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hematuria ddxinfectious: UTI, hemorrhagic cystitisTraumaHeme causes: SCD, TCPMetabolic cause: hypercalcemiaStructural: tumor, obstruction, stones, vascular malformationsGlomerular; Bergers, HSP, PSG, alports236.Proteinuria defn>100mg/m2/day pathologic237.Classification of proteinuriaBenign transient proteinuria: inc protein w/ vig exercise, fever, dehydration, CHFOrthostatic proteinuria: inc urinary protein while upright, but not supine.Pathologic protineuria: glomeular disease or tubular disease(interstitia nephritis, ischemic renal injuryATN) and nephrotoxic drugs238.nephrotic syndromeheavy proteinuriaEdemahypercholesterolemia239.Nephritic syndromegross hematuriaHTNFluid overload from renal insufficiency240.MCC of acute glomerulonephritis? MCC of chronic GN?Acute: PSGNChronic: IgA nephropathy
241.CF PSGN8-14 d after skin or pharynx w/ nephritogenic strian of GABHS. 28 days after impetigo.Hematuria(gross), proteinuria, HTN, fluid overload.Low complement242.Dx of PSGNASO titerADB titerUA, serum complement, renal US, RFTs, serum albumin, serum cholesterol243.Tx of PSGN. Does abx help dec risk of PSGN? Rheumatic fever?Fluid restriction, antihypertensive, dietary restrictions of protein, sodium, potassium, phosphorous. Abx tx doesn't reduce risk of PSGN but will reduce risk of rheumatic fever244.IgA nephropathyEtio:CF:Dx:tx:Etio: abnl clearance or formation of IgA Immune complexesCF: recurrent gross hematuria assoc w/ resp infections. Transient ARF. Microscopic hematuriaDx: renal biopsyTx: suportive, ACEI, steroids, immunosuppressants245.HSP nephritisDefnCFDefn: IgA mediated vaculitis w/ nonTCP palpable purpura on buttocks+thighs, abd pain, arthritis, gross or microscopic hematuria. CF: Protineuria presnt possible glomerular inflammation should do renal bx. In majority renal features self limited-recover in 3 mo.246.Nephrotic syndrome defnheavy proteinuria(>50mg/kg/24hours), hypoalbuminemia, hypercholesterolemia, edema247.Categories of Nephrotic syndromePRimary NS: 90% of all childhood cases. MCC of primary is MCDNS from other primary glomerular diseases: IgA nephropathy, MPGN, PSGNNS that results from systemic diseases: SLE, HSP248.CF of nephrotic syndromeEdema which follows a URI.PRedisposed to thrombosesInc risk of encapsulated org infections-can have SBP, PNA, sepsis249.Dx of Nephrotic syndrome
UA: shows +3/4 protein, elevatedCBCCMP: met acidosis. BUN/CrC3, ANA, Antistrep abRenal US250.massive edema with nephrotic syndromeIV infusions of 25% albumin to achieve a diuresis and maintain intravascular volume251.MCD txsteroids, no added salt. Steroid resistant-cyclophosphamide, cyclosporine252.HUS defnARF in presence of MHA, TCPTwo different subtypes: Shiga toxin assoc HUS, Atypical HUS253.CF of HUSdiarrheal prodrome-->sudden onset of hemolytic anemia, TCP, ARF254.Alports syndromeprogressive hereditary nephritisType IV collagen defectX linked dominant.