Exam 3: Renal 1/2

Question 1

What are the roles of the kidney?

Answer 1

1. Excreting metabolic wastes
2. Maintaining extracellular fluid
3. Maintain electrolytes
4. Maintain acid-base balance
5. Hormonal functions

Question 2

Due to hepatic displacement, the right kidney’s position is ______ than the left kidney

Answer 2

slightly lower

Question 3

A longitudinal section of the kidney reveals two distinct regions, the outer ____ and the inner _____

Answer 3

cortex; medulla

Question 4

The medial margin of the kidney is concave because of the presence of a recessed fissure known as the ___.

Answer 4

hilus

Question 5

Hilus lies at approximately what level?

Answer 5

L1

Question 6

Parasympathetic innervation to the kidneys is via the ____

Answer 6

Vagus nerve

Question 7

Sympathetic innervation to the kidneys is via the ____

Answer 7

T8-L1 preganglionic

Question 8

Sympathetic innervation to the bladder is from _____ and controls what functions?

Answer 8

T11 – L2
Pain, touch, temp

Question 9

Parasympathetic innervation to the bladder is from _____ and controls what functions?

Answer 9

S2-S4
Stretch, motor

Question 10

The functional unit of the kidney is the ____

Answer 10

nephron

Question 11

Production of urine begins with water and solute filtration from plasma flowing into the glomerulus via the _________

Answer 11

AFFERRENT arteriole

Question 12

What are the 2 major determinants of GFR?

Answer 12

1. Glomerular capillary pressure (arterial pressure)
2. Glomerular oncotic pressure (renal blood flow)

Question 13

The normal renal fraction of cardiac output is approximately ______%

Answer 13

25%

Question 14

Renal blood flow is regulated by what 2 things?

Answer 14

1. intrinsic autoregulation
2. neural regulation

Question 15

Afferent arteriole vasodilation and myogenic mechanisms are responsible for ______

Answer 15

autoregulation

Myogenic reflex - pressure

Question 16

GFR relatively constant with changes in MAP from _______

Answer 16

80-200 mmHG

Question 17

______ reabsorbs 2/3 of filtered sodium

Answer 17

Proximal tubule

Question 18

What part of the kidney reabsorbs about 65% of filtered water?

Answer 18

Proximal tubule

Question 19

ADH is secreted by the ____

Answer 19

posterior pituitary gland

Question 20

arterial _________ are activated when hypovolemia leads to a decrease in blood pressure

Answer 20

baroreceptors

Question 21

What is released by atrium in response to increased stretch?

Answer 21

ANP

(Atrial natriuretic peptide)

Question 22

Which renal vasodilator, produced in kidney, is stimulated as a result of
stress, renal ischemia, and HOTN?

Answer 22

Prostaglandin

Question 23

S/Sx of Hyopnatremia

Answer 23

Symptoms rarely unless < 125mEq/L

S&S - anorexia, nausea, and lethargy to convulsions, dysrhythmias, coma, and even death due to osmotic brain swelling

If acute, risk of neurological complications higher; Treat to prevent cerebral edema and seizures

Question 24

S/Sx of Hypernatremia

Answer 24

Serum level > 145mEq/L

Generally due to sodium gain or water loss (usually the latter)

Can cause dehydration of brain leading ; Symptoms from confusion to convulsions and coma

Question 25

Causes, Symptoms and Treatment of Hypokalemia

Answer 25

Causes: Vomiting, diarrhea, drugs, hormones, renal abnormalities, insulin therapy, inadequate intake S/Sx: electrocardiogram (ECG) changes (flattened T waves “no pot, no T,” U waves) and skeletal muscle weakness Treatment: replacement (IV or PO)

Question 26

Causes of Hyperkalemia

Answer 26

abnormal kidney excretion, abnormal cellular potassium release (i.e. cell lysis), or abnormal distribution between the intra- and extracellular space. > 5.5 mEq/L

Question 27

renal pain is linked to what dermatomes?

Answer 27

T10-L1 (sympathetic)

Question 28

if doing neuraxial block for kidney surgery would want coverage from _____________

Answer 28

T8-L4

Question 29

What is a normal GFR for a 70 kg male

Answer 29

125 mL/min

Question 30

What is the primary site of reabsorption in the nephron?

Answer 30

PCT

Question 31

What is the primary site of water movement in the nephron?

Answer 31

Descending loop (b/c that is where aquaporins are)

Question 32

Renal blood flow⬇ = _____ glomerular filtration

Answer 32

⬇ (decrease)

Question 33

Angiotensin II production causes what 3 things?

Answer 33

1. renal efferent arteriolar vasoconstriction 2. ADH release 3. Aldosterone release

Question 34

List *exogenous* nephrotoxins commonly found in hospital settings

Answer 34

Antibiotics Anesthetic agents NSAID Chemotherapeutic Contrast

Question 35

List *endogenous* nephrotoxins commonly found in hospital settings

Answer 35

Increased Calcium Uric acid Myoglobin (Rhabdo) Hemoglobin(hemolysis) Bilirubin Paraproteins

Question 36

True or False. Prerenal azotemia is reversible if the underlying cause is corrected.

Answer 36

True

Question 37

Oliguria is defined as a urinary flow rate less than __________.

Answer 37

0.5 mL/kg/hour

Question 38

Causes of prerenal azotemia:

Answer 38

Absolute decrease - Acute hemorrhage - GI fluid loss - Trauma - Surgery - Burns Low Output syndromes - Renal artery stenosis - Relative decrease - Sepsis - Hepatic failure - Allergic reaction

Question 39

Causes of intrarenal azotemia:

Answer 39

Acute glomerulonephritis, Vasculitis, Interstitial nephritis (drug allergy, infiltrative diseases) Acute tubular necrosis - Ischemia - Nephrotoxic drugs (aminoglycosides, nonsteroidal anti-inflammatory drugs) - Solvents (carbon tetrachloride, ethylene glycol) - Heavy metals (mercury, cisplatin) - Radiographic contrast dyes - Myoglobinuria - Intratubular crystals (uric acid, oxalate)

Question 40

Causes of postrenal azotemia:

Answer 40

Urinary outflow tracts **obstructed** - Prostatic hypertrophy (PBH) or cancer of prostrate or cervix - Bladder carcinoma - Clot retention or nephrolithiasis

Question 41

Risk factors for acute renal failure

Answer 41

- Co-existing renal dz - CHF - Advanced age - Symptomatic CV disease - Major operative procedures (CPB, AAA repair) - Sepsis - Multi-organ system failure - Iatrogenic: inadequate fluid volume replacement, delayed tx of sepsis, nephrotixc drugs or dyes - pre-existing renal insufficiency - shock

Question 42

What procedures are considered high-risk for leading to renal failure?

Answer 42

Renal vascularization Aortic cross-clamping Cardiopulmonary bypass Urologic surgery Transplantation Trauma

Question 43

What are nephrotoxins that can lead to renal failure?

Answer 43

Aminoglycoside antibiotics Radiocontrast dyes Nonsteroidal anti-inflammatory drugs

Question 44

Complications related to renal failure

Answer 44

Neuro - confusion, asterixis, somnolence, seizures CV - systemic HTN, CHF, pulmonary edema, cardiac dysrhythmias, may have dilutional anemia GI - anorexia, nausea, vomiting, ileus, GI bleeding

Question 45

S/Sx of renal failure

Answer 45

Generalized malaise S&S volume overload (dyspnea, edema, HTN) Lethargic, nauseated, confused Pulmonary edema, hypoxia, hyperkalemia, acidosis Encephalopathy (coma, seizures and death)

Question 46

What is the most reliable measure of kidney function?

Answer 46

creatinine clearance