Coca Cola Urine
A 5-year old boy with history of URI 1-week ago presents with a new rash on the buttocks and lower extremities. He also complains of abdominal pain and joint pain, with new brown-colored urine. What is the most likely diagnosis?
What is IgA Vasculitis? (Henoch Schönlein Purpura, HSP)
What is the most common cause of nephrotic syndrome in pediatrics?
What is Minimal Change Disease?
Commonly presents with early morning eyelid swelling (can be misdiagnosed as allergies). Overall good prognosis, but relapses are common.
What is the most common cause of death in CKD?
What is cardiovascular disease?
Heart attacks/heart failure often from years of poorly controlled hypertension and accumulation of waste leading to damaged vasculature.This is the most common cause of obstructive uropathy (often presents in neonatal period).
What is posterior urethra valves (PUV)?
Most cases are found prenatally with bilateral hydroureteronephrosis seen on imaging. All patients with PUV require an immediate urology consult for bladder drainage.
What is the significance of low FeNa?
FeNa < 1% is indicative of pre-renal AKI.
FENa (%) = (Urine Sodium / Plasma Sodium) / (Urine Creatinine / Plasma Creatinine) * 100
An 8-year old boy with recent sore throat 10 days ago develops new onset painless hematuria. What lab test could confirm the diagnosis?
What is anti-streptolysin?
You can also see elevations in anti-DNase B
What are the criteria for Nephrotic Syndrome?
- Heavy proteinuria (>1,000 mg/m2/day) or random urine protein:creatinine ratio > 2
- Hypoalbuminemia (serum albumin < 3)
- Edema
- Hypercholesterolemia
This is a common disorder of chronic kidney disease associated with abnormalities of calcium and phosphorous, elevated parathyroid hormone, vitamin D metabolism, and disordered bone mineralization.
What is renal osteodystrophy? (Hungry bone disease)
Abnormal bone mineralization and turnover, leading to weakened and brittle bones, and an increased risk of fractures
What are the three primary features of Hemolytic Uremic Syndrome?
Microangiopathic hemolytic anemia, AKI, and thrombocytopenia
What are the most common electrolyte disturbances in patients on loop diuretics?
What is hypochloremia, hyponatremia and hypokalemia?
A 10-year old female is seeing you in clinic after recent recovery from post-strep glomerulonephritis. Mom is frustrated and feels like this could have been avoided with antibiotics. Does antibiotic therapy help in preventing PSGN?
No - antibiotic treatment of strep throat will only prevent rheumatic fever and spread to your friends :)
What is the best way to manage edema in nephrotic syndrome patients?
What is salt restriction (<2g per day)?
Fluids can also be restricted, but not typically necessary if following a strict low Na diet. Steroids are the most common form of therapy and used in relapses to obtain remission.
Name at least one type of access for a patient recieving hemodialysis.
- Tunneled catheter (most commonly in the internal jugular?
- Arteriovenous fistula
- Arteriovenous graft
A newborn presents with oligohydramnios, low-set ears, a flat nose, and retracted chin. He is also noted to have palpable abdominal masses, significant hypertension and hepatic fibrosis. What is his most likely diagnosis?
What is Autosomal Recessive Polycystic Kidney Disease (ARPKD)?
Caused by mutation in PKHD1 gene which encodes for fibrocystin. Hepatic fibrosis is a universal finding. Oligohydramnios develops from intrauterine kidney failure and results in insufficient lung development and Potter facies.This is an alternative test of kidney function that is not dependent on muscle mass.
What is Cystatin C?
7 year-old girl presents with sore throat, coca-cola colored urine, and hypertension. What is the most likely diagnosis?
What is IgA Nephropathy?
Most commonly concurrent with acute illness. Recurrent episodes help to differentiate from PSGN.
A 14 year-old girl presents to clinic for evaluation. Urine dipstick at school was positive for protein. Vital signs are within normal limits, she is growing well and just finished a growth spurt. Repeat urine testing in the office shows proteinuria, with otherwise normal UA. What is her diagnosis?
What is Benign Orthostatic Proteinuria?
Check a first-morning urine sample to help differentiate orthostatic proteinuria from persistent proteinuria.What are the five indications for dialysis?
Acidosis (pH < 7.1, refractory)
Electrolyte disturbances (hyperkalemia)
Ingestion (Ethylene glycol, lithium, salicylates)
Fluid Overload (symptoms of pulmonary edema or no response to diuretics)
Uremia (typically BUN > 90, encephalopathy)
This hereditary nephritis presents with persistent hematuria, progressive renal failure, sensorineural hearing loss, and ocular abnormalities—and is often associated with mutations in the COL4A5 gene.
What is Alport Syndrome?
Mutations in Type 4 collagen affect the basement membrane of the kidneys, ears, and eyes.
Name at least 4 causes of high-anion gap metabolic acidosis
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron/Isoniazide/Inborn errors
Lactic acidosis
Ethylene glycol
Salicylates
How can you differentiate between PSGN, lupus, and IgA nephropathy with complement levels?
IgA Nephropathy: Normal C3/C4.
PSGN: Low C3, typically normal C4.
Lupus Nephritis: Low C3/C4
What are the two most common complications of nephrotic syndrome?
What is infection and thrombosis?
Infection is often from loss of IgG and steroid therapy. Thrombosis is secondary to hypercoagulable state from thrombocytosis, increased production of pro-coagulant proteins, and loss of anticoagulant proteins.
Most common thromboses in the renal vein or saggital sinus.
eGFR (creatinine clearance) of 15-29 puts you in this stage of CKD
What is Stage 4 (severely reduced kidney function)?
Stage 1: GFR > 90, normal kidney function.Stage 2: GFR 60-89, mild kidney damage with close to normal function.
Stage 3: GFR 30-59, mild to moderate kidney damage with decreased function.
Stage 4: GFR 15-29, Severe kidney damage with very little function.
Stage 5: GFR < 15, ESRD
This autosomal recessive tubulopathy presents in infancy or early childhood with hypokalemia, metabolic alkalosis, normal to low blood pressure, and elevated renin and aldosterone—mimicking chronic loop diuretic use.
What is Bartter Syndrome?
Abnormal solute transport in the thick ascending limb of the loop of Henle results in loss of Na, Cl, Ca, and Mg in the urine.
Name at least 4 treatments for hyperkalemia
IV calcium gluconate, albuterol, insulin (and dextrose), sodium bicarbonate, Kayexalate (cation exchange resin)