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Fa: Coexisting 2 > 2. Renal > Flashcards

2. Renal Flashcards

1
Q

kidney metabolic rate

A

> 400 kcal/kg tissue/day

HIGH

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2
Q

kidneys CO

A

20-25%

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3
Q

normal glomeruli will filter

A

180 L plasma/day

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4
Q

kidney function

A

regulate water and sodium
volume homeostasis

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5
Q

kidney nephrons

A

1 million

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6
Q

kidney autoregulation

A

50-150 mmHg

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7
Q

what triggers afferent arteriole to dilate or constrict

A

change in Cl-

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8
Q

angiotensin 2 function

A

incr ADH
efferent constriction
incr Na+ absorption in PT
incr aldosterone

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9
Q

aldoserone function

A

incr Na+ absorption from DT

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10
Q

best index of kidney function

A

GFR

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11
Q

normal GFR

A

> 90 mL/min/1.73 m2

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12
Q

after age 20 GFR decreases

A

1% annually

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13
Q

uremia symtoms appear once

A

GFR < 15

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14
Q

easiest marker of kidney function

A

Cr

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15
Q

Cr is byproduct

A

muscle/protein breakdown

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16
Q

why is cr useful

A

not secreted or ecreted

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17
Q

normal Cr (female)

A

0.6-1 mg/dL

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18
Q

normal Cr (male)

A

1-1.3 mg/dL

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19
Q

BUN

A

soft indicator of GFR
can be reabsorbed

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20
Q

what BUN correlates with decr GFR

A

BUN > 50

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21
Q

FENa

A

ratio of Na+ in plasma and urine to ratio of Cr in plasma and urine

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22
Q

FENa < 1%

A

tubule reabsorbing Na appropriately

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23
Q

FENa > 2%

A

tubule failing to recapture Na
tubule dysfunction

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24
Q

FENa > 3%

A

acute tubular necrosis

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25
Q

normal Urine specific gravity

A

> 1.018

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26
Q

what 2 things can affect ability for tubules to concentrate urine

A

diuretics
hyperglycemia

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27
Q

prerenal AKI

A

decr perfusion or blood flow

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28
Q

renal AKI

A

directly affects kidney or nephron

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29
Q

postrenal AKI

A

something blocking urine outflow

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30
Q

prerenal causes

A

hemorrhage
gi losses
burns
cardiogenic shock
surgery
sepsis

31
Q

renal causes

A

acute tubular necrosis
dehydration
contrast dye
NSAIDs
antifreeze
acute golmerulonephritis
vasculitis
interstitial nephritis

32
Q

postrenal causes

A

nephrolithiasis
BPH
bladder malignancy
cystic bleeding/clots
ureter ligation

33
Q

AKI diagnosis

A

Cr incr 0.3 in 48 hrs
or
50+% incr over 7 days

34
Q

severe AKI inidcation

A

oliguria < 100 mL/day

35
Q

nephrotic syndrome

A

severe proteinuria > 3.5 g daily
low albumin

36
Q

CKD stage 2

A

GFR 60-90
mild

37
Q

CKD stage 3a

A

GFR 45-60
mild mod

38
Q

CKD stage 3b

A

GFR 30-45
mod sev

39
Q

CKD stage 4

A

GFR 15-30
sev

40
Q

CKD stage 5

A

GFR < 15
kidney failure

41
Q

which stage CKD may need dialysis

A

stage 4

42
Q

which stage CKD will need dialysis

A

stage 5

43
Q

uremic syndrome

A

constellation of symptoms that manifest once CKD progresses to 10% normal kidney function

affects all other organ systems

44
Q

midodrine effect

A

incr BP during dialysis days

45
Q

uremic syndrome S+S

A

HTN
LVH
diastolic dysfunction
pericarditis
pulm edema
hyponatremai
hyperkalemia
hypomag
hyperphos
hypercal
metabolic acidosis
anemia
hyperparathyroid

46
Q

does ESRD affect propofol

A

no

47
Q

does ESRD affect etomidate

A

no

48
Q

which induction drugs are affected by ESRD

A

thiopental
benzos
** decr protein binding**
decr dose

49
Q

opioid dosing in ESRD

A

lower doses
longer intervals

50
Q

opioid not recommended in ESRD

A

meperidine can cause seizures

51
Q

best opioid for ESRD

A

fentanyl
(dilaudid decent)

52
Q

which muscle relaxants are predicatable and not prolonged in ESRD

A

atracurium
cisatracurium

53
Q

which muscle relaxants will have peaked T waves in ESRD

A

sux

54
Q

laudanosine can cause

A

neuroexcitiation
seizures

55
Q

definitive managment of ESRD

A

dialysis

56
Q

peritoneal dialysis advantages

A

at home
no fluid shifts

57
Q

peritoneal dialysis disadvantages

A

cannot change volume status
infection risk

58
Q

how many hemodialysis sessions

A

3 sessions per week
3 hours long

59
Q

types of vascular access for hemodialysis

A

temporaty catheter
tunnele catheter
AV fistula
AV graft

60
Q

hemodialysis catheter symptoms

A

infection

61
Q

AV fistula/graft SE

A

thrombosis
stenosis
aneurysms
steal syndrome

62
Q

what to ask day of surgery

A

Cr level
dialysis (last dialysis)
K+
BP control
diabetes/glu level
anemia
GERD
urine output

63
Q

most common anesthetic

A

MAC

64
Q

BPH

A

enlarged prostate inhibits urine flow
weak stream
frequent urgency

65
Q

BPH treatment

A

TURP

66
Q

TURP syndrome

A

prostate is vascular and cysto fluids can be forced/absorbed into pts vasculature

67
Q

TURP syndrom pressures

A

< 15 cmH2O

68
Q

how much fluid can be absorbed through prostate

A

200 mL/min

69
Q

TURP syndrome issues

A

fluid overload
hyponatremia
hyperosmolarity
hyperglycinemia

70
Q

TURP irrigation fluid

A

glycine

71
Q

glycine SE

A

transient blindness

72
Q

TURP syndrom triad

A

confusion
bradycardia
HTN

73
Q

TURP syndrome treatment

A

remove cause
supportive care

Fa: Coexisting 2 (7 decks)

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