Flashcards in Renal Deck (197)
What are other causes of post renal failure in the newborn?
1) Ureteropelvic junction obstruction (UPJ)
2) Ureterovesical junction obstruction (UVJ)
3) neurogenic bladder (myelomeningocele)
4) Urethral (strictures of obstructed urinary catheter)
6) calculi (renal stone)
7) renal candidiasis (fungal bezoars)
What is acute kidney injury?
acute renal failure; intrinsic renal failure
What is the incidence of AKI?
affects 6-24% of all NICU admissions; every infant admitted is at risk
What is often the first presenting sign of AKI?
What is oliguria?
What is the prognosis for AKI?
early recognition may revere condition and improve the outcome; non-oliguric AKI/ARF has a better prognosis
What is significant in the family history that may indicate AKI?
a h/o congenital renal dz
What is significant in the perinatal history that may indicate AKI?
- prenatal US
- history of asphyxia (low APGAR scores)
What is significant in the physical exam that may indicate AKI?
- abdominal masses
- genitals, ears, kidneys
- 2 vessels cord (not necessarily a problem)
What is the final common pathway underlying ARF/AKI regardless of etiology?
What is the consequence of any prolongation of any pre renal or post renal failure conditions?
will lead to structural damage to the kidneys; necrosis of the nephrons
What are causes of renal failure?
1) acute tubular necrosis
2) congenital anomalies of renal/ urinary system
3) renal vein thrombosis
4) renal artery thrombosis
What is the cause of acute tubular necrosis?
- prolonged hypoperfusion
- prolonged ischemia/hypoxia
What congenital anomalies of the renal/ urinary system can cause intrinsic renal failure?
1) renal agenesis
2) polycystic kidney dz
3) congenital nephrotic syndrome of Finnish type
4) renal hypoplasia/ dysplasia
What is the clinical presentation of renal vein thrombosis in the IDM with polycythemia and hyperviscosity?
- enlarged kidneys
What is the clinical presentation of renal artery thrombosis?
- enlarged kidneys
AND decreased temp and pulses in lower extremities
What is the mechanism of injury for a UAC to induce intrinsic renal failure?
- possible compromised blood flow to kidney
- induced by hyperosmolar solutions
What septic states can induce intrinsic renal failure?
1) congenital syphillis
What nephrotoxins can induce intrinsic renal failure?
2) amphotericin B
4) contrast agents
(full recovery is expected over time; may require dialysis)
What is the indicated treatment for AKI/ARF?
there is no specific therapy; treat the underlying cause
What is the indication for a renal US?
to assess for structural abnormalities
What is the indication for a doppler renal US?
to assess for:
1) presence of blood flow
2) direction of blood flow
3) velocity of blood flow
What is the indication for a renal resistive index (RRI)?
to measure peak systolic and diastolic flow
What is the fluid challenge?
- infuse 10-20 mL/kg of NS over 1-2 h
- chase with lasix (1-4 mg/kg/dose IV)
When is the fluid challenge indicated?
to r/o hypovolemia
What do the results of the fluid challenge indicate?
- if UOP increases then it was prerenal failure
- in no change then the pt is in renal failure and there is actual damage to the nephron
What is the indication for dopamine in the treatment of renal failure?
to increase renal perfusion
How much dopamine should be given for renal perfusion?
low dose 3-5 mcg/kg/min; in VLBW infants the dose can be as low as 1-2 mcg/kg/min
What is the indication for hydrocortisone in the treatment of renal failure?
for suspected adrenal insufficiency