utis in kids and labs

[syoung]

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young kid w/ recurrent utis since age 1, low height percentile and weight
PE shows pallor, labs show normochromic, normocytic anemia and inc serum [urea] and [creatinine], UA shows low specific gravity
which of the following results is most likely?

Ca _____ PO4 _____1,25vitD ______Epo
up _____ up ______ up __________ down
up _____ up ______ down ________ down
up _____ down ____ down ________ up
down ___ up ______ up __________ down
down ___ up ______ down ________down
down ___ down ____ up __________ up

any help? I am thinking the last set of labs, (down down up up) because he has aplastic anemia, so his Epo is likely to be up, explains his recurrent utis, and low height/weight explained by high vitD

OR I am thinking he has renal failure from recurrent utis which means low Epo and low 1,25 vitD, which means low Ca and up PO4, (down up down down)

 

[cbrons]

What is the BUN:Cr ? A low S.G. suggests an intrarenal cause, i.e. acute pyelonephritis. In which case your latter answer is best.

 

[solitarius]

Going w/ renal chronic disease.

 

[Slade009]

young kid w/ recurrent utis since age 1, low height percentile and weight
PE shows pallor, labs show normochromic, normocytic anemia and inc serum [urea] and [creatinine], UA shows low specific gravity
which of the following results is most likely?

Ca _____ PO4 _____1,25vitD ______Epo
up _____ up ______ up __________ down
up _____ up ______ down ________ down
up _____ down ____ down ________ up
down ___ up ______ up __________ down
down ___ up ______ down ________down
down ___ down ____ up __________ up

any help? I am thinking the last set of labs, (down down up up) because he has aplastic anemia, so his Epo is likely to be up, explains his recurrent utis, and low height/weight explained by high vitD

OR I am thinking he has renal failure from recurrent utis which means low Epo and low 1,25 vitD, which means low Ca and up PO4, (down up down down)

I have a brain fog at the moment. If the child has Renal Failure due to Recurrent UTIs (most common causes are urinary tract obstruction or reflux, especially in males, but in this child I would think due to fused inferior poles i.e Congenital Horseshoe Kidney idk) then wouldn't the labs be Low Epo, Low Active Vit. D, High Phosphate and High Calcium (not Low). Because Renal Failure causes low epo production and low active vit D but the low vit D would cause serum calcium to decrease causing PTH (High) to be released leading to High Compensatory Calcium levels from bone breakdown and since the kidneys have failed low Phosphate excretion and thus excess PO4 in the serum.

 

[syoung]

I have a brain fog at the moment. If the child has Renal Failure due to Recurrent UTIs (most common causes are urinary tract obstruction or reflux, especially in males, but in this child I would think due to fused inferior poles i.e Congenital Horseshoe Kidney idk) then wouldn't the labs be Low Epo, Low Active Vit. D, High Phosphate and High Calcium (not Low). Because Renal Failure causes low epo production and low active vit D but the low vit D would cause serum calcium to decrease causing PTH (High) to be released leading to High Compensatory Calcium levels from bone breakdown and since the kidneys have failed low Phosphate excretion and thus excess PO4 in the serum.

i think in renal failure the lack of vitD >> than PTH effects so low Ca

good catch on the congenital issue, i hadn't thought about that!

 

[syoung]

What is the BUN:Cr ? A low S.G. suggests an intrarenal cause, i.e. acute pyelonephritis. In which case your latter answer is best.

didnt say what the exact #s were, just mentioned that they were both high/increased

 

[Slade009]

i think in renal failure the lack of vitD >> than PTH effects so low Ca

good catch on the congenital issue, i hadn't thought about that!

Thanks, I'm trying to think a step ahead to prepare for the Step 1. So is the Low Calcium the answer? Cause I'm still highly leaning towards the High Calcium.

 

[dfib slim]

Thanks, I'm trying to think a step ahead to prepare for the Step 1. So is the Low Calcium the answer? Cause I'm still highly leaning towards the High Calcium.

The excess phosphate in the serum will bind to calcium leading to low calcium levels.

 

[Slade009]

The excess phosphate in the serum will bind to calcium leading to low calcium levels.

Yes that would make sense. 2 Phosphates bind to 3 Calciums so I guess the Lack of Vit. D + High binding (from PTH releasing Phosphate and Calcium from the bone and since Phosphate can't be excreted it binds to Calcium, in a cycle) the answer is Low then. Thanks for clearing the confusion.