The revised Schwartz formula is the following:

Correct Answer: D

Rationale: The correct answer is option D) GFR = 0.413 × Ht / Cr serum in the revised Schwartz formula for estimating glomerular filtration rate (GFR) in pediatric patients. This formula takes into account the child's height (Ht) and serum creatinine (Cr) levels to estimate kidney function accurately. The height adjustment in the formula is crucial as it helps in normalizing GFR values for pediatric patients, who have varying body sizes compared to adults. Option A) GFR = 0.134 × Ht / Cr serum is incorrect because the coefficient value is different from the revised Schwartz formula. Option B) GFR = 0.413 × Cr serum / Ht is incorrect because the ratio of serum creatinine to height is inverted compared to the correct formula. Option C) GFR = 0.134 × Cr serum / Ht is also incorrect due to the same reasons as option B. Understanding the correct formula for estimating GFR in pediatric patients is essential for healthcare providers, especially those working in pediatric nephrology or general pediatrics. Proper assessment of kidney function is critical in managing pediatric patients with renal conditions or those receiving potentially nephrotoxic medications. Mastery of pharmacology calculations like the Schwartz formula is crucial for safe medication dosing and monitoring in pediatric patients.

Correct Answer: A

Rationale: In the case of a 5-month-old boy with Fanconi syndrome, the correct answer is option A) low-molecular-weight proteins in the urine examination. Fanconi syndrome is a disorder of the kidney tubules that leads to the excessive excretion of certain substances into the urine, including low-molecular-weight proteins such as beta-2 microglobulin and retinol-binding protein. These proteins are not typically found in urine unless there is renal tubular damage, as seen in Fanconi syndrome. Option B) hexagonal crystals are more commonly associated with cystinuria, a different condition characterized by the presence of cystine crystals in the urine. Option C) red blood cell casts are indicative of glomerulonephritis, a condition affecting the glomeruli of the kidneys, which is not typically associated with Fanconi syndrome. Option D) WBC cast presence would indicate inflammation or infection in the kidney tubules, which is not a characteristic finding in Fanconi syndrome. Educationally, understanding the specific urinary findings associated with different renal conditions is crucial for nurses and healthcare providers working with pediatric patients. Recognizing these patterns can aid in early identification, appropriate diagnosis, and timely intervention to improve patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Increased lactate dehydrogenase (LDH). In this scenario, the presentation of the 3-month-old baby boy with repeated fits, rapid breathing, face swelling, and decreased urine output indicates a possible hemolytic crisis, which can be seen in conditions like glucose-6-phosphate dehydrogenase (G6PD) deficiency. Increased LDH is a marker of hemolysis, which occurs in G6PD deficiency during hemolytic episodes. Option B) increased haptoglobin would be decreased in hemolysis as it binds free hemoglobin in the blood. Option C) Increased direct bilirubin would be seen in conditions like biliary obstruction, not typically in hemolysis. Option D) decreased aspartate aminotransferase (AST) is not specifically associated with hemolysis. Educationally, understanding the laboratory markers associated with different conditions is crucial in pediatric pharmacology. Recognizing the significance of LDH elevation in hemolytic crises like in G6PD deficiency can aid in timely diagnosis and management in pediatric patients. This case underscores the importance of thorough assessment and interpretation of clinical and laboratory findings in pediatric genitourinary emergencies.

Correct Answer: D

Rationale: The correct answer is D) Acute tubular necrosis. Acute tubular necrosis is the most common intrinsic cause of acute kidney injury in children. This condition is characterized by damage to the renal tubules due to ischemia, nephrotoxic medications, or sepsis. In children, factors such as dehydration, sepsis, and exposure to nephrotoxic medications can contribute to the development of acute tubular necrosis. Option A) Acute interstitial nephritis is more commonly seen in adults and is characterized by inflammation of the renal interstitium due to medications or infections. Option B) Rhabdomyolysis can lead to kidney injury due to the release of myoglobin into the bloodstream, but it is not the most common cause of AKI in children. Option C) Glomerulonephritis involves inflammation of the glomeruli in the kidney and is more commonly seen in chronic kidney disease rather than acute kidney injury in children. Educationally, it is important for healthcare providers to be able to differentiate between the various causes of acute kidney injury in children to provide prompt and appropriate management. Understanding the etiology of AKI helps in implementing preventive strategies and tailored treatment plans to improve patient outcomes.

Correct Answer: A

Rationale: In pediatric patients with end-stage renal disease (ESRD), the glomerular filtration rate (GFR) is a crucial indicator of kidney function and the need for renal replacement therapy. The correct answer, A) 15 ml/min/1.73 m2, is the threshold at which children with ESRD are typically considered for either dialysis or renal transplantation. Option B) 25 ml/min/1.73 m2 is higher than the typical GFR threshold for initiating renal replacement therapy in children with ESRD. Option C) 35 ml/min/1.73 m2 and Option D) 45 ml/min/1.73 m2 are even further above the threshold, indicating relatively preserved renal function that would not usually necessitate immediate intervention such as dialysis or transplantation. Educationally, understanding the GFR threshold for initiating renal replacement therapy in pediatric ESRD is vital for nurses and healthcare providers caring for these vulnerable patients. This knowledge helps in timely intervention to prevent complications associated with advanced kidney disease and ensures optimal management to improve outcomes and quality of life for pediatric patients with ESRD.