Pediatric Nephrology and Urology
Core concepts
Understand the evaluation of hematuria and proteinuria (transient versus persistent, glomerular versus tubular), the nephrotic syndrome (minimal change disease, steroid response), and acute glomerulonephritis (post-streptococcal, low C3). Know the causes and management of acute kidney injury (prerenal, intrinsic, postrenal) and chronic kidney disease. Master urinary tract infection diagnosis and imaging, vesicoureteral reflux, and the approach to a child with a renal mass or ambiguous genitalia.
Traps
Questions test whether you can distinguish nephrotic (heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia) from nephritic (hematuria, hypertension, oliguria) presentations. Another trap is over-imaging a first febrile UTI in an older child or under-imaging a young infant. Do not forget that a low C3 in glomerulonephritis suggests post-streptococcal disease or lupus.
Worked example
A 5-year-old with periorbital edema, ascites, proteinuria, and a normal blood pressure has nephrotic syndrome; the first-line treatment is corticosteroids, and biopsy is reserved for steroid resistance or atypical features. The trap is performing a renal biopsy before a steroid trial in a typical presentation.
Rule of thumb
Nephrotic = protein; nephritic = blood and hypertension. The presence of hypertension and hematuria pushes you away from minimal change disease.