Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease

Question 1

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

Answer 1

renal, high blood nitrogenous waste levels

common cause of ICU death

Question 2

clinical presentation of acute renal failure

Answer 2

high serum BUN and creatinine

low GFR

Question 3

filtration definition

Answer 3

blood to urine (glomerulus)

anything smaller than a protein

Question 4

reabsorption definition

Answer 4

urine to blood

proximal/distal convoluted tubules

loop of henle

Question 5

secretion definition

Answer 5

blood to urine

K+, H+

Question 6

creatinine clearance is ~ what

Answer 6

the GFR

Question 7

urine formation begins with _______

Answer 7

filtration

Question 8

filtrate is modified by ______ & _______

Answer 8

reabsorption & secretion

Question 9

definition of GFR

Answer 9

volume of fluid filtered from blood plasma to urine/min

Question 10

creatinine is filtered at the ______; not ______ or ________

Answer 10

glomerulus, secreted, reabsorbed

Question 11

the amount of creatinine filtered = the amount _______

Answer 11

excreted

Question 12

calculation for amount of creatinine filtered

Answer 12

filtered = [creat]plasma x GFR

Question 13

calculation for amount of creatinine excreted

Answer 13

excreted = [creat]urine x volume of urine

Question 14

prerenal failure

Answer 14

decreased renal blood flow

Question 15

causes of prerenal failure

Answer 15

hypovolemia

HF

shock

some meds (contrast dye)

Question 16

prostaglandins dilate the ______ arteriole artery

Answer 16

afferent

Question 17

NSAIDS can cause renal failure in people with…

Answer 17

decreased function

Question 18

prerenal failure results from renal ______ when RBF

Answer 18

ischemia, 25%

Question 19

prerenal failure levels

Answer 19

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

BUN more elevated than serum creat

Question 20

at low GFR, urine flow in tubules is _______

Answer 20

sluggish

urea is small and high reabsorption when flow is slow

creat is larger and not reabsorbed

Question 21

postrenal failure

Answer 21

obstruction in ureter or bladder

stones, rumors, neurogenic bladder (spinal injury)

re-establish flow, surgically if necessary

Question 22

intrinsic renal failure

Answer 22

damage to the kidney - glomeruli, tubules, or interstitium

causes: ischemia, toxins, tubular obstruction

Question 23

acute tubular necrosis is the most common cause of….

Answer 23

intrinsic renal failure

Question 24

acute tubular necrosis (ATN)

Answer 24

destruction of tubular epithelium

caused by ischemia, sepsis, toxins, tubular obstruction

may or may not be reversible

Question 25

acute tubular necrosis is seen in...

Answer 25

major surgery with blood loss massive infection trauma burns

Question 26

ATN complicates the use of what

Answer 26

potentially nephrotoxic medications aminoglycosides (gentamycin), chemo, contrast dyes

Question 27

ATN hemoglobin/myoglobin, uric acid

Answer 27

Hb, uric acid, myoglobin in urine causes obstruction Hb from blood rxn myoglobin from muscle trauma, rhabdomyolosis

Question 28

stages of ATN

Answer 28

onset maintenance recovery

Question 29

onset stage of ATN

Answer 29

hours to days happens when the initiating event is occuring

Question 30

maintenance stage of ATN

Answer 30

low GFR, oliguria, edema, electrolyte imbalance low dose dopamine may improve renal blood flow

Question 31

recovery stage of ATN

Answer 31

nephrons are repairing gradual increase in U/O fall in serum creatinine

Question 32

Dx, Rx of ATN

Answer 32

Dx: determine cause Rx: treat symptoms/cause, hemodialysis

Question 33

in prerenal failure the BUN:Creatinine ratio is what fraction of excreted Na SG

Answer 33

greater than 20:1 less than 1% greater than 1.02

Question 34

in intrarenal failure the BUN:Creatinine ratio is what fraction of excreted Na SG

Answer 34

10:1 to 20:1 greater than 1% 1.01 - 1.02

Question 35

the ultrasound for postrenal failure shows

Answer 35

hydronephrosis

Question 36

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

Answer 36

specialist, surgeon

Question 37

chronic kidney disease classification

Answer 37

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)

Question 38

CKD can result from conditions (3)

Answer 38

diabetes HTN glomerulonephritis

Question 39

what is the best measure of kidney function

Answer 39

GFR - measure of functional nephrons falls as # of working nephrons falls

Question 40

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

Answer 40

low

Question 41

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

Answer 41

creatinine clearance serum creatinine

Question 42

albuminuia is a marker for _____ injury

Answer 42

nephron

Question 43

in CKD there is an accumulation of what

Answer 43

nitrogenous waste BUN is high uremia

Question 44

CKD causes what imblances

Answer 44

electrolyte, cardiovascular, acid/base reduced ability to regulate Na sodium retention --> volume expansion --> HTN CHD HF uremia --> pericarditis hyperkalemia acidosis

Question 45

calcium and phosphate imbalances in CKD

Answer 45

phosphate is high, calcium is low high PTH --> osteoclast stimulation sometimes osteoblasts/osteoclasts inhibited decreased mineralization occurs (osteodystrophies)

Question 46

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

Answer 46

yes

Question 47

can CKD cause anemia?

Answer 47

yes low EPO

Question 48

GI symptoms of CKD

Answer 48

N/V - urea in intestinal flora

Question 49

neuromuscular symptoms of CKD

Answer 49

peripheral neuropathy encephalopathy

Question 50

other symptoms of CKD

Answer 50

poor immune response poor skin integrity poor drug elimination

Question 51

slowing progression of CKD

Answer 51

BP target 125/65 - ACEI & ARBS glucose control for those w/ diabetes stop smoking

Question 52

hemodialysis for CKD

Answer 52

blood exchange with dialysis fluid excess H2O, urea, K+ leaves blood may need to replace bicarb

Question 53

peritoneal dialysis

Answer 53

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

Question 54

transplantation for CKD

Answer 54

from cadaver or living donor improved anti-rejection meds have increased success

Question 55

dietary management of CKD

Answer 55

restrict protein feed fat/carbs to insure adequate calories restrict Na/H2O

Question 56

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

Answer 56

Pre-renal failure

Question 57

Chronic renal failure produced what acid/base abnormality the most

Answer 57

Metabolic acidosis