1Main Functions of the kidney mnemonic: A WET BED
A – Acid-base balance
W – Water removal
E – Erythropoiesis
T – Toxin removal
B – Blood pressure control
E – Electrolyte balance
D – Vitamin D activation
2Schwartz formula is used to _______
- Estimate GFR
- GFR(mL/min/1.73m^3)= 0.431 x height (cm)/serum creatinine (mg/dL)
3Normal GFR levels:
Preemie= ______
Term infant - 2 y.o= _______
> 2 y.o= ______
- <10 mL/min/1.73m^3
- 10–40 mL/min/1.73m^3
- 110–120 mL/min/1.73m^3
4AKI is defined as any of the following (not graded): Inc. in serum creatinine (SCr) by ______; Inc. in SCr to _____; Urine Volume < _______
- > 0.3 mg/dl (>26.5 umol/l) within 48 hours
- > 1.5 times baseline
- 0.5 ml/kg/hr for 6 hours
5Prerenal causes of AKI
• Dehydration due to vomiting/diarrhea
• Surgical shock
• Burns
• Hemorrhage
• Accidental poisoning
• Prolonged anesthesia
• Problems with cardiac output
6Intrinsic (parenchymal) causes of AKI
• Damage from disease or nephrotoxic drugs
• Ischemia of the kidney itself due to inability
to reverse hypoperfusion
• Nephrotoxic agents
• Poison
• Tubule blockage
• Systemic Lupus Erythematosus
• Small vessel vasculitis
• Endocarditis
• Sickle Cell Disease
• Malignant Hypertension
• Diabetes Mellitus
7Postrenal causes of AKI
• Ureteral, bladder, or urethral
obstruction
• Stones
• Neurogenic bladder
• Retroperitoneal fibrosis
• Renal injury
8Diffusion is the movement of ____ solutes (glucose, K, urea etc.) from an area of _____ concentration to an area of ______ concentration across a semi-permeable membrane
- Small
- higher
- Lower
*Tea Bag analogy*
9Convection is the movement of _____ solutes across a semi- permeable membrane where the solute is transported with ______
- Small & medium
- solvent (water)
* Coffee Filter analogy*
10Ultrafiltration is the movement of fluids through a membrane caused by a ________ through generating ______
- pressure gradient
- hydrostatic pressure
11Post kidney transplant peds pt will require higher _____; CVP should be ___ to ___; Start _____ MIVF & ______
- mean arterial pressure (titrate to UOP)
- 8 – 10 mmHg
- dextrose containing
- 1:1 UOP replacement
12Antimicrobial ppx is required post kidney transplant with....
• Cephalosporin
• Ganciclovir (CMV)
• Bactrim (PCP)
• Nystatin/Fluconazole (candida)
13When treating HTN crisis, reduce MAP by ___% to ____% over the first 8 hours then finish over ___ to ____ hours
- 20% - 25%
- 48- 72