Kidney 5

Question 1

With prerenal injury, there is __________, but there is no ________

Answer 1

inadequate perfusion of the kidneys but not intrinsic damage

Question 2

Treatment for prerenal injury includes

Answer 2

restoration of renal blood flow with IVF
hemodynamic support
& PRBCs

Question 3

Intrinsic injury can be caused by injury of the

Answer 3

tubules, glomerulus or interstitial space

Question 4

Causes of acute tubular necrosis include

Answer 4

ischemia and nephrotoxic drgus

Question 5

Treatment of intrinsic injury is

Answer 5

supportive

Question 6

The source of obstruction for postrenal injury can arise anywhere between

Answer 6

the collecting duct and the urethra

Question 7

Treatment of postrenal injury is

Answer 7

to remove the obstruction

Question 8

___________ does not prevent or treat AKI

Answer 8

renal dose dopamine

Question 9

Attempting to convert oliguric to nonoliguric AKI with ______ increases the risk of additional renal injury as well as mortality

Answer 9

diuretics

Question 10

The following patients are at risk for AKI during the perioperative period:

Answer 10

pre-existing kidney disease
sepsis
jaundice
prolonged renal hypoperfusion
CHF
advanced age
high-risk surgery (use of aortic cross clamp & liver transplant)

Question 11

What is the RIFLE criteria?

Answer 11

risk
injury
failure
loss
end-stage kidney disease

Question 12

Risk indicates

Answer 12

increased SCr to >1.5x baseline
UOP <0.5 mL/kg/hr for >6 hours

Question 13

Injury indicates

Answer 13

increase in Scr to >2x baseline
UOP <0.5 mL/kg/hr for >12 hours

Question 14

Failure indicates

Answer 14

increase in SCr to >3x baseline or increase >0.5 mg/dL to absolute value of >4 mg/dL
UOP <0.3 mL/kg/hr >12 or anuria >12 hr

Question 15

Loss indicates

Answer 15

need for renal replacement therapy >4 weeks

Question 16

End-stage indicates

Answer 16

need for renal replacement therapy >3 months

Question 17

Prerenal injury can be a result of

Answer 17

intravascular volume depletion
decreased CO
systemic vasodilation
renal vasoconstriction
increased abdominal pressure

Question 18

Intrinsic injury can be a result of

Answer 18

tubular injury
tubulointerstitial injury
glomerular injury
renal vasculature
large vessels

Question 19

The risk of prerenal azotemia is reduced by

Answer 19

maintaining MAP >65 mmHg and providing appropriate hydration

Question 20

The use of _________ is associated with an increased risk of renal morbidity

Answer 20

hydroxyetyl starches

Question 21

In healthy patients, ________ can reduce renal blood flow

Answer 21

alpha-1 agonists

Question 22

__________ preferentially constricts the efferent arteriole. It maintains GFR and UOP better than norepinephrine or phenylephrine

Answer 22

Vasopressin

Question 23

What are the 3 classification schemas for AKI?

Answer 23

RIFLE
AKIN
KDIGO

Question 24

Pathophysiologic considerations for the end-stage renal disease include: (select 3)
a. secondary hyperparathyroidism
b. increased prothrombin time
c. megaloblastic anemia
d. obstructive ventilatory defect
e. gap metabolic acidosis
f. increased bleeding time

Answer 24

a. secondary hyperparathyroidism
e. gap metabolic acidosis
f. increased bleeding time

Question 25

Chronic kidney disease is a

Answer 25

progressive and irreversible disorder that reflects the ongoing inability of the kidneys to sustain their normal functions

Question 26

The most common cause of CKD is

Answer 26

diabetes mellitus

Question 27

The second most common cause is

Answer 27

hypertension

Question 28

Complications of CKD include

Answer 28

uremic syndrome uremic bleeding anemia HTN CHF CAD gap metabolic acidosis hyperkalemia osteodystrophy restrictive ventilatory defect peripheral neuropathy autonomic dysfunction infection

Question 29

_________ is the cornerstone of CKD treatment

Answer 29

dialysis

Question 30

Indications of dialysis include

Answer 30

volume overload hyperkalemia severe metabolic acidosis symptomatic uremia overdose with a drug that is cleared by dialysis

Question 31

____________ is the most common event during dialysis

Answer 31

Hypotension

Question 32

How many stages of CKD are there?

Answer 32

5

Question 33

S/sx of uremic syndrome include

Answer 33

anemia fatigue N/V anorexia coagulopathy

Question 34

The first line treatment for uremic bleeding is

Answer 34

desmopressin

Question 35

With uremic bleeding _________ is normal & _____________ is higher

Answer 35

PT, pTT, and platelet counts; bleeding time

Question 36

Treatment of anemia includes

Answer 36

exogenous EPO or darbepoetin + iron supplementation

Question 37

EPO can cause

Answer 37

hypertension

Question 38

The most common cause of death for CKD patients is

Answer 38

CAD- assume all patients with CKD have CAD

Question 39

Five indications for the use of dialysis include

Answer 39

volume overload hyperkalemia severe metabolic acidosis symptomatic uremia overdose with a drug that is cleared by dialysis

Question 40

_________ is the leading cause of death in dialysis patients

Answer 40

Infection

Question 41

Stage 1, normal, GFR is

Answer 41

>90 mL/min

Question 42

Stage 2, mildly decreased, GFR is

Answer 42

60-89 mL/min

Question 43

Stage 3, moderately decreased GFR is

Answer 43

30-59 mL/min

Question 44

Stage 4, severely decreased, GFR is

Answer 44

15-29 mL/min

Question 45

Stage 5, kidney failure, GFR is

Answer 45

<15 mL/min

Question 46

Why does anemia occur in patients with chronic renal failure?

Answer 46

decreased production of erythropoietin leads to normochromic normocytic anemia

Question 47

What leads to a gap metabolic acidosis in chronic renal failure?

Answer 47

decreased excretion of non-volatile acids

Question 48

Dialysis is indicated when serum potassium exceeds

Answer 48

6 mEq/L