Renal

Question 1

Na

Answer 1

136-145 mEq/L

Question 2

Cl

Answer 2

98-107 mEq/L

Question 3

PH

Answer 3

7.35-7.45

Question 4

Ca

Answer 4

8.6-10.5 mg/dL

Question 5

Phosphate

Answer 5

2.4 -4.5 mg/dL

Question 6

BUN

Answer 6

10-20 mg/dL

Question 7

Potassium

Answer 7

3.5 - 5 mEq/L

Question 8

Bicarbonate

Answer 8

22-30 (24-26) mEq/L

Question 9

Osmolality

Answer 9

285-295 mOsl/L

Question 10

Magnesium (Mg)

Answer 10

1.6-2.6 mg/dL

Question 11

Glucose

Answer 11

70-140 mg/dL

Question 12

Creatinine

Answer 12

0.4-1.5 mg/dL

0.8 - 1.2

Question 13

GFR

Answer 13

180 L/day

125L/min

Men: 120 (+/- 25cc)

Women: 95 (+/- 20cc)

Question 14

With Diabetes Insipidus, it is due to what

Answer 14

(1) lack of quantity (neurogenic)
(2) lack of function (nephrogenic)

…of ADH

Question 15

Sign of DI

Answer 15

Low specific gravity with hyperosmolality of urine

Question 16

Fractional excretion of urine helps us ID what?

Answer 16

Either a pre-renal or renal cause of of AKI/CKD

<1% = normal renal tubules (cause: pre-renal)

> 2% = renal tubules not conserving Na (cause: renal tubular dysfunction)

Question 17

RBC & WBC casts indicative of:

Answer 17

RBC: glomerulonephritis

WBC: pyelonephritis

Question 18

Normal albumin level

Answer 18

<150 mg/dL

Question 19

Nephrotic syndrome

Answer 19

• Pt passing protein (proteinuria)
• may be hypoalbuminemic
• decreases plasma oncotic pressure —> promotes edema
• less albumin = less protein to bind to drugs

Question 20

Cardiac effects of Anesthesia

Answer 20

• Decreases CO
• vasodilation
• Decreased BP
• reduced RBF/GFR/UO/Na excretion

Question 21

Indirect effects of Anesthesia (neurological)

Answer 21

• Increases sympathetic tone
• increased vascular resistance (activates hormonal systems)
• decreased RBF/GFR/UO

Question 22

Indirect Effects of Anesthesia (Endocrine)

Answer 22

• Oliguria (decreased RBF)
• stress response increases hormonal output
• increased Na reabsorption (aldosterone)
• ADH increases water reabsorption
• postop fluid retention

Question 23

Direct Effect of Anesthesia (Gases)

Answer 23

• minimal RBF effects
• Cmpd A (<2 L/min)
• Caution: Fl neurotoxicity in pts with renal failure

Question 24

Direct Effects of Anesthesia (IV agents)

Answer 24

• Ketamine good for Renal Function (sympathetic effects)
• Antidopaminergics impairs renal response
• NSAIDs inhibit prostaglandin syn
• ACE inhibitors cause GFR reduction

Question 25

Best MR for renal patient

Answer 25

Cis-atracurium

Question 26

“Good” side effect of renal impairment with regard to Neostigmine:

Answer 26

Prolongs half-life to more closely parallel MR

Question 27

Most common causes of AKI

Answer 27

Hypotension and hypovolemia resulting from various dz processes

Question 28

Hallmark of AKI

Answer 28

Azotemia: abnormally high concentrations of nitrogen-containing compounds (BUN & Cr) *elderly at high risk: poor fluid intake/polypharmacy (nephrotoxins)/comorbidities*

Question 29

AKI Dx:

Answer 29

(1) Serum Cr increase more than .3 mg/dL within 48 hrs (2) Serum Cr increase of 1.5 mg/dL w/i 7 days **most first develop oliguria: <0.5 mL/kg/hr or 500 mL/day**

Question 30

3 classes of AKI

Answer 30

(1) Pre-Renal: decreased perfusion (initially reversible) **MOST COMMON** (2) Renal: kidney dz/ischemia/nephrotoxins (3) Post-Renal: obstructive uropathy (initially reversible) **LEAST COMMON**

Question 31

Pre-renal Dz/Pre-Renal Azotemia 2/2:

Answer 31

- CHF (decreased CO = decreased renal perfusion) - Liver Dysfunction (increased N-containing cmpds) - Sepsis (massive fluid loss = decreased renal perfusion) *anything that can prevent optimal RBF*

Question 32

Intrinsic Renal Dz

Answer 32

- Glomerulus (Nephritic: inflammation, WBC & RBC filtration/Nephrotic: Proteinuria) - RT (2/2 ischemia, nephrotoxins) - Interstitium - Renal Vasculature (vasulitis)

Question 33

Activated clotting Time (ACT)

Answer 33

90-120 sec