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Anesthesia Principles 2 > Exam 3: Renal 1/2 > Flashcards

Exam 3: Renal 1/2 Flashcards

1
Q

What are the roles of the kidney?

A
  1. Excreting metabolic wastes
  2. Maintaining extracellular fluid
  3. Maintain electrolytes
  4. Maintain acid-base balance
  5. Hormonal functions
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2
Q

Due to hepatic displacement, the right kidney’s position is ______ than the left kidney

A

slightly lower

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3
Q

A longitudinal section of the kidney reveals two distinct regions, the outer ____ and the inner _____

A

cortex; medulla

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4
Q

The medial margin of the kidney is concave because of the presence of a recessed fissure known as the ___.

A

hilus

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5
Q

Hilus lies at approximately what level?

A

L1

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6
Q

Parasympathetic innervation to the kidneys is via the ____

A

Vagus nerve

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7
Q

Sympathetic innervation to the kidneys is via the ____

A

T8-L1 preganglionic

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8
Q

Sympathetic innervation to the bladder is from _____ and controls what functions?

A

T11 – L2
Pain, touch, temp

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9
Q

Parasympathetic innervation to the bladder is from _____ and controls what functions?

A

S2-S4
Stretch, motor

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10
Q

The functional unit of the kidney is the ____

A

nephron

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11
Q

Production of urine begins with water and solute filtration from plasma flowing into the glomerulus via the _________

A

AFFERRENT arteriole

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12
Q

What are the 2 major determinants of GFR?

A
  1. Glomerular capillary pressure (arterial pressure)
  2. Glomerular oncotic pressure (renal blood flow)
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13
Q

The normal renal fraction of cardiac output is approximately ______%

A

25%

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14
Q

Renal blood flow is regulated by what 2 things?

A
  1. intrinsic autoregulation
  2. neural regulation
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15
Q

Afferent arteriole vasodilation and myogenic mechanisms are responsible for ______

A

autoregulation

Myogenic reflex - pressure

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16
Q

GFR relatively constant with changes in MAP from _______

A

80-200 mmHG

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17
Q

______ reabsorbs 2/3 of filtered sodium

A

Proximal tubule

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18
Q

What part of the kidney reabsorbs about 65% of filtered water?

A

Proximal tubule

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19
Q

ADH is secreted by the ____

A

posterior pituitary gland

20
Q

arterial _________ are activated when hypovolemia leads to a decrease in blood pressure

A

baroreceptors

21
Q

What is released by atrium in response to increased stretch?

A

ANP

(Atrial natriuretic peptide)

22
Q

Which renal vasodilator, produced in kidney, is stimulated as a result of
stress, renal ischemia, and HOTN?

A

Prostaglandin

23
Q

S/Sx of Hyopnatremia

A

Symptoms rarely unless < 125mEq/L

S&S - anorexia, nausea, and lethargy to convulsions, dysrhythmias, coma, and even death due to osmotic brain swelling

If acute, risk of neurological complications higher; Treat to prevent cerebral edema and seizures

24
Q

S/Sx of Hypernatremia

A

Serum level > 145mEq/L

Generally due to sodium gain or water loss (usually the latter)

Can cause dehydration of brain leading ; Symptoms from confusion to convulsions and coma

25
Q

Causes, Symptoms and Treatment of Hypokalemia

A

Causes: Vomiting, diarrhea, drugs, hormones, renal abnormalities, insulin therapy, inadequate intake

S/Sx: electrocardiogram (ECG) changes (flattened T waves “no pot, no T,” U waves) and skeletal muscle weakness

Treatment: replacement (IV or PO)

26
Q

Causes of Hyperkalemia

A

abnormal kidney excretion, abnormal cellular potassium release (i.e. cell lysis), or abnormal distribution between the intra- and extracellular space.

> 5.5 mEq/L

27
Q

renal pain is linked to what dermatomes?

A

T10-L1 (sympathetic)

28
Q

if doing neuraxial block for kidney surgery would want coverage from _____________

A

T8-L4

29
Q

What is a normal GFR for a 70 kg male

A

125 mL/min

30
Q

What is the primary site of reabsorption in the nephron?

A

PCT

31
Q

What is the primary site of water movement in the nephron?

A

Descending loop (b/c that is where aquaporins are)

32
Q

Renal blood flow⬇ = _____ glomerular filtration

A

⬇ (decrease)

33
Q

Angiotensin II production causes what 3 things?

A
  1. renal efferent arteriolar vasoconstriction
  2. ADH release
  3. Aldosterone release
34
Q

List exogenous nephrotoxins commonly found in hospital settings

A

Antibiotics
Anesthetic agents
NSAID
Chemotherapeutic
Contrast

35
Q

List endogenous nephrotoxins commonly found in hospital settings

A

Increased Calcium
Uric acid
Myoglobin (Rhabdo)
Hemoglobin(hemolysis)
Bilirubin
Paraproteins

36
Q

True or False. Prerenal azotemia is reversible if the underlying cause is corrected.

A

True

37
Q

Oliguria is defined as a urinary flow rate less than __________.

A

0.5 mL/kg/hour

38
Q

Causes of prerenal azotemia:

A

Absolute decrease
- Acute hemorrhage
- GI fluid loss
- Trauma
- Surgery
- Burns

Low Output syndromes
- Renal artery stenosis
- Relative decrease
- Sepsis
- Hepatic failure
- Allergic reaction

39
Q

Causes of intrarenal azotemia:

A

Acute glomerulonephritis, Vasculitis, Interstitial nephritis (drug allergy, infiltrative diseases)

Acute tubular necrosis
- Ischemia
- Nephrotoxic drugs (aminoglycosides, nonsteroidal anti-inflammatory drugs)
- Solvents (carbon tetrachloride, ethylene glycol)
- Heavy metals (mercury, cisplatin)
- Radiographic contrast dyes
- Myoglobinuria
- Intratubular crystals (uric acid, oxalate)

40
Q

Causes of postrenal azotemia:

A

Urinary outflow tracts obstructed
- Prostatic hypertrophy (PBH) or cancer of prostrate or cervix
- Bladder carcinoma
- Clot retention or nephrolithiasis

41
Q

Risk factors for acute renal failure

A
  • Co-existing renal dz
  • CHF
  • Advanced age
  • Symptomatic CV disease
  • Major operative procedures (CPB, AAA repair)
  • Sepsis
  • Multi-organ system failure
  • Iatrogenic: inadequate fluid volume replacement, delayed tx of sepsis, nephrotixc drugs or dyes
  • pre-existing renal insufficiency
  • shock
42
Q

What procedures are considered high-risk for leading to renal failure?

A

Renal vascularization
Aortic cross-clamping
Cardiopulmonary bypass
Urologic surgery
Transplantation
Trauma

43
Q

What are nephrotoxins that can lead to renal failure?

A

Aminoglycoside antibiotics
Radiocontrast dyes
Nonsteroidal anti-inflammatory drugs

44
Q

Complications related to renal failure

A

Neuro
- confusion, asterixis, somnolence, seizures

CV
- systemic HTN, CHF, pulmonary edema, cardiac dysrhythmias, may have dilutional anemia

GI
- anorexia, nausea, vomiting, ileus, GI bleeding

45
Q

S/Sx of renal failure

A

Generalized malaise

S&S volume overload (dyspnea, edema, HTN)

Lethargic, nauseated, confused

Pulmonary edema, hypoxia, hyperkalemia, acidosis

Encephalopathy (coma, seizures and death)

46
Q

What is the most reliable measure of kidney function?

A

creatinine clearance

Anesthesia Principles 2 (4 decks)

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