FEN/Renal Flashcards
(106 cards)
1
Q
photophobia
conjuctivitis
failure to thrive
generalized scaling
abnormal epiphyseal bone formation
abnormal tooth enamel
A
Vitamin A (Retinol)
2
Q
Vitamin important for pulmonary epithelial growth and cell differentiation
A
Vitamin A
(Retinol)
3
Q
What deficiency:
fatigue
irritability
constipation
cardiac failure
A
B1 - Thiamine
note: Beriberi = thiamine deficiency
4
Q
deficiency a/w:
- pyruvate dehydrogenase complex deficiency
- maple syrup urine disease
A
B1 - Thiamine
5
Q
Wet vs Dry Beriberi
A
*B1 (Thiamine) deficiency
Wet:
- dilated cardiomyopathy
- edema
Dry
- peripheral neuopathy
- muscle wasting
?fatigue, irritability, consitipation
6
Q
Deficiency:
failure to thrive
photophobia
blurred vision
dermatitis
mucositis
A
B2 - riboflavin
*blurred vision/photobia from corneal vascularization?
7
Q
a/w glutaric acuduria type 1
A
B2 (riboflavin) deficiency
8
Q
Triad (what deficiency):
cheilosis
stomatitis/glossitis
NORMOcytic anemia
A
B2 - riboflavin
9
Q
dermatitis
mucositis
hypo chromic anemia
sideroblastic anemia
+/- seizures
A
B6 - pyridoxine
10
Q
alopecia
dermatitis
scaling
seborrhea
A
B7 - Biotin
11
Q
a/w
beta-methylcrrtnyl glycinuria
propionic acidema
pyruvate dehydrogenase complex deficiency
A
B7 - Biotin
(also w/ biotinidase deficiency)
12
Q
MACROcytic anemia
hypersegmented neutrophils
(2 answers)
A
B12 - Cobalamin
B9 - Folate
13
Q
A/w pyruvate dehydrogenase complex deficiency
A
B1 - Thiamine
B7 - Biotin
(deficiency)
14
Q
poor wound healing
bleeding gums
A
Vitamin C (ascorbic acid)
15
Q
A/w transient tyroninemia
A
Vit C deficiency
16
Q
Rickets
Failure to thrive
Possible tetany
A
Vitamin D
17
Q
hemolysis
anemia
reticulocytosis
thrombocytOSIS
acanthocytois
neuro sequelae
A
Vit E
18
Q
failure to thrive
alopecia
diarrhea
peri-anal dermatitis
rash - crusted, erythematous (face/extrem)
nail hypoplasia/dysplasia
low serum alk phos
A
zinc
19
Q
acrodermatitis enteropathica
A
causes zinc deficiency
Autosomal RECessive
defective zinc uptake in duodenum and jejunum
abnormality in ZIP4 (zink transporter protein)
20
Q
Important component in carbonic anhydrase and carboxypeptidase
A
zinc
21
Q
calories in dextrose per gram
A
3.4 kcal/g
22
Q
Preserved during pasteurization process
A
oligosaccharides
Vit A, D, E
lactose
Long chain polyunsaturated fatty acids
epidermal growth factor
IgA and IgG
23
Q
destroyed during pasteurization process
A
lymphocytes
alk phos
cytokines
some growth factors
lipoprotein
some lipases
IgM
*lactoferrin reduced ~50%
* lysozyme reduced ~25%
24
Q
RTA Type 1
Etiology
Urine pH
Serum K
A
Distal tubule - decreased H+ secretion
Urine pH high (>6.5)
Serum K low
*hypercalciuria/nephrocalcinosis - STONES
25
RTA Type 2
Etiology
Urine pH
Serum K
Proximal tubule - decreased bicarb resorption
Urine pH more acidic < 5.5
(H+ secretion/ammonium production enhanced)
Serum K low-normal
26
RTA Type 4
Etiology
Urine pH
Serum K
Urine Calcium
Distal tubule - affects Na/K vs H+ exchange
(like hypoaldosteroneism/ spironolactone)
Urine pH - normal/low
Serum K = HIGH
*can be caused by obstructive uropathy
27
Fanconi = similar to which RTA
Type 2
28
Acetazolamide works like which RTA
Type 2
29
RTA a/w renal stones
Type 1
(decreased citrate excretion and hypercalicuria)
30
amphoterocin can cause RTA _____
Type 1
31
aldosterone works on what channels
Na/K on principal cells (K to urine, Na resorbed)
EnAC on apical side
(K/H+ on intercalated cell - K resorbed but still
net K excretion)
(also ENaC channels on principal cells)
32
lactase levels reach adult levels by ____ wks gestation
36
33
intestinal disacharidases* (except lactase) reach adult levels by ____ wks gestation
*sucrase, maltase, isomaltase
28
34
pancreatic amylase present at ____ gestation
22
35
why is carbohydrate digestion/absorption adequate in neonate
colonic salvage pathway
adequate concentrations of glucosidases/disacharidases
normal glucoamylases concentration
36
preterm formula has more whey or more casein
whey (60:40)
37
colostrum has more whey or more casein
whey (80:20)
38
mature milk has more why or more casein
whey (55:45)
39
at what age (corrected) do ECF and ICF ~equal
3 months
(ECF is coming down and ICF is coming up)
40
TBW % (ECF %) of body weight
24 wks
32 wks
40 wks
24 wks 90% (65%)
32 wks 83% (53%)
40 wks 80% (45%)
41
RTA a/w hearing loss (recessive form)
type 1 RTA
42
kidney development begins with _____ at ____ weeks
nephrogenesis begins at ____ weeks
first glomeruli develop ____ weeks
nephrogenesis complete by ____
pronephros 2-3wks
nephrogenesis (metanephros) 5th wk
glomeruli 9 weeks
complete by 34-36 weeks
43
kidney embryology stages
pronephros - transient disappears by 4th wk
meSOnephros - ureteric bud; absorbed into urogenital sinus (vas defers, seminal vesicles)
meTAnephros - definitieve kidney; appears 5th wk; continues dev through 32-36wk
ureteric bud = collecting ducts, pelvises/calyces, ureter
metanephric mesenchyme (+ interaction with ureteric bud) = glomerulus through DCT
44
urine production begins _____
10-12 weeks
45
urine production at 20 wks and 40 wks gestation
20 wks: 5 ml/hr
40 wks: 50 ml/hr
*90% or amniotic fluid urine by 20 wks
46
in utero, fetal kidneys receive ____% cardiac output
infant kidney's receive ___% of cardiac output
fetal: 25%
infant: 10 % (<5% during birth)
47
endothelin = renal vaso__________
produced by________
stimulated by ________
vasoCONSTRICTOR
produced by RENAL VASCULAR ENDOTHELIAL CELLS
stimulated by ANGIOTENSIN II, BRADYKININ, EPINEPHRINE, or STRESS
48
fetus begins to accumulate copper stores____ trimester (where stored)
third (50-60% stored in liver)
born at least 28wks = enough stores for ~2 mo
49
Free water deficit calculation
4ml H20 per kg
for every 1 mEq Na above 145 (or desired goal)
i.e. = 4* wt (kg) * [desired Na change (mEq/l)]
OR
term: 0.6 x wt x (current-desired /desired)
preterm: 0.7 x wt (current - desired/ desired)
50
Most variable component of breast milk (dependent of gestational age and maternal diet)
triglycerides
51
Protein = ______% of calories for + nitrogen balance
Minimal goal (g/d)
VLBW
preterm
term
7-15%
VLBW: 4 g/kg/d
preterm: 2.5-3.5 g/kg/day
term: 2.0-2.5 g/kg/day
52
kcal expenditure in neonate:
resting metabolic rate
40-60kcal/kg/d
53
Energy expenditures from most to least; in kcal/kg/day
Enterally fed:
40-60 kcal/kg/d- resting metabolic rate
20-30 kcal/kg/d- storage
15 kcal/kg/d- synthesis/thermic effect of feeding
15 kcal/kg/d- excretion
0-5 kcal/kg/d- activity
0-5 kcal/kg/d- cold stress
90-120kcal/kg/day
54
(location of absorption)
protein
fat (some)
CHO
Fe
Calcium
Mag
Jejunum
*Fe mainly in duodenum but some in proximal jejunum
55
(location of absorption)
B12
bile salts
fats
fat-soluble vitamins (ADEK)
Zinc
Ileum
*also releases hormones
*can compensate some functions of the jejunum
56
Cause of poor growth in patients with RTA
direct effect of acidosis on GH (decreased)
additionally - poor feeding i/s/o acidosis
57
infant's reduced ability to concentrate urine is related to:
- tubule insensitivity to vasopressin/ADH
- low serum urea
- reduced NA absorption in thick ascending loop --> low medullary osmolality
- short LOH
58
permeability of glomerlular basement membrane _______ with GA
increases
(more permeable with increasing GA)
59
60
Calories for:
dextrose
protein
fat
dextrose 3.4
protein 4
fat 9
61
hematuria, thrombocytopenia, renal failure
renal vein thrombosis
(though most infantas do not present with this full constellation of symptoms)
62
NON-essential AAs
Alanine
Asparagine
Aspartate
GlutamATE
Serine
Homocysteine (?)
63
AA that are glucose precursors
Alanine*
Glycine*
Glutamate*
Aspartate
Cysteine
Proline
(both glucogenic and ketogenic):
Tyrosine
Isoleucine
Phenylalanine
Tryptophan
64
AA precursor to NO
Arginine
65
Highest AA concentration in human milk
GlutamINE
66
Ratio Ca: Phos
Ca: Phos 1.3 : 1
Calcium: 50-60mg/dL
Phos: 40-45 mg/dL
*gives ~60-70% of that deposited by fetus during 3rd trimester
67
ADH - V1 vs V2
V1:
peripheral vasoconstriction
glycogenolysis
platelet aggregation
vascular smooth muscle hypertrophy
V2:
increase water perm of collecting ducts by inducing aquaphorins
68
When is ADH present in fetus
11 weeks
- aids in regulating proliferation and morphogenesis of target cells in the brain, pituitary, kidney, and liver
69
ADH - made and stored
made: hypothalamus
(supraoptic and paventricular nuclei)
stored: POSTERIOR pituitary
70
Thiazide diuretics mech/location
Distal convoluted tubule (early distal)
block Na/Cl co-transporter
*only ~5% of Na resabsorption happens in distal tubule, so effect is limited
71
Thiazide increases urinary losses of:
Na
Cl
K
Mg
Bicarb
Phos
72
Thiazide diuretics can lead to what metabolic derangement
hypochloremic metabolic ALKalosis*
hyperuricemia
*despite increased loss of bicarb
73
Unlike loop diuretics, Thiazides lead to DECREASE in _____ excretion
Calcium
74
Loop diuretics location and mech
Thick ascending LOH
Inhibit Na+/2Cl-/K + co-trasporter
75
Essential fatty acids
alpha-linolenic (omega 3)
Linoleic (omega 6)
76
2 most prevalent FAs in human milk
Oleic
Palmitic
77
of carbons in ___ chain amino acids
- short
- med
- long
- very long
short: < 6
med: >6-12
long: >12-20
very long: 22 or more
78
measurement for essential FA deficiency
triene : tetraene ratio (Holman index)
> 0.2 diagnostic of EFAD
triene = mead acid 20:3 n-9 (from oleic acid)
tetraene = arachidonic acid 20:4 n-6 (from linoleic acid)
79
Role of ____ in PN cholestasis
- high dextrose
- high protein
- IL
high dextrose - hepatic steatosis
high protein - canalicular dysfunction
Intra lipid - toxic effects on hepatic cells
80
Target for milk pumping by end of 2nd week
350 ml/day
81
90% of Ig in human milk are ____
IgA
82
mortality rate for ARPKD
30% do not survive beyond neonatal period
83
How quickly can EFAD develop
3-7 days w/o LA and ALA
*less than 0.5 mg/kg/d of EFA intake
84
scaly dermatitis
alopecia
thrombocytopenia
increased susceptibility to infection
EFAD
85
____g/kg/day lipids (PN)
____g/kg/day lipids (enteral)
fats should provide _____% of total calories
3 g/kg/d - PN
4.8-6.6 g/kg/d - enteral
30-50% total calories
86
FeNA equation
(Urine Na x Plasma Cr) / (Urine Cr x Plasma Na) x100
Neonates:
< 1% normal
1% - 2.5% pre-renal
>3% intrinsic renal failure
87
Plasma osmolality equation
2(Na+) + glucose/18 + BUN/2.8
88
maternal hormone that inhibits milk production when breast is full
FIL - feedback inhibitor of lactation
89
Water changes during 1st two weeks for preterm infant a/w weight loss
decreased TBW, ECW (esp interstitial)
(increased ICW despite overall decrease in TBW)
90
LBW
VLBW
ELBW
LBW <2500 g
VLBW < 1500g
ELBW < 1000g
91
caloric requirements to maintain growth in preterm infant (formula and estimate)
(REE x 2) + energy losses
enteral: 110- 120 kcal/day
parenteral: 80-100 kcal/day
92
main component of intralipid
soy-based oil
higher concentration of omega 6 than 3
93
More pro-inflammatory FA (omega 3 or 6)
omega 6
94
for each gram of protein (enterally) increase of:
____ g/d in weight
_____ cm/wk in HC
6.5 g/d
0.4 cm/week
95
Fetal protein/day
_____ from placenta
_____ accretion
______ loss
3.5 g/day from placenta
2.5 g/d of accretion
1 g/d loss
96
without protein following delivery, infant will lose ____ g/kg/day of protein stores
0.6- 1 g/kg/d
97
Term infant's glomerular filtration rate ____of adult
GFR reaches adult level by _______
50%
2 years of age (longer in preterm)
98
recommended Ca for healthy infants for first 6 mo
200mg/day
99
Each gram of weight gain requires _____kcal
(on top of other needs)
3.5-4
100
Main AA that are NOT glycogenic (just ketogenic)
Leucine
Lycine
101
Which can be seen on 20 week US:
ARPKD or Multicysticdysplastic kidney
multi cystic dysplastic kidney disease
--> large echogenic kidneys with thin-walled cysts visible by 20 weeks
ARPKD
--> large echogenic kidneys w/ numerous cysts not seen until later (but can be seen prenatally)
--> a/w hepatic fibrosis and some degree of biliary dysgenesis
102
MC sequelae of ARPKD
hypertension (65%)
103
MCC of abdominal mass in the newborn
multicystic dysplastic kidney
(though many involute)
104
Calorie % from CHO, Fat, Protein
~50% carb
~40% fat
~10% protein
Total calories per day parenteral 70-100kcal/kg/d
105
colostrum has more ____ than mature milk
protein
106
Na+ deficit equation
0.6 x weight x (Na desired - Na current)
