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Health Assessment Spring 2024 > Exam 3 Renal Assessment > Flashcards

Exam 3 Renal Assessment Flashcards

1
Q

The kidneys sit retroperitoneal between _______ and _______.

Which kidney is slightly more caudal (lower) to accommodate the liver?

A

T12 and L3

Right

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2
Q

What is the functional unit of the kidney?

A

Nephron

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3
Q

The kidneys receive ______% (range) of CO.

A

20% to 25% (1- 1.25 L)

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4
Q

Besides the kidneys, what organ is retroperitoneal?

A

Spleen

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5
Q

Primary functions of the kidneys (6 functions).

A
  1. Maintain extracellular volume and composition
  2. Blood Pressure Regulation (Intermed/Long)
  3. Excretion of Toxins and Metabolites
  4. Maintain Acid-Base Balance
  5. Hormone Production (EPO)
  6. Blood glucose homeostasis
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6
Q

The lungs and kidneys are the primary regulators of acid-base balance, where the lungs excrete __________ and the kidneys excrete the ___________.

A

Lungs excrete volatile acids (CO2)
Kidneys excrete non-volatile acids

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7
Q

Inadequate oxygen delivery to the kidney causes it to release ________.

A

Erythropoietin

Things that can cause decreased O2 delivery: anemia, reduced intravascular volume, and hypoxia.

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8
Q

What can reduce EPO production and lead to chronic anemia?

A

Severe kidney disease

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9
Q

Calcium requires ________ for adequate absorption and utilization.

A

Calcitriol (Active Vitamin D)

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10
Q

How does Vitamin D get activated?

A

Through the kidneys.

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11
Q

What hormone will increase active Vitamin D levels?

A

PTH

Negative feedback loop

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12
Q

For someone who is chronically anemic what can they take?

A

Synthetic EPO and Iron to generate more RBC

Long term dialysis patients will be on these medications, dialysis will negate the RBCs.

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13
Q

____-% of body weight in non-obese patients is composed of water.

A

60%

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14
Q

What are the two main fluid compartments?

A

ECF and ICF

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15
Q

Per this lecture ECF is _______ the volume of ICF.

A

1/2

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16
Q

What are the ways osmolality sensors in the anterior hypothalamus regulate fluid?

A

Stimulate thirst
Release Vasopressin (ADH)

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17
Q

What is a normal sodium level?

A

135-145 mEq/L

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18
Q

There are no absolute cut offs for sodium level for surgery, but these numbers will be a good reference.

Na level below _________ mEq/L and above _______ mEq/L are a no go for surgery.

A

Below 125 mEq/L
Above 155 mEq/L

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19
Q

What are some causes of hyponatremia?

A

Prolonged sweating
Vomiting/diarrhea
Insufficient aldosterone secretion
Excessive intake of water

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20
Q

What percent of people in the hospital have hyponatremia?

A

15%

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21
Q

There are two patient populations where we are most concerned about sodium levels.

A

Neuro patients
Kids

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22
Q

The most severe consequence of hyponatremia are these three things:

A

Seizures
Coma
Death

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23
Q

What are treatments for hyponatremia?

A

Treat underlying causes
Normal Saline
Hypertonic 3% Saline (1 meq/L/hr)
Lasix
Mannitol

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24
Q

Over half of the patients that had their sodium corrected faster than 6 mEq/L in 24 hours can cause __________ syndrome.

What could this result in?

A

osmotic demyelination

Seizures, coma, death

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25
Q

What is the dose and rate of 3% hypertonic saline for patients that are hyponatremic and seizing?

A

3-5 mL/kg of 3% saline
Give dose of over 15-30 minutes

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26
Q

Hyponatremic seizures are a medical emergency and can cause __________ brain damage.

A

Irreversible

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27
Q

What are the causes of hypernatremia?

A

Excessive evaporation
Insufficient ADH
Poor oral intake (very young, old)
Overcorrection of hyponatremia
Excessive sodium bicarb to tx acidosis

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28
Q

Be cautious when using sodium bicarb to treat acidosis, what is a good alternative to use if you want to avoid raising sodium?

A

Tromethamine injection (THAM) is indicated for the prevention and correction of metabolic acidosis.

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29
Q

Effects of hypernatremia

A

Orthostasis - syncope from standing up
Restlessness
Lethargy
Tremor
Muscle Twitching/ Spasticity
Seizures
Death

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30
Q

Treatments for hypernatremia?

A

First, assess volume status (tachycardic, hypotensive, u/o, skin turgor, CVP, SV variation)

Then treat the cause.

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31
Q

Treatments for the following.

Hypernatremic Hypovolemia:
Hypernatremic Hypervolemia:
Hypernatremic Euvolemic:

A

Hypernatremic Hypovolemia: normal saline
Hypernatremic Hypervolemia: diuretic
Hypernatremic Euvolemic: water replacement (PO or D5W)

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32
Q

What is normal potassium level?

A

3.5 to 5 mEq/L

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33
Q

Patients will not go to surgery if potassium is less than ______ or greater than _______ mEq/L.

A

K+ less than 3 mEq/L
K+ greater than 5 mEq/L

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34
Q

What are the causes of hypokalemia?

A

Excessive release of aldosterone
Diuretics drugs (Lasix, hydrochlorothiazide)
Kidney disease
Excessive intake of licorice (kids eating too much licorice.)
DKA (frequent urination)

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35
Q

Effects of hypokalemia.

A

Generally, cardiac and neuromuscular (K+ of 2mEq/L)
Dysrhythmias (K+ of 2mEq/L)
Muscle weakness
Cramps (Eat a banana)
Paralysis
Illeus (lose parastalsis)

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36
Q

What changes in EKG will you see with hypokalemia?

A

U-waves

You will see this on the exams and boards.

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37
Q

Treatments for hypokalemia

A

IV/PO Potassium
May require days to correct.

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38
Q

10 mEq of potassium will increase serum K+ by _____ mEq/L.

A

0.1 mEq/L

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39
Q

Why may PO potassium be faster in increasing serum potassium levels?

A

A larger dose can be given PO compared to 10-20 mEq/hr with IV.

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40
Q

When replacing potassium levels, what other electrolytes do you need to keep an eye on?

A

Phosphorus (normal levels 2.5 - 4.5 mg/dL)

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41
Q

Who are at the most risk of dysrhythmias when getting potassium replacement?

A

CHF patients
Digoxin patients

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42
Q

What are the causes of hyperkalemia?

A

Renal disease (long-term dialysis pt, fistula)
Insufficient secretion of aldosterone
Acidosis
Tissue/muscle damage
Use of depolarizing NMBD (Sch)
Hypoventilation

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43
Q

With hypoventilation, a pH decrease of 0.1 will cause a ______(range) increase in potassium.

A

0.4 to 1.5 mEq/L increase in potassium

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44
Q

What are the effects of hyperkalemia?

A

Potentially asymptomatic
GI upset
Malaise
Skeletal muscle paralysis
Severe cardiac dysrhythmias (cardiac arrest)
Lowers resting membrane potential
Decreases action potential duration

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45
Q

What are EKG presentations of hyperkalemia?

A

Peaked T-waves (can progress into sine waves if hyperkalemia is severe)

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46
Q

Treatment of hyperkalemia

A

Bicarbonate
Glucose
Insulin (10U and 25g of D50)
Calcium (stabilize cell membrane)
Increase RR
Albuterol
Dialysis

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47
Q

What do CRNAs do that can cause hyperkalemia in a patient?

A

Massive Transfusion Protocol and Blood Products

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48
Q

What are lab tests for renal function?

A

GFR (best measurement) 125-140 ml/min- great for trends but not for acute states.

Creatinine Clearance (best for acute state)

Serum Creatinine 0.6-1.2mg/dL - estimate of GFR

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49
Q

What is creatinine?

A

A substance produced by skeletal muscle and is a byproduct of creatine breakdown.

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50
Q

Creatinine production is constant and directly __________ to muscle mass.

A

proportional

A emaciated individual will probably have a lower creatinine level compared to a bodybuilder. But if you see that a cachectic person has a high creatinine level, it might be a sign that the kidneys are not working well.

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51
Q

Creatinine undergoes renal _________ but not _________, making it a useful indicator of GFR.

A

Creatinine undergoes renal filtration but not reabsorption, making it a useful indicator of GFR.

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52
Q

100% increase in creatinine indicates a ____% reduction in GFR.

A

50%

If creatinine goes from 1.2 to 2.4, GFR will decrease by 50%.

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53
Q

Large amounts of protein in the urine may suggest ________ injury.

Labs values and test.

A

Glomerular Injury
(High levels of protein can also mean UTI and not glomerular injury.)

> 750 mg/day of urine protein or 3+ on dipstick

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54
Q

What are normal BUN ranges?

A

8-20 mg/dL

BUN can be misleading. Diet and changes in intravascular volume can increase or decrease BUN.

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55
Q

What does specific gravity compare?

What are normal ranges of specific gravity?

A

Comparing 1 mL of urine to 1 mL of distilled water. Measures the ability of the kidney to concentrate or dilute urine.

1.001-1.035

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56
Q

What is BUN: Creatinine ratio?

A

10: 1

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57
Q

________ is the primary metabolite of protein metabolism in the liver.

A

Urea

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58
Q

Because urea undergoes filtration and reabsorption, BUN is a better indicator of ____________ symptoms than as a measure of GFR.

A

Uremic symptoms

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59
Q

What causes BUN of <8 mg/dL?

A

Overhydration, too much hydration, dilution.
Decrease Urea production (malnutrition, liver dz)

EtOH patients will forget to eat and get calories just from the booze.

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60
Q

What causes a BUN of 20-40 mg/dL?

A

Dehydration

Increase Protein Input (high protein, GIB, Hematoma breakdown)

Catabolism (Trauma, Sepsis)

Decrease GFR

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61
Q

What causes a BUN >50 mg/dL?

A

Decrease GFR

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62
Q

Which lab test is a good evaluation of fluid hydration status?

A

BUN: Creatinine Ratio

BUN can undergo filtration and reabsorption. Creatinine only undergoes filtration. Because of this reason, the ratio between these substances in the blood is helpful in evaluating hydration status.

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63
Q

A BUN:Cr ratio greater than _________ indicates prerenal azotemia.

A

20:1

64
Q

A medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, and various body waste compounds) in the blood. It is largely related to insufficient or dysfunctional filtering of blood by the kidneys.

A

Azotemia

65
Q

Oliguria definition.
Polyuria definition.
Annuria definition.

A

Oliguria is decreased u/o (500 mL in 24 hours).
Polyuria is excessive u/o.
Annuriaa is no u/o.

66
Q

What are the factors that can lead to a false urine specific gravity (SG)?

A

Look at the big picture and assess the weight of the urine relative to sterile water. SG measures the ability of the kidney to concentrate or dilute urine.

Advanced age
Contrast dye
Abx
Diuretics
Mannitol
Glucose
Proteins

67
Q

What does a high urine specific gravity indicate?

What does a low urine specific gravity indicate?

A

More concentrated urine, more solutes.

Less concentrated urine, less solutes.

68
Q

What number indicates good urine output from an anesthesia standpoint?

A

30 mL/hr (no standardization for weight and no clinical picture)

0.5-1 mL/kg/hr is more accurate

69
Q

The normal values for total U/O range between _________and _______ mL in adults with normal fluid intake of 2L during 24 hours.

A

800 to 2000 mL

70
Q

What is an early indicator of volume change (arm just got cut off)?

A

ABG results will quickly indicate volume change.
-Base Excess or Base Deficits will indicate volume loss (Indicator of acid/base balance in the blood).
-Increase in Lactate

H/H will not show the volume loss as quickly.

71
Q

_________ mL in 24 hours will be called oliguria.

A

500 mL

72
Q

CVP trending below _______ mmHg (range) will be volume responsive.

CVP above ________ mmHg (range) will be considered volume overloaded.

A

5 to 8 mmHg

15 to 20 mmHg

CVP is equivalent to right atrial pressure

73
Q

_______ is a powerful stimulus for renal vasoconstriction.

A

Left atrial pressure (wedge pressure)

Increase LAP, increase vasoconstriction. Afferent arteriole will increase to decrease hydrostatic pressure.

74
Q

What are the criteria for using stroke volume variation in assessing fluid status?

A

Assume the patient is on positive-pressure ventilation.
Assume the patient is in NSR.
Compare inspiratory and expiratory pressure to assess SVV.

75
Q

An IVC greater than _______% collapse indicates a fluid deficit.

A

50%

To assess, place an ultrasound on IVC and perform a passive leg raise, if the quick change in volume dilates IVC, the patient may be in a fluid volume deficit.

76
Q

What is acute renal failure?

A

Deterioration of renal function over hours to days.
Accumulation of nitrogenous waste products over a short period of time. Difficulty maintaining fluid/electrolyte homeostasis.

77
Q

If someone with AKI progress to dialysis and MSOF, mortality is now greater than ________.

A

50% (due to sepsis, CV dysfunction, pulmonary compilations)

78
Q

What do CRNAs do that causes AKI?

A

Letting the patient get hypotensive.

79
Q

What do providers do that can cause AKI?

A

Contrast

Minimize contrast load, and mitigate with fluids.

80
Q

What are the risk factors for AKI?

A

Pre-existing renal disease
Advanced age
Congestive HF
PVD
DM
Sepsis
Jaundice
Emergency Surgery
Major Operative Procedures (Cross-Clamped)

81
Q

Diagnosing AKI:
Serum creatinine rise > ______ mg/dL
_______% decrease creatinine clearance
Serum creatinine change by _______ mg/dL within 48 hours.

A

Diagnosing AKI:
Serum creatinine rise >0.5 mg/dL
50% decrease creatinine clearance
Serum creatinine change by 0.3 mg/dL within 48 hours.

82
Q

Symptoms of AKI

A

Malaise
Fluid Overloaded
Hypotension

83
Q

What are the types of AKI?

A

Pre-renal
Renal
Post-renal

84
Q

What are the causes of prerenal azotemia (ARF)?

A

Hemorrhage
GI fluid loss
Trauma
Surgery
Burns
Cardiogenic shock
Sepsis
Aortic clamping
Thromboembolism
Aortic aneurysm dissection

All these will decrease blood flow to the kidneys

85
Q

What are the causes of renal azotemia (ARF)?

A

Acute glomerulonephritis
Vasculitis
Interstitial nephritis
ATN
Contrast dye
Nephrotoxic drugs
Myoglobinuria

Real kidney problems. Think infections and inflammation.

86
Q

What are the causes of postrenal azotemia (ARF)?

A

Nephrolithiasis (kidney stones, most common cause)
BPH
Clot retention
Bladder carcinoma
UTI- cellular debris
Trauma to the urinary tract

Think mechanical obstruction post-kidney.

87
Q

Pre-renal azotemia makes up _________ of hospitalized acquired cases.

If pre-renal azotemia is not treated in time, it will progress to _____.

A

Half (Fortunately, this is rapidly reversible.)

ATN

88
Q

How can you distinguish a pre-renal from an intra-renal AKI?

A

Pre-renal can reabsorb sodium and water.

Obtain urine/serum test prior to dopamine, mannitol, diuretics, fluids.

89
Q

Treatment of pre-renal azotemia.

A

Treat through the restoration of renal blood flow.

Usually, a fluid bolus will be enough to reverse pre-renal azotemia.

90
Q

Compare diagnostic findings between prerenal oliguria and ATN.

A

BUN: Cr ratio will be normal in ATN and 20:1 in Pre-renal.

Pre-renal urine will be clear. ATN will have more sediments.

91
Q

What are the causes of renal azotemia?

A

Reperfusion injury
Release of cytokines, free radicals, and inflammatory cells
Blockage/obstruction inside the kidney

92
Q

What will be the BUN: Cr ratio of renal azotemia?

What happens to GFR?

What happens to Urea?

What happens to Creatinine?

A

Less than 15

GFR will decrease, and nothing will get filtered

Urea does not get reabsorbed; low urea in the blood, high urea in the urine.

Creatinine filtration decreases, leading to higher Cr in the blood.

93
Q

Neurological complications of AKI.

A

Uremic Encephalopathy (d/t protein and amino acids in the blood).

Improve with dialysis

94
Q

List the order of incidence from compilations of CKD:
Pulmonary Edema, LVH, CHF, Systemic HTN

A

Order of incidence:
1. Systemic HTN
2. LVH
3. CHF
4. Pulmonary Edema

95
Q

Hematological complications of AKI.

A

Anemia - d/t decreased RBC production, RBC survival, EPO production, hemodilution

Platelet dysfunction (uremic bleeding) - treat with DDAVP

96
Q

Metabolic complications of AKI.

A

Hyperkalemia
Water and Sodium retention
Hypoalbuminemia - responds slower to medication
Metabolic Acidosis

97
Q

Anesthesia concerns of AKI.

A

Correct fluid, electrolytes, acid/base status

Maintain MAP

Vasopressors-(consider carefully, and think about where the receptors work).
Prophylactic sodium bicarb - decreases the formation of free radicals and treats academia.

Invasive hemodynamic monitoring and lots of ABGs

Pre-Op dialysis, lower K+ (BZD and opioids might stick around longer in patients until they have dialysis).

98
Q

Unlike AKI, CKD is progressive and __________.

What is the leading cause of CKD?

A

Irreversible

DM and HTN

99
Q

RIFLE Criteria

A
100
Q

Describe stages of ESRD and GFR for each stage.

A

No U/O with stage 4 or 5
Stages 3,4,5 - dialysis-dependent

101
Q

On average, GFR decreases by ______ per decade starting from age 20.

A

10

102
Q

CV effects of CKD.

A

Systemic HTN (cause and consequence)
Retention of sodium and water
Activation of RAAS d/t decreased GFR
Dyslipidemia (Triglycerides >500, LDL >100)
Silent MI (most prevalent in DM and women)

103
Q

What are the functions of ACE inhibitors and ARBs?

Why do we want to hold these medications on the day of surgery?

A

Decrease systemic and glomerular hypertension
Decrease proteinuria
Decrease glomerulosclerosis

Hold ACE inhibitors/ARBs on the day of surgery to reduce the risk of intraoperative hypotension.

104
Q

What are the hematological complications of CKD?

A

Anemia - responds well to EPO, target >10 Hgb

105
Q

What are the five indications of dialysis?

A
  1. Volume overload
  2. Hyperkalemia
  3. Severe Metabolic Acidosis
  4. Symptomatic Uremia
  5. Medication Overdose
106
Q

Considerations of dialysis:

HD is more ______ than PD.

PD is more gradual and favored for patients that can’t tolerate __________ associated with HD (CHF/unstable angina).

__________ is the most common adverse event.

_________ is the leading cause of death in dialysis patients.

A

HD is more effective than PD.

PD is more gradual and favored for patients that can’t tolerate fluid shifts associated with HD (CHF/unstable angina).

Hypotension is the most common adverse event.

Infection is the leading cause of death in dialysis patients.

107
Q

The risk of pre-renal azotemia is reduced by maintaining a MAP greater than _______ mmHg and providing appropriate hydration.

A

> 65 mmHg

108
Q

No clear benefit to crystalloids vs. colloids, but _______ are clearly associated with an increased risk of renal injury.

A

Hydroxyethyl starches (synthetics)

109
Q

Excessive use of 0.9% NaCl leads to ________.

A

Hyperchloremic Metabolic Acidosis

110
Q

In healthy patients, what does alpha-1 agonist do to renal blood flow?

A

Reduce RBF

Septic renal patients will benefit from alpha-1 agonists for MAP support. Increased renal perfusion outweighs the renal vasoconstrictive effects.

111
Q

Vasopressin preferentially constricts the __________ arteriole. Maintains GFR and UOP better than NE or Neo.

A

efferent

112
Q

Renal dose __________ does NOT prevent or treat AKI.

A

dopamine

113
Q

Anesthesia concerns of CKD.

A

Assess the stability of ESRD.
Get the accurate weight of the patient within 24 hrs of surgery.
Well-controlled BP
Glucose management (A1c).
Aspiration Precaution (increase risk)
Uremic bleeding (dysfunctional platelets)

114
Q

What are treatments of uremic bleeding?

Max effect time:
Duration:

A

DDAVP - max effect 2-4 hours, last 6-8 hours, give this in pre-op

Cryo (Factor VIII, vWF)

115
Q

What neuromuscular blockers are not dependent on the kidneys?

A

Atracurium
Cisatracurium

Hoffman elimination- plasma esterases affected by pH and temperature.

116
Q

When taking care of renal patients, what medications do we worry about having active metabolite?

A

Opioids (morphine, meperidine)

Morphine is cleared through the urine, active morphine metabolite will lead to respiratory depression.

117
Q

Lipid insoluble drugs will have a _________ duration of action in renal patients.

A

prolonged duration (Thiazides, loop diuretics, digoxin, Abx)

Consider decreasing the dose base off of GFR

118
Q

What induction medications are excreted by the kidneys?

A

Phenobarbital
Thiopental

119
Q

What muscle relaxants are excreted by the kidneys?

A

Pancuronium
Vecuronium

If kidneys do not excrete them, the liver will.

120
Q

What cholinesterase inhibitors are excreted by the kidneys?

A

Edrophonium
Neostigmine

121
Q

What CV drugs are excreted by the kidneys?

A

Atropine
Digoxin
Glycopyrrolate
Hydralazine
Milrinone

122
Q

What antimicrobials are excreted by the kidneys?

A

Vancomycin
Aminoglycosides
Cephalosporins
PCN

123
Q

What is the main adverse effect of Demerol?

A

Demerol has active analgesic and CNS effect.
The main adverse effect is neurotoxicity.

124
Q

Patients maintained on dialysis should undergo dialysis _______ hours preceding elective surgery.

A

24 hours

125
Q

What is TURP?

When is it indicated?

A

Transurethral Resection of the Prostate.

TURP is indicated for prostate removal in BPH.

126
Q

Neuraxial anesthesia is common in TURP procedures. The spinal is up to a ______ level.

A

T10 level

This will allow earlier detection of complications because you can assess the patient’s mentation throughout the procedure.

127
Q

What are the irrigation fluids used in TURP procedures? List the Pros and Cons of each fluid.

A
128
Q

TURP requires continuous irrigation to facilitate visualization. The fluid is absorbed through the open venous sinuses of the prostate. Estimated absorption volume: __________ ml/min.

A

30 ml/min

Risk for fluid overload and toxicity. TURP syndrome.

129
Q

The pressure of infusion is influenced by the height of the irrigation solution. The height should be no more than __________ cm above the patient.

A

60 cm

130
Q

Cardiopulmonary Sx of TURP.
CNS Sx
Metabolic Sx
Misc Sx

A
131
Q

Treating TURP syndrome.

A

Stop the case
Na+ > 120 mEq/L, fluid restriction and lasix
Na+ < 120 mEq/L give 3% at 100 mL/hr, d/c when Na+ >120 mEq/L.

132
Q

Complications of TURP

A

Bladder Perforation
Bleeding
Hypothermia

133
Q

What are the three types of Urolithiasis?

A

Nephrolithiasis - Renal Stone
Ureterolithiasis - Ureter Stone
Cystolithiasis - Bladder Stone

134
Q

What do patients with kidney stones present with?

A

Intermittent or continuous moderate to severe colicky pain in the ipsilateral flank and upper abdomen

135
Q

Treatment for kidney stones.

A

Conservative nonsurgical therapy for smaller stones consists of analgesics (NSAIDS, opioids)

Aggressive fluid administration to promote urine flow and passage of the stone

Medical expulsive therapy (MET)- promotes ureter relaxation and spontaneous passage of small ureteral stones.

ESWL, PCNL, Laser Lithotripsy

136
Q

What is ESWL?

Absolute contraindications for this procedure?

A

Extracorporeal Shock Wave Lithotripsy - a machine that will direct energy to the stone.

Pregnancy and high risk of bleeding.

137
Q

The shock wave of ESWL is timed to the R-wave to reduce the risk of __________.

A

R on T Phenomenon

Other risks include tissue and internal organ trauma.

138
Q

What is a PCNL?

A

Percutaneous Nephrolithotomy.
Place urethral stents and then a nephrostomy tube to access the stone.

139
Q

Paraplegic patients with a sensory deficit below ______ are at risk for autonomic hyperreflexia and require anesthesia to block afferent stimulation that can provoke this reaction (bladder distention).

A

Below T6

140
Q

Patients with a spinal corder injury at _______ or higher are at risk for autonomic hyperreflexia.

A

T7 or higher

Vascular instability, initially a substantial increase BP above the level of the lesion, followed by overzealous vagal response, with bradycardia, heart block, vasodilation, and flushing

141
Q

Patients with idiopathic hypercalciuria, treated with _______-

A

thiazide diuretics

142
Q

_______ prophylaxis is important, particularly with infected stones or pyelonephritis.

A

Abx

143
Q

When lasers are required, appropriate _______ protection for the perioperative team and patient.

A

eye

144
Q

Combined blood flow through both kidneys accounts for ______ of total cardiac output.

A

20-25%

145
Q

Angiotensin, NE, and ______ influence renal arterial tone.

A

Epinephrine

146
Q

The primary source of urea is in the ________.

A

Liver

147
Q

Normal serum creatinine concentration for males.

Normal serum creatinine concentration for females

A

Males: 0.8-1.3 mg/dL

Females: 0.6 - 1.0 mg/dL

148
Q

Normal creatinine clearance (range): _________

A

110-150 mL/min

149
Q

Creatinine clearance measurements for mild renal impairment (range) __________

A

40-60 mL/min

150
Q

Creatinine clearance measurements for moderate renal impairment (range) __________

A

25-40 mL/min

151
Q

These drugs undergo hepatic metabolism and conjugation prior to elimination in the urine (Select all that apply).

A. Pavulon
B. Benzos
C. Opioids
D. Anectine

A

A, B, and C

Anectine (Sch) is metabolized by plasma cholinesterase

152
Q

What is the ideal anesthetic agent for renal patients?

A

Forane (Isoflurane)

153
Q

Which kidney is lower?

A

The right kidney is slightly lower than the left kidney.

154
Q

What are the three layers of the kidney?

A

Renal capsule
Renal fascia
Adipose capsule

155
Q

Acceptable urine output in the OR is _____ mL/kg/hr unless the patient is on bypass, then it is ______ml/kg/hr.

A

0.5 mL/kg/hr (OR)

1 mL/kg/hr (bypass)

156
Q

Renin is secreted by the _______.

A

Juxtaglomerular Apparatus

Health Assessment Spring 2024 (24 decks)

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