Flashcards in Renal Deck (197)
How is Ca distributed in the body?
- 50% biologically active as iCa
- 40% bound to albumin
- 10% complexed or chelated with citrate, lactate, bicarbonate, phosphate & sulfate
What is the threshold for determining hypocalcemia?
total Ca < 8 (FT)
total Ca < 7 (PT)
iCa < 4 (FT & PT)
What is the indicated acute treatment for hypocalcemia?
calcium gluconate 100-200mg/kg via PIV over 10-30 minutes with constant cardiac monitoring
What is the primary route of phosphorus elimination in the body?
via the kidney
What is the effect of hyperphosphatemia?
excessive phosphate binds with Ca > decreases Ca level
What is the indicated treatment of hyperphosphatemia?
- treat with dietary Ca to bind to PO4 (calcium carbonate)
- treat with phosphate binders (aluminum hydroxide)
As acidosis is corrected in the neonate, what electrolyte should be monitored closely?
treatment of acidosis increases iCa binding to albumin, resulting in decreased circulating levels of iCa
What is the effect of HTN on the nephrons?
the force of high blood flow over time damages renal blood vessels that can eventually cause sclerosis and scarring of the nephrons
What is the proper way to assess BP?
- 1.5h after a feed or medical intervention
- infant lying prone or supine
- appropriately sized BP cuff
- R upper arm
- after cuff placement, the infant is left undisturbed for 15 min
- infant should be asleep or quiet awake state
- 3 successive BP reading at 2 min intervals
- record the middle BP
What is the recommended kcal range for an infant with renal failure?
100-120 kcal/kg/day of glucose and fat
What is the recommended protein range for an infant with renal failure?
* too much protein and too little protein adds to the kidney's work load
How does PM 60/40 formula help renally impaired infants?
What are the different forms of dialysis?
2) peritoneal dialysis
What is the dialysis method of choice for infants?
What are the contraindications for dialysis in the neonate?
1) bowel problems
3) hemodynamic instability
4) extreme prematurity
What is the mechanism of action for peritoneal dialysis?
- fairly simple and can be done at home
- peritoneum acts as semipermeable membrane
- exchange of solutes and H2O between blood and dialysate
What are the benefits of a kidney transplant?
BETTER THAN LONG TERM DIALYSIS
- improved survival
- improved growth and development
- improved quality of life
- complications of dialysis and avoided
What factors do NOT affect the prognosis of renal failure in neonates?
- birth weight
- APGAR scores
- peak Cr and BUN
What is the cycle of renal failure?
nephron loss > hypertrophy of remaining nephrons that have excess flow (hyperfiltration) > sclerosis and cause cellular death
What are the recommendations for renal f/u in neonates?
at 1 mo after recovery and annually:
3) elevated BUN and elevated Cr
at 5yrs, good prognosis if normal kidney growth
Why is the incidence of mortality decreasing in infants with a h/o renal failure?
- improved transplantation
- improved immunosuppressive medications
What are the considerations for urine culture collection?
1) no need for a UCX in 1st 3 dol
2) ALWAYS consider UTI in septic patient after that time (liability in HR, SpO2, poor feeding)
What is indicative of a UTI in a UCX?
>10^3 mL of a single organism
Why are nitrites indicative of a UTI in a UCX?
because bacteria convert urinary nitrates into nitrites (think G neg)
Why is leukocyte esterase indicative of a UTI in a UCX?
WBCs produce this enzyme when they are sent to the site to "clean it up"
What is the major site of action for lasix?
the loop of Henle
What is the mechanism of action for lasix?
blocks ACTIVE Cl reabsorption
- blocks passive Na reabsorption
- blocks passive Ca reabsorption
What is hypochloremic metabolic alkalosis?
Na is decreased d/t cellular depletion of K
- cellular K exits cells to maintain serum levels
- serum Na moves into cells to take the place of K
What is the indicated treatment for hypochloremic metabolic alkalosis?
provide PO or IV KCL
- repletes cellular K allowing Na to move back into the serum
- corrects hypocholremia
- corrects acid base balance