Flashcards in Renal - (Part 2) - Unit 3 Deck (38)
What are the three different types of nephrotic syndrome?
Minimal change nephrotic syndrome (most common), Secondary Nephrotic syndrome (often due to acute glomerulonephritis, can be due to other diseases such as lupus) and congenital nephrotic syndrome (transplant by age 2)
What is minimal change nephrotic syndrome?
Autoimmune process that occurs one week after an immune assault - increases glomerular permeability to protein - leads to MASSIVE MASSIVE MASSIVE urinary protein loss.
Which is the most common presentation of glomerular injury in pediatrics?
What are the four main issues in nephrotic syndrome?
Massive proteinuria, hyperlipidemia, edema, hypoalbuminemia
Proteins in the blood help hold fluid in the blood vessel, so if you potty out the protein...the water passes from the vascular space to the tissues. T/F?
Who is most likely to get nephrotic syndrome? (Hint - think of a certain little one you know and love...)
Preschoolers & males
What are some manifestations of nephrotic syndrome?
Weight gain, edema (begins with facial edema), diarrhea, decreased urine output, urine is dark and frothy!, and normal/slightly decreased BP
What is severe generalized edema called?
Why do we see the lines on the nails (muehrcke) for nephrotic syndrome patients?
Due to prolonged hypoalbumemia.
Why would the child with nephrotic syndrome experience high levels of platelets?
How do we diagnose nephrotic syndrome?
History, MASSIVE MASSIVE MASSIVE proteinuria, hypoalbuminemia, hyperlipidemia (cholesterol may be as high as 400-1500)
How do we manage nephrotic syndrome?
Managed at home, decrease protein, regular diet but Na restriction, don't need high protein (no evidence), 3 months corticosteroids, immunosuppressive (cytoxan - reduces relapse), loop diruetics
What are some complications of nephrotic syndrome?
Renal failure, infection, cellulitis, pneumonia, relpase
What is the accumulation of nitrogenous waste within the body?
What is renal failure?
The inability of the kidney to excrete waste or conserve water/electrolytes
What is the most common cause of renal failure in children?
Dehydration and poor perfusion
What are the causes of acute renal failure (3)
Prerenal (due to reduction in renal perfusion in a normal kidney), intrinsic (diseases and nephrotoxic agents that damage kidneys), post renal (obstruction)
What is stimulated in the presence of hypovolemia and decreased glomerular perfusion?
Renin, Aldosterone, ADH - leads to an even more decreased renal flow.
ARF - elevated BUN, severe reduction in glomerular filtration, stimulation of renin mechanism (leads to vasoconstriction), reduction in renal blood flow. T/F?
What are some manifestations of ARF?
Oliguria (less than 1ml/kg/hr), edema, HTN, circulatory congestion, cardiac arrhythmia's (r/t hyperkalemia), seizures (r/t hyponatremia/hypocalcemia), metabolic acidosis
What electrolytes are increased in ARF?
PUMP - potassium, urea, magnesium, phosphate
What electrolyte is decreased in ARF?
what are some complications of ARF?
Anemia, seizures/coma, cardiac failure, death
How do we treat ARF?
Prevention, treat underlying cause, dialysis, fluids, foods HIGH in carbs and FAT but low in protein, TPN, manage complications
Peritoneal dialysis - how is it done?
Water and solutes diffuse across the child's peritoneum.
High glucose concentration in the fluids = more pulled from the peritoneum during peritoneal dialysis. T/F?
What are some complications of peritoneal dialysis?
Peritonitis, pain during infusion of fluids, leakage around the catheter, respiratory symptoms (too much abdominal fluids, leakage of fluid to chest from hole in diaphragm)
Who is NOT a candidate for peritoneal dialysis?
Abdominal incisions, respiratory distress, bowel perforation
What 3 major manifestations are seen in hemolytic uremic syndrome?
Hemolytic anemia, thrombocytopenia, renal failure