Renal

Question 1

Kidney begins functioning at …

Answer 1

9-10 weeks of gestation

Question 2

nephrogenesis, the process of ___________, is complete by about ______ weeks GA

Answer 2

process of nephron formation, completed by 34-36 weeks

Question 3

Bladder formation begins at ______ weeks gestation

Answer 3

4-6 weeks

Question 4

uretheral development is complete by _____ weeks

Answer 4

12-13 weeks

Question 5

the major determinate of GFR

Answer 5

blood pressure in the peritubular capillary system

Question 6

Tubular function: proximal tubules

Answer 6

are generally re-absorptive and absorb water, sodium, potassium glucose, amino acids, bicarb, phosphorous, magnesium, chloride, and calcium

secreted: organic acids, hydrogen ions

Question 7

distal tubular function

Answer 7

secrete potassium and hydrogen ions
reabsorb: water in the presence of arganine vasopressin, variable sodium reabsorption (dependent on presence of aldosterone)

Question 8

ADH system

Answer 8

regulates renal blood flow through the renin-angiotensis-aldosterone-AHD system

Question 9

ADH system: in the ascending loop of henle, a drop in sodium chloride will cause a ______ of the afferent arteriole, allowing for _______ blood flow

Answer 9

relaxation —–increased

Question 10

ADH system: the macula dense cells will stimulate the juxtaglomerular cells to release _______ activating the ADH system.

Answer 10

renin

Question 11

The goal of the ADH system is to maintain adequate renal perfusion by _______ sodium chloride and water _______ by the peritubular capillaries to increase intravascular volume, increasing cardiac output and blood pressure.

Answer 11

increasing sodium chloride and increasing water reabsorption

Question 12

Renin

Answer 12

released in response to decreased renal blood flow; converts angiotensinogen from the liver to angiotensin I

Question 13

angiotensin I

Answer 13

undergoes further conversion to angiotensin II in the lungs and renal endothelium by enzyme angiotensin-converting-enzyme (ACE)

Question 14

Angiotensin II

Answer 14

a potent vasoconstrictor of peripheral blood vessels and the efferent arteriole that increases tubular sodium, chloride, and water reabsorption

Question 15

Aldosterone

Answer 15

a mineral corticoid hormone released by the adrenal cortex in response to angiotensin II, adrenocorticotropic hormone, or hyperkalemia.

aldosterone increases intravascular volume through sodium, chloride, and water reabsorption and excretion of potassium and hydrogen ions

Question 16

Arginine Vasopressin

Answer 16

increases the permeability of the collecting ducts to water, and allows for water reabsorption into the peritubular capillaries, increasing intravascular volume

Question 17

Atrial natriuretic Protein and B natriuretic protein

Answer 17

reverse the action of the ADH system

Question 18

Elevated maternal serum or amniotic alpha-fetoprotein levels indicate (renal)

Answer 18

obstructive uropathy, renal agenesis, or congenital nephrotic sydrome

Question 19

oligohydramnios associated with

Answer 19

renal agenesis, dysplasia, polycystic kidney disease or urinary tract obstruction

Question 20

polyhydramnios may be associated with (renal)

Answer 20

due to renal tubular dysfunction and decreased ability to concentrate urine

Question 21

Elevated BUN

Answer 21

may be seen in AKI or hypercatabolic states or with increased protein intake

Question 22

An increase in serum creatinine

Answer 22

increase >0.2mg/dL per day or creatinine >1.5 indicate renal dysfunction

creatinine at birth reflective of mother but should either remain the same or decrease after that (depending on GA)

Question 23

BUN / Creatinine ratio

Answer 23

disproportionate rise - prerenal azotemia

proportionate rise - intrinsic AKI

Question 24

Potassium in AKI

Answer 24

often elevated in AKI due to impaired excretion

Question 25

Normal urine specific gravity

Answer 25

1.021 to 1.025 in full term infants

Question 26

glycosuria in infants \<34 weeks

Answer 26

common due to decreased tubular reabsorption of glucose

Question 27

Fractional Excretion of Sodium

Answer 27

amount of urinary sodium excretion is a percentage of the filtered sodium, reflecting the balance between glomerular filtration and tubular reabsorption of sodium (urine sodium x plasma creatinine) / plasma Na x urine creatinine x 100% FENa \>3% indicative of intrinsic renal injury FENa \<2.5% indicative of pre-renal injury

Question 28

Pre-renal azotemia causes and incidence

Answer 28

85% of AKI (most common) State of hypoperfusion * hypotension * CHF * RDS * Dehydration * Nephrotoxic meds (ACE inhibitors,NSAIDS, COX2 inhibitors, ARBs, aminoglycosides)

Question 29

Intrinsic AKI

Answer 29

* renal dysfunction due to direct structural damage * may result from prolongation of prerenal causes of renal injury, * congenital defects, * inflammation / infection due to viral or yeast infections * vascular ischemia/hypoperfusion such as aortic or artery thrombosis * nephrotoxic administration of meds in utero or postnatal * ATN may be due to perinatal asphyxia

Question 30

Postrenal AKI

Answer 30

primarily due to obstruction of urine flow * posterior uretheral valves * bilateral ureteropelvic junction obstruction * bilateral ureterovesical junction obstruction * neurogenic bladder * obstructive nephrolithiasis

Question 31

AKI management

Answer 31

fluid challenge for prerenal AKI renal ultrasound to assess for presence of urine in bladder low of low-dose dopamine may be used to increase renal blood flow treat underlying condition lasix for fluid overload

Question 32

fluid management for AKI

Answer 32

fluid restriction for low output injury fluid replacement for high-output injury

Question 33

bilateral renal agensis

Answer 33

the failure of renal development or the complete absence of the kidneys associated w/ potter sequence

Question 34

management of bilateral renal agenesis

Answer 34

oligohydramnios leads to compression of the fetus leading to pulmonary hypoplasia comfort measures, dialysis if pulmonary hypoplasia is not severe almost always 100% mortality

Question 35

Polycystic Kidney Disease

Answer 35

autosomal recessive cystic kidney disorder; will have a palpable flank mass bilaterally with oliguria or decreased UOP usually occurs bilaterally

Question 36

multicystic dysplastic kidney disease

Answer 36

nongenetic, developmental renal disorder which usually occurs in only one kidney; the cysts are described as “**grape-like” cysts** ## Footnote **usually presents with unilateral abdominal mass** **one of the most common causes of abdominal masses in neonates**

Question 37

Hydronephrosis

Answer 37

damage to the kidney from a congenital obstruction of the flow of urine which causes urine to backup into the kidneys which dilates the renal pelvis and calyces

Question 38

Ureteropelvic Junction Obstruction

Answer 38

UPJO is one of the most common causes of hydronephrosis; more common in males; obstruction at kidney and ureter junction

Question 39

Posterior urethral valves

Answer 39

most common lower urinary tract obstruction in males; obstruction via membrane blocking the exit from the bladder into the urethra

Question 40

Vesicoureteral Reflux

Answer 40

condition that results in urine backflowing out of the bladder into the ureters

Question 41

Renal Vein Thrombosis

Answer 41

usually unilateral thrombosis, usually on left side; * abdominal flank mass * possible abdominal distention * significant hematuria * thrombocytopenia high HCT at birth may contribute If clots occur with UVCs, often occur in the IVC

Question 42

Renal Artery Thrombosis

Answer 42

clot in the renal artery, blocks blood flow to the kidney (Frequent w/ UAC) * asymptomatic OR * systemic HTN * hematuria * thrombocytopenia * oliguria or anuria

Question 43

Urinary Tract Infection most common organism

Answer 43

E. Coli (Klebsiella common)

Question 44

UTI Diagnostic

Answer 44

positive urine culture *obtained via sterile bladder tap* or a gram stain with high colony count

Question 45

Prune Belly Syndrome or Eagle-Barrett

Answer 45

a) lack of abdominal wall muscles. b) hydronephrosis with a dilated bladder c) bilateral cryptorchidism

Question 46

Patent urachus

Answer 46

appearance of clear fluid / urine from the umbilicus at birth; at risk of developing UTI or excoriation of skin; supportive care and surgical closure after 1 year of age

Question 47

chordee

Answer 47

abnormal ventral curvature of the penis

Question 48

Cryptorchidism associated with syndromes

Answer 48

Down, klinefelter, noonan, prader-willi, fetal hydantoin syndrome

Question 49

Renal Tubular Acidosis

Answer 49

Normal kidneys excrete hydrogen ions and reabsorb bicarb to compensate for acidosis. RTA is a failure to to respond or attempt to compensate for acidosis

Question 50

RTA Types

Answer 50

Type 1 - distal RTA - inability to secrete hydrogen type 2 - proximal RTA - defect in the ability to reabsorb bicarb Type 3 - a combination of types 1 and 2 type 4 - hyperkalemic tubular type is due to a problem with aldosterone (deficiency or resistence) that results in high levels of potassium

Question 51

RTA presentation

Answer 51

polyuria, weight loss despite adequate caloric intake; Normal anion gap

Question 52

RTA Treatment

Answer 52

sodium bicarb or bicitra; type 4 may require sodium supplementation and potassium restriction Type 2 - associated with Fanconi anemia - investigate

Question 53

Creatinine levels

Answer 53

\>1.5 indicative of renal impairment, or increase of \>0.3-0.5 rise per day worrisome

Question 54

Fluid challenge

Answer 54

give 10-20ml/kg of NS over 1-2 hours, UOP \<2ml/kg/hr worrisome

Question 55

Hypertension

Answer 55

Term: 100/70 Preterm: 90/60 ; most common cause is acute renal damage, or fluid overload; ARF is most common cause, tx w/ Hydralazine

Question 56

Metabolic acidosis requiring treatment

Answer 56

pH \<7.2 or CO2 \<14, if treating, monitor ionized calcium