Flashcards in Renal Deck (197)
Loading flashcards...
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
