Hurricane Katrina Aug 29, 2005
description
Transcript of Hurricane Katrina Aug 29, 2005
![Page 1: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/1.jpg)
Hurricane Katrina Aug 29, 2005
![Page 2: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/2.jpg)
![Page 3: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/3.jpg)
![Page 4: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/4.jpg)
![Page 5: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/5.jpg)
Gross Hematuria Presenting to ER
• UTI 50%• Perineal/Urethral Irritation 18%• Trauma 7%• Acute Nephritis 4%• Coagulopathy 3%• Stone 2%• No etiology identified 10%• Don’t forget about tumors (Wilms)
![Page 6: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/6.jpg)
Asymptomatic Gross Hematuria
• No identifiable cause 36%• Hypercalciuria 22%• IgA Nephropathy 16%• Post-strep glomerulonephritis 7%• Other glomerular (thin b.m.) 2%• Congenital anomalies 2%• Sickle cell 1%
![Page 7: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/7.jpg)
Evaluation (H&P!!!)
• Trauma: CT Scan• S/S of malignancy?– Wilm’s– Neuroblastoma
![Page 8: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/8.jpg)
Evaluation
• Post-infectious Acute Glomerulonephritis (strep)– 10 days post pharyngitis– 21 days post impetigo– Edema, HTN (85%)– Strep antibody titers– Low C3
![Page 9: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/9.jpg)
Evaluation
• IgA– Most common presentation recurrent hematuria– 5 days post URI– Can be associated with edema, HTN, renal
insufficiency– Dx: Kidney biopsy
![Page 10: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/10.jpg)
Anatomic Abnormalities and Hematuria
![Page 11: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/11.jpg)
![Page 12: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/12.jpg)
UPJ Obstruction
• Blockage (often partial) of urine flow where ureter enters kidney.
• Both congenital and acquired• Most common pathologic cause of antenatally
detected hydronephrosis• Intrinsic narrowing (most common)• Extrinsic compression (10%) aberrant renal a.
![Page 13: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/13.jpg)
UPJ Obstruction: Presentation
• Fetal/neonatal: Fetal U/S, palpable abd mass, UTI, hematuria, FTT
• Children: Intermittent flank pain, hematuria with minor trauma, calculi, HTN
![Page 14: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/14.jpg)
UPJ Obstruction: Treatment
• Asymptomatic: Watchful waiting• Symptomatic: Surgery
![Page 15: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/15.jpg)
ADPKD
• Most common hereditary kidney dz• Presents from neonate to 5th decade• Hematuria, B flank pain, abdominal masses, HTN,
UTI• Cysts in liver, pancreas, spleen, ovaries• Mitral valve prolapse 12% of peds pts• Intracranial aneurysms (adults)• Dx by U/S, bilateral macrocysts• Tx: Supportive
![Page 16: Hurricane Katrina Aug 29, 2005](https://reader035.fdocuments.us/reader035/viewer/2022062310/5681631a550346895dd392a4/html5/thumbnails/16.jpg)
ARPKD
• Infantile PKD• Neonatal B flank mass, oligohydramnios, pulm
hypoplasia, potter facies• Severe hepatic cirrhosis and portal HTN• 30% die as neonates• If survive 1st year, 10 year survival 80%• ESRD >50%