ABP Pediatric Nephrology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Minimal change disease

Most common cause of childhood nephrotic syndrome, especially under age 10; light microscopy is normal, proteinuria is selective, and most children respond to corticosteroids within 4 weeks.

Post-streptococcal glomerulonephritis

Follows group A streptococcal pharyngitis or impetigo by 1-3 weeks; presents with hematuria, hypertension, edema, low C3, and elevated ASO; resolves with supportive care and C3 normalizes in 6-8 weeks.

Hemolytic uremic syndrome

Triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury, usually from Shiga toxin-producing E. coli O157:H7; treatment is supportive with dialysis, avoiding antibiotics and antimotility drugs.

Alport syndrome

X-linked nephritis from COL4A5 mutations; presents with microscopic hematuria, progressive chronic kidney disease, sensorineural hearing loss, and anterior lenticonus; ACE inhibitors slow progression.

Osmotic demyelination prevention

Correcting chronic hyponatremia faster than 8-10 mEq/L per 24 hours risks osmotic demyelination; hypertonic saline is reserved for seizures or severe symptoms.

Proximal renal tubular acidosis

Type 2 RTA: impaired proximal bicarbonate reabsorption causes bicarbonaturia and hypokalemia; urine pH falls below 5.5 once bicarbonate is depleted; may accompany Fanconi syndrome.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate, normal 8-12 mEq/L; with hypoalbuminemia add 2.5 times (4 minus measured albumin) for the corrected value.

Hyperkalemia emergency treatment

Give IV calcium gluconate first when ECG changes are present, then insulin with glucose and albuterol to shift potassium intracellularly; remove potassium with binders or dialysis.

Pediatric hypertension threshold

Hypertension is systolic or diastolic blood pressure at or above the 95th percentile for age, sex, and height on three occasions; stage 2 is at or above the 99th percentile plus 5 mmHg.

White coat hypertension

Elevated office blood pressure with normal readings on 24-hour ambulatory monitoring; identifying it avoids unnecessary medication and further evaluation.

Coarctation of the aorta

Presents with upper-extremity hypertension, lower-extremity hypotension, and diminished femoral pulses; associated with bicuspid aortic valve; may cause residual or recurrent hypertension after repair.

Bilateral renal artery stenosis

ACE inhibitors and ARBs are contraindicated because they reduce glomerular filtration pressure, causing acute kidney injury and hyperkalemia in this setting.

KDIGO acute kidney injury criteria

AKI is a creatinine rise of at least 0.3 mg/dL within 48 hours, at least 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Fractional excretion of sodium

FENa equals (urine sodium × plasma creatinine) divided by (plasma sodium × urine creatinine) × 100; below 1% suggests prerenal AKI, above 2% suggests intrinsic injury, and diuretics make it unreliable.

Tumor lysis syndrome

Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia from massive cell lysis; treat with aggressive hydration and rasburicase to lower uric acid.

Continuous renal replacement therapy

Preferred for hemodynamically unstable children with AKI, severe fluid overload, or need for gradual solute and fluid removal; modalities include CVVH, CVVHD, and CVVHDF.

CKD GFR staging

KDIGO stages chronic kidney disease by GFR: G1 at least 90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, and G5 below 15 mL/min/1.73 m².

CKD mineral bone disease

Phosphate retention and low calcitriol cause hypocalcemia and secondary hyperparathyroidism; treat with dietary phosphate restriction, phosphate binders, and active vitamin D.

Growth hormone in CKD

Recombinant human growth hormone at about 0.05 mg/kg/day improves height velocity in children with CKD and growth failure after nutrition, acidosis, and bone disease are optimized.

CKD anemia management

Normocytic normochromic anemia results from low erythropoietin; correct iron deficiency first, then use erythropoiesis-stimulating agents targeting hemoglobin around 11-12 g/dL.

Peritoneal dialysis peritonitis

Cloudy effluent with abdominal pain and effluent white count above 100 cells/mm³, mostly neutrophils, indicates peritonitis; treat with intraperitoneal vancomycin plus a cephalosporin.

Dialysis disequilibrium syndrome

Cerebral edema from rapid urea removal during early dialysis sessions; prevent with shorter, slower first treatments and mannitol; presents with headache, seizures, and altered mental status.

Arteriovenous fistula maturation

Arteriovenous fistulas are the preferred hemodialysis access in children over about 20 kg and require 6-8 weeks to mature before first use.

CVVH versus CVVHD

CVVH uses convective clearance with replacement fluid, CVVHD uses diffusive clearance with dialysate, and CVVHDF combines both to achieve higher solute clearance.

Tacrolimus monitoring

Calcineurin inhibitor that blocks IL-2 transcription and T-cell activation; monitored by trough levels, and causes nephrotoxicity, hyperkalemia, hypomagnesemia, tremor, and hypertension.

Acute cellular rejection

Rising creatinine, fever, and graft tenderness weeks to months after transplant; biopsy shows interstitial lymphocytic infiltrate and tubulitis; treated with pulse corticosteroids.

BK virus nephropathy

Polyomavirus reactivation causes tubulointerstitial nephritis and graft dysfunction; screen with urine decoy cells and plasma PCR; primary treatment is reduction of immunosuppression.

Post-transplant lymphoproliferative disorder

EBV-driven lymphoid proliferation from intensified immunosuppression; presents with lymphadenopathy, fever, or a graft mass; treat by reducing immunosuppression and using rituximab.

Posterior urethral valves

Most common lower urinary tract obstruction in boys; bilateral hydronephrosis, thick-walled bladder, and keyhole urethra on imaging; treat with catheter drainage and endoscopic valve ablation.

Vesicoureteral reflux grading

Graded I-V by voiding cystourethrogram; grade I involves the ureter only and grade V shows gross dilation and tortuosity; management ranges from observation to antibiotic prophylaxis and surgery.

Autosomal recessive polycystic kidney disease

PKHD1 mutations cause enlarged cystic kidneys, congenital hepatic fibrosis, and portal hypertension; severe perinatal disease causes oligohydramnios and Potter sequence.

Nephrogenic diabetes insipidus

Renal resistance to vasopressin from AVPR2 or aquaporin-2 mutations; causes polyuria, dilute urine, and hypernatremia; treated with a low-solute diet, thiazides, and amiloride.