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AFN Health Assessment > Renal > Flashcards

Renal Flashcards

(79 cards)

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1
Q

What part of nephron regulates the fx of the nephron?

A

JGA

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2
Q

What 3 things can stimulate renin release from JGA cells

A

-Beta 1 stimulation

-decreased renal perf pressure

-decreased Na in filtrate (sensed my macula densa)

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3
Q

Cheif mineralocorticoid?

A

Aldosterone

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4
Q

Aldo does what and where in the nephron?

A

Reabsorbs Na (therfore H20 follows in collecting duct) in the DCT

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5
Q

Where is ADH synthesized and released?

A

Synthesized - hypothalamus

Release - post. pituitary

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6
Q

The most potent diuretic in human body

A

ANP (atrial natriuretic peptide)

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7
Q

Prostaglandins do what to the vasculature?

A

Vasodilate

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8
Q

Thromboxane A2 does what to the vasculature?

A

Vasoconstricts

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9
Q

What class of drugs should you hold w/ renal dysfunction

A

NSAIDs

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10
Q

3 Major mechanisms of kidney

A

-Filtration

-reabsorption

-tubular secretion

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11
Q

Normal RBF

A

1200mL/min

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12
Q

Normal GFR

A

125mL/min

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13
Q

What % of CO is RBF?

A

20-25%

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14
Q

MAP range for autoregulation to maintain RBF

A

50-180

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15
Q

W/ MAP < ___ renal filtration ceases

A

50

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16
Q

Does PNS affect RBF?

A

No

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17
Q

Decreased RBF = __________ GFR

A

Decreased

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18
Q

Most important part of H&P w/ renal pts

A

Past medical history

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19
Q

What labs to assess GFR

A

BUN/Cr

Cr clearance

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20
Q

What labs to assess tubular fx?

A

Urine specific gravity

Urine Osmolality

Urine Na

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21
Q

Chief product of protein metabolism

A

Urea

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22
Q

Where is urea formed

A

Liver

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23
Q

Normal BUN

A

10-20

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24
Q

Low BUN = what hydration status?

A

Hypervolemic

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25
High BUN = what hydration status?
Hypovolemic
26
BUN > ____ = decreased GFR (almost always)
50
27
Is BUN a good early indicator of reduced GFR?
No
28
BUN does not increase until GFR is reduced by ____%
50%
29
Reliable marker of GFR
Creatinine
30
Creatinine is almost 100% removed by __________ filtration
Glomerular
31
Normal Cr
0.7-1.5
32
Normal BUN/Cr ratio
10:1
33
Most specific test for GFR and most reliable for renal fx
Cr clearance
34
Normal Cr clearance
95-150 mL/min
35
Normal specific gravity
1.003-1.030
36
Urine Na >___ indicates damage to the renal tubules; diuretics (AKA RENAL)
40
37
Urine Na <___ indicates hypovolemia (AKA PRE-RENAL)
20
38
FENa of <___% = pre-renal dx
1%
39
FENa of >___% = renal dx
2%
40
3 main renal protective strategies
- goal-directed fluid therapy -isotonic crystalloids -hemodynamics within autoregulation limits
41
What AKI stage? UOP < 0.5mL/kg/hr for >6hrs Cr increased >1.5x GFR decreased > 25%
AKI stage 1
42
What AKI stage? UOP < 0.5mL/kg/hr for >12hrs Cr increased >2x GFR decreased > 50%
AKI stage 2
43
What AKI stage? UOP < 0.5mL/kg/hr for >24hrs Anuria for >12hrs Cr increased >3x GFR decreased > 75%
AKI stage 3
44
What is the leading cuase of AKI in hospital pts
Surgery
45
List the 10 renal protective strategies w/ evidence
1. correct anemia/minimize transfusions 2. Maintain perfusion (MAP 80-160) 3. Avoid nephrotoxins 4. Use balanced crystalloids (avoid NS and HES solutions) 5. Avoid diuretics 6. Continue statin therapy 7. Maintain normoglycemia 8. Consider low-dose dexmedetomidine & NaHCO3 infusions 9. Dexamethasone (protective effect) 10. Early initiation of CRRT
46
What meds do you hold DOS?
ACEI ARBs NSAIDs Diuretics
47
Low dose ___________ is NOT supported in the literature
dopamine
48
What renal protective strategy provides the greatest protective benefit?
Maintaining perfusion within autoregulation & adminstering appropriate fluid therapy
49
Should you postpone surgery w/ pt w/ active HF w/ elective surg
Yes
50
GFR <___ for > 3months = CKD
60
51
GFR <____ represents loss of at least 50% of kidney fx
60
52
What GFR category jumps to a high risk?
G3b (G3a is very moderate/low risk)
53
What GFR for stage G3a?
45-59
54
What GFR for stage G3b?
30-44
55
Most common CV complication of CKD?
Systemic HTN
56
Is sevoflurane ok for renal pts?
Yes, all inhalation agents are safe according to the literature
57
GFR <15 = ?
ESRD
58
What are the 2 leading causes of CKD & ESRD
HTN DM
59
What do you check w/ hyperkalemia in renal pts?
12 lead EKG
60
What range should you keep your preop Hgb for renal pts?
11-12 (not over 13!)
61
What is the most important way to prevent contrast induced nephropathy (CIN)
Ensuring pre-procedural hydration
62
T/F, Pts should be dialyzed prior to elective surgery
True
63
Maintain what UO for renal pts?
0.5ml/kg/hr
64
Renal pts have __________ sensitivity to CNS depressants
increased
65
What could you mix in w/ propofol to mitigate expected hypotension w/ induction?
Ketamine
66
What co-ag test is best indicator of platelet fx?
Bleeding time
67
Renal pts may have increased bleeding risk, even with normal coags d/t what?
Platelet dysfunction
68
What can be done post op to help restore platelet fx?
Dialysis (within 24 hrs)
69
What should you have readily available for induction hypotension w/ renal pts?
Pressors (don't give a lot of fluids)
70
What 2 drugs/drug types are less protein bound and are safer to use with pts w/ hypoalbunemia
Ketamine & benzos
71
NMB is prolonged or shortened w/ renal pts?
Prolonged
72
Which NMB is least effected by renal dysfunction?
Cis-atracurium (d/t hoffman elimination)
73
Caution w/ SCh in renal pts why?
Increased serum K
74
(t/f), SCh is ok in normo-K+ patients w/ recent dialysis
True
75
List main anesthetic pharmacology considerations
-decrease propofol dose by mixing w/ ketamine -Caution w/ SCh d/t hyperkalemia -Cis-atracurium least effected d/t hoffman elimination -w/ rocuronium, 1/3 renal excreted, so will have to use higher dose of suggamadex -all inhalation agents are safe -Opioid duration is prolonged, caution with long-acting meds
76
LR ok to us w/ anuric pts?
NOOO
77
Replace UO w/ what IV solution?
0.45% saline
78
What is only definitive tx for hepatorenal syndrome?
Hepatic transplant
79
List out pathophysiology steps for hepatorenal syndrome
1. Portal HTN 2. splanchnic (GI vessels) vasodilation 3. reduced circulatory volume 4. RAAS activiation 5. Renal vasoconstriction 6. Hepatorenal syndrome

AFN Health Assessment (12 decks)

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