Renal

Question 1

Functions of the kidneys

Answer 1

Acid-base balance
Water removal
Erythropoietin
Toxin removal
Blood pressure control
Electrolyte balance
D activation (vitamin)

Question 2

GFR

Answer 2

105-125ml/min

preferred measure of kidney function

Question 3

Serum creatinine

Answer 3

0. 6-1.5 mg/dL
   * most indicative of renal failure*

-waste product of muscle metabolism

Question 4

BUN

Answer 4

8-20 mg/dL
*not as sensitive as creatinine

-waste product of protein metabolism

Question 5

BUN to creatinine ratio

Answer 5

10: 1

* hydration status*

Question 6

Uric acid

Answer 6

2-7mg/dL

End product of purine metabolism

Question 7

UA abnormalities

Answer 7

Blood, glucose, protein, ketones

Question 8

Creatinine clearance

Answer 8

Indicative of renal function
85-135 ml/min
24hr specimen (start and stop with empty bladder)
At least 10ml/hr to avoid dialysis
Done with serum creatinine

Question 9

IV pyelogram

Answer 9

Assess for iodine allergy and renal function
IV contrast given and scan done of urinate system
May feel flushed, give fluids after

Question 10

Pyelogram

Answer 10

Dye injected into renal pelvis and X-rays taken

Iodine allergy not quite as important because dye is not systemic

Question 11

Renal US

Answer 11

first test used in acute renal failure, noninvasive

May show enlargement, stones, infection, tumors

Question 12

Renal biopsy

Answer 12

Monitor for bleeding!
Pre: NPO, mild sedative
Post: vitals, pressure dressing, observe for bleeding, bed rest x24hrs, encourage fluids, no heavy lifting x 2 wks

Question 13

Rules for diabetics r/t radiologic studies

Answer 13

Monitor kidney function
Flush contrast with a lot of fluid after study
Taking metformin, should not have contrast

Question 14

Electrolytes in kidney failure

Answer 14

K: up
Na: normal then goes up in late stages
Ca: goes down
Phos: goes up
Mg: goes up
Albumin & HCO3 goes down

Question 15

RIFLE

Answer 15

Staging of AKI
Risk
Injury 
Failure
Loss
End stage renal disease

Question 16

Oliguric phase of AKI

Answer 16

Decreased GFR
Output < 400 ml/day
Lasts 10-14 days
Manifestations: hyperK, hypoCa, fluid volume excess, metabolic acidosis, elevated BUN and creatinine

Question 17

Diuretic phase of AKI

Answer 17

Output 1-5 L/day
Elevated urea causes osmotic diuresis
Monitor for hypoK, hypoNa, and dehydration
Unconcentrated urine

Question 18

Recovery phase of AKI

Answer 18

GFR increases, BUN and creatinine stabilize then decrease
Can take 12 months
Most common cause of death is infection

Question 19

Pre Renal biopsy mgmt

Answer 19

Pre: blood type and cross match, consent form, assess coag status, medical history, CBC, Hct, clotting time, stop ASA (warfarin, etc.)

Question 20

Post Renal biopsy mgmt

Answer 20

Post: monitor for bleeding, HoTN, decreasing Hct, fever, chills, urinary frequency, dysuria, hematuria
-pressure dressing, patient to be on affected side for 30-60 min, VS q5-10 min x1 hr, bedrest x24 hrs, avoid heavy lifting 5-7 days, hold anticoagulant until discuss with HCP

Question 21

Dialysis access assessment

Answer 21

Hear a bruit
Feel a thrill
Neurovascular assessment distal to AVG

Question 22

Initial treatment for hyperkalemia

Answer 22

Calcium Gluconate IV (stabilize myocardium)

Insulin w/ D50 (shift K and prevent hypoglycemia)

Question 23

Secondary treatment for hyperkalemia

Answer 23

Sodium bicarbonate and prolonged high doses of albuterol

Question 24

Non acute Hyperkalemia treatments

Answer 24

Dietary restrictions
Patiromer-PO
Kayexalate (Sodium polystyrene sulfonate)-PO/retention enema
K wasting diuretics