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Renal Flashcards

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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 oligo vs poly AFI tell you about the kidneys?

A

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

False- gfr is lower in preterm neonate and increases with advancing GA

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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- inheritance, pathogenesis

A

Defect in proximal tubular reabsorption

(Think Faconi + proximal RTA
No HCO3 reabsorption)

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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
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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
Location and mechanism of action of thiazides
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
26
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 _____
Kidneys Liver Plasma Lung vasculature (by ACE) Adrenals Cortical collecting ducts (CCD) and DCT
27
What are the effects of Bicarb administration for acidosis (5)?
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
Why are neonates prone to becoming acidotic fairly easy?
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
Most common renal anomalies
1/200 Horshoe kidney Unilateral renal agenesis (L>R) Pelvic kidney (L>R)
30
Infant with proteinuria, hyperlipidemia, edema. Large placenta noted at the time of delivery, increased AFP. Dx? Inheritance?
Finnish congenital nephrotic syndrome AR, Chromosome 19, NPHS1 gene 90% w symptoms by 1 mo
31
Why are infnats with congenital nephrotic syndrome at risk for infection and thromboemboli?
Secondary to urinary losses of IgG and coagulation proteins
32
Fetal Us with large echogenic kidneys, oligohydramnios, empty bladder. What is the most likely diagnosis? genetics? US appearance? Other organ involvement?
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. Renal and liver involvement only Increased risk hepatic fibrosis and biliary dysgenesis Severe Hypertension May have pulm hypoplasia, potters facies, club foot from oligohydramnios 30% mortality w severe neonatal presentation 50% end stage renal disease by 10 yo
33
Male neonate with cataracts, hypotonia, renal tubular dysfunction, cryptorchidism- diagnosis, inheritance. What test to reach diagnosis?
Lowe syndrome/oculocerebrorenal syndrome X-linked recessive (Males>females)- enzyme deficiency disrupting golgi apparatus Skin biopsy to asses nucleotide pyrophosphatase in skin fibroblasts Tx: symptom directed, no treatment will reverse enzyme deficiency and golgi dysfunction
34
You suspect a neonate has an ectopic ureterocele. Pathophys? What findings in VCUG would be consistent with your diagnosis? More common M vs F?
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. Filling defect in the bladder (the ureterocele) More common in females, usually unilateral
35
Which genetic condition is associated with horseshoe kidney?
Turner syndrome (Monosomy X)
36
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?
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
Triad of renal vascular thrombosis?
Enlargement of kidney (flank mass), hematuria and renal failure
38
Which disorders are associated with neohrocalcinosis?
Williams syndrome Type 1 distal RTA Neonatal primary hyperparathyroidism Barrter’s syndrome Remember its associated with hypercalciuric states
39
Risk factors for Hypertension
BPD Central lines Postnatal acute renal failure
40
Will upper or lower extremities give you a higher BP?
Lower extremities gave higher BP
41
Which anti hypertensive is contraindicated in neonates?
Verapamil
42
Name the most common nephrotoxic drugs
Acyclovir Aminoglycosides Amphotericin V Vancomycin
43
Definition of chronic renal failure
Decrease in GFR<25% normal for a period of >3 months Majority secondary to congenital urinary tract abnormalities Need dialysis or transplant
44
Complications for those with chronic renal failure?
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
How to distinguish RTA type I vs II?
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
Common risk factors for RVT? Classic symptoms
Asphyxia, maternal diabetes, polycythemia, prematurity Inherited prothrombotic conditions more common with RVT Minority presents with classic flank mass, renal failure, thrombocytopenia, and hematuria Usually presents <3days
47
Effects of Angiotensin II
Adrenal cortex--> aldosterone Increase water and salt reabsorption in the renal tubules Vasoconstriction of systemic and renal arterioles? Stimulate release ADH Activates Vit D, EPO
48
Nephrogenesis is complete at what GA?
34-36 weeks
49
What stimulates renin secretion?
Decrease in Afferent arteriole stretch Increased in renal sympathetic activity Decreased na cl transport to macula densa
50
Nephrocalcinosis in a short bowel pt is due to _______.
Increase in oxalate excretion in the urine (leads to excess calcium oxalate urine deposits)
51
Typical laboratory findings associated with Type1 Distal RTA ?
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
Most common site of urinary obstruction in hydronephrosis is?
Uretopelvic junction obstruction
53
Which conponent of the RAS pathways is necessary for normal nephrogenesis?
Angiotensin II bc it serves as a renal growth factor
54
What causes réabsorption of HCO3 in kidneys?
Decreased réabsorption with volume expansion or increaed PTH HCO3 réabsorption is increased with acidosis, hypercapnia or volume contraction
55
Normocalcemic hypercalciuric nephrocalcinosis is seen with _______.
Distal renal tubular disease Bartter syndrome hyper prostaglandin E syndrome Cushing syndrome chronic lasix use familial hypomagnesemia
56
Hypercalcemic hypercalciuric nephrocalcinosis is seen with _______.
Hyperparathyroidism hypophosphatasua subcutaneous fat necrosis Williams syndrome
57
Location of action for a acetazolamide (Diamox)
Proximal convoluted tubule Remember PCT is where you Pee out bicarb (Acetazolamide increases HCO3 excretion, such as when trying to correct contraction alkalosis)
58
Hemofiltration utilizes _________ to remove solutes from plasma.
Convection
59
Hemodialysis utilizes __________ to remove solutes from plasma.
Dialysis
60
Infant kidneys receive what percentage of cardiac output?
10% compared to adults which is 25%
61
Name renal vasodilators
Prostaglandin | Nitric oxide
62
What is endothelin?
Renal Vasoconstrictor Produced by the renal vascular endothelial cells Release is stimulated by angiotensin II, bradykinin, epinephrine or stress
63
What is the cause of FTT in RTA?
Decreased secretion of growth hormone as a result of metabolic acidosis
64
Neonate w eye clouding, hypotonia, renal tubular dysfunction, and cryptorchidism. Dx?
Lowe syndrome. X linked recessive affecting enzymatic fumction of golgi apparatus Oculocerebro-renal syndrome Dx: increased nucleotide pyrophosphatase in skin fibroblasts
65
Describe findings of bartter syndrome
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
66
Name 3 mesodermic structures for kidney Which of the following mesodermic structures becomes definitive kidney
Pronephros, mesonephros, metanephros Metanephros
67
Most common cause of UTD on antenatal US
Transient/physiologic
68
Renal agenesis occurs bc failure of developing _____
Ureteric bud
69
Intrauterine exposure to maternal antenatal steroids ______ insensible water loss
Decrease- better skin maturation and better perfusion with steroids
70
ADH mediated by 2 receptors. What are their actions?
V1: peripheral vasoconstriction, glycogenolysis, plt aggregation, vascular smooth muscle hypertrophy V2: induce aquaporins--> greater water retention, decreased urine
71
When is ADH present in fetus
11 weeks
72
FENa equation
Urine Na x Plasma cr/ Urine Cr x Plasma Na
73
Fena<2 Fena>2
Pre renal Intrinsic
74
What decreases with advancing gestational age/BW?
Total body water Extracellular water Na content Cl content
75
What increases with GA/BW
Intercellular water Protein Fat Calcium phosphorous magnesium Iron
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