Pedia 3a - Nephro Gn - Dr. Matheus Samplex - Ejg

PEDIA 3A – NEPHRO GN - DR. MATHEUS (SAMPLEX) (Sabayan nyo ng trans to. Gamit ko yung 3B trans. Pero paulit ulit lang naman yung mga tanong. At madaming cases.Napaghalo ko yung majors and shiftings. Pero umuulit lang talaga yung mga tanong. STUDY AT YOUR OWN RISK.)

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Mga clue lang from samplex dahil nalilito din ako dito:

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UTI - imaging: ultrasound of kidneys and urinary bladder - confirm: urine culture and sensitivity - better sensitivity: pyuria and nitrite test and wbc esterase test - to diagnose: do a urine culture - neonates: sepsis syndrome - infant: fever - lower UTI: Amoxicillin Nephrotic syndrome - hematuria - massive protein loss in the urine - initial diagnostic study: urinalysis - DOC: prednisone - pag may sinabing varicella sa case: give varicella immune globulin - pag vaccine tas naka steroid si patient: conjugate pneumococcal - to determine presence of nephrotic range proteinuria: urine protein/creatinine ratio - manifestation is caused by: hyperalbuminemia PIGN - edema, swelling - confirm: urinalysis, complement 3, ASO titer, creatinine - strengthen diagnosis: latent period Glomerulonephritis - Cardinal manifestation: hematuria - Lab exam to diagnose: Urinalysis - GN is considered when: urinalysis has significant hematuria and proteinuria - Complication: hypertension IgA nephropathy - IgA deposition WITHOUT systemic disease - assoc with URTI

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HSP - IgA deposits in mesangial cells of glomerulus WITH systemic manifestations HUS - Microangiopathic haemolytic anemia - Hemoglobinuria - tea colored urine (yung PIGN and IgA nephro may tea colored din pero meron silang edema and URTI respectively) Hemorrhagic cystitis - bright red urine with blood clots

MAJOR EXAMS AND SHIFTINGS HEMATURIA IS GLOMERULAR  Urinalysis is positive for significant hematuria and proteinuria MICROSCOPIC HEMATURIA  Isolated microscopic hematuria: Long term follow up is necessary to rule out progressive renal disease  Isolated microscopic hematuria: correlates with best renal prognosis  Case: 10y/o female. Microscopic hematuria from 10-20 rbc/hpf on 3 diff occasions. No complaints by the patient. PE findings were normal. Next step: repeat urinalysis and observe  Alport's syndrome: initially presents with microscopic hematuria without systemic manifestations in vhildren but may persist in adulthood with associated sensorineural loss  CASE: 11 y/o male consulted due to isolated microscopic hematuria ranging from 10-20 RBC/Hpf on 3 separate occasions. There are no complaints by the patient and PE findings were essentially normal. As part of hx taking it is important to ask for: Family hx of chronic kidney dse  CASE: On a routine examination done for school entrants, a 6 y/o male was found to have microscopic hematuria ranging from 1020rbc/hpf and proteinuria of +2. The patient was asymptomatic. What would you ask if you are thinking of glomerulonephritis?: history of previous infection

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In children: >40,000 CFU from a suprapubic sample In children: Initial renal imaging: ultrasound of the kidneys and urinary bladder Case: 2y/o girl, had 2 eps of UTI in the past 4mos. Urine culture was E. coli >100,000 CFU/ml. Renal imaging study: ultrasound of the kidneys and urinary bladder Neonates: Sepsis is the most common manifestation of UTI; sepsis syndrome Highest possibility that UTI is present: positive test for WBC esterase and nitrite test Better sensitivity for diagnosing true UTI: pyuria, +nitrite test, +WBC esterase test, bacteriuria Case: 3y/o, abd pain, fever, pain on urination, lower abdominal tenderness, right sided costo-vertebral angle tenderness. To confirm diagnosis: urine culture and sensitivity Case: 3 month old boy, high grade fever for one day. Urinalysis was done and revealed Dark colored urine with pus cell of 50-60/hpf, nitrite test+3 and WBC esterase test +2. Next step: do a urine culture (used to diagnose) In infant: seen as fever Suprapubic aspiration: any number of colonies Catheterized urine: >/= 10,000 colonies Clean catch urine: >/= 100,000 single colony Urine bag urine specimen: > 100,000 2 or more organisms Lower UTI: Amoxicillin For a case of UTI, in what situation would you advice advanced renal imaging?: Patients with midline anomalies at the lumar area Least reliable indicator for the presence of UTI: pus cells Usual organism isolated for UTI in children: E. coli

NEPHROTIC SYNDROME  Main event that leads to cascade of manifestations: massive protein loss in urine  Minimal Change Nephrotic Syndrome (MCNS): male, 2-6 years old, most steroid-responsive

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Proteinuria: greater than 40 mg/m2/hr Minimum: 40 mg/m2/hr Minimum duration of tx with high dose steroid prior tapering: 4 weeks Patients diagnosed with nephrotic syndrome should be started with prednisone: 60 mg/m2/day (sagot sa iba ay 20 mg/m2/day, di ko alam kung alin ang tama. Pero feeling ko yung 60 yung tama. Hahaha. Walang sisihan ah) Adult nephrotic syndrome: Membranous GN Case: 8y/o girl, new onset swelling around the eyes. Periorbital, sacral, pretibial edema. BP is 96/64. Most appropriate initial dx study: urinalysis Case: 2y/o male, pale looking, generalized edema. Urinalysis showed Albumin of +4. Serum albumin was 2.2 gm/dL. Cholesterol was 2x above normal. 24 hr urine protein was 44 mg/m2/hr. ASO titer was 200), Albumin 1.6 g/dL (hypoalbuminemia, coz