Renal

Question 1

What is the mean onset age of CKD? Males or females?

Answer 1

Mean age is 7
Affects more males than females

Question 2

What is the role of the renal vein? Renal artery?

Answer 2

Renal vein: transports clean blood out of kidney
Renal artery: transports blood with waste into the kidney so the kidney can filter the blood

Question 3

What are the major functions of the kidneys? (9)

Answer 3

1. Regulates fluids and osmolarity
2. Regulates electrolytes
3. Regulates acid/base
4. Removes metabolic waste (urea)
5. Excretes medications and toxins
6. Regulates BP
7. Simulates RBC production via producing hormones
8. Synthesizes hormones (RAAS, erythropoetin)
9. Regulates bone formation (conversion of vitamin D and site of action for PTH)

Question 4

What is the role of amniotic fluid?

Answer 4

Urine and kidney development
GI development
Lung development

Question 5

What is a baby born with in relation to the kidneys? What happens if you are premature?

Answer 5

Born with total nephron mass
Preemies (before 37 weeks) have low mass so they are at increased risk of CKD

Question 6

How long do kidneys grow for?

Answer 6

Grow through puberty

Question 7

When do the tubules mature? What does immature tubules affect?

Answer 7

Mature at 2 years

Infants unable to concentrate urine –> excessive dilute urine
Less responsive to ADH, aldosterone
Naturally higher potassium
Transient acid/base disturbances
More prone to dehydration

Question 8

What is creatinine dependent on?

Answer 8

Muscle mass

More muscle –> higher creatinine

Question 9

What is the normal creatinine for an infant? Preschooler? School age? Adolescent?

Answer 9

Infants: < 0.2

Preschool: 0.4

School age: 0.6

Adolescent: 0.8-1

Question 10

What is the relationship between serum creatinine and GFR?

Answer 10

inverse relationship
SMALL changes in serum creatinine –> GFR decreases significantly
GFR goes down by 50% every time creatinine is doubles

Question 11

Is bed wetting common?

Answer 11

Yes

Question 12

At what age are UTI diagnosed and treated differently?

Answer 12

Under 2 and over 2

Question 13

What should be used to confirm a UTI? How can you get urine from a child that is not potty trained?

Answer 13

Urine culture

Straight cath

Question 14

What are 3 things that are necessary for normal kidney function?

Answer 14

1. Good blood flow to the kidney
2. Healthy tissue within the kidney
3. Unobstructed urinary tract so it allows for urinatation

Question 15

What is prerenal AKI? is it common?

Answer 15

Sudden and severe reduction in blood pressure (shock) and interruption of blood flow to kidneys from severe injury or illness

Most common

Question 16

What are the causes of pre-renal AKI?

Answer 16

Blood loss
Dehydration (vomit, diarrhea)
Heart failure
Sepsis
Vascular occlusion

Question 17

What is intrinsic (intra) renal AKI?

Answer 17

direct injury to kidneys by inflammation, drugs, toxins, infection, or reduced blood supply

Question 18

What are the causes of intrinsic (intra) renal AKI?

Answer 18

Acute tubular necrosis (drugs, toxins, prolonged hypotension, autoimmune, infection)
Glomerulonephritis
Small vessel vasculitis

Question 19

What is post renal AKI? What are the causes?

Answer 19

Urine obstruction

Kidney stones
Congenital anomaly of urinary tract (CAKUT)
Vesicoureteral reflux
Hydronephrosis

Question 20

What does one year of AKI mean?

Answer 20

CKD

Question 21

What are the long term complications of CKD? (6)

Answer 21

Growth failure
Anemia
Endocrine disorders (delayed puberty)
Metabolic abnormalities and bone deformities
Neurocognitive delays
CVD (inflammation, vascular tone and HTN, edema)

Question 22

What is a common cause of death in children with CKD?

Answer 22

cardiac issues d/t highly inflammatory

Question 23

What are causes of loss of water and electrolytes?

Answer 23

Fever
GI suction
Vomiting and diarrhea
Diaphoresis
Increase UOP

Question 24

What are the s/s of water and electrolyte losses?

Answer 24

Irritability
Dry mucous membranes
Increased thirst
Decreased skin turgor
UOP less than 1ml/kg/hr
Dark colored urine and high urine specific gravity
Sunken eyes
Decreased tears
Lethargy
Depressed fontanels

Question 25

What are nephrotoxic agents?

Answer 25

Contrast media TPN Drugs (NSAIS, antibacterials, antivirals, immunosuppressants, antineoplastic, angiotensin-converting enzyme inhibitors, diuretics, anti-ulcer (cimetidine), PPI, lithium) Anesthetics

Question 26

What is Uteteropelvic junction obstruction?

Question 27

What is posterior urethral valve? What is the concern in utero? What is the concern if you are born with this?

Answer 27

Valve at bladder where it meets the uretra so completely obstructs urine In utero - urine goes back into the kidney and squishes kidney tissue Born with this --> poor lung development b/c amniotic fluid is important for lung development

Question 28

What is vesicoureteral reflux?

Answer 28

Shoots urine back to kidney Usually needs transplant

Question 29

What is hydronephrosis mean?

Answer 29

Urine/water on the kidney

Question 30

Who is CAKUT most common in? What does it cause?

Answer 30

Males Causes a post renal condition

Question 31

What are the complications of CAKUT?

Answer 31

CKD Neurogenic bladder Hydronephrosis Recurrent UTI (constant collection of urine)

Question 32

When should a catheter culture be obtained?

Answer 32

Under 2

Question 33

Does CAKUT effect the genitalia?

Answer 33

Yes - abnormal genitalia

Question 34

How does CAKUT lead to urinary obstruction/disrrupt the stream of urine?

Answer 34

Phimosis - foreskin too tight Epispadias: uretra too high Hypospadias: urethra too low Cryptorchidism: undescended testicle

Question 35

How is cryptorchidism treated? What does it increase the risk for?

Answer 35

Surgery 6-15 months (post op - infection, pain, UOP) Increased risk of testicular cancer

Question 36

Why is increased potassium at risk if kidney issues? How can potassium be removed from the body? What else should be monitored?

Answer 36

Kidneys excrete potassium from the body Diuretics (furosemide), bicarb, k-exalate Strict I&Os and EKG

Question 37

If a child is already dehydrated and you add sodium such as with normal saline what occurs?

Answer 37

It can further damage the kidney

Question 38

What is the bladder regimen for a child with CAKUT?

Answer 38

intermittent cath 5 times a day

Question 39

Why does a child with CKD need iron and GH shots and nutritional supplement?

Answer 39

GH because they don't grow well and are short Iron because they are usually anemic Nutritional supplement because they protein/muscle waste

Question 40

What nursing interventions for post renal AKI? (9)

Answer 40

Diuretics/anti HTN Strict I&Os, daily weight, and girth Labs Unine specimen Avoid Na, K, and phos in diet CV and BP assessments EKG Neuro and resp assessments Medications to avoid

Question 41

What type of AKI are glomerular diseases?

Answer 41

infrarenal

Question 42

Who does nephrotic syndrome affect? What is the cause?

Answer 42

Toddlers Genetic, environmental Most kids grow out of it

Question 43

What are the s/s of nephrotic syndrome?

Answer 43

Proteinura >4+ Normal serum creatinine Low albumin level in blood (hypoalbuminemia <2mg/dL) so fluid goes into tissues Significant fluid volume overload +/- HTN

Question 44

What is the treatment for nephrotic syndrome?

Answer 44

Steroid (corticosteroids) for 12 weeks minimum Low sodium and fluid restriction Diuretics Albumin (before diuretics to pull fluid back to vessels) Vaccines Hand hygiene

Question 45

What is the priority concern regarding nephrotic syndrome?

Answer 45

Fluid volume overload Fluid volume deficit d.t all fluids in tissues

Question 46

What are the complication of nephrotic syndrome?

Answer 46

Infections Peritonitis Sepsis Thrombosis (blood thick and sluggish) Cushing syndrome (long term steroid use)

Question 47

Who does glomerulonephritis affect?

Answer 47

School age and teens

Question 48

What are the s/s of glomerulonephritis?

Answer 48

Proteinuria AND hematuria Elevated serum creatinine Fluid overload varies Azotemia ALWAYS HTN Decreased H&H

Question 49

What are two types of glomerulonephritis?

Answer 49

Post infectious glomerular nephritis (PIGN) Hemolytic uremic snydrome (HUS)

Question 50

What is PIGN? Treatment?

Answer 50

Post strep infection --> glomerulonephritis Self-limiting

Question 51

What is HUS? What if you require RTT d/t this?

Answer 51

E. coli infection --> glomerulonephritis Wide spread in spectrum and severity If require RRT --> high risk for CKD and eventually need transplant

Question 52

Is glomerulonephritis or nephritis worse?

Answer 52

glomerulonephritis look sick but usually is self-limiting with treating s/s

Question 53

What does a raw hamburger cause?

Answer 53

HUS d/t E. coli