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Flashcards in Renal Deck (197)
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91

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)
5) teratoma
6) calculi (renal stone)
7) renal candidiasis (fungal bezoars)

92

What is acute kidney injury?

acute renal failure; intrinsic renal failure

93

What is the incidence of AKI?

affects 6-24% of all NICU admissions; every infant admitted is at risk

94

What is often the first presenting sign of AKI?

low UOP

95

What is oliguria?

UOP <1mL/kg/h

96

What is the prognosis for AKI?

early recognition may revere condition and improve the outcome; non-oliguric AKI/ARF has a better prognosis

97

What is significant in the family history that may indicate AKI?

a h/o congenital renal dz

98

What is significant in the perinatal history that may indicate AKI?

- prenatal US
- history of asphyxia (low APGAR scores)
- abruption

99

What is significant in the physical exam that may indicate AKI?

- abdominal masses
- genitals, ears, kidneys
- 2 vessels cord (not necessarily a problem)

100

What is the final common pathway underlying ARF/AKI regardless of etiology?

decreased GFR

101

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

102

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
5) DIC
6) UAC
7) sepsis
8) nephrotoxins

103

What is the cause of acute tubular necrosis?

- prolonged hypoperfusion
- prolonged ischemia/hypoxia

104

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

105

What is the clinical presentation of renal vein thrombosis in the IDM with polycythemia and hyperviscosity?

- hematuria
- enlarged kidneys
- thrombocytopenia
- anemia

106

What is the clinical presentation of renal artery thrombosis?

- hematuria
- enlarged kidneys
- thrombocytopenia
- anemia
AND decreased temp and pulses in lower extremities

107

What is the mechanism of injury for a UAC to induce intrinsic renal failure?

- possible compromised blood flow to kidney
- induced by hyperosmolar solutions

108

What septic states can induce intrinsic renal failure?

1) congenital syphillis
2) toxoplasmosis
3) candidiasis
4) pyelonephritis

109

What nephrotoxins can induce intrinsic renal failure?

1) aminoglycosides
2) amphotericin B
3) Acyclovir
4) contrast agents
(full recovery is expected over time; may require dialysis)

110

What is the indicated treatment for AKI/ARF?

there is no specific therapy; treat the underlying cause

111

What is the indication for a renal US?

to assess for structural abnormalities

112

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

113

What is the indication for a renal resistive index (RRI)?

to measure peak systolic and diastolic flow

114

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)

115

When is the fluid challenge indicated?

to r/o hypovolemia

116

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

117

What is the indication for dopamine in the treatment of renal failure?

to increase renal perfusion

118

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

119

What is the indication for hydrocortisone in the treatment of renal failure?

for suspected adrenal insufficiency

120

How much hydrocortisone should be given for adrenal insufficiency?

physiologic dosing; start at 3mg/kg/d divided Q6h
* if also hypotensive, can increase to 5mg/kg/d divided Q6h