Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Acute Care 2 > Renal, Acid Base > Flashcards

Renal, Acid Base Flashcards

(50 cards)

Start Studying
1
Q

HRS definition

HRS type 1 vs type 2

A

Development of renal failure in pts w/ advance chronic liver disease. Splanchic circulation is dilated while renal circulation is constricted

HRS1 = acute onset, rapid progression. Med. Survival 2 weeks

HRS2 = slower progression (diuretic resistant, can have normal liver function). Med. Survival 3-6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HRS risk factors

A

Large volume paracentesis w/o giving albumin (volume shifts)

Spont. Bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HRS labs and Dx

A

Labs: Low renal function s/p fluid resusitation and stopping renal toxic meds. Liver failure.

Infectious workup

renal US (-) obstruction and intrarenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HRS management

A

renal function improves w/ fixing liver function

Liver Tx, optimize liver, avoid renal toxic drugs

Cefotaxime for peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

urogenital/renal trauma risk factors

A

Possible trauma 2/2 lumbar injuries, lower rib injuries, pelvic fx, flan pain, hematoma to back, abdominal prostate exam or bleeding rectal or hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

s/s trauma

A

S/S: HOTN, shock, hematomas, Cullen sign, RP bleeding, inability to void, distended bladder, flank pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

trauma imaging options/orders

A

retrograde urethrogram = suprapubic catheter if positive, foley if negative

retrograde cystogram = assess bladder; can follow w/ voiding cysto to monitor flow from bladder to urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Trauma grading according to capsular rupture, collecting duct and vascular involvement

A

-I = microscopic or gross hematuria; monitor
-II = nonexpanding confined perirenal hematoma or cortical lac < 1 cm deep w/o urinary extravasation
-III = parenchymal lac extending more than 1 cm into cortex w/o extravasation
-IV = parenchymal lac extending through corticomedullary junction and into collecting system. Lac at segmental vein may be present. Thrombosis of renal artery w/o parenchymal laceration
-V = thrombosis of main renal artery. Fx, avulsion or shattered of kidney w multiple tears and laceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of trauma grades

A

No foley if urethral damage suspected

1-3 mostly watch/wait
4-5 require surgery to repair asap.

HD stable may be able to done percutaneous repair

HD ubstable needs ex-lap and likely multiple surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RAS definition and risk factors

A

Progressive narrowing of renal artery r/I decreased blood flow can r/i renal atrophy, renal failure

-Atherosclerosis, Renal fibromuscular dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RAS s/s, labs and Dx

A

HTN, HA, blurry vision
Bruit over renal arteries

Cr, UA
US, CT, MRI to visualize kidney
Renal arteriography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RAS management

A

Manage HTN

Balloon angioplasty w/ stent placement

Renal artery graft/bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AKI definition and RIFLE criteria

A

An abrupt (w/I 48 hours) reduction in kidney function as an absolute increase in Sr Cr of more than or equal to 0.3, > 50% increase from baseline (1.5 fold), or a reduction in UOP of < 0.5 mL/Kg/hr for more than 6 hours – AKIN

Staging Modified RIFLE
1 = sCr > 0.3 or > 150-200% from baseline
2 = > 200-300% from baseline
3 = > 300% from baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AKI pre-renal causes

A

d/t decr perfusion. NO NEPHRON DAMAGE

-Volume depletion (hemorrhage, GI losses, urinary loss, skin loss)
-Vasodilatory states (sepsis, cards shock, NSAIDS, ACEI, diuretics, anaphylaxis)
-Decreased cards output
-arterial occlusion/vaso spasm
-Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AKI post-renal causes

A

Postrenal
-obstruction from the papillae to the urethral meatus
-Stones, BPH, tumor, masses, clots, strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AKI intrarenal causes

A

Intrarenal
-ATN = ischemia d/t low flow, clots, shock and vascular causes. Nephrotoxic exposure d/t drugs, radiographic contrast media. Rhabdomyolysis, rapid hemolysis
-Glomerular nephritis = immune related, glomerular inflammatory lesions
-Interstitial nephritis = immune reaction to offensive meds (PCN, cephalosporins, sulfas, rifampin, allopurinol) and infection (strep, RM spotted fever, sarcoidosis, SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

s/s and labs rhabdo/ATN

A

Rhabdo/ATN = Cr Kinase, urine granular casts, renal tubular epithelial cells. HYK, HYphos, HOCa, HYMg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

s/s and labs interstitial nephritis

A

Interstitial nephritis = fever, rash, eosinophilia, UA w/ WBC, RBC, WBC casts, proteinuria. Dx Renal Bx sometimes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

s/s, labs and Dx of glomerular

A

Glomerular = HTN, edema, elevated sCr days to months, hematuria, proteinuria, dysmorphic red cells, RBC casts, pyuria. Dx w/ Renal Bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

FENa: when can be used and what does it mean

A

differentiate pre-renal vs intrinsic renal.
CANNOT be used: diuretics, CKD, obstruction, acute glomerular disease

<1 % pre renal
> 2% ATN
1-4 = intrinsic
>4% post renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

cystogram purpose

Study These Flashcards
A

bladder filled w/ water soluble contrast to eval voiding and possible backup into kidneys

22
Q

pre renal management

Study These Flashcards
A

PRERENAL = empiric IV fluids for dehydration, do not overhydrate is c/f postrenal cause, fix H&H, improve heart function, improve liver function, renal artery US for vascular issues

23
Q

contrast induce ATN treatment

Study These Flashcards
A

NS 1-3 mL/kg for 6 hours pre and post exam

24
Q

when to consult nephro

Study These Flashcards
A

Intrarenal causes
-stop offending meds, reestablish blood flow, manage other illness that are causing renal damage. Glomerular and interstitial nephritis may respond to steroids

25
post renal management
reestablish flow in urinary tract; remove stones, foley, Bx masses/tumors, urology consult
26
CKD definition
Renal dysfunction with 2 or more: albuminuria, abnormal urine sediment, electrolyte issues, histology abnormalities, CT or US showing abnormal kidney structure or small size, Hx renal transplant
27
CKD risk factors
Age > 65 Female > male Race (high to low): AA, Hispanic, Asian, Caucasian Conditions: RA, glomerular scarring, PKD, HTN, DM, autoimmune, drugs, HyCa, HyPhos
28
CKD s/s
fatigue, itching, hair loss/brittle nails, metallic taste, DOE/SOB, anorexia, N, ED/nocturia, irritability, decreased concentration, anemia, FO
29
CKD physical assessment findings
bruising, pallor xerosis, broken nails, epistaxis, “urine breath”, rales, pleural effusion, edema, cardiomegaly, NV, stupor, hyperreflexia, decreased sensation, anemia, proteinuria
30
CKD staging
-Stage 1 = renal damage w/ normal kidney function. GFR > 90. 90-100% function -Stage 2 = damage w/ mild loss of kidney function. GFR 60-89 -Stage 3a = mild to mod loss of function. GFR 45-59 -Stage 3b = mod to severe loss of function. GFR 30-44 -Stage 4 = severe loss of function. GFR 15-29 -Stage 5 = kidney failure. GFR < 15
31
normal serum osmo symptoms at 385, 400-420 and > 420
normal 275-295 385 = stupor 400-420 = seizures >420 = coma, death
32
normal osmolar gap and what it means if the gap is higher than normal
measured osmo - calculated osmo should be < 10. > 10 means methanol, ethanol, isopropanol, ethylene, propylene, ketoacids, sortibol, mannitol, glycerol
33
HTN management in CKD
watch added Na, maintain hydration BP goal < 140/80 unless proteinuria then < 125/75 ACE or CCB better than ARB Stop ACE if K > 5.6 or Cr > 30% baseline avoid drugs that increase BP NSAIDS, stimulants protect renal blood flow, watch nephrotoxic drugs like NSAIDS and ABX
34
Fluid overload prevention/management in CKD
daily wt, set danger limits on wt gain/loss watch K and Cr regulate fluid and Na if still functioning nephrons then lasix - start 20-80 up to 1G/day
35
anemia management in CKD
Treat correctable causes like GIB, and vitamin deficiency Fe replacement only if indicated by iron studies Epo if: on HD, if Hgb < 9 and all underlying causes have been treated and pts wants the drug Epo BB warning; stroke, clots, severe HTN
36
renal osteodystrophy management in CKD
-Tied to Ca, vit D and PTH levels -PREVENT acidosis, HOCa, HYPhos -Vit d replacement -Bone scan to determine severity -Monitor renal weekly and correct
37
Alk phos, Ca, phos and PTH monitoring recommendations based on CKD classification
-Annual alk phos if Class 3a-5 -Class 1-3b: Ca/phos q 6-12 mo, PTH once -Class 4: Ca/Phos 3-6 mo, PTH q6-12 mo -Class 5: Ca/Phos q1-3 mo, PTH q3-6 mo
38
protein catabolism management in CKD
-If CKD progression risk then limit protein to 1.3 g/kg/day; if DM then limit to 0.8 -Minimize trauma, infection and immobilization. Avoid over exercising -Worse w/ thyroid replacement, steroids and tetracycline. Check TSH and give least amount necessary -Can give anabolic agents
39
metabolic acidosis treatment in CKD
-Sodium citrate 10-30 mL PCHS -Polycitra: 1 packet PC. Does contain K so monitor level -NaHCO3 = 1 gram w/ 13 mEq sodium for severe acidosis
40
Hyperphos management in CKD
-Increased mortality at all stages with Ph > 4.6 -Dietary restriction: eggs, soda, meat, dairy If stage IV/V -Ca carbonate used only in high risk -Sevelamer or fosrenol -Aluminum hydroxide in emergency only and limit use to 3 days -HD
41
Hyperkalemia prevention and management
-Dietary restrictions: avoid legumes, dried fruits, spinach, melon -Caution for pts in hypercatabolic states (trauma, infection etc) -Maintenance: Kayexalate 30-60 G/day in divided doses Emergency: 1. EKG: flat p waves, peaked T waves, PR > .20, QRS < 0.10, bradycardia 2. IV Ca 3. 25 units D50 then regular insulin 10 units, 150 mEq HCO3 in D5W 4. Albuterol neb 5. HD for CKD or severe
42
Hypermagnesemia management in CKD
s/s: weakness, confusion, decreased RR, decreased reflexes -stop meds that contain Mg like laxatives, vitamins, antacids 4.0 = decreased reflexes > 5.0 = prolonged AV conduction > 10 = CHB > 13 = cardiac arrest
43
Hyperparathyroid mangement in CKD for 3a-5 and NOT on HD
i. CKD 3a-5 and NOT on HD -PTH high or rising then check Phos, Ca, Vit D and correct levels -AGAINST calcitriol and Vit D analogs -Remove parathyroid if poor control w/ meds ii.Class 5 and NOT on HD -Aim for level 2-9 times normal -DO use calcimemetics, calcitriol and vit d analogs
44
Hypocalcemia management in CKD
i.Treat if significant AND/OR symptomatic ii. DO NOT Tx if not on dialysis and asymptomatic iii. If on HD then use calcitriol and vit d analogs iv. If Tx pt then treat like a non-HD and use Ca acetate or carbonate if needed. Vit d if bone scan is bad
45
High anion gap acidosis causes
CATMUDPILES CO/cyanide poisoning, aminoglycosides, theophylline, methanol, uremia, DKA, Tylenol poisoning, Fe/isoniazid overdose, lactic acidosis, ethanol/ethylene glycol (antifreeze), salicylates
46
Respiratory acidosis causes
COPD, pulm fibrosis, sedation overdose, NM weakness, major airway obstruction
47
Respiratory alkalosis causes
hyperventilation, decreased lung compliance (sepsis, PE, PNA), trauma/shock early chronic = high altitude, pregnancy 3rd trimester
48
metabolic acidosis causes
CATMUDPILES, USEDCARP, prolonged cardiac arrest, CKD
49
metabolic alkalosis causes
vomiting, high aldosterone (diuretics, cushings), Bicarb intake (antiacids), massive anion infusion (citrate or acetate infusion ex massive blood transfusion, long term TPN)
50
KDIGO AKI definitions for 1-3
1: Cr 1.5-1.9 X baseline OR Cr > 0.3 OR UOP < 0.5 mL/Kg/Hr for 6-12 hrs 2: Cr 2-2.9 X baseline OR UOP < 0.5 mL/Kg/Hr for 12 hrs 3: Cr 3.0 X baseline, OR > 4.0 increase OR CRRT OR GFR < 35 mL/min

Acute Care 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions