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Coexisting 2016 > Renal > Flashcards

Flashcards in Renal Deck (92)
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1

These factors will result in prostaglandin synthesis by the kidneys

Renal ischemia, renal hypotension, and physiological stress

2

This common drug used for post-op pain relief should be avoided in those at risk for medullary ischemia. Why?

Ketorolac (Toradol) This is because it is a powerful NSAID, which drastically reduces prostaglandin synthesis, putting the kidneys at risk for ischemia

3

Low dose dopamine will do this, but not this

Will have positive inotropic effects, which increase UO. Will not decrease the incidence of ARF, dialysis, or mortality

4

The kidneys are able to autoregulate over this range of MAPs

80-180 Some say up to 200 Either way, kidneys are very sensitive to a reduction in MAP Also, may be higher than 80 if the patient has chronic HTN

5

Surgical stimulation can cause release of this hormone

ADH This will cause a drop in UO

6

This will cause aldosterone release

baroreceptor response to volume depletion

7

In hypotension, blood will be shunted (towards/away) from the kidneys

Away from the kidneys! Towards the vital organs

8

What ion are we concerned about in renal failure?

Floride. Free fluoride ions cause tubular injury and loss of concentrating ability (can result in ARF)

9

Ranking of volatile agent effects on the kidney

Methoxy>Enflu>Sevo>Iso>Des>Halo (MESID H)

10

We prefer the use of these IAs in renal failure patients

Iso and des These have negligible effects on renal function

11

This is the minimum amount of gas flow that should be given with Sevo

2L to prevent compound A formation

12

BUN > ___ is indicative of decreased GFR

50

13

These factors may cause GFR to rise despite a normal GFR

High protein diet GI bleed Febrile illness Dehydration

14

What is the most common cause of high BUN

CHF secondary to the reabsorption of BUN Low CO causes lows kidney perfusion. Kidneys try to correct perceived fluid deficit by reabsorbing urea.

15

There is a __-__ hour lag time after a change in GFR before the increase creatinine levels are seen

8 - 17

16

What test is the most reliable estimate of GFR?

Creatinine clearance

17

Why is anemia common in renal failure?

1) Decreased EPO production 2) Build-up of toxins decreases the lifespan of RBCs

18

Chronic renal patients will usually have an increased or decreased CO?

Increased to compensate for the anemia

19

Hemoglobin levels as low as __-__ are common for renal patients, so don't freak out

5-8

20

Renal patients usually have fucked up coags. Which coags are fucked up and why?

PT, PTT, and bleeding time. These are fucked up because they have shitty vWF. Treat this by replacing vWF.

21

How can you treat the fucked up coags seen in renal dysfunction?

Replace the vWF! 1) Desmopressin .3-.4mg/kg over 30 min) - Desmopressin will increase the release of vWF from endothelial cells 2) Cryoprecipitate (remember that this contains factor VIII, XIII, fibrinogen, and whaddup --> vWF!)

22

The hyperkalemia seen in RF can result in these EKG changes

Peaked T waves, ST depression, prolonged PR interval and QRS complex, heart block, and V-fib

23

Hypermagnesemia resulting from RF can cause

Coma and CNS depression Prolongs the duration of NMBs

24

Why do we use a microdripper to give fluids in renal patients?

To make sure we don't fluid overload them

25

Why does RF cause HTN?

1) Renin release by the diseases kidney 2) High intravascular fluid volume d/t inappropriate handling of sodium and water

26

RF can lead to ____ pericarditis and cause

uremic pericarditis tamponade

27

Hypocalcemia causes this on EKG

Prolonged QT

28

Digitalis toxicity produces this on EKG

Shortened QT and depressed ST

29

These meds are excreted via the kidneys unchanged and are contraindicated in RF

Gallamine (100% renal elimination) and phenobarbital

30

Is UO predictive of post-op renal insufficiency?

No