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MI Internal Medicine and Infectious Disease > Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease > Flashcards

Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease Flashcards

1
Q

acute renal failure is the rapid decline in _____ function and high ____ _______ waste levels

A

renal, high blood nitrogenous waste levels

common cause of ICU death

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2
Q

clinical presentation of acute renal failure

A

high serum BUN and creatinine

low GFR

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3
Q

filtration definition

A

blood to urine (glomerulus)

anything smaller than a protein

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4
Q

reabsorption definition

A

urine to blood

proximal/distal convoluted tubules

loop of henle

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5
Q

secretion definition

A

blood to urine

K+, H+

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6
Q

creatinine clearance is ~ what

A

the GFR

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7
Q

urine formation begins with _______

A

filtration

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8
Q

filtrate is modified by ______ & _______

A

reabsorption & secretion

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9
Q

definition of GFR

A

volume of fluid filtered from blood plasma to urine/min

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10
Q

creatinine is filtered at the ______; not ______ or ________

A

glomerulus, secreted, reabsorbed

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11
Q

the amount of creatinine filtered = the amount _______

A

excreted

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12
Q

calculation for amount of creatinine filtered

A

filtered = [creat]plasma x GFR

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13
Q

calculation for amount of creatinine excreted

A

excreted = [creat]urine x volume of urine

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14
Q

prerenal failure

A

decreased renal blood flow

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15
Q

causes of prerenal failure

A

hypovolemia

HF

shock

some meds (contrast dye)

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16
Q

prostaglandins dilate the ______ arteriole artery

A

afferent

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17
Q

NSAIDS can cause renal failure in people with…

A

decreased function

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18
Q

prerenal failure results from renal ______ when RBF

A

ischemia, 25%

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19
Q

prerenal failure levels

A

U/O & fractional excretion of Na are low, but SG is high

BUN more elevated than serum creat

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20
Q

at low GFR, urine flow in tubules is _______

A

sluggish

urea is small and high reabsorption when flow is slow

creat is larger and not reabsorbed

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21
Q

postrenal failure

A

obstruction in ureter or bladder

stones, rumors, neurogenic bladder (spinal injury)

re-establish flow, surgically if necessary

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22
Q

intrinsic renal failure

A

damage to the kidney - glomeruli, tubules, or interstitium

causes: ischemia, toxins, tubular obstruction

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23
Q

acute tubular necrosis is the most common cause of….

A

intrinsic renal failure

24
Q

acute tubular necrosis (ATN)

A

destruction of tubular epithelium

caused by ischemia, sepsis, toxins, tubular obstruction

may or may not be reversible

25
Q

acute tubular necrosis is seen in…

A

major surgery with blood loss

massive infection

trauma

burns

26
Q

ATN complicates the use of what

A

potentially nephrotoxic medications

aminoglycosides (gentamycin), chemo, contrast dyes

27
Q

ATN hemoglobin/myoglobin, uric acid

A

Hb, uric acid, myoglobin in urine causes obstruction

Hb from blood rxn

myoglobin from muscle trauma, rhabdomyolosis

28
Q

stages of ATN

A

onset

maintenance

recovery

29
Q

onset stage of ATN

A

hours to days

happens when the initiating event is occuring

30
Q

maintenance stage of ATN

A

low GFR, oliguria, edema, electrolyte imbalance

low dose dopamine may improve renal blood flow

31
Q

recovery stage of ATN

A

nephrons are repairing

gradual increase in U/O

fall in serum creatinine

32
Q

Dx, Rx of ATN

A

Dx: determine cause

Rx: treat symptoms/cause, hemodialysis

33
Q

in prerenal failure the BUN:Creatinine ratio is what

fraction of excreted Na

SG

A

greater than 20:1

less than 1%

greater than 1.02

34
Q

in intrarenal failure the BUN:Creatinine ratio is what

fraction of excreted Na

SG

A

10:1 to 20:1

greater than 1%

1.01 - 1.02

35
Q

the ultrasound for postrenal failure shows

A

hydronephrosis

36
Q

a nephrology consult involves a ________, and a urology consult involves a _______

A

specialist, surgeon

37
Q

chronic kidney disease classification

A

GFR used to define 5 stages

stage 2: modest decline in GFR (hypovolemia)

kidney failure stage 5: very low GFR requires dialysis (permanent loss of nephrons)

38
Q

CKD can result from conditions (3)

A

diabetes

HTN

glomerulonephritis

39
Q

what is the best measure of kidney function

A

GFR - measure of functional nephrons

falls as # of working nephrons falls

40
Q

constant = GFR x [creat]p so if GFR is high, then [creat]p is…

A

low

41
Q

GFR can be measured by ________ clearance or calculated from….

A

creatinine clearance

serum creatinine

42
Q

albuminuia is a marker for _____ injury

A

nephron

43
Q

in CKD there is an accumulation of what

A

nitrogenous waste

BUN is high

uremia

44
Q

CKD causes what imblances

A

electrolyte, cardiovascular, acid/base

reduced ability to regulate Na

sodium retention –> volume expansion –> HTN CHD HF uremia –> pericarditis

hyperkalemia

acidosis

45
Q

calcium and phosphate imbalances in CKD

A

phosphate is high, calcium is low

high PTH –> osteoclast stimulation

sometimes osteoblasts/osteoclasts inhibited

decreased mineralization occurs (osteodystrophies)

46
Q

should you restrict high phosphate foods (milk) and give vitamin D in CKD?

A

yes

47
Q

can CKD cause anemia?

A

yes

low EPO

48
Q

GI symptoms of CKD

A

N/V - urea in intestinal flora

49
Q

neuromuscular symptoms of CKD

A

peripheral neuropathy

encephalopathy

50
Q

other symptoms of CKD

A

poor immune response

poor skin integrity

poor drug elimination

51
Q

slowing progression of CKD

A

BP target 125/65 - ACEI & ARBS

glucose control for those w/ diabetes

stop smoking

52
Q

hemodialysis for CKD

A

blood exchange with dialysis fluid

excess H2O, urea, K+ leaves blood

may need to replace bicarb

53
Q

peritoneal dialysis

A

uses peritoneal memb. as dialysis memb.

infuse 1-3L of soln and equilibriate for 30min

allow to run out

repeat 4x/day

advantage: can be done at home

54
Q

transplantation for CKD

A

from cadaver or living donor

improved anti-rejection meds have increased success

55
Q

dietary management of CKD

A

restrict protein

feed fat/carbs to insure adequate calories

restrict Na/H2O

56
Q

Type of Acute renal failure associated w/ highly concentrated urine is…

A

Pre-renal failure

57
Q

Chronic renal failure produced what acid/base abnormality the most

A

Metabolic acidosis

MI Internal Medicine and Infectious Disease (35 decks)

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