genitourinary System )
53 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the recommended GFR level to initiate Kidney Replacement Therapy (KRT)?

  • 20 ml/min/1.73 m²
  • 15 ml/min/1.73 m²
  • 10 ml/min/1.73 m²
  • 12 ml/min/1.73 m² (correct)

    • Hemodialysis is typically done at home for patients.

    False

    What is the advantage of peritoneal dialysis compared to hemodialysis?

    Better hypertension control.

    The definitive treatment for kidney failure after finding a donor is __________.

    <p>renal transplantation</p> Signup and view all the answers

    Match the type of dialysis with its key characteristics:

    <p>Peritoneal dialysis = Home set-up, approx 12 hr/day, better HTN control Hemodialysis = Hospital set-up, approx 3 times/week for 3-4 hrs each</p> Signup and view all the answers

    What is a primary characteristic of Vesico-Ureteric Reflux (VUR)?

    <p>Reflux of urine from the bladder into the ureter</p> Signup and view all the answers

    Vesico-Ureteric Reflux (VUR) is commonly caused by infections in children.

    <p>False</p> Signup and view all the answers

    What is the primary diagnostic tool used to confirm Vesico-Ureteric Reflux (VUR)?

    <p>micturating cysto urethrogram (MCV)</p> Signup and view all the answers

    What is the minimum absolute increase in serum creatinine that indicates Acute Kidney Injury (AKI)?

    <p>0.3 mg/dl</p> Signup and view all the answers

    Decreased urine output is defined as less than 0.5 ml/kg/hr for over 6 hours in AKI.

    <p>True</p> Signup and view all the answers

    Vesico-Ureteric Reflux may lead to __________ of the kidneys due to recurrent urinary tract infections.

    <p>scarring</p> Signup and view all the answers

    What are the two main characteristics used to define acute kidney injury?

    <p>Increased serum creatinine and decreased urine output.</p> Signup and view all the answers

    Match the following features of VUR with their correct descriptions:

    <p>Autosomal dominant = Screen siblings for VUR CKD = Chronic Kidney Disease from bilateral VUR Hypertension = Possible complication of bilateral VUR Reflux nephropathy = Renal damage due to reflux</p> Signup and view all the answers

    An absolute serum creatinine level of _____ mg/dl or greater indicates a significant decline in kidney function.

    <p>4</p> Signup and view all the answers

    Match the following stages of AKI with their corresponding serum creatinine increases:

    <p>Stage 1 = ↑ of ≥ 0.3 mg/dl over 48 hrs or 1.5 to 2 fold from baseline Stage 2 = 2 to 3 fold increase from baseline Stage 3 = Absolute serum creatinine ≥ 4 mg/dl or patient undergoing dialysis</p> Signup and view all the answers

    What is the mode of inheritance of Liddle Syndrome?

    <p>Autosomal dominant</p> Signup and view all the answers

    Liddle Syndrome is caused by a loss of function mutation in the SCNN1 gene.

    <p>False</p> Signup and view all the answers

    What is the result of ENAC overactivity in Liddle Syndrome?

    <p>Increased sodium reabsorption and subsequent hypertension.</p> Signup and view all the answers

    In Liddle Syndrome, the primary electrolyte imbalance seen is __________.

    <p>hypokalemia</p> Signup and view all the answers

    Match the following features with their related conditions:

    <p>Metabolic alkalosis = Liddle Syndrome Hypokalemic metabolic alkalosis = Bartter Syndrome Metabolic acidosis = Gitelman Syndrome Hypermagnesemia = Not specifically associated with any</p> Signup and view all the answers

    Which of the following is a consequence of ENAC overexpression in Liddle Syndrome?

    <p>Hypertension</p> Signup and view all the answers

    Inhibition of aldosterone secretion is a feature of Liddle Syndrome.

    <p>True</p> Signup and view all the answers

    Name one type of evaluation associated with Liddle Syndrome.

    <p>Hypokalemic metabolic alkalosis.</p> Signup and view all the answers

    What is the primary mode of inheritance of Gitelman syndrome?

    <p>Autosomal Recessive</p> Signup and view all the answers

    Gitelman syndrome is characterized by hyperkalemia.

    <p>False</p> Signup and view all the answers

    Which region of the nephron is primarily affected in Gitelman syndrome?

    <p>Distal Convoluted Tubule (DCT)</p> Signup and view all the answers

    Gitelman syndrome results in excretion of __________ and __________ in urine, leading to metabolic alkalosis.

    <p>Na+</p> Signup and view all the answers

    Match the following consequences of Gitelman syndrome with their descriptions:

    <p>Hypokalemia = Low potassium levels in the blood Hypomagnesemia = Low magnesium levels in the blood Hypochloremic = Low chloride levels in the blood Metabolic alkalosis = Increased blood pH due to bicarbonate retention</p> Signup and view all the answers

    What is the typical pH level of urine?

    <p>Acidic</p> Signup and view all the answers

    Urine is typically neutral in pH.

    <p>False</p> Signup and view all the answers

    What is the primary characteristic of urine concerning its pH level?

    <p>Acidic</p> Signup and view all the answers

    The pH of urine is generally considered to be __________.

    <p>acidic</p> Signup and view all the answers

    Match the following urine properties with their characteristics:

    <p>Acidic = Prevents bacterial growth Basic = Promotes UTIs Neutral = Rarely occurs in human urine Variable = Depends on diet and hydration</p> Signup and view all the answers

    Which of the following is a clinical presentation of inherited tubular disorders?

    <p>Polyuria</p> Signup and view all the answers

    Electrolyte imbalances are not associated with inherited tubular disorders.

    <p>False</p> Signup and view all the answers

    What is the primary defect seen in Fanconi syndrome?

    <p>Type II Renal Tubular Acidosis (RTA)</p> Signup and view all the answers

    The reabsorption of bicarbonate, glucose, and amino acids primarily occurs in the ________.

    <p>proximal convoluted tubule (PCT)</p> Signup and view all the answers

    Match the inherited tubular disorders with their characteristics:

    <p>Fanconi syndrome = Type II Renal Tubular Acidosis Bartter syndrome = Electrolyte imbalances with hypokalemia Gitelman syndrome = Electrolyte imbalances with magnesium wasting Liddle syndrome = Hypertension due to increased sodium reabsorption</p> Signup and view all the answers

    What is the most common presentation of D+ HUS?

    <p>Diarrhea</p> Signup and view all the answers

    The Coombs' test is typically positive in cases of D+ HUS.

    <p>False</p> Signup and view all the answers

    What are schistocytes, and where are they typically found?

    <p>Lysed red blood cells found in the peripheral smear.</p> Signup and view all the answers

    The duration of symptoms in D+ HUS typically lasts for __________ days.

    <p>5-10</p> Signup and view all the answers

    Match the following stages of Chronic Kidney Disease (CKD) with their corresponding GFR values:

    <p>Stage 1 = GFR &gt; 90 Stage 2 = GFR 60-89 Stage 3 = GFR 30-59 Stage 4 = GFR 15-30 Stage 5 = GFR &lt; 15</p> Signup and view all the answers

    Which of the following is a common cause of obstructive uropathy?

    <p>Stones</p> Signup and view all the answers

    Reflex nephropathy causes scars in the kidneys.

    <p>True</p> Signup and view all the answers

    What is the recommended management for short stature in patients with renal complications?

    <p>Recombinant growth hormone (rGH)</p> Signup and view all the answers

    The primary management for anemia in patients with GFR less than 30 ml/min/1.73 m² is __________.

    <p>Darbopoetin</p> Signup and view all the answers

    Match the following management strategies with their corresponding complications:

    <p>Anemia = Darbopoetin injection Mineral bone disease = Calcitriol supplementation Short stature = Recombinant growth hormone Hypertension = Lifestyle management</p> Signup and view all the answers

    Which of the following is a pre-renal cause of Acute Kidney Injury (AKI)?

    <p>Dehydration</p> Signup and view all the answers

    Hemolytic Uremic Syndrome (HUS) can be classified into two types: D+ and D-.

    <p>True</p> Signup and view all the answers

    What is the primary goal in the management of pre-renal AKI?

    <p>Restore circulating blood volume</p> Signup and view all the answers

    In the case of hyperkalemia, _________ can be used to shift potassium intracellularly.

    <p>insulin</p> Signup and view all the answers

    Match the complications of AKI with their management:

    <p>Anemia = Packed Red Blood Cell transfusion Metabolic acidosis = IV sodium bicarbonate Hyperkalemia = Dialysis if refractory Hyponatremia = Fluid management</p> Signup and view all the answers

    Study Notes

    Kidney Replacement Therapy (KRT)

    • For patients with End Stage Kidney Disease (ESKD).
    • Starts when Glomerular Filtration Rate (GFR) is below 12 ml/min/1.73 m².
    • Two main types:
      • Dialysis:
        • Peritoneal dialysis: Done at home, involves fluid exchange in the peritoneal cavity.
        • Hemodialysis: Done in hospital, involves filtering blood through a machine.
      • Renal transplantation: The preferred treatment, involves receiving a kidney transplant.

    Vesico-Ureteric Reflux (VUR)

    • Backflow of urine from the bladder to the ureters.
    • Usually present at birth.
    • Can cause scarring of the kidneys and lead to CKD.
    • Diagnosed using micturating cysto urethrogram (MCU), also known as voiding cysto urethrogram (VCUG).

    Acute Kidney Injury (AKI)

    • Sudden decrease in kidney function.
    • Key features:
      • Increase in serum creatinine levels, either absolute or relative.
      • Decreased urine output.
      • Staged based on severity of creatinine elevation and urine output.

    Inherited Tubular Disorders (ITDs)

    • Group of disorders affecting the kidneys' ability to reabsorb water, electrolytes, and nutrients.
    • Common symptoms:
      • Polyuria (excess urine production)
      • Electrolyte imbalances
      • Failure to thrive
    • Some common ITDs:
      • Fanconi syndrome
      • Bartter syndrome
      • Gitelman syndrome
      • Liddle syndrome

    Fanconi Syndrome

    • Generalized proximal tubule dysfunction.
    • Key features:
      • Impaired bicarbonate reabsorption leading to metabolic acidosis with normal anion gap.
      • Glycosuria (glucose in urine)
      • Aminoaciduria (amino acids in urine)
      • Phosphaturia (phosphate in urine)

    D+ HUS

    • Hemolytic Uremic Syndrome associated with diarrhea.
    • Caused by Shiga-toxin producing bacteria like Shigella dysenteriae or Enterohemorrhagic E.coli (EHEC).
    • Key features:
      • Most common age group: under 4 years old.
      • Usually presents with diarrhea.
      • Symptoms: pallor, weakness, oliguria (reduced urine output).
    • Often self-resolving, but supportive care and antibiotics are needed. Dialysis may be required in severe cases.

    Chronic Kidney Disease (CKD)

    • Progressive decline in kidney function over time.
    • Staged based on GFR and other factors.
    • Management focuses on slowing the progression of CKD and treating complications.

    Genitourinary System

    • The system responsible for the production, storage, and elimination of urine.
    • Includes kidneys, ureters, bladder, and urethra.

    Etiology of Chronic Kidney Disease (CKD)

    • Variety of causes:
      • Active space (structural):
        • Obstructive uropathy: blockage in the urinary tract.
        • Reflex nephropathy: damage caused by vesicoureteric reflux.
      • Chronic glomerulonephritis: inflammation of the filtering units of the kidneys.
      • Congenital anomalies: birth defects in the urinary system.

    Management of Chronic Kidney Disease (CKD)

    • Focuses on addressing the cause and managing complications:
      • Surgical correction: for structural anomalies.
      • Medical management for irreversible damage.
      • Nutritional guidance: No protein restrictions, but emphasis on polyunsaturated fatty acids (PUFAs) and complex carbohydrates to promote growth.

    Complications of Chronic Kidney Disease (CKD)

    • Common complications and their management:
      • Anemia:
        • Cause: reduced erythropoietin production.
        • Management: Darbopoetin (recombinant erythropoietin).
      • Mineral Bone Disease:
        • Cause: imbalance of calcium, phosphorus, and Vitamin D.
        • Management: Calcitriol supplementation, calcium supplementation, phosphate binders (calcium-based or non-calcium based).
      • Short stature:
        • Management: Recombinant growth hormone (rGH).
      • Hypertension (HTN):
        • Management: Lifestyle modifications, ACE inhibitors, ARBs.

    Acute Kidney Injury (AKI)

    • Etiology of AKI:
      • Pre-renal causes (most common): Reduced blood flow to the kidneys.
      • Renal causes: Direct damage to the kidney tissues.
      • Post-renal causes: Blockage in the urinary tract.

    Management of AKI

    • Focuses on identifying the cause and providing appropriate treatment:
      • Pre-renal AKI: Fluid resuscitation
      • Renal AKI: Fluid management and preventing further kidney injury.

    Complications of AKI

    • Include:
      • Anemia: Managed with PRBC transfusion if needed.
      • Metabolic acidosis: Managed with IV sodium bicarbonate.
      • Hyponatremia: May require fluid management.
      • Hyperkalemia: Managed with fluid management, K+ binding resins, or dialysis in refractory cases.

    Hemolytic Uremic Syndrome (HUS)

    • Two main types:
      • D+ HUS: Associated with diarrhea, caused by Shiga-toxin producing bacteria.
      • D- HUS: Not associated with diarrhea, caused by a defect in the alternate complement pathway.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on crucial kidney health topics such as Kidney Replacement Therapy, Vesico-Ureteric Reflux, and Acute Kidney Injury. This quiz covers definitions, diagnostics, and treatment options that are essential for understanding these conditions. Perfect for healthcare students and professionals alike.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser