TEST BANK For CURRENT Diagnosis and Treatment
Pediatrics 27th Edition by Maya Bunik; William W. Hay
What should be included in the history when renal disease is suspected? - ANSWER:
Preceding acute or chronic illnesses, rashes or joint pain/swelling, growth delay or
failure to thrive, urinary symptoms, hematuria/proteinuria, pain, sudden weight
gain/loss or edema, drug/toxin exposure, perinatal history, family history of kidney
disease
What are important aspects of the physical examination for evaluating the kidney
and urinary tract? - ANSWER: Height, weight, growth percentiles, skin lesions, pallor,
edema, skeletal deformities, anomalies of ears/eyes/external genitalia, blood
pressure measurement, abdominal palpation and auscultation
What should be assessed during blood pressure measurement in a child? - ANSWER:
Measured in a quiet setting, with a manual cuff of appropriate size, in the right upper
extremity, child seated with feet flat on the ground, cuff covering two-thirds of the
child's upper arm, assessment of peripheral pulses
What should be assessed during abdominal palpation and auscultation in a child? -
ANSWER: Nephromegaly, abdominal masses, musculature, ascites, bruits
What is the purpose of laboratory evaluation of renal function? - ANSWER: To assess
kidney function and detect abnormalities
What is serum analysis? - ANSWER: Measurement of various substances in the blood
to evaluate kidney function
What substances are commonly measured in serum analysis for renal function? -
ANSWER: Creatinine, blood urea nitrogen (BUN), electrolytes (sodium, potassium,
chloride), albumin
What is the significance of creatinine in serum analysis? - ANSWER: Indicates kidney
function and can help diagnose kidney disease
What is the significance of blood urea nitrogen (BUN) in serum analysis? - ANSWER:
Indicates kidney function and can help diagnose kidney disease
What is the significance of electrolytes (sodium, potassium, chloride) in serum
analysis? - ANSWER: Imbalances can indicate kidney dysfunction
,What is the significance of albumin in serum analysis? - ANSWER: Low levels can
indicate kidney damage or disease
What is urinalysis? - ANSWER: Examination of urine to assess kidney function and
detect abnormalities
What are the components of a urinalysis? - ANSWER: Physical characteristics,
chemical analysis, microscopic examination
What physical characteristics are assessed in urinalysis? - ANSWER: Color, clarity,
odor, specific gravity
What chemical analysis is performed in urinalysis? - ANSWER: Measurement of
substances such as glucose, protein, blood, pH
What microscopic examination is performed in urinalysis? - ANSWER: Detection of
cells, casts, crystals, bacteria
What is a urine culture? - ANSWER: Laboratory test to identify and determine the
sensitivity of bacteria in the urine
What is a renal ultrasound? - ANSWER: Imaging test that uses sound waves to
visualize the kidneys and urinary tract
What is a renal biopsy? - ANSWER: Procedure to obtain a small sample of kidney
tissue for microscopic examination
What are the standard indicators of renal function? - ANSWER: Serum levels of urea
nitrogen and creatinine.
What is the normal ratio of urea nitrogen to creatinine? - ANSWER: 10:1.
When may the urea nitrogen to creatinine ratio increase? - ANSWER: When renal
perfusion or urine flow is decreased.
What can cause an increase in the urea nitrogen to creatinine ratio? - ANSWER:
Urinary tract obstruction or dehydration.
Why is serum creatinine considered the most reliable single indicator of glomerular
function? - ANSWER: Because it is less affected by factors like nitrogen intake,
catabolism, and corticosteroid use.
What factors can affect the generation of creatinine? - ANSWER: Age, sex,
malnutrition, chronic illness, and amputation.
How does serum creatinine level change over the first 1-2 weeks after birth? -
ANSWER: It declines to reach a normal level for age.
,What is serum cystatin C? - ANSWER: A cysteine protease inhibitor produced by all
nucleated cells and released in the blood.
How are levels of serum cystatin C affected? - ANSWER: They are not affected by sex,
height, or muscle mass.
What is an additional indicator of glomerular function besides creatinine? - ANSWER:
Serum cystatin C.
What are some limitations of cystatin C assays? - ANSWER: They are less widely
available and less reliable in certain clinical settings.
What are some less precise but important indicators of possible renal disease? -
ANSWER: Abnormalities of serum electrolytes, bicarbonate, pH, calcium,
phosphorus, magnesium, albumin, or complement.
What does GFR stand for? - ANSWER: Glomerular Filtration Rate.
What does GFR measure? - ANSWER: The rate at which blood is filtered by the
glomeruli in the kidneys.
What does endogenous creatinine clearance (CCr) estimate? - ANSWER: Glomerular
filtration rate (GFR)
What is the 'classic' approach for determining CCr? - ANSWER: A 24-hour urine
collection
Why is it difficult to accurately obtain CCr in the pediatric population? - ANSWER:
Especially in children who are not continent
What is the normal range for total daily creatinine excretion? - ANSWER: 15-25
mg/kg
Are normal values higher in males or females? - ANSWER: Higher in males, reflective
of differences in muscle mass
What does the CCr formula require measurements of? - ANSWER: Plasma or serum
creatinine (PCr), urine creatinine (UCr), and urine volume (V)
What is the formula for calculating CCr? - ANSWER: CCr = (UCr x V) / PCr
Why is correction for size needed in children? - ANSWER: Because accepted ranges
of normal CCr are based on adult parameters
What is the standard body surface area used for correction in the formula? -
ANSWER: 1.73 m2
, At what age do children reach adult levels of GFR? - ANSWER: Approximately 2 years
of age
What does GFR below 90 mL/min/1.73 m2 in children > 2 indicate? - ANSWER:
Underlying kidney disease
When can equations to estimate GFR be used? - ANSWER: When the creatinine is
stable and not in patients with acute kidney injury (AKI)
What is the 'Bedside Schwartz' equation used for? - ANSWER: Approximating
estimated GFR in children
What are the variables used in the 'Bedside Schwartz' equation? - ANSWER: Plasma
or serum creatinine level and length in centimeters
What is the formula for the 'Bedside Schwartz' equation? - ANSWER: eGFR = 0.413 x
height (cm) / PCr (mg/dL)
What is the Creatinine-Cystatin C-based CKiD equation used for? - ANSWER:
Estimating GFR when cystatin C (cysC) and blood urea nitrogen (BUN) are assessed
What is the formula for the Creatinine-Cystatin C-based CKiD equation? - ANSWER:
Not provided in the notes
Who was the 'Bedside Schwartz' equation developed for? - ANSWER: Children with
chronic kidney disease (CKD)
Has the 'Bedside Schwartz' equation been validated in children with normal renal
function? - ANSWER: Yes
What is the purpose of the confirmatory test for estimated GFR? - ANSWER: To
provide a more accurate measurement in certain circumstances.
Where can online tools be found to calculate GFR? - ANSWER:
https://www.kidney.org/professionals/KDOQI/gfr_calculatorPed
What data was used to develop new eGFR equations for children and young adults
with CKD? - ANSWER: Data from the Chronic Kidney Disease in Children Study (CKiD)
What variables are used in the new eGFR equations for children and young adults
with CKD? - ANSWER: Age and sex-dependent variables
Where can an online tool for calculating eGFR in children and young adults with CKD
be found? - ANSWER: https://ckid-gfrcalculator.shinyapps.io/eGFR/
Pediatrics 27th Edition by Maya Bunik; William W. Hay
What should be included in the history when renal disease is suspected? - ANSWER:
Preceding acute or chronic illnesses, rashes or joint pain/swelling, growth delay or
failure to thrive, urinary symptoms, hematuria/proteinuria, pain, sudden weight
gain/loss or edema, drug/toxin exposure, perinatal history, family history of kidney
disease
What are important aspects of the physical examination for evaluating the kidney
and urinary tract? - ANSWER: Height, weight, growth percentiles, skin lesions, pallor,
edema, skeletal deformities, anomalies of ears/eyes/external genitalia, blood
pressure measurement, abdominal palpation and auscultation
What should be assessed during blood pressure measurement in a child? - ANSWER:
Measured in a quiet setting, with a manual cuff of appropriate size, in the right upper
extremity, child seated with feet flat on the ground, cuff covering two-thirds of the
child's upper arm, assessment of peripheral pulses
What should be assessed during abdominal palpation and auscultation in a child? -
ANSWER: Nephromegaly, abdominal masses, musculature, ascites, bruits
What is the purpose of laboratory evaluation of renal function? - ANSWER: To assess
kidney function and detect abnormalities
What is serum analysis? - ANSWER: Measurement of various substances in the blood
to evaluate kidney function
What substances are commonly measured in serum analysis for renal function? -
ANSWER: Creatinine, blood urea nitrogen (BUN), electrolytes (sodium, potassium,
chloride), albumin
What is the significance of creatinine in serum analysis? - ANSWER: Indicates kidney
function and can help diagnose kidney disease
What is the significance of blood urea nitrogen (BUN) in serum analysis? - ANSWER:
Indicates kidney function and can help diagnose kidney disease
What is the significance of electrolytes (sodium, potassium, chloride) in serum
analysis? - ANSWER: Imbalances can indicate kidney dysfunction
,What is the significance of albumin in serum analysis? - ANSWER: Low levels can
indicate kidney damage or disease
What is urinalysis? - ANSWER: Examination of urine to assess kidney function and
detect abnormalities
What are the components of a urinalysis? - ANSWER: Physical characteristics,
chemical analysis, microscopic examination
What physical characteristics are assessed in urinalysis? - ANSWER: Color, clarity,
odor, specific gravity
What chemical analysis is performed in urinalysis? - ANSWER: Measurement of
substances such as glucose, protein, blood, pH
What microscopic examination is performed in urinalysis? - ANSWER: Detection of
cells, casts, crystals, bacteria
What is a urine culture? - ANSWER: Laboratory test to identify and determine the
sensitivity of bacteria in the urine
What is a renal ultrasound? - ANSWER: Imaging test that uses sound waves to
visualize the kidneys and urinary tract
What is a renal biopsy? - ANSWER: Procedure to obtain a small sample of kidney
tissue for microscopic examination
What are the standard indicators of renal function? - ANSWER: Serum levels of urea
nitrogen and creatinine.
What is the normal ratio of urea nitrogen to creatinine? - ANSWER: 10:1.
When may the urea nitrogen to creatinine ratio increase? - ANSWER: When renal
perfusion or urine flow is decreased.
What can cause an increase in the urea nitrogen to creatinine ratio? - ANSWER:
Urinary tract obstruction or dehydration.
Why is serum creatinine considered the most reliable single indicator of glomerular
function? - ANSWER: Because it is less affected by factors like nitrogen intake,
catabolism, and corticosteroid use.
What factors can affect the generation of creatinine? - ANSWER: Age, sex,
malnutrition, chronic illness, and amputation.
How does serum creatinine level change over the first 1-2 weeks after birth? -
ANSWER: It declines to reach a normal level for age.
,What is serum cystatin C? - ANSWER: A cysteine protease inhibitor produced by all
nucleated cells and released in the blood.
How are levels of serum cystatin C affected? - ANSWER: They are not affected by sex,
height, or muscle mass.
What is an additional indicator of glomerular function besides creatinine? - ANSWER:
Serum cystatin C.
What are some limitations of cystatin C assays? - ANSWER: They are less widely
available and less reliable in certain clinical settings.
What are some less precise but important indicators of possible renal disease? -
ANSWER: Abnormalities of serum electrolytes, bicarbonate, pH, calcium,
phosphorus, magnesium, albumin, or complement.
What does GFR stand for? - ANSWER: Glomerular Filtration Rate.
What does GFR measure? - ANSWER: The rate at which blood is filtered by the
glomeruli in the kidneys.
What does endogenous creatinine clearance (CCr) estimate? - ANSWER: Glomerular
filtration rate (GFR)
What is the 'classic' approach for determining CCr? - ANSWER: A 24-hour urine
collection
Why is it difficult to accurately obtain CCr in the pediatric population? - ANSWER:
Especially in children who are not continent
What is the normal range for total daily creatinine excretion? - ANSWER: 15-25
mg/kg
Are normal values higher in males or females? - ANSWER: Higher in males, reflective
of differences in muscle mass
What does the CCr formula require measurements of? - ANSWER: Plasma or serum
creatinine (PCr), urine creatinine (UCr), and urine volume (V)
What is the formula for calculating CCr? - ANSWER: CCr = (UCr x V) / PCr
Why is correction for size needed in children? - ANSWER: Because accepted ranges
of normal CCr are based on adult parameters
What is the standard body surface area used for correction in the formula? -
ANSWER: 1.73 m2
, At what age do children reach adult levels of GFR? - ANSWER: Approximately 2 years
of age
What does GFR below 90 mL/min/1.73 m2 in children > 2 indicate? - ANSWER:
Underlying kidney disease
When can equations to estimate GFR be used? - ANSWER: When the creatinine is
stable and not in patients with acute kidney injury (AKI)
What is the 'Bedside Schwartz' equation used for? - ANSWER: Approximating
estimated GFR in children
What are the variables used in the 'Bedside Schwartz' equation? - ANSWER: Plasma
or serum creatinine level and length in centimeters
What is the formula for the 'Bedside Schwartz' equation? - ANSWER: eGFR = 0.413 x
height (cm) / PCr (mg/dL)
What is the Creatinine-Cystatin C-based CKiD equation used for? - ANSWER:
Estimating GFR when cystatin C (cysC) and blood urea nitrogen (BUN) are assessed
What is the formula for the Creatinine-Cystatin C-based CKiD equation? - ANSWER:
Not provided in the notes
Who was the 'Bedside Schwartz' equation developed for? - ANSWER: Children with
chronic kidney disease (CKD)
Has the 'Bedside Schwartz' equation been validated in children with normal renal
function? - ANSWER: Yes
What is the purpose of the confirmatory test for estimated GFR? - ANSWER: To
provide a more accurate measurement in certain circumstances.
Where can online tools be found to calculate GFR? - ANSWER:
https://www.kidney.org/professionals/KDOQI/gfr_calculatorPed
What data was used to develop new eGFR equations for children and young adults
with CKD? - ANSWER: Data from the Chronic Kidney Disease in Children Study (CKiD)
What variables are used in the new eGFR equations for children and young adults
with CKD? - ANSWER: Age and sex-dependent variables
Where can an online tool for calculating eGFR in children and young adults with CKD
be found? - ANSWER: https://ckid-gfrcalculator.shinyapps.io/eGFR/
