Current Diagnosis and Treatment Pediatrics: C
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h 24: Kidney & Urinary Tract Questions and Cor
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Whattshouldtbetincludedtintthethistorytwhentrenaltdiseasetistsuspected?
✓ ~~~t Precedingtacutetortchronictillnesses,trashestortjointtpain/swelling,tgrowthtdelaytortf
ailurettotthrive,turinarytsymptoms,thematuria/proteinuria,tpain,tsuddentweighttgain/losst
ortedema,tdrug/toxintexposure,tperinatalthistory,tfamilythistorytoftkidneytdisease
Whattaretimportanttaspectstoftthetphysicaltexaminationtfortevaluatingtthetkidneytandturi
naryttract?
✓ ~~~t Height,tweight,tgrowthtpercentiles,tskintlesions,tpallor,tedema,tskeletaltdeformities,
tanomaliestoftears/eyes/externaltgenitalia,tbloodtpressuretmeasurement,tabdominaltpal
pationtandtauscultation
Whattshouldtbetassessedtduringtbloodtpressuretmeasurementtintatchild?
✓ ~~~t Measuredtintatquiettsetting,twithtatmanualtcufftoftappropriatetsize,tintthetrighttuppe
rtextremity,tchildtseatedtwithtfeettflattontthetground,tcufftcoveringttwo-
thirdstoftthetchild'stuppertarm,tassessmenttoftperipheraltpulses
Whattshouldtbetassessedtduringtabdominaltpalpationtandtauscultationtintatchild?
✓ ~~~t Nephromegaly,tabdominaltmasses,tmusculature,tascites,tbruits
Whattistthetpurposetoftlaboratorytevaluationtoftrenaltfunction?
✓ ~~~t Totassesstkidneytfunctiontandtdetecttabnormalities
Whattistserumtanalysis?
✓ ~~~t Measurementtoftvarioustsubstancestintthetbloodttotevaluatetkidneytfunction
Whattsubstancestaretcommonlytmeasuredtintserumtanalysistfortrenaltfunction?
✓ ~~~t Creatinine,tbloodtureatnitrogent(BUN),telectrolytest(sodium,tpotassium,tchl
oride),talbumin
Whattistthetsignificancetoftcreatininetintserumtanalysis?
✓ ~~~t Indicatestkidneytfunctiontandtcanthelptdiagnosetkidneytdisease
Whattistthetsignificancetoftbloodtureatnitrogent(BUN)tintserumtanalysis?
, ✓ ~~~t Indicatestkidneytfunctiontandtcanthelptdiagnosetkidneytdisease
Whattistthetsignificancetoftelectrolytest(sodium,tpotassium,tchloride)tintserumtanalysis?
✓ ~~~t Imbalancestcantindicatetkidneytdysfunction
Whattistthetsignificancetoftalbumintintserumtanalysis?
✓ ~~~t Lowtlevelstcantindicatetkidneytdamagetortdisease
Whattisturinalysis?
✓ ~~~t Examinationtofturinettotassesstkidneytfunctiontandtdetecttabnormalities
Whattaretthetcomponentstoftaturinalysis?
✓ ~~~t Physicaltcharacteristics,tchemicaltanalysis,tmicroscopictexamination
Whattphysicaltcharacteristicstaretassessedtinturinalysis?
✓ ~~~t Color,tclarity,todor,tspecifictgravity
Whattchemicaltanalysististperformedtinturinalysis?
✓ ~~~t Measurementtoftsubstancestsuchtastglucose,tprotein,tblood,tpH
Whattmicroscopictexaminationtistperformedtinturinalysis?
✓ ~~~t Detectiontoftcells,tcasts,tcrystals,tbacteria
Whattistaturinetculture?
✓ ~~~t Laboratoryttestttotidentifytandtdeterminetthetsensitivitytoftbacteriatinttheturine
Whattistatrenaltultrasound?
✓ ~~~t Imagingttesttthattusestsoundtwavesttotvisualizetthetkidneystandturinaryttract
Whattistatrenaltbiopsy?
✓ ~~~t Procedurettotobtaintatsmalltsampletoftkidneyttissuetfortmicroscopictexa
mination
Whattaretthetstandardtindicatorstoftrenaltfunction?
✓ ~~~t Serumtlevelstoftureatnitrogentandtcreatinine.
Whattistthetnormaltratiotoftureatnitrogenttotcreatinine?
, ✓ ~~~t 10:1.
Whentmaytthetureatnitrogenttotcreatininetratiotincrease?
✓ ~~~t Whentrenaltperfusiontorturinetflowtistdecreased.
Whattcantcausetantincreasetintthetureatnitrogenttotcreatininetratio?
✓ ~~~t Urinaryttracttobstructiontortdehydration.
Whytistserumtcreatininetconsideredtthetmosttreliabletsingletindicatortoftglomerulartfunction
?
✓ ~~~t Becausetittistlesstaffectedtbytfactorstliketnitrogentintake,tcatabolism,tandtcorti
costeroidtuse.
Whattfactorstcantaffecttthetgenerationtoftcreatinine?
✓ ~~~t Age,tsex,tmalnutrition,tchronictillness,tandtamputation.
Howtdoestserumtcreatininetleveltchangetovertthetfirstt1-2tweekstaftertbirth?
✓ ~~~t Ittdeclinesttotreachtatnormaltleveltfortage.
WhattistserumtcystatintC?
✓ ~~~t Atcysteinetproteasetinhibitortproducedtbytalltnucleatedtcellstandtreleasedtintthet
blood.
HowtaretlevelstoftserumtcystatintCtaffected?
✓ ~~~t Theytaretnottaffectedtbytsex,theight,tortmuscletmass.
Whattistantadditionaltindicatortoftglomerulartfunctiontbesidestcreatinine?
✓ ~~~t SerumtcystatintC.
WhattaretsometlimitationstoftcystatintCtassays?
✓ ~~~t Theytaretlesstwidelytavailabletandtlesstreliabletintcertaintclinicaltsettings.
Whattaretsometlesstprecisetbuttimportanttindicatorstoftpossibletrenaltdisease?
✓ ~~~t Abnormalitiestoftserumtelectrolytes,tbicarbonate,tpH,tcalcium,tphosphorus,tm
agnesium,talbumin,tortcomplement.
WhattdoestGFRtstandtfor?
✓ ~~~t GlomerulartFiltrationtRate.
WhattdoestGFRtmeasure?
, ✓ ~~~t Thetratetattwhichtbloodtistfilteredtbytthetglomerulitintthetkidneys.
Whattdoestendogenoustcreatininetclearancet(CCr)testimate?
✓ ~~~t Glomerulartfiltrationtratet(GFR)
Whattistthet'classic'tapproachtfortdeterminingtCCr?
✓ ~~~t At24-hourturinetcollection
WhytistittdifficultttotaccuratelytobtaintCCrtintthetpediatrictpopulation?
✓ ~~~t Especiallytintchildrentwhotaretnottcontinent
Whattistthetnormaltrangetforttotaltdailytcreatininetexcretion?
✓ ~~~t 15-25tmg/kg
Aretnormaltvaluesthighertintmalestortfemales?
✓ ~~~t Highertintmales,treflectivetoftdifferencestintmuscletmass
WhattdoestthetCCrtformulatrequiretmeasurementstof?
✓ ~~~t Plasmatortserumtcreatininet(PCr),turinetcreatininet(UCr),tandturinetvolumet(V)
WhattistthetformulatfortcalculatingtCCr?
✓ ~~~t CCrt=t(UCrtxtV)t/tPCr
Whytistcorrectiontfortsizetneededtintchildren?
✓ ~~~t BecausetacceptedtrangestoftnormaltCCrtaretbasedtontadulttparameters
Whattistthetstandardtbodytsurfacetareatusedtfortcorrectiontintthetformula?
✓ ~~~t 1.73tm2
AttwhattagetdotchildrentreachtadulttlevelstoftGFR?
✓ ~~~t Approximatelyt2tyearstoftage
WhattdoestGFRtbelowt90tmL/min/1.73tm2tintchildrent>t2tindicate?
✓ ~~~t Underlyingtkidneytdisease
WhentcantequationsttotestimatetGFRtbetused?
✓ ~~~t Whentthetcreatininetiststabletandtnottintpatientstwithtacutetkidneytinjuryt(AKI)
Whattistthet'BedsidetSchwartz'tequationtusedtfor?
t t t t t
h 24: Kidney & Urinary Tract Questions and Cor
t t t t t t t t
rect Answers t
Whattshouldtbetincludedtintthethistorytwhentrenaltdiseasetistsuspected?
✓ ~~~t Precedingtacutetortchronictillnesses,trashestortjointtpain/swelling,tgrowthtdelaytortf
ailurettotthrive,turinarytsymptoms,thematuria/proteinuria,tpain,tsuddentweighttgain/losst
ortedema,tdrug/toxintexposure,tperinatalthistory,tfamilythistorytoftkidneytdisease
Whattaretimportanttaspectstoftthetphysicaltexaminationtfortevaluatingtthetkidneytandturi
naryttract?
✓ ~~~t Height,tweight,tgrowthtpercentiles,tskintlesions,tpallor,tedema,tskeletaltdeformities,
tanomaliestoftears/eyes/externaltgenitalia,tbloodtpressuretmeasurement,tabdominaltpal
pationtandtauscultation
Whattshouldtbetassessedtduringtbloodtpressuretmeasurementtintatchild?
✓ ~~~t Measuredtintatquiettsetting,twithtatmanualtcufftoftappropriatetsize,tintthetrighttuppe
rtextremity,tchildtseatedtwithtfeettflattontthetground,tcufftcoveringttwo-
thirdstoftthetchild'stuppertarm,tassessmenttoftperipheraltpulses
Whattshouldtbetassessedtduringtabdominaltpalpationtandtauscultationtintatchild?
✓ ~~~t Nephromegaly,tabdominaltmasses,tmusculature,tascites,tbruits
Whattistthetpurposetoftlaboratorytevaluationtoftrenaltfunction?
✓ ~~~t Totassesstkidneytfunctiontandtdetecttabnormalities
Whattistserumtanalysis?
✓ ~~~t Measurementtoftvarioustsubstancestintthetbloodttotevaluatetkidneytfunction
Whattsubstancestaretcommonlytmeasuredtintserumtanalysistfortrenaltfunction?
✓ ~~~t Creatinine,tbloodtureatnitrogent(BUN),telectrolytest(sodium,tpotassium,tchl
oride),talbumin
Whattistthetsignificancetoftcreatininetintserumtanalysis?
✓ ~~~t Indicatestkidneytfunctiontandtcanthelptdiagnosetkidneytdisease
Whattistthetsignificancetoftbloodtureatnitrogent(BUN)tintserumtanalysis?
, ✓ ~~~t Indicatestkidneytfunctiontandtcanthelptdiagnosetkidneytdisease
Whattistthetsignificancetoftelectrolytest(sodium,tpotassium,tchloride)tintserumtanalysis?
✓ ~~~t Imbalancestcantindicatetkidneytdysfunction
Whattistthetsignificancetoftalbumintintserumtanalysis?
✓ ~~~t Lowtlevelstcantindicatetkidneytdamagetortdisease
Whattisturinalysis?
✓ ~~~t Examinationtofturinettotassesstkidneytfunctiontandtdetecttabnormalities
Whattaretthetcomponentstoftaturinalysis?
✓ ~~~t Physicaltcharacteristics,tchemicaltanalysis,tmicroscopictexamination
Whattphysicaltcharacteristicstaretassessedtinturinalysis?
✓ ~~~t Color,tclarity,todor,tspecifictgravity
Whattchemicaltanalysististperformedtinturinalysis?
✓ ~~~t Measurementtoftsubstancestsuchtastglucose,tprotein,tblood,tpH
Whattmicroscopictexaminationtistperformedtinturinalysis?
✓ ~~~t Detectiontoftcells,tcasts,tcrystals,tbacteria
Whattistaturinetculture?
✓ ~~~t Laboratoryttestttotidentifytandtdeterminetthetsensitivitytoftbacteriatinttheturine
Whattistatrenaltultrasound?
✓ ~~~t Imagingttesttthattusestsoundtwavesttotvisualizetthetkidneystandturinaryttract
Whattistatrenaltbiopsy?
✓ ~~~t Procedurettotobtaintatsmalltsampletoftkidneyttissuetfortmicroscopictexa
mination
Whattaretthetstandardtindicatorstoftrenaltfunction?
✓ ~~~t Serumtlevelstoftureatnitrogentandtcreatinine.
Whattistthetnormaltratiotoftureatnitrogenttotcreatinine?
, ✓ ~~~t 10:1.
Whentmaytthetureatnitrogenttotcreatininetratiotincrease?
✓ ~~~t Whentrenaltperfusiontorturinetflowtistdecreased.
Whattcantcausetantincreasetintthetureatnitrogenttotcreatininetratio?
✓ ~~~t Urinaryttracttobstructiontortdehydration.
Whytistserumtcreatininetconsideredtthetmosttreliabletsingletindicatortoftglomerulartfunction
?
✓ ~~~t Becausetittistlesstaffectedtbytfactorstliketnitrogentintake,tcatabolism,tandtcorti
costeroidtuse.
Whattfactorstcantaffecttthetgenerationtoftcreatinine?
✓ ~~~t Age,tsex,tmalnutrition,tchronictillness,tandtamputation.
Howtdoestserumtcreatininetleveltchangetovertthetfirstt1-2tweekstaftertbirth?
✓ ~~~t Ittdeclinesttotreachtatnormaltleveltfortage.
WhattistserumtcystatintC?
✓ ~~~t Atcysteinetproteasetinhibitortproducedtbytalltnucleatedtcellstandtreleasedtintthet
blood.
HowtaretlevelstoftserumtcystatintCtaffected?
✓ ~~~t Theytaretnottaffectedtbytsex,theight,tortmuscletmass.
Whattistantadditionaltindicatortoftglomerulartfunctiontbesidestcreatinine?
✓ ~~~t SerumtcystatintC.
WhattaretsometlimitationstoftcystatintCtassays?
✓ ~~~t Theytaretlesstwidelytavailabletandtlesstreliabletintcertaintclinicaltsettings.
Whattaretsometlesstprecisetbuttimportanttindicatorstoftpossibletrenaltdisease?
✓ ~~~t Abnormalitiestoftserumtelectrolytes,tbicarbonate,tpH,tcalcium,tphosphorus,tm
agnesium,talbumin,tortcomplement.
WhattdoestGFRtstandtfor?
✓ ~~~t GlomerulartFiltrationtRate.
WhattdoestGFRtmeasure?
, ✓ ~~~t Thetratetattwhichtbloodtistfilteredtbytthetglomerulitintthetkidneys.
Whattdoestendogenoustcreatininetclearancet(CCr)testimate?
✓ ~~~t Glomerulartfiltrationtratet(GFR)
Whattistthet'classic'tapproachtfortdeterminingtCCr?
✓ ~~~t At24-hourturinetcollection
WhytistittdifficultttotaccuratelytobtaintCCrtintthetpediatrictpopulation?
✓ ~~~t Especiallytintchildrentwhotaretnottcontinent
Whattistthetnormaltrangetforttotaltdailytcreatininetexcretion?
✓ ~~~t 15-25tmg/kg
Aretnormaltvaluesthighertintmalestortfemales?
✓ ~~~t Highertintmales,treflectivetoftdifferencestintmuscletmass
WhattdoestthetCCrtformulatrequiretmeasurementstof?
✓ ~~~t Plasmatortserumtcreatininet(PCr),turinetcreatininet(UCr),tandturinetvolumet(V)
WhattistthetformulatfortcalculatingtCCr?
✓ ~~~t CCrt=t(UCrtxtV)t/tPCr
Whytistcorrectiontfortsizetneededtintchildren?
✓ ~~~t BecausetacceptedtrangestoftnormaltCCrtaretbasedtontadulttparameters
Whattistthetstandardtbodytsurfacetareatusedtfortcorrectiontintthetformula?
✓ ~~~t 1.73tm2
AttwhattagetdotchildrentreachtadulttlevelstoftGFR?
✓ ~~~t Approximatelyt2tyearstoftage
WhattdoestGFRtbelowt90tmL/min/1.73tm2tintchildrent>t2tindicate?
✓ ~~~t Underlyingtkidneytdisease
WhentcantequationsttotestimatetGFRtbetused?
✓ ~~~t Whentthetcreatininetiststabletandtnottintpatientstwithtacutetkidneytinjuryt(AKI)
Whattistthet'BedsidetSchwartz'tequationtusedtfor?
