FEN, Acid Base, Renal Flashcards
0
Q
easy maintenance fluid req for wt >20kg
A
60cc/hr + 1cc/kg/hr
1
Q
Maintenance electrolyte requirements, Na, K, Chloride
A
PSC: 1, 2, 3
Potassium: 1 meq/kg/day
Sodium: 2 meq/kg/day
Chloride: 3 meq/kg/day
2
Q
Calculating % of dehydration by skin turgor and mucus membranes
- normal/slightly decreased skin turgor
- decreased
- markedly decreased
- cold/dry
A
normal skin, slightly dry mucus membranes: 3-5%
decreased skin, dry mm 6-10%
markedly decr skin, parched cotton mouth 10-15%
Cold/cry, parched >15%
3
Q
When does pulse go up and resp go up with % dehydration, and when does orthostatus start
A
6-10% BP still normal
10-15%: orthostatic
4
Q
cause of late seizure in child with hypernatremic dehydration?
A
hypocalcemia
5
Q
how to correct hypernatremic dehyration?
A
Calculate 48 hour water req, and give slowly over this time use hypotonic (0.2%NS)
6
Q
volume of distribution of Na? Calculation
A
0.6 x body weight
7
Q
Quick and easy way to look at urine lytes and determine if dehyrated?
A
UNa < 10!
8
Q
FeNa to determine dehydration vs renal failure
A
1% renal failure
9
Q
Syndrome w/ Incr risk of renal artery stenosis due to renovascular disease?
A
Williams
10
Q
possible causes of htn in NF? (4)
A
- pheo
- CoA
- RAS
- tumor
11
Q
Clue to renal artery stenosis (4)
A
- renal asymmery
- acute incr BP
- ARF w/ ACEi
- refractory htn
12
Q
causes of Renal artery stenosis? (4 etiology)
A
- fibromuscular dysplasia: string of beads
- syndrome: Williams
- athero
- idiopathic
13
Q
4 syndromes assoc w/ pheo
A
- NF
- Von hippel landau
- sturge weber
- MEN2
14
Q
In child w/ endo syndrome with htn/pheo what are the other things to look for? what is dx?
A
MEN2
higher risk for thyroid and hperparathyroid Ca
15
Q
dx in child with HTN, wt loss, hyperglycemia, dilated cardiomyopathy
A
pheo
16
Q
Dx steps for pheo
A
24 urine metanephrines, plasma metanephrines more sens in kids.
If high, check abd MRI/CT and MIBG/octreoscan
17
Q
nephrotic syndrome mortality?
A
5%
18
Q
three top bugs in nephrotic syndrome peritonitis?
A
- Strep pneumo**
- E. coli
- aseptic
19
Q
hx of large placenta and massive anasarca
finnish autosomal recessive
dx and cause of death?
A
congenital nephrotic syndrome
Ecoli sepsis
20
Q
define microscopic hematuria
A
> /= 3 RBC/hpf x 2 fresh voided urines
21
Q
urine pos for blood could mean what? next step?
A
+ hemoglobin, myoglobin, porphyrins.
Obtain a UA!! (dip can’t tell, UA can)…
22
Q
UA findings for myoglobinuria, hemoglobinuria
A
myoglobinuria 1-2 cells and dark urine
hemoglobinuria will have jaundice and anemia, but no hematuria / RBC in urine
23
Q
5 things to know if you get microscopic hematuria to guide work up? If none present, next step?
A
Just repeat UA in 2 wks unless: Proteinuria HTN Abd pain Dysuria FH Kidney dz
24
If Microscopic hematuria repeatedly (persistent hematuria), management should be what next and why?
What else to look for?
Check for hypercalciuria in random urine sample
.look for Urine Ca/Cr > 0.25
-may also see crystals in urine and have abd pain/dysuria even w/o frank stones
25
Urine Calcium / Creatinine ratio < 0.2-0.25 should prompt what work up / management in microscopic hematuria?
24 urine collection, in which value >4mg/day of total calcium would indicate hypercalciuria, therefore need for renal US to look for stone
26
Urine Calcium / Cr ratio < 0.2 in eval for microscopic hematuria
should check for UPJ obstruction with renal ultrasound to look for structural abnormalities
27
Relationship between sickle cell and renal disease?
trait and disease can cause hematuria
28
consider dx in child w/ microscopic hematuria after injury/trauma
UPJ obstruction (very large kidney)
29
confirmatory test for suspected UPJ
after hydronephrosis found, get renal scan to show delayed excretion from that kidney, and consider VCUG in opposite kidney b/c risk of VUR
30
how to dx orthostatic proteinuria
first AM urine should be negative, and subsequent daytime one would be positive
31
protein / creatinine ratio suggestive of renal disease
Protein / Creatinine > 0.2
32
scenarios in which proteinuria can be benign (2)
1. concentrated urine (high spec grav)
| 2. alkaline urine
33
If 24 hr urine protein collection is done, what would lead to renal biopsy
>8mg/kg/day (halfway to 16 which is nephrotic...)
34
What is alport syndrome?
X linked dominant d/o w/ b/l sensorineural hearing loss, ocular defects, and renal failure in males
(two kidney planes landing on eyes that you can't hear)
35
unilateral flank mass should lead to what, and what should you consider
Multicystic dysplastic kidney disease:
dysplastic kidney, may have oligo prenatally. usu unilateral, 50% with other GU anomalies like UPJ obstrx, VUR, posterior valves, megaureter/duplication *think of this as causing the mass. And need VCUG
36
multicystic dysplastic kidney disease is associated with what?
hepatic fibrosis / portal htn (autosomal recessive polycystic kidney dz)
37
two presentations of autosomal recessive polycystic kidney dz (AR)
1. neonate w/ bilateral flank masses, oligo
| 2. older child w/ liver issue and kidney masses, TCP/splenomegaly
38
which polycystic kidney disease is associated w/ brain thing
| -what is it and whats the trm
cerebral aneurysm in adult onset PCKD (autosomal dom)
39
What is nephronophthisis and what do you need to look for (3 things)
juvenile medullary cystic disease (Aut Rec), polyuria, enuresis, polydipsia, hyposthenuria (can't concentrate urine)
-assoc w/ short stature, eye problems/retinal disease**, anemia
40
mass from urethral meatus or round filling defect on IVP causing urinary obstruction and urinary retention?
ureteroceles
41
Grades of VUR and management?
VUR 1 and 2: periodic cultures, most self resolve
VUR 3: Abx and f/u VCUG, 1/2 resolve
VUR 4-5: surgery needed (moderate dilation of ureter and renal pelvis)
Females: Abx
42
Normal bladder size (wt)
age (yrs) + 2 (ounces)
43
newborn with palpable bladder and weak urinary stream.
| Treatment and prognosis?
posterior urethral valves, prob: even w/ surgery they can get ESRD w/n 5 yrs!
44
UTI culture result dx
| bugs? (3)
100,000 colonies or >10,000 on cath
| three most common bugs: Ecoli, Klebsiella, Enterococcus
45
prune belly triad (Eagle Barrett syndrome)
1. lack of abd muscles
2. undesc testes
3. GU abnormalities w/ obstrx mostly
46
lipid issue in nephrotic syndrome
LDL / HDL is high, very high cholesterol
47
nephrotic syndrome and calcium issue?
low albumin, decreases bound AND AVAILABLE calcium, so you get low Ca
48
nephrotic syndrome and thyroid?
loss of thyroxine binding globulin, so functional hypothyroidism.
49
RBC casts suggests what
glomerular disease
50
3 causes of low complement (C3)
1. SLE
2. Post-strep
3. Membranoproliferative glomerulonephritis
(PMS: not in the mood to complement)
51
typically black teen male w/ progressive renal failure, not responding to steroids
Tx
focal and segmental glomerulosclerosis.. this sucks
| Steroids don't work, use cyclophos or try ACEi or ARB
52
If you suspect Minimal change disease, but no response to steroids, consider what?
Then its likely focal segmental glomerulosclerosis
53
what kidney disease should NOT get steroids, and how do you know not to give... 1st step in management?
membranoproliferative GN b/c they may get severe htn, you don't give them if they have low C3 (also often an older female). Get Renal Bx instead.
54
peritonitis complication in minimal change nephrotic syndrome caused by what bugs? (3), mortality?
strep pneumo, ecoli, aseptic (5% mortality)
55
top three nephrotic syndrome?
1. Minimal change
2. focal segmental (increasing)
3. membranoproliferative
56
massive anasarca in newborn, large placenta, death by 1 yr from ecoli sepsis, what is dx?
autosomal recessive congenital nephrotic syndrome
57
tea colored, cola colored, rusty, smoky urine
hypertension
edema
Dx?
post strep GN
58
Berger dz?
IgA nephropathy
59
IgA nephropathy causes what sx?
| indicator of poor prognosis
hematuria, often after URI
| bad prognosis if persistent proteinuria
60
acid/base d/o in chronic renal failure and type of ca/phos issue?
1. metabolic acidosis (decr bicarb production by tubule so acid not excreted)
2. secondary hyperparathyroid (high because kidney is bad at getting rid of phosphorous and does get rid of calcium --> high PTH) --> decreased calcitriol leads to decr Ca absorption / incr ca loss)
61
Tx of common HUS in kids?
SYNSORB pk binds verotoxin in Ecoli o157 strain
62
define htn in kids?
>95% x 3!
STage 1: 95% - 99%+5
Stage 2: >99% + 5
63
treatment of hypercalciuria
thiazide and fluids (thiazide decreases urinary excretion of calcium (remember hyper-GLUC)
64
% of IgA nephropathy that get chronic renal disease?
15%
65
htn + prematurity
umbilical cath causing renal injury
66
htn + joint pain/swelling
SLE / connective tissue d/o
67
htn + flushing, palp, fever, wt loss
pheo
68
htn with weakness and muscle cramps
hypo K - hyperaldo problem!
69
htn + sexual development onset
enzyme def (CAH)
70
htn with pale color and edema
think renal dz (pallor from poor epo / anemia)
71
HTN w/ low BP in legs vs arms, decr femoral pulse
Coarct Ao
72
tx before surgery for pheo
alpha blockade before beta blockade (no unopposed alpha or htn crisis)
73
2 wk infant normal electrolyte lab values
creat -0.2-0.4, high phosphate, relative acidosis, increased FENA
74
don't use ACE i in what htn disease?
RAS b/l!!
75
diagnosing RAS? (3)
can do a random renin level (best after captopril premed)
can check MRA/CTA
US/Doppler - technique dep
76
water requirement rule for maintenance / day and /hr/
hour: 4-2-1
day: 100-50-20
77
fluid/electrolyte fluid for 10kg infant? 40kg child?
0.2% NS + 10 meq KCL x 24h
(1/4NS)
child: D5 1/4NS + 20mEQ KCL
78
1kg = how many ccs of fluid when calculating % loss (deficit) of fluid
1kg = 1000cc
79
Calculate fluid deficit of 10kg baby 10% dehydrated
0.10 x 10 x 1000 = 1kg = 1000cc
80
calculation for serum osmolality and what is normal
2 (Na) + 10 + [BUN/3 + Gluc/18]
Estimate with 2(Na) + 10
Normal 290
81
electrolyte abnormality causing seizure after hypernatremic dehydration
hypocalcemia
82
calculate free water deficit / excess
Wt x 0.6 = volume of distribution
(Na level x Vc ) / 140 (nl sodium) = new volume distr
New Vd - normal Vd = excess/deficit
83
Formula for FeNa
UNa x P Cr / UCr x PNa x 100
84
3 causes of nongap acidosis?
1. Renal loss of bicarb (RTA, carbonic anhydrase inhib)
2. GI loss of bicarb (diarrhea)
3. acid administration (HCl, parenteral nutrition)
85
anion gap formula, normal?
Na - (HCO3 + Cl)
| normal 8-16
86
RTA type 1 features
Cannot excrete acid load so never w/ urine pH < 6!
| renal stones, can get low K w/ Na salts
87
prob w/ bicarb admin in acidosis
blood will quickly equilibrate with increased bicarb and incr pCO2, but CSF will not catch up right away and will incr pCO2 w/o concomitant bicarb right away;, causing a low pH in CSF...
88
if urine pH <6, the diagnosis is NOT what?
RTA 1 (can't excrete acid)
89
where is defect in RTA 1
distal tubule where you excrete acid from NH4 production
90
UNa for prerenal
<20 is the clue for prerenal azotemia
91
clue for renal azotemia in urine sodium
UNa >30
184
RTA 1 vs 4
both can acidify urine, but four can have hyperkalemia
185
two drugs potential use in siadh if fluid rstrx fails
demeclocycline
| fludrocortisone
186
two chemo agents that can cause hyponatremia and how
cylcophos decreases water excretion
| vincristine causes siadh
187
diabetes drug that can cause hyponatremia
chlorpropamide
188
what is the total body sodium in water tox?
| what is the urine concentration of na
normal
| high urine Na
189
what is the total body sodium in pseudohyponatremia (like in high TG)
total body na high (water is high, but volume is low so total na looks low)
190
low calcium effect on ekg
long qt
191
low magnesium effect on ekg
long pr or qt
192
hypokalemia ekg changes
flat T, st depr, pvcs
193
hyperkalemia ekg changes
peak t, no p, wide qrs, EMD
194
best replacement fluid for toddlers oral
glucose 2-2.5%
na 60-90 meq
(teens water)
195
appropriate correction of hypernatremia
slow: no more than 10-12 in 24 hours
196
for every 1L of maintenance fluid, how much Na, CL, K do you need?
How do you figure out deficit Na?
30mEq Na
20meq K
20 meq Cl
Can figure out deficit electrolytes too by multiplying ECF deficit (60% deficit) x 140meq. (This is the 0.6 volume of distribution for Na!)
