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Fall principles 2013 > RENAL > Flashcards

RENAL Flashcards

0
Q

WHAT EXITS THE HILUS?

A

RENAL ARTERIES, VEINS, NERVES, LYMPHATICS AND URETERS.

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1
Q

WHERE DOES FILTRATION TAKE PLACE?

A

THE GLOMERULUS

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2
Q

WHAT ARE THE 4 PARTS OF THE NEPHRON?

A
  • GLOMERULUS
  • GLOMERULAR (BOWMANS) CAPSULE
  • RENAL TUBULE (PCT, LOOP OF HENLE, DCT)
  • COLLECTING DUCT
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3
Q

WHERE DOES FILTRATION TAKE PLACE AND WHAT GETS FILTERED?

A

IN GLOMERULUS.
FILTERS…SMALL MOLECULES IE: IONS H2O GLUCOSE UREA
MACROMOLECULES (PROTEIN) IS UNTOUCHED.

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4
Q

WHAT HAPPENS IN THE PCT?

A

THE BULK OF FLUID/CONTENTS ARE REABSORBED. OSMOTIC GRADIENT STAYS THE SAME.

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5
Q

WHAT DOES THE LOOP OF HENLE DO?

A

REABSORB WATER CHLORIDE AND SODIUM.
DESCENDING LIMB: ESTABLISHES A COUNTERCURRENT BY LETTING BOTH SODIUM AND H2O OUT OF LUMEN.
ASCENDING LIMB: IMPERMEABLE TO H2O SO WATER STAYS IN LUMEN AS MORE NA IS PUMPED OUT CREATING A HYPOOSMOTIC LUMEN.

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6
Q

WHAT IS HAPPENING IN DCT?

A

NA REABSORBED CONTROLLED BY ALDOSTERONE
K SECRETED
PROTONS SECRETED
H2O PERMEABILITY CONTROLLED BY ADH

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7
Q

WHAT IS NET FILTRATION PRESSURE AND HOW DO YOU CALCULATE IT?

A

10 MM HG
BLOOD PRESSURE (HYDROSTATIC) - PROTEIN PRESSURE IN PLASMA (ONCOTIC) AND FLUID PRESSURE IN BOWMANS CAPSULE.
55-(30 + 15) = 10

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8
Q

WHAT MAP DOES RENAL BLOOD FLOW REMAIN CONSTANT AT?

A

50-150

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17
Q

WHAT 3 THINGS REGULATE GFR?

A

FILTRATION PRESSURE (BP AND RESISTANCE)
TUBULOGLOMERULAR FEEDBACK.
ANS/HORMONES (ACE/PROSTEGLANDIN)

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18
Q

WHAT IS GLOMERULAR TUBULAR BALANCE?

A

WHEN THERE IS A DECREASE IN GFR THERE IS A DECREASE IN TUBULE FLOW.

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19
Q

WHAT MAJOR HORMONES CONTRIBUTE TO GFR?

A

INCREASE GFR: ANP, NO, PROSAGLANDIN E2. ALL VASODILATE.

DECREASE GFR: ANGIOTENSIN 2, ENDOTHELIN. VASOCONSTRICT.

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20
Q

WHAT DOES SNS STIM. DO TO GFR?

A

DECREASE GFR BY VASOCONSTRICTION. THIS HAPPENS DURING EXERCISE AND HEMMORHAGE.

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21
Q

WHAT DOES ERYTHROPOIETIN DO?

A

STIM. RBC PRODUCTION. PRODUCED IN KIDNEYS….CRF PT HAS DECR. ERTYHROPOETIN AND DECREASED HGB.

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22
Q

WHAT DOES ALDOSTERONE DO?

A

PRODUCED BY ADRENALS AND NA/H2O RETENTION. RELEASE REGULATED BY RENIN-ANGIOTENSIN.

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23
Q

WHAT DOES ADH DO?

A

WITH ADH….TUBULAR PERMEABILITY INCREASED AND WATER REABSORBED. TRIGGERS FOR ADH=STRESS, PAIN, HYPOTENSION.

24
Q

DO PROSTAGLANDIN AND THROMBOXANE A2 HAVE OPPOSING EFFECTS?

A

YES.

PROSTEGLANDIN VASODILATES AND INHIBITS PLT AGGREGATION.

25
Q

HOW DOES VIT D AFFECT CALCIUM?

A

VIT D IS NEEDED TO ABSORB CALCIUM. RENAL PTS CANT DO THIS. LOW CA.

26
Q

WHAT IS SPASTIC BLADDER DYSFUNCTION?

A

FAILURE TO STORE.

27
Q

WHAT IS FLACCID BLADDER DYSFUNCTION?

A

FAILURE TO EMPTY.

28
Q

WHAT ARE THE 4 PHASES OF ARF?

A

INITIATING=INSULT TO S/S.
OLIGURIC= U/O < 400 /24 HRS.
DIURETIC = KIDNEYS INABILITY TO CONCENTRATE URINE. LOW GFR. LABS BEGIN TO NORMALIZE.
RECOVERY = BEGINS WHEN GFR INCREASES.

29
Q

WHAT IS THE #1 CAUSE OF CRF?

A

DIABETES

30
Q

HOW MANY NEPHRONS NEED TO STOP WORKING BEFORE S/S OF KIDNEY DISEASE APPEAR?

A

80%

DIALYSIS IS NEEDED WHEN 90% ARE LOST.

31
Q

WHAT IS THE FIRST SIGN OF DIABETIC NEPHROPATHY?

A

PROTEIN IN THE URINE. BASEMENT MEMBRANE THICKENS. GLOMERULUS ENLARGES.

32
Q

WITH RENAL PTS WHAT DO YOU NEED TO THINK ABOUT RELATING TO BP?

A

THEY ARE INTRAVASCULARLY DRY SO VASODILATION FROM ANESTHESIA CAUSES BP TO BOTTOM OUT. CONSIDER ETOMIDATE FOR INDUCTION.

33
Q

WHAT ARE SIDE EFFECTS OF DIALYSIS?

A

HYPOXEMIA, HYPOTENSION, MUSCLE CRAMPS

34
Q

ARE RENAL FAILURE PREDISPOSED TO BLEEDING?

A

YES. DECREASED PLT FXN. CONSIDER DDAVP AND CRYO.

35
Q

WHAT IS MOST EFFECTIVE TREATMENT FOR HYPERKALEMIA?

A

DIALYSIS. FOR K > 6.

ALSO: BICAR, HYPERVENTILATE, INSULIN/GLUCOSE, CALCIUM.

36
Q

S/S OF HYPERMAGNESEMIA?

A

HYPOTENSION, HYPOVENT, COMA.

MUSC. RELATORS POTENTIATED.

37
Q

WHAT IS NORM BUN/CR?

A

BUN: 10-20. LATE INDICATOR OF RENAL DX.
CR: 0.7-1.5. MOST COMMONLY USED MARKER. INVERSELY RELATED TO GFR.

38
Q

WHAT IS THE MOST RELIABLE ASSESSMENT TOOL OF RENAL FX?

A

CREATININE CLEARANCE. NORM= 95-150

39
Q

WHAT TO DO PREOP FOR A RENAL PT?

A 
LABS: LYTES MG PHOS. CBC.  
TAKE HOME MEDS
ENSURE NPO....DELAYED GASTRIC EMPTYING.
GET CARDIAC CLEARANCE.
GOOD VASCULAR ACCESS.  
LAST DIALYSIS.
40
Q

IS REGIONAL OK FOR RENAL PTS?

A

YES AS LONG AS COAGS ARE NORMAL WITH ADEQUATE BP.

Fall principles 2013 (16 decks)

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