Kidney and hematologic disorders in children

HUS HSP tTP ITP

HUS HSP tTP ITP

Children URI

Kidney manifestations AST, hematuria

Key.differential points;. , Age, diarrhea. ..

Most common age Previous infection

Normal Normal Normal

Normal Normal Normal

Children URI

Kidney manifestations AST, hematuria

Key.differential points;. , Age, diarrhea. ..

HUS s hemolytic ureinic syndrome, BSP ï= Henoch-,Schonlem purpura,TTP = thrombotic thrombocytopenic purpura, ITP 2? idiopathic: thrombocytopenic purpura, URi ~ upper respiratory infection, ARF - acute rénal failure, CNS. - central riervous system* ARP rs acute renal failure.

* ÏU HUS and HJ>i* patients may need dialysis aud transfusions.

t .Do not give platelet transfusions, to patients withTTP (may form dots).

* Give steroids only if thi- patient is symptomatic (bleeding) or platelets < >0,000,

Renal stones: present with severe, intermittent, unilateral flank and/or groin pain. Most stones show tip on abdominal x-ray and are composed of calcium. Most cases are idiopathic and should be treated with lots of hydration and pain control (to see if stone will pass). If stone does not pass, it needs to be removed surgically (preferably endoscopically) or by lithotripsy.

Underlying causes of stones:

1. Hypercalcemia: due to hyperparathyroidism or malignancy (metastases or squamous cell lung cancer-secreting parathyroid hormone).

2. Infection: from ammonia-producing bugs (Proteus, Staphylococcus spp.). Look for Staghorn calculi.

3. Hyperuricemia: from gout or from leukemia treatment (allopurinol and IV fluids arc given before chemotherapy as preventive measures).

4. Cystinuria/aminoaciduria: suspect if the stone is made of cystine and in repetitive stone-forining patients.

llllllllilill^^llll^ll Rheumatology

Arthritis: the large majority of eases are due to osteoarthritis (OA). When in doubt or if you suspect something other than OA, aspirate fluid from the affected joint for examination. Examine the fluid for cell count and differential, glucose, bacteria (Gram stain and culture), and crystals:

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