Renal YSK Flashcards
(120 cards)
1
Q
What is a relative contraindication for renal transplantation?
A
Relative contraindication – advanced age, severe cardiovascular disease**
2
Q
What is the paralytic of choice for renal transplantation?
A
Roc – drug of choice****
3
Q
When should immonsuppression therapy be started for someone receiving a renal transplantation?
A
Immunosuppression therapy started on day in surgery
4
Q
Where should the Serum K be before renal transplantation?
A
Serum K should be less than 5.5 Coagulations corrected
5
Q
Brisk urine / good urine / good urinary flow following anastomosis is indicative of good graft function, You may be asked to give what medication?
A
1Brisk urine / good urine / good urinary flow following anastomosis is indicative of good graft function, You may be asked to give mannitol
6
Q
What drug may be given to prevent ischemic renal injury during surgeries involving retroperitoneal lymph node dissection??
A
Mannitol may be given to prevent ischemic renal injury***** during surgeries involving retroperitoneal lymph node dissection
7
Q
What is a major disadvantage of regional anesthesia for lithothripsy?
A
Major disadvantage of regional anesthesia, is the inability to control diaphragmatic movement***
8
Q
What level is good for a regional block for ESWL?
A
T6 ESWL anesthesia*** T6 anesthesia for neuraxial anesthesia for ESWL is adequate
9
Q
What are the effects of immersion for ESWL?
A
Effects of immersion – result in vasodilation (decrease BP)***Intrathroacic will be increase, FRC will be decrease. Prone to hypoxemia.
10
Q
What are the complications for ESWL?
A
Complication***** - Mild hematuria, occurs frequently
11
Q
What are the contraindications to ESWL?
A
Contraindication to ESWL*****, Urinary obstruction below the stone, Pregnancy, Infection
12
Q
Whats a major complication with a TURP?
A
Hypothermia is going to be a major complication with a TURP** related to large volumes of room temperature solution
13
Q
Post op shivering will increase o2 consumption by how much with a TURP?
A
post op shivering, it will increase o2 consumption by 300%-400%
14
Q
Absorption of irrigation fluid influenced by what?
A
Absorption of irrigation fluid***influenced by resection time (20mL/min), height and pressure of irrigation fluid 16-32 cm above the patient maximum
15
Q
Treatment of TURP syndrome is with what drug?
A
Treatment of TURP syndrome: loop diuretics furosemide
16
Q
What level of a block do you need for a TURP?
A
T10 epidural / spinal , decrease surgical blood loss
17
Q
In a cysto, if you have injury to the common peroneal nerve, what will happen?
A
Injury to the common peroneal nerve, loss of dorsal flexion of the foot, if the lateral thigh rest on the rest support*****
18
Q
What will happen if you rapidly lower the patients legs during a cystoscopy?
A
Rapid lowering of the legs will cause hypotension, check BP after legs are lowered*****
19
Q
What level of a block would you need for a cystoscopy?
A
Sensory level at T10 will provide good anesthesia*****
20
Q
What can Indago carmine cause? (in terms of BP)
A
Indigo carmine may cause hypotension or hypertension**
21
Q
What is the most effective means for management of hyperkalemia?
A
Management of Perioperative Hyperkalemia:*
Hemodialysis most effective means**
22
Q
For kidney patients, what is hypocalcemia secondary to???
A
Hypocalcemia secondary to the inability of the kidneys to respond to hydroxylate (the active form of vitamin D)
23
Q
Increase in levels of 2-3 GDP causes what?
A
Increase in levels of 2-3 GDP causes a shift to the right oxy-hemoglobin dissociative curve, allowing for the release of O2
24
Q
Renal insufficiency occurs when (what %) the nephrons are functioning properly?
A
Renal insufficiency occurs when 10-40% the nephrons are functioning properly
25
Cardiovascular system hypotension contributing factors?
Cardiovascular system hypotension contributing factors, blunted sympathetic response associated with uremia, reduced plasma volume, dialysate in blood has cardiac depression and vasodilation, anemia should be corrected if hct < 20% decreased erythrocyte production as well as decreased lifespan of the erythrocyte, vasodilation
26
After renal failure is establish, what is the most frequent complication that results in death?
Infection most frequent complication resulting in death****(pts need to be treated aggressively with antibiotics)
27
What is the Initiation period in the intrarenal acute renal failure?
Initiation period – renal hypoperfusion or nephrotoxin insult may initiate renal failure to a previously health kidney
- The result is decreased tubule function or tubule obstruction
- Decreased renal blood flow and GFR
- Decrease urine volume
- Decrease in urine solutes
28
How is nonoliguric acute renal failure classified?
Nonoliguric acute renal failure**** greater than 400 ml per day (urine will be poor) abnormalities will be less severe
29
How is Anuric acute renal failure classified?
Anuric acute renal failure (less than 100ml per day)
30
How is oliguric acute renal failure classified?
Oliguric acute renal failure (urine volume less than 400ml per day or intra op less than 0.5cc/kg/hr)
31
Intra renal failure is going to be more serious, that will often requiring what?
Intra renal failure is going to be more serious, that will often require dialysis***
32
Prerenal failure is related to what?
Prerenal failure – related to hemodynamic or endocrine factor, impair renal function****
which Causes decrease renal profusion pressure and cause increase renal vascular resistance
33
How will hypovolemia, decrease cardiac output, and hypotension effect renal profusion pressure?
- Hypovolemia will cause a decrease renal profusion pressure
- Decrease cardiac output will cause a decrease renal profusion pressure
- Hypotension will cause a decrease renal profusion pressure
34
How is acute renal failure classified?
Classified according to predominant use or on basis of urine flow rates*
35
Bowmans capusle feed by what?***
Bowmans capusle – feed by a single afferent arterial and drained by a single efferent arterial*****
36
What is the tubular system?
Tubular system – proximal tubule, loop of henle, distal convoluted tubule, collecting duct (two portions, medullary and corticox)***
37
What is acute renal failure??
Acute renal failure – sudden inability of the kidneys to vary urine volume and content
This is dependent on many variables and factors, and usually will be self limiting** acute renal failure syndrome
38
Chronic renal failure is slow, progressive, irreversible, and occurs over how many months??
Chronic renal failure is slow, progressive, irreversible, and occurs over 3-6 months
39
What is the ideal inhalation agent for someone with renal impairment??
Ideal choice will be isoflurane for someone with renal impairment*******
40
Which inhalation agents has the potential for fluoride accumulation?
Enflurane and sevoflurane has potential for fluoride accumulation
41
How is Atracurium (tracrium) metabolized?
Atracurium tracrium degraded by the esterase hydrolasis and hoffmans(histamine release)
42
How is Cisatracurium (nimbex) metabolized?
Cisatracurium (nimbex, hoffman eliminations)
43
How is vercuronium (nurcium) metabolized?
Vecuronium (nurcium, primarly hepatic) prolong with renal impairment, 20%of drug will be eliminated in urine (.1mg/kg)
44
How do barbiturates effect patients with renal impairment?
Barbiturates – patients with renal impairment have an increase sensitivity to induction, decrease protein binding
45
What are normal albumin levels?
3.3-4.5 normal albumin levels
46
What is specific gravity related to?
Specific gravity related to urinary osmolality and indicative of renal concentrating ability*****
47
What is normal specific gravity?
Normal specific gravity is 1.025-1.030**
48
Glycosuria is a result of what?
Glycosuria is the result of a low tubular threshold for glucose or hyperglycemia*****
49
Protein urea maybe seen without the presence of renal failure in things such as what?
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****
50
Creatinine clearance measurements:
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
51
What is the most accurate method available for clinically assessing overall renal function (GFR)??
CREATININE CLEARANCE
52
Normal BUN?
Normal BUN : creatinine ratio is ~10:1
53
BUN : Creatinine ratios greater than 15:1 are seen in what?
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*********
54
Decreases in tubular flow can be caused by what two things?
Decreases in tubular flow can be caused by decreased renal perfusion or obstruction
55
Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result, what happens to the ratio?
Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result ratio increases above 10:1
56
What will increase serum creatinine without a change in GFR
Large meat meals, cimetadine therapy, and acetlyacetate will increases in ketoacidosis will increase serum creatinine without a change GFR******
57
GFR declines with increasing age yet, what happens to serum creatinine?
GFR declines with increasing age yet serum creatinine remains relatively normal*****
58
Each doubling of serum creatinine represents a (what %) reduction in GFR?*
Each doubling of serum creatinine represents a 50% reduction in GFR*
59
Serum creatinine is directly related to body muscle mass and inversely related to what?
Directly related to body muscle mass and inversely related to glomerular filtration****increase muscle mass, we will increase our creatinine
60
Creatinine production is relatively constant and related to what?
Creatinine production is relatively constant and related to muscle mass*
61
Normal BUN concentration?
Normal BUN concentration 10-20mg/dL*****
62
BUN concentration will vary with GFR, what will happen if...
- BUN less than 8 will....
- BUN levels between 20-40 will...
- BUN greater than 50, generally....
- BUN concentration will vary with GFR
- 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
63
BUN directly related to protein catabolism and is inversely related to what?
BUN directly related to protein catabolism and inversely related to glomerular filtration*****
64
Ammonia is produced from deamination of what?
Ammonia is produced from deamination of amino acids****
Ammonia is going to be toxic to cells
65
Primary source of urea is where?
Primary source of urea is in the liver
66
With evaluating renal function, the greatest derangements are caused by abnormalities of what?
Greatest derangements are caused by abnormalities of glomerular function******
67
Most useful laboratory tests are those related to GFR, Most accurate lab for clinically assessing renal function and GFR is the what?
Most useful laboratory tests are those related to GFR , Most accurate lab for clinically assessing renal function and GFR is the creatinine clearance*
68
How are diuretics classified as?
Classified according to their mechanism of action, Many diuretics have more than one mechanisms of action
69
You can increase urinary output by decreasing reabsorption of what two things?
Increase urinary output by decreasing reabsorption of sodium and water
70
With volatile agents, what should you watch out for?
Volatile agents – watch out for fluride (sevo), be aware of compound A (keep flow greater than 2L), watch out for the cardiac depressive effects of the gases
71
What are the indirect endocrine effects of anesthesia on renal function?
Endocrine effects – reduced blood flow, reduced urinary blood flow, increase in catecholamine due to the stress response
72
What are the indirect neuronal effects of anesthesia on renal function?
Neuronal effects – reduction in renal blood flow, caused by sympathetic system, this can be the stress response
73
What are the indirect cardiovascular effects of anesthesia on renal function?
Cardiovascular effects - Keep MAP between 80-180 (outside these ranges will be pressure dependent)
74
What are the effects of anesthesia on renal functions?
- Reversible decrease in renal blood flow and GFR
- Typically will be less if you provide regional anesthesia as long as hypotension is avoided.
- Maintain hydration and pressure (give them a drink)
75
Renal blood flow:
Renal blood flow: ~1200mL/minute 20-25%***
76
Glomerular filtration rate:
Glomerular filtration rate: ~125mL/minute 180L/day***
77
What is intrinsic regulation?
Intrinsic regulation - auto regulation of renal blood flow – occurs between MAP 80-180 (outside these limits it will be pressure dependent, the blood flow)
78
Glomerular filtration will cease or stop during what pressure?
Glomerular filtration will cease or stop during 40-50torr
79
Renal blood flow will be generally decrease if MAP less than what?
Renal blood flow will be generally decrease if MAP less than 70
80
What is Tubuloglomerulo balance?
Tubuloglomerulo balance - (self limiting and feedback system), If it sense a increase in tubular flow, it will decrease GFR. If you have a decrease in tubular flow, it will send a message out to let more in.
81
What is Hormonal regulation?
Hormonal regulation - Angiotensin II, epi and Noriepi, all will effect AFFERENT arterial tone, renal filtration rate will generally stay the same***
82
What will dopamine do to the arterials?
Dopamine will dilate afferent as well as efferent arterials, this will increase GFR***
83
What is neuronal regulation?
Neuronal regulation – (sympathetic innervations is responsible stressed induction in renal blood flow, this will decrease urinary output. Stress response to a decrease urinary output.)
84
Combined blood flow through both kidneys accounts for (what %) of total cardiac output
Combined blood flow through both kidneys accounts for 20-25% of total cardiac output
85
How is each kidney supplied?
(Renal blood flow is going to be 1200ml per min.* Each kidney is supplied by a single renal artery that will arise form abd aorta)
86
Oxygen consumption is determined by what?
Oxygen consumption is determined by renal blood flow
87
Normal urine output?
0.5cc/kg/ml is normal urine output
88
What is the poor mans CVP?
Foley is poor mans CVP
89
Renal function is intimately related to what?
Renal function is intimately related to renal blood flow (normal urine formation denotes normal renal blood flow)
90
Major function of Juxtaglomerular apparatus?
Major function: secretion of renin*****
91
Two ways to stimulate renin release?
- Beta adranergic sympathetic stimulation can also release Renin
- Changes in afferent arterial wall pressure can release renin release as well
92
What is the MOA of Renin?
- Renin is release into the blood stream (released by the juxtaglomerular cells),
- act on angiotensinogen (a protein that is synthesized by the liver) to form angiotensin I,
- angiotensin I is converted into angiotensin II (in the lungs) by the ACE (plays a major role in BP regulation)
93
Juxtaglomerular cells contains what? and are innervated by the which part of the nervous system?
Juxtaglomerular cells contain renin and are innervated by the sympathetic nervous system*******located near the afferent arterial, which is next to the glomerulus
94
Where is the Juxtaglomerular cells located?
Juxtaglomerular cells located in the macula densa are Located near the afferent arteriole, major function is to sense sodium concentration amount and secret renin
95
What is the macular densa?
The macula densa (area of closely pack cells)- Sensitive to NaCl concentration (this is a monitor), It will sense sodium chloride.
96
If the macular densa senses a decrease in NaCl, what happens?
If there is a decrease in NaCl ->
1. Decrease resistance to blood flow via the afferent arterial, leads to increase blow flow via vasodilation
2. Increase renin release from juxtaflomerular cells
97
If the macular densa senses a increase in NaCl, what happens?
If it sense an increase in NaCl -> increase resistance that will decrease blood flow, this will vaso constrict, and decrease renin release
98
What is the collecting tubule known for?
Collecting tubule:
| Known for it’s concentrating ability*******This would be in the presence of ADH
99
If we increase ADH, what happens to urine output?
If we increase ADH, decrease urine output (this is the concentrating ability)
100
If we decrease ADH, what happens to urine output?
If we decrease ADH, increase urine output (this is the concentrating ability)
101
What is the Loop of Henle responsible for???
Loop of Henle
| Responsible for maintaining a hypertonic medullary interstium****
102
What is the major function of Proximal tubule?
Proximal tubule:
| Major function: reabsorption (retention) of sodium****
103
Glomerular capillaries:
Glomerulus composed of tufts of capillaries that jut into Bowman’s capsule, what is the purpose of the tufts of capillaries?
Glomerular capillaries:
| Glomerulus composed of tufts of capillaries (increases surface area) that jut into Bowman’s capsule****
104
What % of plasmids are filtered as they pass through Glomerulus?
20% of plasmids are filtered as they pass through Glomerulus
105
Glomerular filtration pressure is about what % of MAP***
Glomerular filtration pressure is about 60% of MAP***
106
How is the glomerulus feed and drained?
Glomerulus is feed by one Afferent Arterial and drained by one efferent arterial**
107
If Vasodilate afferent arterial, what will happen?
If Vasodilate afferent arterial, we will decrease arterial tone and decrease arterial resistance, will increase renal blood flow and increase GFR
108
If we vasoconstrict afferent arterial, what will happen?
If we vasoconstrict afferent arterial, increase arterial tone and arterial resistance, this will decrease renal blood flow and decrease GFR
109
Work force of the body, basic unit of the filtering system is what?
THE NEPHRON
110
GFR is what?
GFR 125ml/min
111
Where is Filtered fluid will convert to urine?
Tubule system is where Filtered fluid will convert to urine***
112
What is the ratio for cortical nephron to the juxtamedullary nephrons?
7 to 1… cortical nephron to juxtamedullary nephrons
113
What contains the longer loops of henle?
Juxtamedullary nephrons contain “longer loops of henle”****** located in the medulla
114
What contains the short loops of henle?
Cortical nephrons contain “short loops of henle”***** (in the cortex of the kidney)
115
Each kidney consists of what two portions?
Each kidney consists of cortical portion (outer) and medullary portion (inner)*****
116
Three layers to the kidneys?
Three layers to the kidneys
1. Fiberous membrane that covers the kidneys itself
2. Adipose capsule
3. Renal facisa – anchors the kidneys to the abdominal wall and surrounding structures
117
What is the sympathetic innervation to the kidneys?
Sympathetic innervation: renal plexus
Nerves are vasomotor, they regulate circulation of blood in the kidneys
118
What are the three essential functions of the kidneys?
1. Glomerarly filtration – forcing of fluids through a membrane under pressure
- GFR 125ml/min
- 20% of CO are sent to the kidneys
- Kidneys will bleed if you cut it, that will be the difference between a total nephrectomy vs. partial
2. Tubular reabsorption – retention – movement of filtrate back into the blood form the renal tubule (these are the nutrients, such as amino acid and glucose)
3. Execretion – secretion - Movement of substances from the blood to the filtrate such as urea, uric acid, and creatinine
- Important to Calculate fluids carefully
- Adequate hydration and maintain renal profusion during anesthesia
119
What hormones does the kidneys secrete?
Secrete hormones Renin, erythropoetin activated form of Vitamin D****
120
Excretion (secretion) of end products of metabolism from the kidneys are what?
Excretion (secretion) of end products of metabolism (urea)****** Uric acid, creatinine, and end products of hemoglobin break down
