Renal Flashcards
(115 cards)
1
Q
5 characters for pre-renal impairment?
A
- Deceased BF
- Low BP
- HF
- Hepatorenal syndrome
- Toxins
2
Q
What is used to buy time during definitive treatment?
A
Dialysis
3
Q
Form of impaired kidney function that occurs in individuals with advanced liver disease. Do not have any identifiable cause of kidney dysfunction and the kidneys themselves are not structural damaged.
A
Hepatoreanl syndrome (HRS)
4
Q
What 3 things/tests are used to evaluate renal function?
A
- Serum creatinine
- Creatinine clearance
- Blood urea nitrogen (BUN)
5
Q
Non-protein nitrogenous waste product that is produced by the breakdown of creatine do to the normal wear and tear on muscles of the body
A
Creatinine
6
Q
A rise in serum creatinine levels is a late marker, observed only with marked damage to what?
A
Functioning nephrons
7
Q
Serum creatinine levels may increase or decrease when an ACEI is taken for HF and renal insufficiency?
A
Increase
8
Q
Normal serum creatinine values for men and women?
A
Men: .8-1.3 mg/dL
Women: .6-1 mg/dL
9
Q
The higher the blood creatinine level, the lower the what are (2)?
A
- Estimated GFR
2. Creatinine clearance
10
Q
Amount of blood the kidneys can make creatinine free each minute
A
Creatinine clearance
11
Q
Creatinine clearance helps to estimate what?
A
GFR
12
Q
GFR increase or decrease with age?
A
Decrease
13
Q
Normal creatinine clearance in men and women?
A
Men: 97-137 ml/min
Women: 88-128 ml/min
14
Q
Why do men have greater creatinine clearance?
A
Because greater muscle mass
15
Q
Is creatinine reabsorbed?
A
NO
16
Q
As renal function declines, creatinine clearance goes up or down?
A
Down
17
Q
2 main ways to use creatinine tests to measure kidney function?
A
- Measure amount of creatinine present in urine sample over 24 hrs
- GFR estimated by single blood level
18
Q
Creatinine clearance formula
A
(140-pts age) x (wt) x (1(men) or .85(women)) / 72 x serum creatinine level
19
Q
GFR 90 or greater
A
Stage 1
20
Q
GFR 60-89
A
Stage 2
21
Q
GFR 45-59
A
Stage 3a
22
Q
GFR 30-44
A
Stage 3b
23
Q
GFR 15-29 (preparation transplant)
A
Stage 4
24
Q
GFR <15 (require dialysis)
A
Stage 5
25
Is a waste product formed in liver when protein is metabolized into amino acids to produce ammonia
Urea
26
Urea is released by the liver into the blood and is carried to the kidneys, where it is filtered out of the blood and released into the what?
Urine
27
Is there a small but stable amount of urea nitrogen in the blood?
Yes
28
Renal function decreases, BUN level rise or falls?
Rise
29
Significant liver damage or disease inhibits the production of urea, then BUN concentrations may rise or fall?
Fall
30
Normal BUN values?
10-20 mg/dL
31
Is BUN a reliable indicator of GFR?
NO
32
Greater than what BUN value indicate renal impairment?
50
33
Normal BUN:Creatinine ratios?
10: 1
20: 1
34
Abrupt deterioration in kidney function with an increase in serum creatinine level with or without reduced urine output
Acute kidney injury
35
Decreased renal perfusion (often from hypovolemia) leading to decrease in GFR
Prerenal AKI
36
Is prerenal AKI reversible?
YES
37
Intrinsic kidney damage; acute tubular necrosis most common due to ischemic/nephrotoxic injury
Intrarenal AKI
38
Extrinsic/intrinsic obstruction of the urinary collection system
Postrenal AKI
39
AKI is usually what classification?
Prerenal
40
Oliguria in adults:
Too much pee
| <400cc/day
41
Anuria
Too little pee
| <100 cc/day
42
Most common causes of death in AKI (3)?
1. Sepsis
2. CV dysfunction
3. Pulmonary complications
43
Management of AKI (3)?
1. Fluid resuscitation
2. Avoid nephrotoxic medications and contrast media exposure
3. Correction of electrolyte imbalances
44
2 main steps to drug dosing considerations with renal impairment:
1. Estimate ECF volume
2. Tailoring drug dosing to estimate the creatinine clearance (since rate of elimination of drugs excreted bu kidneys is proportional to GFR)
45
If ECF is contracted, increase or decrease loading dose?
Decrease
46
If ECF is expanded, increase or decrease loading dose?
Increase
47
For meds with wide therapeutic ranges/long plasma half lives, the interval between doses is generally increased or decreased?
Increased
48
For meds with narrow therapeutic ranges/short plasma half lives, the interval between doses is generally increased or decreased?
Decreased
49
Chronic renal failure GFR value?
<25 ml/min and/or dependent on dialysis
50
What percent of loss of function is considered CRF?
>60%
51
2 main causes of CRF?
1. DM
| 2. HTN
52
Main complication from CRF?
Iron deficiency anemia
53
2 pulmonary problems from renal failure?
1. Hyperventilation
| 2. Edema
54
2 neurological problems with renal failure?
1. Uremic encephalopathy
| 2. Autonomic and peripheral neuropathies
55
2 hematological problems with renal failure?
1. Anemia
| 2. Platelet and leukocyte dysfunction
56
Endocrine problem with renal failure?
Abnormal glucose tolerance
57
5 GI problems with renal failure?
1. Nausea
2. Vomit
3. Peptic ulcer
4. Hemorrhage
5. Delayed gastric emptying
58
Unique sign of CRF?
Uremic frost
59
Latrogenci components that predispose to AKI (4):
1. Inadequate fluid replacement
2. Hypotension
3. Delayed treatment of sepsis
4. Administration of nephrotoxic drugs or dyes
60
CRF causes hyperkalemia or hypokalemia?
Hyperkalemia
61
Cats of hypocalcemia?
C-convulsion
A-arrhythmias
T-tetany
S-spasm and stridor
62
CRF causes hypercalcemia or hypocalcemia?
Hypocalcemia.
63
Involuntary contraction of muscles in the hand and wrist that occurs after the compression of the upper arm with a blood pressure cuff
Trousseau’s sign
64
Increased irritability of the facial nerve, manifested by twitching of the ipsilateral facial muscles on percussion over the branches of the facial nerve
Chvostek sign
65
2hr OGTT results for normal, preDM/IGT, DM:
Normal: <140
PreDM/IGT: 140-199
DM: >200
66
Hemodialysis must be drawn from what and returned to what?
Drawn from an artery
| Returned to a vein
67
3 types of hemodialysis:
1. AV fistula
2. AV graft
3. Central venous catheter
68
Artery (usually in forearm) is sewn into vein, and the high pressure from the artery enlarges the vein in the forearm
AV fistula
69
Advantage: mature faster than fistulas
Disadvantage: more likely to narrow and clot, higher incidence of infection
AV graft
70
One lumen draws blood out to the dialysis machine, while the other lumen reinfuses the filtered blood back to the pt
-short term solution until fistula or graft can be established
Central venous catheter
71
3 advantage to peritoneal dialysis:
1. Can be done at home
2. Relatively easy to learn
3. Fluid balance is usually easier than hemodialysis
72
4 disadvantages to peritoneal dialysis:
1. Infection is more common
2. Long term PD can change permeability of visceral peritoneum
3. Risk of hernias
4. Fluid leaks into surrounding tissue
73
Neurological signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis
Dialysis disequilibrium syndrome (DDD)
74
Common CV complication?
LV hypertrophy
75
What 2 invasive hemodynamic monitoring is mandatory?
Frequent BG analyses
| Electrolyte measurements
76
Does administration of diuretics to maintain urine output in pts who are not oliguric show improvement?
NO
77
What 2 main things are caused by renal failure?
1. Decreased protein binding
| 2. Greater brain penetration due to breach of blood-brain barrier
78
What 3 induction agents are not too significantly affected by impaired renal function?
1. Propofol
2. Etomidate
3. Ketamine
79
Chronic renal failure AND severe anemia (Hb<5) does what to B:G partition coefficient and induction?
Decrease
| Accelerate induction
80
Opioids agents:
Accumulation of morphine and meperidine metabolites which prolongs respiratory depression
81
Atropine use:
Accumulation following repeated doses
82
Sux is safely used in renal failure when serum K is less than what?
<5 mEg/L
83
Neostigmine use:
Renal excretion is principle route of elimination; half live prolonged
84
Preop evaluation (5)
1. Time since last dialysis
2. ABG
3. ECG
4. Cardiac echo
5. CBC
85
Induction needs to be RSI or not?
Yes
86
During induction, what should you be prepared for with BP?
HTN
87
What fluids should you avoid and why?
LR due to K+
88
Normally during spontaneous inspiration, what happens with SBP and pulse?
SBP: decreases by <10mmHg
Pulse: slightly increase
89
Why does spontaneous inspiration affect SBP and pulse?
Inspiration makes intra-thoracic pressure more negative to atmospheric pressure, which increases systemic venous return to RA by reducing back-pressure on veins (vena cava)
90
What prevents the septum of R and L ventricles from bulging dramatically into the LV during inspiration?
Large pressure gradient between L>R ventricles
91
Reduced L-heart filling leads to a reduced SV which manifests as a decrease in SBP, leading to a faster what due to the baroreceptor reflex, which stimulates sympathetic outflow to the heart?
HR
92
Naturally occurring phenomenon in which the arterial pulse pressure falls during inspiration and rises during expiration due to changes in intra-thoracic pressure secondary to negative pressure ventilation (spontaneously breathing)
Stroke volume variation
93
Normal range of variation in spontaneously breathing pts is btn:
5-10 mmHg
94
Variations over 10mmHg have been referred to as what?
Pulses paradoxus
95
With normal lung compliance and a regular HR, a SVV >13% suggest that the pt is what?
Dry
96
Mechanism of SVV:
Large negative intra-thoracic pressure (spontaneous ventilation) increases the pressure across the wall of the LV
97
Arterial pressure rises during inspiration and falls during expiration due to changes in intra-thoracic pressure secondary to positive pressure ventilation
Reverse pulses paradoxus
98
Traditional CVV calculation:
SVmax - SVmin / SVmean
99
Difference between maximal and minimal values of the SBP during one mechanical breath
Systolic pressure variation (SPV)
100
Systolic pressure variation has been shown to be a valuable indicator of what?
Cardiac preload
101
SPV was considered to be a sensitive indicator of what
Hypovolemia
102
Desirable urinary output?
>.5 ml/kg/h
103
ESWL shock waves can produce what?
PVCs
104
Occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation
TURP syndrome
105
Result of TURP syndrome:
Fluid overload and disturbed electrolyte balance and hyponatremia
106
Regional vs general anesthesia preferred for TURP syndrome?
Regional
107
What types of fluids can be toxic to the CV and CNS for TURP syndrome?
Fluids containing glycine
108
Ideal surgery times for TURP syndrome?
Under 1 hr
109
Pt positioning for TURP syndrome?
Horizontal
110
Suggested optimum ht of irrigating fluid bag ht for TURP syndrome?
60 cm
111
Correction of hyponatremia for TURP syndrome?
Hypertonic saline
112
Rapid increase in serum sodium concentration may lead to what?
Central pontine myelinolysis
113
Slow administration of what can correct the sodium concentration for TURP syndrome?
Diuretics like furosemide
114
Can giving diuretics paradoxically cause a reduction in serum sodium concentration?
Yes
115
Raising the sodium at what rate is considered safe?
1 moo/L/hr
