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Flashcards in Renal / GU Deck (113)
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What is the definition of hematuria?

3 or more RBC per high power field

1

What is the likely diagnosis in a boy who participates in vigorous sports who has dark urine and 1-2 RBC on urinalysis ?

Myoglobinuria

2

What should you do in a patient who presents with isolated asymptomatic microscopic hematuria?

Repeat UA in 2 weeks

3

What 2 things should be checked in a patient with persistent microscopic hematuria?

blood pressure and calcium/creatinine ratio

4

What is an abnormal calcium/creatinine ratio?

Greater than 0.25

5

What lab and imaging studies should be ordered in a patient with persistent microscopic hematuria and normal calcium/creatinine ratio? (7 answers)

Bun/creatinine
Electrolytes
C3/C4
ANA
ASO
ANCA
Renal/bladder US

6

What could be the cause of hematuria in a patient on LASIX?

Hypercalciuria

7

What is the next step in a patient with elevated calcium/creatinine ratio? What result would be diagnostic?

24 hour collection
>4 mg/day confirms hypercalciuria

8

What diagnosis should you consider in a one day old patient who presents with palpable flank mass and unilateral mass on ultrasound?

UPJ obstruction

9

What diagnosis should you consider in a patient with microscopic hematuria after a MVA? How would this present on imaging?

UPJ obstruction
Hydronephrosis

10

How do you confirm UPJ obstruction? What's the next test after the diagnosis is confirmed?

Renal scan shows delayed excretion

Vcug should be done to look for reflux in other kidney

11

When should cystoscopy be performed in a child with hematuria ?

Never - only indicated in adults

12

What are the common causes of gross hematuria in children? (9 answers)

H (HSP or hereditary nephritis)
E (bEnign familial)
M (membranoproliferative)
A (Alport or IgA nephropathy)
T (trauma)
U (UPJ obstruction)
R (renal stones)
I (infectious - strep)
A (abnormal sickle cells)

13

What diagnosis would you consider in a patient with painless tea colored urine?

Glomerulonephritis

14

What is the next step in a patient with isolated proteinuria that resolves on first void urine?

3 month follow up

15

What is the appropriate next step in a patient with isolated proteinuria even on first morning void? What finding would be considered abnormal?

Protein creatinine ratio (renal disease suggested if ratio >0.2)

16

What are 3 common causes of benign transient proteinuria?

Fever
Exercise
dehydration

17

What is the inheritance of Alport syndrome?

X linked dominant

18

What diagnosis should you consider in a patient with bilateral sensorineural hearing loss, ocular defects and renal failure ?

Alport syndrome

19

What is the likely diagnosis in a patient with a unilateral flank mass who has oligohydramnios in utero?

Multicystic dysplastic kidney

20

What is the gross pathology of a multicystic dysplastic kidney?

Enlarged kidney with non communicating cysts with thin parenchyma and dysplasia

21

What are other urinary tract anomalies that occur in 50% of patients with unilateral multicystic dysplastic kidney disease ? (4 answers)

UPJ obstruction
Vesicoureteral reflux
Posterior urethral valves
Megaureter and duplication

22

What is the best initial study to diagnose multicystic dysplastic kidney?

Renal ultrasound

23

What is the next best step in a patient with confirmed multicystic dysplastic kidney disease ?

Vcug to rule out other urinary tract anomalies

24

What diagnosis should you consider in a patient with kidney mass, palpable liver, thrombocytopenia and hematemesis?

Multicystic dysplastic kidney or autosomal recessive polycystic kidney disease
and resulting portal hypertension

25

What diagnosis should you consider in an infant with bilateral flank masses and hx of oligohydramnios ?

Autosomal recessive polycystic kidney disease

26

What other malformation is associated with autosomal dominant (adult) polycystic kidney disease?

Intracranial aneurysm

27

What diagnosis presents with polyuria, enuresis and low specific gravity as well as short stature, anemia and eye problems?

Juvenile onset medullary cystic disease aka nephronopththisis

28

What eye problem is associated with nephronophthisis?

Retinitis pigmentosa

29

What diagnosis presents with dysuria, hematuria and abdominal pain as well as a mass from the urethral meatus?

Ureterocele