FEN/Renal Flashcards by Divya Keerthy

neonatal evaporative water loss attributed to

respiratory tract 1/3
skin 2/3

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when is ADH present

11 weeks

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where is ADH produced

paraventricular and supraoptic nuclei of hypothalamus –> posterior pituitary

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where does ADH act

late distal tubule
cortical and medullary collecting ducts
increases urine osmolality

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factitious hyponatremia from:

hyperlipidemia 0.002
hyperproteinemia 0.25
hyperglycemia 1.6

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Na deficit =

(na desired - na current) X 0.6 x weight

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u wave on ekg

hypokalemia

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alkalosis related hypokalemia pathophys

H+ exits cell and K+ enters cell

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acidosis effect on K+

for every 0.1 reduction in pH

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

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intracellular buffers

bone apatite
hemoglobin
organic phosphates

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extracellular buffers

HCO3-
phosphates
proteins

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mechanisms of acid-base balance in kidney

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

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anion gap =

Na+ - {Cl- + HCO3-}

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side effects of NaHCO3 administration

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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RTA4 subtypes and labs

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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secondary causes of RTA II

prematurity
tyrosinemia
tubular disorders (fanconi, cystinosis, Lowe)

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secondary causes of RTA I

interstitial renal disease
genetic
autoimmune
hypotonic states
drug induced

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Bartter syndrome pathophysiology

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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Management of Bartter

potassium, +/- thiazide, +/- indomethacin

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what dermal layer does kidney come from?

mesoderm

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what are the 3 structures of kidney embryology

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

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when do nephrons appear

8 weeks

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FGR affects size or number of nephrons?

number

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

34-35

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which area are nephrons most mature at birth

juxtaglomerular nephrons

when does urine start being produced?

10-12 weeks

reasons for decreased concentrating capacity in preterm infants

- tubule insensitivity to ADH - short loop of henle - low osmolality of medullary interstitium - low serum urea

sodium reabsorption in parts of kidney

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

reabsorption and secretion of K+ in kidney

- reabsorption PT and ascending loop - secreted in DCT and CT

FENa =

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

Ca reabsorption in kidney

reabsorption in PT, loop of Henle, DCT and CT

Phosphorus reabsorption in kidney

80% PT 10% DCT

tubular reaborption of phosphorus =

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

Mg reabsorption in kidney

65percent PT and TAL

aldosterone effects on kidney

- Na reabsorption - Cl passively - secrete K+ and H+

pseudohypoaldosteronism pathophysiology

- XLR - renal tubule unresponsive to aldosterone --> hypoNa, hyperK+, metabolic acidosis - increased aldosterone and renin

protein reabsorption in kidney

95% PT

Estimated GFR =

0.45 x height(cm) / PCr

Difference between DMSA, DTPA, and MAG3

DMSA static DTPA and MAG3 dyanamic images

epi of renal anomalies

1/200

MCC renal anomalies

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

types of congenital nephrotic syndrome

Finnish Diffuse mesangial sclerosis

Genetics of Finnish congenital nephrotic syndrome

chr 19 AR NPHS1 nephrin protein

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

Finnish - **large** placenta, **increased** AFP, **SGA** DMS - normal palcenta, normal AFP, normal weight

risk of renal agenesis

1/10000 40% still born

recurrence risk of renal agenesis

3-5%

genetics of ARPKD and ADPKD

**ARPKD** - chr 6p21 - PKHD1 - fibrocystin/polyductin cilia related **ADPKD** - chr 16p13.3 - PKD1 - polycystin1

prognosis of ARPKD

30% mortality 50% ESRD

Syndromes of tubular dysfunction

Fanconi Cystinosis Lowe

Pathogenesis of Fanconi

- AD - PT dysfunction - losses of AA, glucose, phosphate and bicarbonate

Pathogenesis of Cystinosis

- AR - defective carrier mediated transport of cystine --> excess cystine in lysosomes

Diagnosis of cystinosis

- normal plasma cystine - need cornea slit lamp - cystine crystals

management of cystinosis

cysteamine and renal transplant

Pathogenesis of Lowe syndrome and other name

- oculocerebrorenal syndrome - XLR - enzyme deficiency disrupting golgi apparatus

clincal findings of lowe syndrome

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

diagnosis of lowe syndrome

- increased maternal and AF **AFP** - increased **nucleotide pyrophosphatase in skin fibroblasts**

who gets prophylactic Abx in hydronephrosis?

- moderate if female and bilateral - severe

ectopic urterocele epidemiology and definition

- F > M - 10% bilateral - duplicated renal pelvis and ureter which may drain into neck of bladder

pathophysiology of exstrophy of bladder sequence

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

occurrence and recurrence of exstrophy of bladder

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

what renal anomalies in Zellwegers

cortical renal cysts

what renal anomalies in Jeune?

- cystic tubular dysplasia - glomerulosclerosis - hydronephrosis - horseshoe kidneys

what renal anomalies in Meckel-Gruber syndrome

polycystic/dysplastic kidneys

what renal anomalies in Tuberous sclerosis?

polycystic kidneys renal angiomyolipomas

what renal anomalies in nail-patella syndrome

proteinuria and nephritic syndrome

stage 0 AKI

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

stage 1 AKI

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

stage 2 AKI

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

stage 3 AKI

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

GFR threshold for CKD? chronic renal failure?

60 mL/min/1.73 m^2 15 mL/min/1.73 m^2

highest PPV for fetal nephropathy

AP diameter of renal pelvis

MCC acute renal failure in neonates

perinatal asphyxia

secondary hyperoxaluria

SGS and malabsorption

PTH effect on bicarbonate reabsorption

decreases

FEN/Renal Flashcards

(74 cards)