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NICU Board Review > Renal > Flashcards

Renal Flashcards

1
Q

Neonates have a ____GFR and ____ tubules

A

Lower GRF and immature tubules

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2
Q

RTA with failure of bicarb reabsorption. Which type?

A

Proximal RTA (Type 2)

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3
Q

RTA that fails to acidify urine. Which type of RTA?

A

Distal (Type I)

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4
Q

Normal GFR

A

100ml/hr

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5
Q

What does AF tell you about the kidneys?

A 
Amniotic fluid volume
Oligohydramnios:
Poor function
Obstruction vs. intrinsic
May or may not be amenable to
intervention (in utero or after
birth)
•
Polyhydramnios
Polyuric conditions (e.g., Bartter
syndrome)
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6
Q

T or F

If serum Cr doubles, GFR falls by 50%

A

True

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7
Q

T or F

GFR is NOT altered by prematurity

A

True

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8
Q

Name causes of hypercalcemic hypercalciuria

A 
Subq fat necrosis 
Hyper parathyroid 
Hypophosphatasia
Williams syndrome 
Vit D toxicity 
Idiopathic infantile hypercalcemia
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9
Q

Who receives postnatal antibiotic management for hydronephrosis?

A

Moderate b/l hydronephrosis in female

Severe unilateral or b/l hydronephrosis in male or female

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10
Q

What has the highest positive predictive value for the development of fetal nephropathy?

A

Anteroposterior diameter of the renal pelvis

As in hydronephrosis

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11
Q

Increase in GFR during fetal development depends on?

A

Number of glomeruli

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12
Q

What is the GFR threshold for chronic kidney disease vs chronic kidney failure?

A

Chronic kidney disease
60ml/min/1.7 m2

Chronic kidney failure
15ml/min/1.7 m2

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13
Q

Which diuretic does not require sufficient tubular drug concentration in order to exert its effect?

A

Spironolactone

It is an aldosterone antagonist that competes with aldosterone by binding on collecting tubule receptors

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14
Q

Name the different sites for H20 and solute absorption in the nephron?

A

Proximal Convoluted tubule
Na active transport across tubule wall
H20 passively follows

Loop of Henle and distal convoluted
Active reabsorption of solutes
Impermeable to H20

Collecting ducts
Reabsorption of h20 is TIGHTLY regulated by arginine vasopressin or ADH

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15
Q

Fanconi syndrome

A

Defect in proximal tubular réabsorption

Glucose
AA
Uric acid 
Phosphate
Hco3

(Think Faconi + proximal RTA
No HCO3 réabsorption)

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16
Q

Whar GA is nephrogenesis complete?

A

34-36 weeks

After that the nephrons begin to enlarge

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17
Q

Effects of drugs used for PDA closure

A

Decrease afferent arteriole dilation (ibuprofen, indomethacin)

  • prostaglandin inhibitor
  • causing vasoconstriction
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18
Q

Which meds effect efferent arteriole system?

A

Block efferent arteriole (kidney)constriction —-> decreasing renal blood flow and decreasing time spent in glomeruli) —> thereby vasodilating

  • ACE inhibitors
  • NSAID
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19
Q

What are the most common causes of acute renal failure?

A

Severe perinatal adphyxia (40%)
Sepsis (22%)
Feeding intolerance (18%)

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20
Q

Metabolic acidosis with defect in H secretion. Which RTA?

A

Distal Type I

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21
Q

Metabolic acidosis due to defect in bicarb reabsorption. Which defect?

A

Proximal Type II RTS

Urine pH is alkaline

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22
Q

Metabolic acidosis, hyperkalemia and salt wasting. Which acidosis?

A

Type IV RTA

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23
Q

Mechanism of beta blockers

A

Decrease HR
Decrease Stroke Volume
Decrease Renin

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24
Q

Renin ultimately stimulates _____ to make more ________.

A
  1. ACE— throughout body, but highest in vascular endothelium of lungs.
  2. Angiotensin II—potent vasoconstrictor
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25
Q

Location and mechanism of action of thiazides

A

Distal convoluted tubule (the Na-Cl cotransporter)

Causes decreased Na, K and Cl reabsorption but INCREASED Ca++

Leads to smaller osmotic gradient so don’t reabsorb water

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26
Q

Renin is made in the ___

Angiotensinogen is made in the ___

Angiotensinogen is converted to Angiotension I in the ___

Angiotensin II is made in the ____

Aldosterone is made in the ___ and acts at the _____

A

Kidneys

Liver

Plasma

Lung vasculature (by ACE)

Adrenals

Cortical collecting ducts (CCD) and DCT

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27
Q

What are the effects of Bicarb administration for acidosis (5)?

A

During administration:

  1. Can worsen acidosis if poor pulmonary blood flow/ventilation ratio because cannot eliminate CQ
  2. Increased risk of hypernatremia
  3. Calcium decreases since HCO; causes Ca to bind to albumin and thus decreases ionized Ca concentral
  4. K* may decrease
  5. Increased risk of developing intraventricular hemorrhage secondary to hypertonicity,
28
Q

Why are neonates prone to becoming acidotic fairly easy?

A

Low serum Bicarb threshold in the proximal tubule and once surpassed bicarb is excreted in urine

Limited ability to excrete acid load (reduced distal urinary acidification?

29
Q

Most common renal anomalies

A

1/200

Horshoe kidney
Unilateral renal agenesis (L>R)
Pelvic kidney (L>R)

30
Q

Infant with proteinuria, hyperlipidemia, edema. Large placenta noted at the time of delivery. Dx? Inheritance?

A

Finnish congenital nephrotic syndrome

AR, Chromosome 19, NPHS1 gene

90% w symptoms by 1 mo

31
Q

Why are infnats with congenital nephrotic syndrome at risk for infection and thromboemboli?

A

Secondary to urinary losses of IgG and coagulation proteins

32
Q

Fetal Us with large echogenic kidneys, oligohydramnios, empty bladder. What is the most likely diagnosis?

A

ARPKD

1/20,000

Chromosome 6p, PKHD1 expressed on cilia of renal cells and bile duct cells.

Cysts in collecting ducts usually with “snowstorm” appearance on US.

Have renal and liver involvement only 
Severe Hypertension (respond to acei or loop diuretics)

May have pulm hypoplasia, potters facies, club foot frok oligohydramnios

30% mortality w severe neonatal presentation
50% end stage renal disease by 10 yo

33
Q

Male neonate with cataracts, hypotonia, renal tubular dysfunction. What test to reach diagnosis?

A

Lowe syndrome/oculocerebrorenal syndrome

Skin biopsy to asses nucleotide pyropjosphatase in skin fibroblasts

Xlinked recessive , due to gene defect leading to enzyme deficiency disrupting golgi apparatus

Tx: symptom directed, no treatment will reverse enzyme deficiency and golgi dysfunction

34
Q

You suspect a neonate has an ectopic ureterocele. What findings in VCUG would be consistent with your diagnosis?

A

Filling defect in the bladder (the ureterocele)

Ectopic ureteroceles are more common in females, usually unilateral, renal pelvis and ureter are duplicated.

One of the ureters (the one that drains the upper pole of the duplex kidney) enters ectopically unto the neck of the bladder.

35
Q

Which genetic condition is associated with horseshoe kidney?

A

Turner syndrome (Monosomy X)

36
Q

You get a call about an infant with GU abnormality, notably with a single opening in the perineum. What diagnosis are you concerned about and other associated findings to look for?

A

Extrophy of cloaca sequence

defect of early mesoderm

Remember OEIS
Omphalocele
Extrophy of cloaca 
Imperforare anus
Spinal defects (incomplete development of lumbosacral vertebrae with hydromelia)

May have cryptoorchidism
Females w bifid uterine horns

37
Q

Triad of renal vascular thrombosis?

A

Enlargement of kidney (flank mass), hematuria and renal failure

38
Q

Which disorders are associated with neohrocalcinosis?

A

Williams syndrome
Type 1 distal RTA
Neonatal primary hyperparathyroidism
Barrter’s syndrome

Remember its associated with hypercalciuric states

39
Q

Risk factors for Hypertension

A

BPD
Central lines
Postnatal acute renal failure

40
Q

Will upper or lower extremities give you a higher BP?

A

Lower extremities gave higher BP

41
Q

Which anti hypertensive is contraindicated in neonates?

A

Verapamil

42
Q

Name the most common nephrotoxic drugs

A

Acyclovir
Aminoglycosides
Amphotericin V
Vancomycin

43
Q

Definition of chronic renal failure

A

Decrease in GFR<25% normal for a period of >3 months

Majority secondary to congenital urinary tract abnormalities
Need dialysis or transplant

44
Q

Complications for those with chronic renal failure?

A

Failure to thrive
Normal GH, IGF but low IGFBP
Give high cals 120-180% of daily rec

Renal osteodystrophy
Secondary to decreased Vit D hydroxylation from loss of renal tissue.
Give 1,25OH Vit G to prevent hypocalcemia

Neuro complications from excess aluminum, HTN, electrolyte abnls

45
Q

How to distinguish RTA type I vs II?

A

Type 1 RTA (distal) failure if H+ resorption has nephrocalcinosis whereas Type II RTA (proximal) failure Bicarb reabsorption doesnt

Type I urinary pH >6.5 whereas type II is very high>7.5

Type 4 has hyperkalemic metabolic acidosis

46
Q

Most common risk factor for RVT?

A

Asphyxia

Then maternal diabetes, polycythemia

Usually presents <3days

47
Q

Effects of Angiotensin II

A
  • stimulates the adrenal cortex to secrete aldosterone for Na réabsorption

In response to a decrease in renal blood flow, renin levels increase, which leads to increase
angiotensin I.

Angiotensin HI has several functions, including the following:
Increase in water and salt reabsorption in the renal tubules!
Vasoconstriction of systemic and renal arterioles?

Stimulation of the adrenal cortex to produce aldosterone, further increasing sodium réabsorption in
renal tubules and nonrenal sites

Increase in glomerular filtration*
• Possible vascular smooth muscle cell and myocardial hypertrophys

Ques 26

48
Q

Nephrogenesis is complete at what GA?

A

34-36 weeks

49
Q

What stimulates renin secretion?

A

Decrease in Afferent arteriole stretch

Increased in renal sympathetic activity

Decreased na cl transport to macula densa

50
Q

Nephrocalcinosis in a short bowel pt is due to _______.

A

Increase in oxalate excretion in the urine (leads to excess calcium oxalate urine deposits)

51
Q

Typical laboratory findings associated with Type1 Distal RTA ?

A

Hypercalciuria

Hypokalemia: potassium replaces hydrogen as a cation in the urine

  • Hypocitraturia: citrate is reabsorbed to create bicarbonate
  • Hypercalciuria: increased calcium secretion from bone to serve as a buffer
  • High urine pH with hyperchlorèmic metabolic acidosis and normal anion gap
52
Q

Most common sight of urinary obstruction in hydroneohrosis is?

A

Uretopelvic junction obstruction

53
Q

Which conponent of the RAS pathways is necessary for normal nephrogenesis?

A

Angiotensin II bc it serves as a renal growth factor

54
Q

What causes réabsorption of HCO3 in kidneys?

A

Decreased réabsorption with volume expansion or increaed PTH

HCO3 réabsorption is increased with acidosis, hypercapnia or volume contraction

55
Q

Normocalcemic hypercalciuric nephrocalcinosis is seen with _______.

A

Distal renal tubular disease Bartter syndrome
hyper prostaglandin E syndrome Cushing syndrome
chronic lasix use
familial hypomagnesemia

56
Q

Hypercalcemic hypercalciuric nephrocalcinosis is seen with _______.

A

Hyperparathyroidism hypophosphatasua
subcutaneous fat necrosis
Williams syndrome

57
Q

Location of action for a acetazolamide (Diamox)

A

Proximal convoluted tubule

Remember PCT is where you Pee out bicarb

(Acetazolamide increases HCO3 excretion, such as when trying to correct contraction alkalosis)

58
Q

Hemofiltration utilizes _________ to remove solutes from plasma.

A

Convection

59
Q

Hemodialysis utilizes __________ to remove solutes from plasma.

A

Dialysis

60
Q

Infant kidneys receive what percentage of cardiac output?

A

10% compared to adults which is 25%

61
Q

Name renal vasodilators

A

Prostaglandin

Nitric oxide

62
Q

What is endothelin?

A

Renal Vasoconstrictor

Produced by the renal vascular endothelial cells

Release is stimulated by angiotensin II, bradykinin, epinephrine or stress

63
Q

What is the cause of FTT in RTA?

A

Decreased secretion of growth hormone as a result of metabolic acidosis

64
Q

Neonate w eye clouding, hypotonia, renal tubular dysfunction, and cryptorchidism. Dx?

A

Lowe syndrome. X linked recessive affecting enzymatic fumction of golgi apparatus

Oculocerebro-renal syndrome

Dx: increased nucleotide pyrophosphatase in skin fibroblasts

65
Q

Describe findings of bartter syndrome

A

Hypokalemia, metabolic alkalosis, hypercalciuria

Defects in Na, Cl, K transport in loop of henle

Antenatal presentation polyhydramnios

Triangular facies, protruding ears, large eyes w strabismus, drooping mouth. Can develop hypotension w salt wasting

NICU Board Review (19 decks)

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