Pediatric Nephrology Questions

1. A 3-year-old girl presents with mild periorbital and 1+ pretibial edema. Her blood pressure is 126/85, BUN 30mg/dl, Cr 1.2 mg/dl, and albumin 1.6 mg/dl. The most likely diagnosis is

• focal segmental glomerulosclerosis
• acute postinfectious glomerulonephritis
• lupus nephritis
• minimal change disease
• cirrhosis

2. A 4-week old infant who had a birth weight os 3.6kg has a current weight of 3.0kg. Laboratory values are: Na 135, K 3.2, Cl 102, Bicarb 8. An arterial blood gas shows pH 7.22 and pCO2 of 28. Which of the following is the most likely diagnosis

• respiratory failure
• chronic diarrhea
• proximal renal tubular acidosis
• distal renal tubular acidosis
• maple syrup urine disease

3. A 4-year old otherwise well child has a weight and height below the 3rd percential. Renal ultrasound shows echogenic kidneys and laboratory tests show Na 136, K 3.2, Cl 114, Bicarb 10, and urine pH 6.5. The most likely diagnosis is

• proximal renal tubular acidosis
• distal renal tubular acidosis
• Fanconi syndrome
• polycystic kidney disease
• diabetic ketoacidosis

4. Children with posterior urethral valves may have each of the following at birth EXCEPT:

• anomalous development of the urethra
• bladder thickening
• hydronephrosis
• dysplastic kidney
• XY chromosome

5. A 4-month-old child who has a large atrioventricular septal defect has been receiving furosemide for 2 months. The serum electrolyte profile reveals (all in mEq/L) Na 134, K 3.8, Bicarb 33, and chloride 86. Of the following, the treatment that is MOST likely to correct the electrolyte abnormality is administration of oral

•  ammonium chloride
• calcium glubionate
• potassium chloride
• sodium chloride
• sodium citrate 

 6. Prenatal ultrasonography of a male fetus reveals bilateral hydronephrosis. Postnatal abdominal ultrasonography confirms this finding, with markedly reduced renal parenchyma. A coiding cystourethrogram reveals posterior urethral valves and bilateral grade IV vesicoureteral reflux. A urologist performs ablation of the valves and bilateral ureterostomies. The infant's serum creatinine at weeks after birth is 2.1 mg/dL. The remainder of the serum electrolyte concentrations are normal, and the urine output is 5.2 mL/kg/hr. The patient has no signs of volume depletion or overload.

Of the following, the MOST appropriate statement to provide the child's parentsis that their son

• is unlikely to progress to end stage renal disease (ESRD)
• is unlikely to reach ESRD until adulthood
• likely will develop ESRD within 5 years
• needs to start peritoneal dialysis immediately
• should progress slowly to ESRD by adolescence