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Nicu Brodsky+Pediatrix+NeoReview Questions > FEN/Renal > Flashcards

FEN/Renal Flashcards

1
Q

Pasteurization destroys immunological properties of milk - what is destroyed and what is preserved?

A

IgM destroyed; IgA and IgG are preserved

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2
Q

Deficiency: diaper dermatitis, hypoalbuminemia, crusted rash perioral

A

Zinc - important component of enzymes like carbonic anhydrase, important for growth; inherited form is acrodermatitis enteropathica (AR); defective zinc uptake in duodenum/jejunum bc abnormality in Zinc transporter protein ZIP4

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3
Q

What do selenium and chromium do?

A

Selenium: cofactor for glutamine peroxidase, antioxidant (deficiency = cardiomyopathy)
Chromium: regulates glucose levels, role in insulin metabolism (unknown side effect of deficiency)

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4
Q

Copper’s role and deficiency

A

critical for RBC and Hgb formation, absorption of iron
Deficiency: anemia, osteoporosis, pigmentation of hair and skin, neutropenia, poor weight gain, hypotonia/ataxia

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5
Q

Describe the 3 types of RTA, urine pH, serum K, hyperCalciuria

A

1 (distal): diminished acid secretion,&raquo_space;6.5 urine pH, low-normal K, YES hyper Ca in urine
2 (proximal): failure to absorb bicarbonate; <6.5 urine pH, low-normal K, NO hyper Ca in urine
4 (aldosterone deficiency/resistance); pH < 6.5 in urine, high K, NO hypercalciuria

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6
Q

When do lactase and intestinal disaccharidases ready adult c concentrations?

A

Lactase: 36 weeks
Disaccharides: 28 weeks

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7
Q

Whey to casein ratios for colostrum, mature BM, preterm formulas

A

Colostrum: 80:20
Mature BM: 55:45
Preterm formulas: 60:40

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8
Q

Over time in ELBW, what happens to TBW, ECF, ICF?

A

TBW, ECF, and NaCl are DECREASING (TE-creasing)
at 3 mo, ICF = ECF
At 24 weeks, ECF 65, ICF 25

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9
Q

Deficiency: alopecia, scaling dermatitis, seborrhea

A

Biotin deficiency

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10
Q

Ascorbic acid deficiency:

A

wound healing poor, bleeding gums, associated with transient tyrosinemia

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11
Q

Retinol function and deficiency

A

pulmonary epithelial growth and cellular differentiation, may be associated with CLD; deficiency = photophobia, conjunctivitis, abnormal epiphyseal bone formation and tooth enamel, scaling, FTT

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12
Q

Riboflavin vs Thiamine

A

Riboflavin: FTT, photophobia, blurred vision, dermatitis, mucositis, glutamic aciduria type 1

Thiamine: beriberi; fatigue, irritability, constipation, cardiac failure; PDH complex deficiency and MSUD

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13
Q

When does first glomeruli develop and when is nephrogenesis complete? How many nephrons at that time

A

Pronephros: 2-3 weeks
First glomeruli at 9 weeks
Nephrogenesis completes at 34-36 weeks (1 million nephrons)
Urine production nat 10-12 weeks
90% of amniotic fluid is urine at 20 weeksI

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14
Q

In infants, kidneys only receive _____% of CO

A

10%

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15
Q

Copper is stored primarily in _____. and Begins to accumulate in _____ trimester

A

Liver; 3third trimester

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16
Q

Menkes disease

A

X-linked recessive; inability of cellular absorption of copper. Difficult to dx bc lack of normal values, large variation in copper/ceruloplasmin values
Hypochromic anemia, NEUTROPENIA, osteoporosis

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17
Q

What is the one thing cow’s milk has more than BM?

A

amino acids. Otherwise BM has more long chain PUFA, carnitine, cholesterol, docosahexaenoic acid

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18
Q

Preterm vs term milk?

A

Preterm milk has more protein, NaCl, PUFA, but LOWER lactose

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19
Q

Most variable component of human milk is ______

A

Triglycerides! depends on GA and maternal diet. Cholesterol is constant and independent of maternal diet

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20
Q

Protein should provide ____% of kcal to prevent catabolic state

A

7-15%

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21
Q

Selenium vs chromium vs zinc functions

A

selenium: glutathione peroxidase, antioxidant
Chromium: carb/lipid metabolism (deficiency not described)
Zinc: bone development

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22
Q

Preterm vs term formula differences

A

Preterm formula has higher protein, sodium, but lower lactose compared to term formula
Preterm formula is ISO-osmolar unless > 24 kcal

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23
Q

Absorptive functions of jejunum and ileum

A

Jejunum: protein, fat, carbs, iron, CA, Mg
Ileum: B12, releases neurologically important hormones, absorbs bile salts, fats, FAT-SOLUBLE VITAMINS, zinc

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24
Q

Foremilk vs hindmilk

A

Foremilk has higher lactose but lower fat. Same protein.

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25
Q

What is Lowe syndrome

A

X-linked recessive, Golgi apparatus. Oculocerebrorenal syndrome

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26
Q

Why do preterm infants have higher serum Cr in first few weeks of life compared to term?

A

Preterm has greater reabsorption of filtered Cr in leaky renal tubules and lower Cr clearance bc impaired glomeruli filtration

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27
Q

Describe renal embryology

A

Pronephros: 2-3 weeks, regress by 4 weeks
Mesonephros –> mesonephric tubule and duct
Mesonephric duct –> ureteric bud –> collecting ducts –> nephrons

Renal genesis occurs when ureteric bud FAILS to develop
If ureteric bud forms but no interaction with undifferentiated mesoderm –> renal dysplasia

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28
Q

When is vesicoamniotic shunt indicated?

A

2nd trimester (20 weeks)

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29
Q

Most common cause of hydronephrosis?

A

no specific anomaly

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30
Q

Prerenal vs renal tubular injury (urine osm, urine Na, FeNa)

A

Prerenal: urine ism high, urine Na low, FeNa < 2%
Renal tubular injury: urine ism low, urine Na high, FeNa > 2%

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31
Q

What is the role of placental lactogen?

A

Growth and development of fetus by coordinating metabolic and nutrient supply from pregnant woman to the developing fetus

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32
Q

Preterm infants can reach urine osm of _____ while adults can reach _____

A

500, 1200

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33
Q

Radiant warmer increases insensible water losses by _____ %. Steroids _____ IWL.

A

15-35%, DECREASE

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34
Q

Risk factors for renal vein thrombosis?

A

Prematurity, PV, maternal diabetes

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35
Q

IgA represents ____% of all IG in human milk. IgM _____ over time in lactating mothers.

A

90%; decreases

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36
Q

What is potter syndrome?

A

Oligohydramnios –> pulmonary hypoplasia –> physical deformities of face and extremities (renal agenesis, hypoplasia or bladder outlet obstruction)

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37
Q

What are extra-renal complications of autosomal recessive polycystic kidney disease?

A

Pulmonary hypoplasia, systemic hypertension, 45% liver involvement

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38
Q

Bile salts are _____ molecules while lipases are ____-soluble

A

amphiphilic; lipases are water soluble

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39
Q

Free fatty acids, bile salt, and monoglycerides form a ____

A

micelle –> contact with intestinal wall –> FFA and monoglyceride diffuse across plasma membrane into enterocyte. Within enterocyte, free fatty acids and monoglycerides are transported to ER and then re-esterified into TG and incorporated into chylomicrons –> packaged into exocytic vesicles in Gogli apparatus

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40
Q

Plasma osmolality equation

A

2 x Na + glucose / 18 + BUN / 3

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41
Q

Sx of essential fatty acid deficiency

A

dermatitis, THROMBOCYTOPENIA, increased infection, failure to thrive

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42
Q

Resting energy expenditure of a VLBW or ELBW infant is_____, while fecal loss of energy is ______

A

50 kcal/kg/day
10 kcal/kg/day

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43
Q

Growth in preterm infant =

A

REE x 2 + energy losses

44
Q

For each gram of protein supplied enterally, there is a ____ increase in weight and a _____ cm/week increase in HC

A

6.5 g/day; 0.4 cm/week

45
Q

Prenatally, placenta provides _____ g/kg AA to developing fetus

A

3.5 g/kg AA. Infants lose 0.6-1 gm/kg/day of protein so provide them ASAP

46
Q

VLBW needs ____ g/kg of protein to maintain intrauterine rates of weight gain and nitrogen retention, but realistically need ____ g/kg to grow

A

2.8; 3.5-4

47
Q

GFR reaches adult values after ____

A

2 years

48
Q

In utero, kidneys receive ____% of fetal CO, decreases to less than _____% during birth, gradually ______ during first 2 months of age

A

25%, 5%, increases

49
Q

Majority of fetal skeletal calcium is acquired during third trimester when placenta actively transports Ca. However, increased intestinal Ca absorption in pregnant women begins in 1st trimester and is maintained throughout pregnancy. This is ______ on Vitamin D

A

Independent

50
Q

Fetal calcium homeostasis is ____ of vitamin D and calcitriol, but deficiency postnatally is ______

A

fetal calcium is independent of vit D / calcitriol, but deficiency will impair postnatally

51
Q

Fetal calcium levels are ____ than maternal blood

A

Higher. After birth, transient drop and Ca returns to normal within first 48 hrs of life

52
Q

In neonate, Ca is absorbed from intestine _____. Later becomes ____.

A

passively, facilitated by lactose; later becomes active

53
Q

Formula contains _____ calcium than breast milk

A

more. Human BM meets Ca requirements for first 6 mo of an infant’s lifeR

54
Q

recommended daily Ca allowance in first 6 mo of life is _____ mg/day

A

200 mg/day

55
Q

Gold standard to measure GFR in adults and children?

A

inulin clearance

56
Q

Serum Cr steady state takes _____ for term infants

A

1-2 weeks. GFR at birth doubles in first two postnatal weeks

57
Q

Main AA for gluconeogenesis

A

alanine, glycine, glutamate. (leucine cannot)

58
Q

Smith Lemli Opitz syndrome

A

d/o of cholesterol synthesis. DHCR7gene. Elevated plasma 7-dehydrocholesterol value. Dysmorphic, cleft palate, CHD, hypospadias, polydactyly, syndactyly of 2nd-3rd toe

59
Q

Calcium accretion peaks during _____ weeks GA. Fetus accretes _____ mg/kg Ca / day

A

32-36 weeks. 100-130 mg/kg Ca / day. Breastfed term infants daily Ca retention is 90 mg so needs fortifier or preterm formula

60
Q

Coordination of suck swallow breathe improves with age. When does peak vacuum created occur in suck cycle?

A

Even day 4-5 is > 2-3 days of age of sucking

Peak vacuum when sucking coincides with lowering of newborn’s tongue

Term newborns: 10-30 sucks per burst
Preterm newborns at 32 weeks if 3-5 sucks per burst

61
Q

Excess of this mineral leads to basal ganglia injury.

A

Manganese
Manganese deficiency: dermatitis, hair depigmentation, FTT, GI symptoms

62
Q

What does chromium, copper, molybdenum, zinc toxicity lead to?

A

Chromium toxicity - chronic renal failure
Copper - liver cirrhosis
Molybdenum - disruption of copper metabolism
Zinc - decreased leukocyte and phagocyte activity

63
Q

What is cysteine useful for?

A

Synthesis of anti-oxidant glutathione, helps maintain redox potential, and assists with calcium homeostasis

64
Q

What does folate do?

A

important for degradation of AA homocysteine and histidine

65
Q

Estimated survival time for newborn who was 2 kg and no external nutrient supply?

A

10 days
1 kg = 4 days
500 g = 2 days

66
Q

Most common reasons for pump-dependent mothers of preterm neonates to have decrease in established milk supply

A

infrequent pumping, breast shield with tight fit, progestin based contraception

67
Q

What do milk banks screen for in terms of ID

A

HIV, HTLV, hep B + C, syphilis

68
Q

How much copper to preterm neonates need?

A

120 mcg/kg/d

69
Q

Predominant storage site for zinc

A

bone (40%) and liver (20%)

70
Q

Highest amount of LCPUFA is in ______

A

brain and retina

71
Q

Early hypocalcemia of prematurity

A

usually asymptomatic. Typically normal by 7-10 days

72
Q

How much zinc supplementation is required?

A

350 mcg/kg/day

73
Q

What ID does pasteurization eliminate?

A

HIV, CMV

74
Q

What is prevalence of severe cholestasis with PN between 14-28 days

A

14%

75
Q

Lactoferrin + probiotic benefits?

A

lower incidence of LOS

76
Q

The negative side of donor milk

A

associated with decrease in early weight gain compared to preterm formula

77
Q

what beneficial contents of gastric residuals

A

contain nutrients, gastric acid, enzymes that are likely beneficial for GI motility and development

78
Q

Pasteurization eliminates _____

A

HIV and CMV, IgA, lactoferrin, and lysozymes. Does NOT alter human milk oligosaccharides

79
Q

Can IV / enteral nutrition in preterm achieve intrauterine accretion rates of LCPUFAs?

A

NO

80
Q

What is creamatocrit

A

estimates amount of lipids and calories in human milk

81
Q

What is platelet-activating factor acetylhydrolase?

A

anti-inflammatory component in human milk that degrades platelet-activating factor, which is thought to be involved in NEC development

82
Q

What is suck ratio in non-nutritive BF?

A

6-1 to 8-1 (young neonates is 1-1, 2-1)

83
Q

What is lactoferrin

A

most common whey protein in milk. In stomach, pepsin assists with proteolysis of lactoferrin, which produces lactoferrin (microbicid). Lactoferrin assists with direct destruction of bacteria, viruses, fungi, and parasites. That’s why H2 antagonists / PPI can interfere with pepsin-induced proteolysis of lactoferrin

84
Q

Where is phosphorus absorbed? through what mechanism?

A

active + passive transport in jejunum
Preterm milk does NOT have extra phos (hence need fortifier)

85
Q

Zinc deficiency

A

perianal dermatitis, FTT, alopecia, diarrhea, crusted erythematous rash

86
Q

Benefits of trophic feeds

A

prevent intestinal atrophy, stimulate GI development, improve gut motility, greater activity of digestive enzymes

87
Q

Cord blood Mg is _____ than maternal Mg. Where is it stored in fetus?

A

Cord blood Mg is HIGHER, reflecting active placental transport of Mg

Fetal Mg > maternal Mg. Mostly in bone (65%), then muscle + soft tissues (34%)
5 of what is ingested
Gi only absorbs 40

88
Q

Intralipid is composed of?

A

100% soybean

89
Q

Weight loss during first week for preterm is 10-20% weight loss. From what compartment?

A

Decrease in TBV is interstitial fluid (TBW, ECF, interstitial fluid). No alteration in plasma volume

90
Q

Most fetal calcium accretion occurs during third trimester

A

25-30g by term.
250-300 mg/day
After birth, can only absorb 50-60% intestinal absorption Ca. Need 2x Ca compared to phos.

91
Q

Zinc intestinal absorption is increased by ______

A

AA and protein

92
Q

What is phytate? where is it found?

A

phytate decreases zinc absorption
found in soy milk, Ca, iron, Mg

93
Q

Copper deficiency

A

hypo chromic anemia, neutropenia, osteoporosis, seborrheic dermatitis-like rash, FTT, diarrhea, HSM, hypotonia, apnea

94
Q

Major long chain PUFA is:

A

docosahexaenoic acid (22:6, n-3)

95
Q

lactoferrin protein contains binding sites for

A

ferric iron, ribonuclease, nucleotide, and heparin, but NOT heme

96
Q

Omegavan is _____

A

100% fish oil
Neonates receiving fish oil able to rachieve higher docosahexaenoic acid than were those receiving nonfish oil based emulsions; but immediate decrease in levels after birth not prevented

97
Q

Frequency of rickets/fractures BW < 1.5 kg and <1 kg

A

rickets / fractures occurs in 10-32% of neonates with BW < 1.5 kg, and in 50-60% with BW < 1 kg
Osteopenia of prematurity typically has normal Ca, low / normal Phos

98
Q

Human milk promotes commensal bacteria, which attach to _______, preventing pathogenic bacteria from binding

A

toll-like receptors

99
Q

Anti-inflammatory mediators resolvin D1 and protectin D1 are derived from

A

docosahexaenoic acid (22:6, n-3)

100
Q

Primary factor in development of bone disease of prematurity is

A

Vitamin D deficiency

101
Q

Lipoprotein lipase

A

glycoprotein mostly found in adipose tissue

102
Q

Copper absorption is impaired by

A

enteral intake of ascorbic acid, iron, zinc

103
Q

Pasteurization eliminates ______, but does NOT affect

A

Pasteurization eliminates IgM, lipoprotein lipase, bil salt-activated lipase. IgA and IgG decrease slightly. Lactoferrin and lysozyme decrease by a lot

Does NOT affect linoleic acid, FFA, or monoglycerides.

104
Q

Folate daily intake

A

400 mcg/day, but only 30% adhere to it

105
Q

When to initiate iron?

A

2 weeks of life

106
Q

How much lipids required to prevent essential fatty acid deficiency? symptoms?

A

0.5-1 g/kg. Poor growth, scaly skin lesions, visual problems, neuro deficits

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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