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H+P (Exam 3) Renal Lecture > Chronic Kidney Injury > Flashcards

Chronic Kidney Injury Flashcards

1
Q

What are the leading causes of CKD?

A
  • DM
  • HTN

S45

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2
Q

What CKD stage is kidney damage with normal or increased GFR?

A

Stage 1

GFR: >90

S46

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3
Q

What CKD stage is kidney damage with mildly decreased GFR?

A

Stage 2

GFR: 60-89

S46

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4
Q

What CKD stage is moderately decreased GFR?

A

Stage 3

GFR: 30-59

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5
Q

What CKD stage is severely decreased GFR?

A

Stage 4

GFR: 15-29

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6
Q

What drugs are often used to combat chronic kidney disease?

A

ACEi’s and ARBs

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7
Q

How do ACEi’s and ARBs help treat CKD?

A
  • Decrease systemic & glomerular HTN
  • Decrease proteinuria
  • Decrease glomerular sclerosis

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8
Q

What antihypertensive drugs need to be held on the day of surgery to decrease the risk of intraoperative hypotension?

A

ACEi’s & ARBs

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9
Q

Which populations are at a higher risk for silent MI?

A

Women and diabetics

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10
Q

What lab values reflect dyslipidemia?

A
  • Triglycerides > 500
  • LDL > 100

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11
Q

What is the CV effects of CKD and the treaments?

A
  1. Sytemic hypertension
    d/t activation of RAAS and retentionof sodium and water
  2. Dyslipidemia
  3. predisposed to “Silent MI”
    Peripheral & autonomic neuropathy, sensation may be blunted

Treatments:
1st line-Thiazide Diuretics
May need ACE-I/ARB

S47, S49

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12
Q

What medications to use when ACE-I/ARBs are taken by surgical patient?

A
  • Vasopressin
  • Epinephrine
  • NE

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13
Q

What is the hematologic effects of CKD?

A

Anemia

d/t responsive to exogenous erythropoietin and platelet dysfunction

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14
Q

What is one risk of blood transfusion with CKD?

A

excess hgb leads to sluggish circulation

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15
Q

What is the leading cause of death in dialysis patients?

A

Infection

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16
Q

What is the most common adverse event associated with dialysis?

A

Hypotension

S51

17
Q

What are the indications for dialysis?

A
  • Volume overload
  • ↑K⁺
  • Severe metabolic acidosis
  • Symptomatic uremia
  • Failure to clear medications

S51

18
Q

What are the anesthesia concerns with CKD?

A
  • Assess stability of ESRD
  • Body weight pre/post dialysis (within 24 h of surgery)
  • Well-controlled BP
  • Pressors
  • Glucose management
  • Aspiration precautions
  • Uremic bleeding

S52

19
Q

How to manage uremic bleeding?

A
  • asess platelet function
  • give:
    1. Cryo
    2. Factor VIII / vWF
    3. Desmopressin

S52

20
Q

What anesthetic medications to consider with CKD?

A
  • agents NOT dependent on renal elimination
  • NO active metabolites
    (such as Morphine, Demerol)

S53

21
Q

What Induction agents are excreted in the kidneys?

A
  • Phenobarbital
  • Thiopental

S55

22
Q

What Muscle relaxants are excreted in the kidneys?

A
  • Pancuronium
  • Vecuronium

S55

23
Q

What Cholinesterase inhibitors are excreted in the kidneys?

A
  • Edrophonium
  • Neostigmine

S55

24
Q

What CV drugs are excreted in the kidneys?

A
  • Atropine
  • Digoxin
  • Glycopyrrolate
  • Hydralazine
  • Milrinone

S55

25
Q

What antimicrobials are excreted in the kidneys?

A
  • Aminoglycosides
  • Cephalosporins
  • Penicillins
  • Vancomycin

S55

26
Q

How much of Morphine is cleared through the urine and what happens when it is not cleared?

A

40 % is cleared through urine

Failure to clear leads to significant metabolites which can result to life-threatening respiratory depression

S56

27
Q

What is Normeperidine?

A

Active metabolite of Meperidine/Demerol and has a longer E1/2

S57

28
Q

What is the main adverse effect of Normeperidine?

A

neurotoxicity

S57

29
Q

What are the preoperative concerns of CKD?

A
  • K+ < 5.5 mEq/L on elective surgery
  • Dialysis pts should be dialyzed within 24 h preceding elective surgery
  • Aspiration prophylaxis, especially in DM
  • Anesthesia & surgery decrease RBF & GFR
  • Blood loss activates baroreceptors→↑SNS outflow
  • Catecholamines activate α1-Rs→↑afferent arteriole constriction→↓RBF
  • Longer periods of hypotension (cross-clamping, hemorrhage, sepsis) →↓RBF

S58

H+P (Exam 3) Renal Lecture (10 decks)

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