Kidney 4 Flashcards by Hannah Garrison

Loop diuretics include

furosemide
bumetanide
ethacrynic acid

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lasix dosing is

20-200 mg

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Bumetanide dosing is

0.5-2 mg

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Ethacyrnic acid dosing is

25-100 mg

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Clinical uses of loop diuretics includes

acute pulmonary edema
AKI
CHF
hypercalcemia
HTN
anion overdose
intracranial HTN (not as effective as mannitol)
mobilization of edema fluid

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Complications of loop diureticcs include

hypokalemic, hypochloremic metabolic alkalosis
hypocalcemia
hypomagnesemia
hypovolemia
ototoxicity
hypokalemia
reduced lithium clearance

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Thiazide diuretics include

hydrochlorothiazide
chlorthialidone
metolazone
indapamide

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The hydrochlorothiazide dose is

12.5-50 mg

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Clinical uses of thiazide diuretics include

essential HTn
mobilize edema fluid
CHF
osteoporosis

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Complications of thiazide diuretics include

hyperglycemia
hypercalcemia
hyperuricemia
hypokalemic, hypochloremic metabolic alkalosis
hypovolemia
HLD
sexual dysfunction

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Potassium-sparing diuretics include

spironolactone
amiloride
triamterene

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Spironolactone exists in a subclass of potassium-sparing diuretics called

aldosterone antagonists

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Clinical uses of potassium-sparing diuretics include

secondary hyperaldosteronism
to reduce K+ loss in a patient receiving a loop or thiazide diuretic

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Complications of potassium-sparing diuretics include

hyperkalemia
metabolic acidosis
gynecomastia
libido changes
nephrolithiasis

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Identify the BEST tests of tubular function. (select 2)
a. blood urea nitrogen
b. urine osmolality
c. fractional excretion of sodium
d. creatinine clearance

b. urine osmolality
c. fractional excretion of sodium

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Renal function tests provide an assessment of either

glomerular function or tubular function

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Test of glomerular function include

BUN
serum creatinine
creatinine clearance

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Tests of tubular function (concentrating ability) include

fractional excretion of sodium
urine osmolality
urine sodium concentration
urine specific gravity

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Normal BUn is

10-20 mg/dL

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Normal serum creatinine is

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0.7-1.5 mg/dL

Normal creatinine clearance is

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110-150 mL/min

Normal fractional excretion of sodium is

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1-3%

Normal urine osmolality is

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65-1,400 mOsm/L

Normal urine sodium concentration is

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130-260 mEq/day

Normal urine specific gravity is

1.003-1.030

The best indicator of GFR is

creatinine clearance

_______ is the primary metabolite of protein metabolism in the liver

Urea

A BUN of <8 mg/dL is indicative of

overhydration decreased urea production- malnutrition, severe liver disease

A BUN of 20-40 mg/dL is indicative of

dehydration decreased GFR increased protein input- increased diet, GI bleed, hematoma breakdown catabolism- trauma, sepsis

A BUN of >50 mg/dL is indicative of

a decreased GFR

________ is produced by skeletal muscle and __________ is a metabolic byproduct of ________ breakdown

creatine; creatinine, creatine breakdown

Normal BUN: Cr ratio is

10:1

A BUN: Cr ratio of __________ suggests prerenal azotemia

>20:1

Working kidneys_________ sodium, while failing kidneys _______ sodium

conserve; waste

If the fractional excretion of sodium is <1%, this suggests

prerenal azotemia (more sodium is conserved relative to the amount of creatine cleared)

If the fractional excretion of sodium is >3%, this suggests

impaired tubular function (more sodium is excreted relative to the amount of creatinine cleared

A large amount of protein in the urine indicates

glomerular injury (>750 mg/day or +3 by urinalysis)

_________ is a better test of tubular function than specific gravity

Urine osmolality

What are the diagnostic test values for prerenal oliguria?

Fractional excretion of Na+ <1 Urinary Na+ <20 Urine osmolality >500 BUN: creatinine ratio >20:1 Sediment: normal, possible hyaline casts

What are the diagnostic test values for acute tubular necrosis?

fractional excretion of Na+: >3 urinary Na+: >20 urine osmolality <400 BUN:Creat ration: 10-20:1 sediment: granular casts, tubular epithelial cells

Anesthetic considerations for AKI include (Select 2:) a. prerenal azotemia can cause acute tubular necrosis b. hydroxyethyl starches are associated with an increased risk of renal morbidity c. renal dose dopamine prevents AKI d. diuretics should be used to convert oliguric to nonoliguric AKI

a. prerenal azotemia can cause acute tubular necrosis b. hydroxyethyl starches are associated with an increased risk of renal morbidity

The most significant source of perioperative morbidity and mortality is

acute kidney injury

The most common cause of perioperative kidney injury is

ischemia-reperfusion injury

Patients at greatest risk for AKI include

those with pre-existing kidney disease CHF advanced age sepsis

The problem with using urine output as a surrogate of renal perfusion is that oliguria is often the result of

the physiologic response to perioperative stress (increased ADH release during surgey)

We can classify AKI on the basis of

prerenal intrinsic or post renal injury

Prerenal injury is indicative of

hypoperfusion

Intrinsic injury is indicative of

parenchymal

Postrenal injury is indicative of

obstruction

Kidney 4 Flashcards

(49 cards)