Renal II

Question 1

Anesthetic care of patients is determined by status of what?

Answer 1

Anesthetic care of patients is determined by status of preoperative renal function

Question 2

Diseases affecting the kidneys are grouped into syndromes based what two things?

Answer 2

Diseases affecting the kidneys are grouped into syndromes based on common clinical and laboratory findings

Question 3

Greatest derangements of renal function are caused by abnormalities of what??****

Answer 3

Greatest derangements are caused by abnormalities of glomerular function****

Question 4

Most useful laboratory tests are those related to what?

Answer 4

Most useful laboratory tests are those related to GFR

Question 5

Renal impairment may be due to what three things?

Answer 5

Renal impairment may be due to glomerular dysfunction, tubular dysfunction, or obstruction

Question 6

When evaluating renal function, accurate assessment relies on what?

Answer 6

Accurate assessment relies on laboratory determinations

Question 7

Most accurate lab for clinically assessing renal function and GFR is what?*

Answer 7

Most accurate lab for clinically assessing renal function and GFR is the creatinine clearance*

Question 8

Primary source of urea is from what organ?

Answer 8

Primary source of urea is in the liver

Question 9

Ammonia is produced from deamination of what?**

Answer 9

Ammonia is produced from deamination of amino acids**

Question 10

Hepatic conversion of ammonia to urea prevents accumulation of what kind of toxic levels?

Answer 10

Hepatic conversion of ammonia to urea prevents accumulation of toxic ammonia levels

Question 11

BUN directly related to protein catabolism, (BLANK) related to glomerular filtration*****

Answer 11

BUN directly related to protein catabolism, INVERSELY related to glomerular filtration*****

Question 12

BUN not reliable indicator of GFR unless protein catabolism is normal and what???

Answer 12

BUN not reliable indicator of GFR unless protein catabolism is normal and constant

Question 13

Normal BUN concentration??*****

Answer 13

Normal BUN concentration 10-20mg/dL*****

Question 14

Is BUN a reliable indicator of GFR?

Answer 14

BUN is not a reliable indicator of GFR

Question 15

Is Ammonia toxic to cells?

Answer 15

Ammonia is going to be toxic to cells

Question 16

BUN concentration will vary will GFR.

BUN less than 8…

BUN between 20-40…

BUN greater than 50…

Answer 16

• BUN less than 8 will indicate of over hydration or under production of urea
• BUN levels between 20-40 will indicate dehydration and decrease GFR or high nitrogen level
• BUN greater than 50, generally you can assume there is some renal issue going on and usually reflects GFR
• BUN is generally a late indicator of renal impairment

Question 17

Creatine product of muscle metabolism converted to what?

Answer 17

Creatine product of muscle metabolism converted to creatinine

Question 18

Creatinine production is relatively constant and related to what?*

Answer 18

Creatinine production is relatively constant and related to muscle mass*

Question 19

Creatinine is (BLANK) related to body muscle mass and (BLANK) related to glomerular filtration**

Answer 19

Creatinine is DIRECTLY related to body muscle mass and INVERSELY related to glomerular filtration**increase muscle mass, we will increase our creatinine

Question 20

What is generally reliable indicator of GFR?

Answer 20

Creatinine is generally reliable indicator of GFR

Question 21

GFR declines with increasing age yet serum creatinine remains (BLANK)*****

Answer 21

GFR declines with increasing age yet serum creatinine remains relatively normal*****

Question 22

Each doubling of serum creatinine represents a (what percent??) reduction in GFR*

Answer 22

Each doubling of serum creatinine represents a 50% reduction in GFR*

Question 23

What will increase serum creatinine without a change in GFR??

Answer 23

Large meat meals, cimetadine therapy, and increases in ketoacidosis will increase serum creatinine without a change GFR****

Question 24

Normal BUN : creatinine ratio???

Answer 24

Normal BUN : creatinine ratio is ~10:1

Question 25

Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result ratio does what?

Answer 25

Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result ratio increases above 10:1

Question 26

Decreases in tubular flow can be caused by what two things?

Answer 26

Decreases in tubular flow can be caused by decreased renal perfusion or obstruction

Question 27

BUN : Creatinine ratios greater than 15:1 are seen with what four things??*********

Answer 27

BUN : Creatinine ratios greater than 15:1 are seen in volume depletion, disorders associated with decreased tubular flow, obstructive uropathies, and increases in protein catabolism*********

Question 28

what is the most accurate method available for clinically assessing overall renal function (GFR)???*****

Answer 28

Creatinine clearance is the Most accurate method available for clinically assessing overall renal function (GFR)*****

Question 29

Measurements of creatinine clearance are preformed over 24 hours, what else can be reasonably accurate and easier to obtain?

Answer 29

Two-hour creatinine clearance determinations are reasonably accurate and easier to obtain

Question 30

What is normal creatinine clearance???*

Answer 30

Creatinine clearance measurements: Normal clearance: 110-150mL/min 40-60mL/min: mild renal impairment 25-40mL/min: moderate renal dysfunction <25mL/min: indicative of overt renal failure

Question 31

Specific gravity related to urinary osmolality and indicative of renal concentrating ability, what is normal specific gravity?***

Answer 31

Specific gravity related to urinary osmolality and indicative of renal concentrating ability*****1.025-1.030**

Question 32

What is the result of a low tubular threshold for glucose or hyperglycemia???*****

Answer 32

Glycosuria is the result of a low tubular threshold for glucose or hyperglycemia*****

Question 33

Protein urea maybe seen without the presence of renal failure in what circumstances?*

Answer 33

Protein urea maybe seen without the presence of renal failure in things such as Stress, fever, deyhradtion, chf, exercise* More likely to develop acute renal failure post operatively then those that do not have protein urea

Question 34

In regards to the effects of anesthetic agents on renal function, most drugs administered perioperatively are at least partly dependent on what?

Answer 34

Most drugs administered perioperatively are at least partly dependent on renal excretion

Question 35

Intravenous agents: | What are the effects of Barbiturates?

Answer 35

Barbiturates – patients with renal impairment have an increase sensitivity to induction, decrease protein binding

Question 36

Intravenous agents: | What are the effects of Propofol?

Answer 36

Propofol not signigicantly impaired by renal function

Question 37

Intravenous agents: | What are the effects of Benzodiazepines?

Answer 37

Benzodiazepines hepatic metabolism, conjugation prior to eliminations in urine

Question 38

Intravenous agents: | What are the effects of Opioids?

Answer 38

Opioids – most will be inactivated by the liver, most excreted by the kidneys

Question 39

Enflurane and sevoflurane has potential for (BLANK) accumulation

Answer 39

Enflurane and sevoflurane has potential for FLUORIDE accumulation

Question 40

What is the ideal gas to use for someone with renal impairment??***

Answer 40

Ideal choice will be isoflurane for someone with renal impairment*******

Question 41

What are the effects of Atracurium and Cisatracurium on the kidneys?***

Answer 41

Atracurium tracrium degraded in the esterase hydrolasis and homans (histamine release) and Cisatracurium (nimbex, hoffman elminations)*

Question 42

What are the effects of Vecuronium on the kidneys?

Answer 42

Vecuronium (nurcium, primarly hepatic) prolong with renal impairment, 20%of drug will be eliminated in urine (.1mg/kg)*

Question 43

What are the effects of Rocuronium on the kidneys?

Answer 43

Rocuronium (zemuron, primarly hepatic) prolong with renal impairment

Question 44

What are the effects of Pancuronium on the kidneys?

Answer 44

Pancuronium metabolized by the liver, 60-80% renal excreation

Question 45

What are the effects of reversal agents on the kidneys?

Answer 45

Reversal agents: are going to be prolonged in renal impaired patients.