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NICU Boards > Renal, electrolytes > Flashcards

Renal, electrolytes Flashcards

1
Q

In a normal pregnancy, when is the highest growth velocity (g/kg)?

A

28-32 weeks

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2
Q

In a normal pregnancy, what is the growth rate in the 3rd trimester?

A

gain 30-35 g a day until 32-34 weeks when it decreases after

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3
Q

At what weeks of gestation do infants gain the most weight in g/day?

A

32-36 weeks, gain ~30 g/day

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4
Q

When does the pronephros disappear?

A

4th week of GA

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5
Q

What structures form from the mesonephros?

A

vas deferens, seminal vesicles, and epididymis

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6
Q

What tissue types does the kidney come from?

A

mesodermi

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7
Q

What happens if there is unilateral dysgenesis of the mesonephros?

A

dysgenesis of the unilateral kidney and gonad

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8
Q

What structures from the kidney and at what gestation does this start?

A

metanephros, starts at 5th week GA

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9
Q

When do the first nephrons appear?

A

8th week

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10
Q

When is nephrogenesis complete?

A

34-36 weeks

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11
Q

What does fetal growth restriction do to the number of nephrons in the kidney?

A

reduces it

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12
Q

How does renal agenesis occur?

A

the uteretic bud fails to develop.

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13
Q

When does the fetus start to produce urine?

A

10-12 weeks; is 5 ml/hr by 20 weeks and 50 mL/hr at 40 weeks. At 20 weeks, the amniotic fluid is 90% urine

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14
Q

When does the neonatal kidney reach adult concentrating ability?

A

6-12 months of age

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15
Q

What are the 4 factors that reduce the premature infant from concentrating the urine?

A

tubule insensitivity to vasopressin, short loop of Henle, low osmolality of medullary interstitium (secondary to limited Na reabssorption in the thick ascending loop); low serum urea

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16
Q

Why do preterm infants have an increased [Cr] in the first few weeks of life compared to terms?

A

preterm infants have greater reabsorption of filtered creatinine in baby renal tubules therefore, preterm infant have a decreased Cr clearance 2/2 impaired GFR

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17
Q

What syndromes are a/w renal agenesis?

A

VATER/VACTERL, CHARGE, brachio-oto-renal, Jeune syndrome, T13,T18, T21

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18
Q

What is the most common cause of obstructuve uropathy in males?

A

posterior urethral valves; caused by a congenitall membrane that obstructs the urethra

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19
Q

What is the most common cause of congenital hydronephrosis?

A

UPJ obstruction; no dilated ureter on imaging

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20
Q

What is the second most common cause of congenital hydronephrosis?

A

UVJ obstruction: secondary to deficient development if the ureter or a ureterocoele (an outpouching of the ureter into the bladder); will see a dilated ureter in imaging

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21
Q

non-anion gap metabolic acidosis, low K, FTT, and polyuria- whats the Dx?

A

RTA type I or Type 2

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22
Q

Explain the pathophys behind RTA type 1. What’s the urine pH ? What’s the treatment?

A

aka Distal RTA, cannot secrete acid (H+) in the DCT; alkaline urine the pH> 5.5; Tx bicarb or citrate

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23
Q

Explain the pathophys behind RTA type 2. What’s the urine pH ? What’s the treatment?

A

AKA proximal RTA, cannot absorb bicarb but normal acid secretion, pH acidic (<5.3, which is normal); Recover by toddler to school age. Tx Bicarb or citrate

24
Q

Urine pH < 5.5, hyperkalemia, hyperchloremic metabolic acidosis. What is the Dx?

A

type 4 RTA

25
Q

Labs show decreased Na, increased K, metabolic acidosis, increased aldosterone, increased renin. Prenatally, the baby had polyhydramnios. What’s the Dx?

A

pseudohypoaldosteronism. X-link recessive

26
Q

Labs with decreased Na and Cl, increased renin, metabolic acidosis, increased K, decreased urine aldosterone. What the diagnosis and what is it a/w?

A

Aldosterone deficiency; a/w Addison’s disease and CAH

27
Q

Labs show increased urine aldosterone, decreased NaCl (salt wasting), metabolic acidosis, increased K. What’s the diagnosis>

A

pseudohypoaldosteronism

28
Q

Flank mass, hematuria and thrombocyopenia. Name the Dx?

A

Renal vein thrombosis

29
Q

What is the most common cause of neonatal HTN?

A

Renal artery thrombosis

30
Q

Which region of the kidney does acetazolamine (carbonic anhydrase inhibitor) act upon?

A

proximal convoluted tubule

31
Q

Which region of the kidney does furosemide act upon?

A

thick ascending loop of Henle

32
Q

What region of the kidney do thiazide duiretics work on?

A

distal convoluted tubule

33
Q

What region of the kidney do aldosterone antagonists (like spironolactone) work?

A

Collecting duct. Remember it is a postassium sparking diuretic

34
Q

What kind of drug us amiloride?

A

ENaC channel blocker, K sparing duiretic, works on the collecting duct

35
Q

Proteinuria, hypoalbinemia and edema represent what sydrome?

A

congenital nephrotic syndrome

36
Q

Name the 5 clinical findings for congenital nephrotic syndrome

A

immunodeficient (loss of igG); iron deificent (loss of transferrin); hyperlipidemia( loss of apoproteins and lipoprotein lipase which leads to elevated triglycerides), hypercoaguable (loss of ATIII), hypothyroid (loss of TBG)

37
Q

This kind of congenital nephrotic syndrom presents within the first month of life, is autosomal dominant, has an increased risk of preterm delivery and SGA, with a large placenta and increased AFP

A

Finnish congenital nephrotic syndrome

38
Q

Define mild AKI

A

increase 0.3 mg/dL within 48 hours, 1.5-1.9x baseline within 7 days, UOP < 0.5 ml/kg/hr for 6-12 hours

39
Q

Define moderate AKI

A

increase 2.0-2.9 from baseline, UOP < 0.5 ml/kg/hr for = or > 12hours

40
Q

Define severe AKI

A

increase of 3.0 x Cr from baseline OR Cr >/= 2.5 mg/dL OR dialysis; < 0.3 ml/kg/hr for >/= 24 hours or anuria for >/= 12 hours

41
Q

What does a decreased TRP (tubular reabsorption of phos) tell you in the presence of hypophosphatemia?

A

renal defect in phosphate reabsorption

42
Q

What is the most common cause of urinary tract dilatkon on antenatal US?

A

transient/ physiologic

43
Q

What are the direct effects of vasopressin?

A

renal water absorption and increasing blood pressure. Do NOT have a direct effect on renal sodium absorption or urine output; it is secreted by the fetal pituitary as early as 11 weeks; the fetal nephron is less sensitive to vasopressin than the adult

44
Q

What vitamin is important for pulmonary epithelial growth and cellular differentiation?

A

Vit A

45
Q

Why do patients with RTA have poor growth?

A

direct effect of serum acid leading to a decreased release of growth hormone and less drive to feed

46
Q

Congenital nephrotic syndrome has been a/w what infections?

A

toxo, rubella, CMV, syphili, HSV, HIV, Hep B

47
Q

Lowe syndrome is also known as?

A

oculocerebrorenal syndrome. Its an x-linked recessive disorder that affects the enzymatic function of the golgi apparatus.

48
Q

This syndrome presents with cataracts, low tone, severe mental deficiency, kidney disease, and cryptorchidism

A

Lowe syndrome

49
Q

What syndrome has elevated maternal and amniotic AFP with increased nucleotide pyrophosphatase in skin fibroblasts?

A

Lowe syndrome

50
Q

Infant has triangular facies, protruding ears, large eyes with strabismus and a drooping mouth. Whats the syndrome and what electrolyte abnormalities do you expect to see?

A

Barter syndrome, will see hypokalemia, metabolic alkalosis, hypercalciuria. It is a disorder of the loop of Henle involving Na, Ka and Cl transport. Will also have hypercalciuria and nephrocalcinosis. Affected infants may develop dehydration and hypotension related to severe salt wasting. Treat with Na and K replaement and monitor fluid balance

51
Q

What is the most common cause of acute renal failure in the neonate?

A

HIE

52
Q

What are indications for dialysis in a newborn?

A

Acidosis (metabolic), electrolyte issues (hyperkalemia, hyperphosphatemia, hypocalcemia, hyponatremia with volume overload), inability to provide adequate nutrition, overload with fluids, uremia. Notice NOT elevated Cr but that will often coincide with these indications

53
Q

Will the infant born to a mother with vit D defiency be born with low blood calcium levels?

A

NO. There is an increase is maternal intestinal absorption in the first two trimesters that is independent of the vit D so the fetus will have normal blood calcium levels and a normal skeleton at birth

54
Q

What happends to the blood flow to the kidneys during birth?

A

drastically decreases. 25% of CO goes to kidneys and then due to hemodynamic changes during and after birth it decreases to 5%

55
Q

When does the GFR reach adult levels?

A

2 years

56
Q

In infants with Barter syndrome, what are the levels of renin and aldosterone? What about parathyroid hormone?

A

both increased, but parathyroid hormone is normal despite hypercalciuria

NICU Boards (10 decks)

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