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Flashcards in Renal Deck (197)
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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?

~ 2g/kg/d
* too much protein and too little protein adds to the kidney's work load


How does PM 60/40 formula help renally impaired infants?

less phosphate


What are the different forms of dialysis?

1) hemodialysis
2) peritoneal dialysis


What is the dialysis method of choice for infants?

peritoneal dialysis


What are the contraindications for dialysis in the neonate?

1) bowel problems
2) coagulopathies
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?

- 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
- FeNa
- 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:
1) hypertension
2) proteinuria
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
leukocyte esterase
cast cells


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


What should be considered in the treatment for hypochloremic metabolic alkalosis in an infant <34 weeks?

you may need to give a small amount of Na Cl (0.5-1); only if renal fx is still immature and you suspect Na losses are still occuring