The nurses admiting a school-age child in acute renal failure o reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?

Infants with congenital heart defects, including VSD, may have increased caloric needs due to the added work of their hearts. Congestive heart failure can lead to poor weight gain and failure to thrive. Therefore, increasing the caloric density of the formula is a common approach to providing the necessary nutrition for growth and development. This can be achieved by using specialized high-calorie infant formulas or fortifying breast milk.

The other options are not the primary supportive measures for an infant with congestive heart failure in this context:

B. Oxygen therapy to ensure oxygen saturation is > 98%: While oxygen therapy may be necessary for infants with congenital heart defects, it is not the primary supportive measure to address failure to thrive. Oxygen therapy primarily aims to ensure adequate oxygenation but does not directly address caloric intake.

C. Sedatives to keep the infant from crying: The use of sedatives is not a typical approach to managing congestive heart failure in infants. Addressing the underlying cause, optimizing nutrition, and providing supportive care are more appropriate strategies.

D. Emergent surgical correction of the defect: Surgical correction of a VSD is typically considered for specific indications, such as significant hemodynamic compromise, but it is not the first-line intervention for all cases of VSD, especially if the primary concern is failure to thrive. Treatment decisions for VSD are made based on the specific clinical presentation and severity of the defect.

Creatinine is a waste product generated by muscle metabolism and excreted by the kidneys. It is commonly used as a marker of renal function because it is filtered by the glomeruli and almost entirely excreted in the urine. When there is a reduction in GFR, as in acute renal failure, creatinine levels in the blood tend to rise. Elevated serum creatinine levels are indicative of impaired kidney function and a decreased GFR.

The other options are not direct indicators of GFR:

A. Protein level: While proteinuria (elevated protein levels in urine) can be a sign of kidney dysfunction, it is not a direct measurement of GFR. Proteinuria can occur for various reasons, including glomerular damage, but it doesn't provide a precise assessment of GFR.

C. Osmolality: Urine osmolality reflects the concentration of solutes in urine but is not a direct measure of GFR. It can provide information about the concentrating ability of the kidneys, but it doesn't assess the overall filtration rate.

D. pH: Urine pH is a measure of the acidity or alkalinity of urine and is not a direct indicator of GFR. It can be influenced by factors such as diet and renal tubular function but does not directly measure the filtration rate of the glomeruli.