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Critical Care Paramedic > 2-3: Renal and Urology > Flashcards

2-3: Renal and Urology Flashcards

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1
Q

What are the three main functions of the renal system?

A
  • excretion
  • elimination
  • regulation
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2
Q

What is the difference between excretion and elimination?

A

They both have to do with organic waste products, but things do no stay in the body during excretion and they do stay in the body during elimination

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3
Q

What types of things does the renal system regulate?

A
  • blood volume and solute concentration
  • control of the body’s water balance
  • fluid and electrolyte balance
  • regulation of BP
  • regulation of the acid-base balance
  • regulation of hematocrit
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4
Q

Where are the kidneys located?

A

on either side of the vertebral column between L1 and L3
left kidney is higher than right

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5
Q

What is the GFR

A

the glomerular filtration rate- amount of filtrate produced by the kidneys each minute

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6
Q

Where is creatinine produced

A

in the muscles

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7
Q

What types of things can alter the creatinine level?

A
  • muscle mass changes
  • liver disease
  • malnutrition
  • exercising
  • renal failure
  • medications
  • ketoacidosis
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8
Q

What is the lag time of serum creatinine behind GFR?

A

2-3 days

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9
Q

what is the most common cause of elevated BUN?

A

poor kidney function

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10
Q

What is the normal value for BUN?

A

7-21 mg per 100 mL of blood

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11
Q

What does a very high BUN indicate?

A

moderate-to-severe renal failure

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12
Q

What is the most commonly used diuretic and what does it do ?

A

Thiazide
inhibits the sodium-chloride transporter in the distal tubule

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13
Q

Acute renal failure is now referred to as _____

A

acute renal injury (AKI)

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14
Q

What is azotemia?

A

a rise in BUN

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15
Q

What are the three types of acute renal failure (or AKI)

A
  • prerenal
  • intrinsic
  • postrenal
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16
Q

How does prerenal AKI come about?

A

decreased blood flow to the kidney -> causes volume loss, decreased renal perfusion, and heart failure

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17
Q

How does intrinsic AKI come about?

A

there is actual tissue damage to the parenchyma
- structural injury is the hallmark of intrinsic AKI

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18
Q

What are some causes of intrinsic AKI?

A
  • acute interstitial nephritis (AIN)
  • acute glomerular nephritis (AGN)
  • acute tubular necrosis (ATN)
  • renal artery / vein insult
  • hepatorenal syndrome`
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19
Q

How does postrenal failure come about?

A

mechanical obstruction of the urinary collecting system, including the renal pelvis, ureters, bladder, or urethra

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20
Q

What is the mnemonic for dialysis indications?

A

AEIOU
A- acidosis
E- electrolyte imbalance (hyper-k)
I- ingestion
O- (fluid) overload (pulm edem)
U- uremia (encephalopathy)

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21
Q

What is the mnemonic for dialyzable toxins?

A

I STUMBLE
I- isopropyl alcohol
S- salicylates
T- theophylline
U- uremia
M- methanol
B- barbituates, beta blockers
L- lithium
E- ethylene glycol

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22
Q

At what GFR percentage do substances such as urea and creatinine start to show significant increases?

A

50%

23
Q

What are some emergency complications of CRF / CKD?

A
  • pericarditis
  • encephalopathy
  • GI symptoms
    • anorexia
    • n/v/d
  • hypertension
  • CHF
  • malnutrition
  • hypoglycemia
  • platelet dysfunction with tendency to bleeding
24
Q

When is emergency dialysis especially beneficial for a patient with acidosis?

A

when the acidosis is severe (<7.2) and refractory to sodium bicarbonate (or unable to give bicarb due to fluid overload)

25
Q

When is emergency dialysis especially useful for a patient with electrolyte imbalances?

A

in pt with hyperkalemia when potassium >6.5 or when seen with EKG changes

26
Q

What is rhabdomyolysis?

A

breakdown of muscle fibers secondary to injury resulting in the release of their intracellular contents into the bloodstream

27
Q

skeletal muscles account for __-___% of total body mass

A

40-50%

28
Q

What components are primarily intracellular in the muscle?

A
  • potassium (leads to hyperK if cell bursts)
  • Lactic acid (leads to metabolic acidosis if cell bursts)
  • Purines and myoglobin (are nephrotoxic if cell bursts)
29
Q

What two things must the Na+/K+ pump have in order to function?

A

ATP and oxygen

30
Q

Failure of the sodium potassium pump results in what?

A

failure of the pump allows sodium, chloride, and calcium to flood into the cells.

31
Q

If the Na/K pump fails and calcium shifts into the cells, what will this cause?

A

hypocalcemia, calcium deposits in muscle and renal tissue

32
Q

If the Na/K pump fails and sodium shifts into the cells, what will this cause?

A

water follows Na, which results in cell swelling and then lysis
the cell then releases its intracellular components

33
Q

What is the most “important” toxin as cells break down?

A

potassium- and lethal hyperkalemia can occur quickly

34
Q

What is the sequential sequelae of rhabdo?

A
  • electrolyte disturbances
  • hypovolemia
  • hyperkalemia
  • metabolic acidosis
  • coagulopathy disturbances
  • AKI
  • multi-system organ failure
35
Q

When should rhabdo be suspected when evaluating CK levels in a patient and what are CK levels usually in a rhabdo patient?

A

rhabdo should be suspected when the CK levels are 2-3 x greater than normal
CK values are typically 5-10x greater than normal reference ranges

36
Q

What will be present in the urine in cases of rhabdo?

A

hemoglobin or myoglobin

urine test is only 50% sensitive, so it does not rule out rhabdo

37
Q

Why do PTT, PT, and platelet count need to be evaluated in cases of rhabdo?

A

because DIC is possible

38
Q

What is the risk of developing a UTI with an indwelling catheter?

A

10-30%

39
Q

What is the prehospital treatment for rhabdo?

A

aggressive fluid resuscitation with isotonic crystalloids

administer a min of 500 ml/H bolus, then titrate to maintain a urinary output of 1.5-2 mL/kg

40
Q

What is the most common association with UTIs in men under the age of 50?

A

STDs

41
Q

____ stones account for 75% of kidney stones

A

calcium

42
Q

20% of kidney stone patients will require hospital admission because of:

A
  • severe pain
  • inability to excrete fluid
  • urinary tract infection
  • inability to pass the stone
43
Q

What is the most commonly used diagnostic test for kidney stones?

A

CT scans without contrast

44
Q

How do NSAIDs work for kidney stone pain?

A

they inhibit the formation of prostaglandin E2, which is the mediator of renal colic pain

45
Q

Patients presenting with kidney stone signs and symptoms should be examined for possible _____. Why?

A

AAA

the signs and symptoms of a leaking aneurysm mimic those of a kidney stone

46
Q

What are the indications of a Foley catheter?

A
  • any patient that requires monitoring of urinary output
  • sedated or medically paralyzed patients
  • long transports
  • prevention or management of neurogenic bladder
47
Q

What are the contraindications of a Foley catheter?

A
  • urethral trauma
    • multisystem injuries
    • pelvic fractures
    • straddle impacts
  • indications of urethral trauma
    • blood at the meatus of urethra
    • scrotal hematoma
    • high riding prostate
48
Q

What should urinary output be for adults?

A

20-50 cc’s/hour for adults

49
Q

What should you consider if the catheter is draining little or there is no urine despite adequate fluid intake

A
  • consider the level of the drainage bag
  • consider flushing the catheter

The bag should always be lower than the level of the bladder

50
Q

Where in the brain is ADH released?

A

The posterior pituitary

51
Q

In renal insufficiency, what happens to relative tubular secretion? What does this do to serum creatinine?

A

relative tubular secretions increase, which can falsely depress creatinine and interfere with correlation of serum creatinine with GFR

52
Q

What are the three acid-base compensatory systems in the body?

A
  1. buffer
  2. respiratory
  3. renal
    (in that order!!)
53
Q

What are the two markers for AKI?

A

BUN and creatinine

Critical Care Paramedic (20 decks)

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