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FEN/Renal Flashcards

1
Q

neonatal evaporative water loss attributed to

A

respiratory tract 1/3
skin 2/3

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2
Q

when is ADH present

A

11 weeks

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3
Q

where is ADH produced

A

paraventricular and supraoptic nuclei of hypothalamus –> posterior pituitary

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4
Q

where does ADH act

A

late distal tubule
cortical and medullary collecting ducts
increases urine osmolality

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5
Q

factitious hyponatremia from:

A

hyperlipidemia 0.002
hyperproteinemia 0.25
hyperglycemia 1.6

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6
Q

Na deficit =

A

(na desired - na current) X 0.6 x weight

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7
Q

u wave on ekg

A

hypokalemia

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8
Q

alkalosis related hypokalemia pathophys

A

H+ exits cell and K+ enters cell

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9
Q

acidosis effect on K+

for every 0.1 reduction in pH

A

every 0.1 reduction in arterial pH –> 0.6 mEq/L increase in K+

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10
Q

intracellular buffers

A

bone apatite
hemoglobin
organic phosphates

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11
Q

extracellular buffers

A

HCO3-
phosphates
proteins

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12
Q

mechanisms of acid-base balance in kidney

A
  • reabsorption of HCO3- (PT)
  • H+ excretion via ammoniagenesis in PT
  • formation of titratable acids in cortical/medullary collecting tubule
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13
Q

anion gap =

A

Na+ - {Cl- + HCO3-}

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14
Q

side effects of NaHCO3 administration

A
  • worsening acidosis if poor pulm blood flow/ventilation because CO2 cannot be removed
  • increase risk hypernatremia
  • hypocalcemia: Ca decreases as HCO3 causes Ca to bind to albumin decreasing ionized Ca+
  • K+ may decrease
  • increase risk IVH due to hypertonicity
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15
Q

RTA4 subtypes and labs

A

subtype 1: NaCl wasting, decreased urine aldosterone
a.w Addisons and CAH

subtype 4: NaCl wasting, increased urine aldosterone
Pseudohypoaldosteronism

subtype 5 (MCC): NaCl reabsorption normal, tubule insensitive

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16
Q

secondary causes of RTA II

A

prematurity
tyrosinemia
tubular disorders (fanconi, cystinosis, Lowe)

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17
Q

secondary causes of RTA I

A

interstitial renal disease
genetic
autoimmune
hypotonic states
drug induced

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18
Q

Bartter syndrome pathophysiology

A
  • hypertrophy + hyperplasia of renal juxtaglomerular apparatus
  • defect in Cl transport in ascending loop preventing reabsorption
  • increased renin, increased aldosterone, hypokalemic metabolic alkalosis, normal PTH
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19
Q

Management of Bartter

A

potassium, +/- thiazide, +/- indomethacin

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20
Q

what dermal layer does kidney come from?

A

mesoderm

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21
Q

what are the 3 structures of kidney embryology

A

pronephros-transient
mesonephros - epididymis, vas deferens, seminal vesicles
metanephros - pevicalyceal system, 5th week

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22
Q

when do nephrons appear

A

8 weeks

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23
Q

FGR affects size or number of nephrons?

A

number

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24
Q

number of nephrons increase until ____ weeks then start increasing in size

A

34-35

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25
Q

which area are nephrons most mature at birth

A

juxtaglomerular nephrons

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26
Q

when does urine start being produced?

A

10-12 weeks

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27
Q

reasons for decreased concentrating capacity in preterm infants

A
  • tubule insensitivity to ADH
  • short loop of henle
  • low osmolality of medullary interstitium
  • low serum urea
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28
Q

sodium reabsorption in parts of kidney

A

65% proximal tubule
25% ascending loop of henle
10% DCT/collecting duct

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29
Q

reabsorption and secretion of K+ in kidney

A
  • reabsorption PT and ascending loop
  • secreted in DCT and CT
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30
Q

FENa =

A

(UNa x PCr)/(UCr x PNa) x 100

31
Q

Ca reabsorption in kidney

A

reabsorption in PT, loop of Henle, DCT and CT

32
Q

Phosphorus reabsorption in kidney

A

80% PT
10% DCT

33
Q

tubular reaborption of phosphorus =

A

TRP = (UPhos x PCr)/(UCr x PPhos) x 100

34
Q

Mg reabsorption in kidney

A

65percent PT and TAL

35
Q

aldosterone effects on kidney

A
  • Na reabsorption
  • Cl passively
  • secrete K+ and H+
36
Q

pseudohypoaldosteronism pathophysiology

A
  • XLR
  • renal tubule unresponsive to aldosterone –> hypoNa, hyperK+, metabolic acidosis
  • increased aldosterone and renin
37
Q

protein reabsorption in kidney

A

95% PT

38
Q

Estimated GFR =

A

0.45 x height(cm) / PCr

39
Q

Difference between DMSA, DTPA, and MAG3

A

DMSA static
DTPA and MAG3 dyanamic images

40
Q

epi of renal anomalies

A

1/200

41
Q

MCC renal anomalies

A

horse shoe
unilateral renal agenesis (L>R)
pelvic kidney (L > R)

42
Q

types of congenital nephrotic syndrome

A

Finnish
Diffuse mesangial sclerosis

43
Q

Genetics of Finnish congenital nephrotic syndrome

A

chr 19 AR
NPHS1
nephrin protein

44
Q

differences between finnish and dms in terms of placenta, AFP and BW

A

Finnish - large placenta, increased AFP, SGA

DMS - normal palcenta, normal AFP, normal weight

45
Q

risk of renal agenesis

A

1/10000
40% still born

46
Q

recurrence risk of renal agenesis

A

3-5%

47
Q

genetics of ARPKD and ADPKD

A

ARPKD
- chr 6p21
- PKHD1
- fibrocystin/polyductin cilia related

ADPKD
- chr 16p13.3
- PKD1
- polycystin1

48
Q

prognosis of ARPKD

A

30% mortality
50% ESRD

49
Q

Syndromes of tubular dysfunction

A

Fanconi
Cystinosis
Lowe

50
Q

Pathogenesis of Fanconi

A
  • AD
  • PT dysfunction
  • losses of AA, glucose, phosphate and bicarbonate
51
Q

Pathogenesis of Cystinosis

A
  • AR
  • defective carrier mediated transport of cystine –> excess cystine in lysosomes
52
Q

Diagnosis of cystinosis

A
  • normal plasma cystine
  • need cornea slit lamp - cystine crystals
53
Q

management of cystinosis

A

cysteamine and renal transplant

54
Q

Pathogenesis of Lowe syndrome and other name

A
  • oculocerebrorenal syndrome
  • XLR
  • enzyme deficiency disrupting golgi apparatus
55
Q

clincal findings of lowe syndrome

A

occulo - cataracts, glaucoma
cerebo - MR, hypotonia/areflexia
renal - tubular dysfunction > nephrotic syndrome

56
Q

diagnosis of lowe syndrome

A
  • increased maternal and AF AFP
  • increased nucleotide pyrophosphatase in skin fibroblasts
57
Q

who gets prophylactic Abx in hydronephrosis?

A
  • moderate if female and bilateral
  • severe
58
Q

ectopic urterocele epidemiology and definition

A
  • F > M
  • 10% bilateral
  • duplicated renal pelvis and ureter which may drain into neck of bladder
59
Q

pathophysiology of exstrophy of bladder sequence

A
  • primary defect of intraumbilical mesoderm
  • 6-7 weeks infraumbilical mesenchyme migrates giving rise to lower abdominal wall, genital tubercles and pubic rami
60
Q

occurrence and recurrence of exstrophy of bladder

A

1/30,000
<1% if unaffected parent
1/70 if affected parent

61
Q

what renal anomalies in Zellwegers

A

cortical renal cysts

62
Q

what renal anomalies in Jeune?

A
  • cystic tubular dysplasia
  • glomerulosclerosis
  • hydronephrosis
  • horseshoe kidneys
63
Q

what renal anomalies in Meckel-Gruber syndrome

A

polycystic/dysplastic kidneys

64
Q

what renal anomalies in Tuberous sclerosis?

A

polycystic kidneys
renal angiomyolipomas

65
Q

what renal anomalies in nail-patella syndrome

A

proteinuria and nephritic syndrome

66
Q

stage 0 AKI

A

<0.3 Scr/no change
>0.5mL/kg/h UOP

67
Q

stage 1 AKI

A

> 0.3 SCr change in 72 hr or 1.5-1.93 in 7d
<0.5mL/kg/h UOP for 6-12

68
Q

stage 2 AKI

A

> 2.0-2.93 in SCr
<0.5mL/kg/h UOP for 12

69
Q

stage 3 AKI

A

> 2.5 in SCr or 3x reference
<0.3mL/kg/h UOP for 24 or anuria for 12h

70
Q

GFR threshold for CKD?

chronic renal failure?

A

60 mL/min/1.73 m^2

15 mL/min/1.73 m^2

71
Q

highest PPV for fetal nephropathy

A

AP diameter of renal pelvis

72
Q

MCC acute renal failure in neonates

A

perinatal asphyxia

73
Q

secondary hyperoxaluria

A

SGS and malabsorption

74
Q

PTH effect on bicarbonate reabsorption

A

decreases

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