Sunday, May 8, 2016

CME Live: Session four

Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. 

Neonatal Renal Physiology 

Dr Saroj patnaik

Glomerular function:
Kidney receives 15% of CO 
Low systemic blood pressure
Increased vascular resistance
Renal blood flow more to inner cortex and medulla
GFR is 10-30 ml/min/1.73m2

Limited adaptive features to stress, sepsis, anorexia and exposure to nephrotoxic drugs are challenges in assessing renal function

Range of autoregulation set to lower perfusion pressure
Susceptible to Hypovolemic insult

Tubular function:
Total body water 75% of the weight
Shift of ECF into cells
Physiologic weight loss 10-15%

Low urine concentrating capacity
Dilution mechanism better than conc. capacity
Prone to dehydration
It maybe non oligouric despite poor renal function

Sodium balance: 
Hyponatremia in preterms and rapidly growing LBW babies

Potassium levels of 6-6.5 is considered acceptable in term and preterm neonates

Acid base balance:

Suboptimal acid excretion
Lower serum bicarbonate levels are acceptable in preterm and term neonates
Disease states and drugs can accentuates metabolic acidisis.

Neonatal AKI

Dr Malcolm Coulthard

Why did AK failure become AK injury, it should be AK dysfunction

Deficiency of AK*
Reduced GFR
Reduced urine output

Pre-renal causes:
Non osmotic release of ADH

does not lead to damage if reverses

Deal with reversible components
Improve renal perfusion
Multiple organ failure

Furosemide if indicated
Obsessional fluid care
Blood results for fine tuning

When to dialyze?
Fluid is the key. If oligouric keep using conservative management until biochemistry is life threatening

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