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Green PANCE book Flashcards

1
Q

a syndrome of rapidly deteriorating glomerular filtration rate (GFR) with the accumulation of nitrogenous wastes (urea, creatinine) referred to as azotemia

A

Acute renal failure (Acute Kidney Injury)

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2
Q

Serum creatinine increases by more than 0.5 mg/dL or more than 50% over baseline levels

A

Acute renal failure (Acute Kidney Injury)

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3
Q

The classification of ARF (acute renal failure) in the critical care setting is based on….

A

GFR

Urine output

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4
Q 
Risk of renal dysfunction
Injury to kidney
Failure of kidney function
Loss of kidney function
End stage kidney dz
A

RIFLE classification of renal disease

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5
Q

Reduced renal perfusion and

Acute tubular necrosis

A

2 diseases that account for majority of ARF

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6
Q 
Exposure to nephrotoxins
Family hx of renal disease
Urologic disease
Contributing factors like.....
HTN, hypotension, volume loss, CHF or diabetes
A

increased risk of ARF

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7
Q 
N/V/D
Pruritus
Drowsiness
Dizziness
Hiccups
SOB
Anorexia
Hematochezia
A

General symptoms of ARF

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8
Q

Tachycardia and hypotension may indicate a _____ cause of ARF

A

prerenal

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9
Q

A distended bladder, costovertebral angle tenderness or enlarged prostate may indicate a _____ cause of ARF

A

postrenal

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10
Q 
anuria or oliguria
change in volume status (weight)
change in mental status
edema
weakness
dehydration
rashes
JVD
uriniferous odor
ecchymosis
A

signs of ARF

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11
Q

The key parameter in measuring renal function

A

GFR

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12
Q

_____ and _____ are helpful for monitoring renal insufficiency and provide clues to cause

A

BUN and creatinine

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13
Q

____ provides an estimate of renal function but is more sensitive to dehydration, catabolism, diet, renal perfusion, and liver disease

A

BUN

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14
Q

Urea is reabsorbed in the nephron during stasis, which causes false elevations of…

A

BUN

*therefore is not a reliable indicator of renal function

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15
Q 
Hypovolemia
Hypotension
Ineffective circulating volume (CHF, cirrhosis, nephrotic syndrome, early sepsis)
Aortic aneurysm 
Renal artery stenosis or embolic disease
A

PRE-renal causes of ARF

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16
Q

Acute tubular necrosis
Nephrotoxins (NSAIDs, aminoglycosides, radiologic contrast)
Interstitial disease (acute interstitial nephritis, SLE, infection)
Glomerulonephritis
Vascular disease (PAN, vasculitis)

A

Intrinsic renal causes of ARF

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17
Q 
Tubular obstruction
Obstructive uropathy (urolithiasis, BPH, bladder outlet obstruction)
A

POST-renal causes of ARF

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18
Q

Urinalysis is essentially normal in what types of ARF?

A

Post renal and Pre renal

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19
Q

Granular casts, WBCs and casts, RBCs and casts, proteinuria and tubular epithelial cells indicate what type of ARF?

A

Intrinsic

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20
Q

Serum cystatin C is a serum biomarker that can detect…

A

AKI (acute kidney injury)

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21
Q

Urine sodium under 20 mEq/L

Elevated BUN:Cr ratio of 20:1

A

Pre renal ARF

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22
Q

Increased urine sodium greater than 40 mEq/L

Decreased BUN:Cr ratio of under 15:1

A

Intrinsic ARF

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23
Q

a kidney smaller than 10 cm (looked at with renal ultrasonography) indicates a…

A

chronic problem

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24
Q

Azotemia (increase in BUN)
decreased creatinine clearance
metabolic acidosis
hyperkalemia

A

lab findings associated with loss of renal function

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25
Treatment= achievement of normal hemodynamics (IV fluids, improving cardiac output) This is for what type of ARF?
Pre renal
26
Treatment= adjustment and avoidance of medications and nephrotoxic agents This is for what type of ARF?
Intrinsic
27
Treatment= relief of urinary tract obstruction (ureteral stents, urethral catheter) This is for what type of ARF?
Post renal
28
Short term dialysis should be implemented when serum creatinine exceeds...
5-10 mg/dL
29
The progression of ongoing loss of kidney function (GFR)
chronic kidney disease (CKD)
30
Kidney damage with normal GFR greater than 90 and persistent albuminuria
Stage 1 CKD
31
Kidney damage with mild decrease in GFR 60-89
Stage 2 CKD
32
Moderate decrease in GFR from 30-59
Stage 3 CKD
33
Severe decrease in GFR from 15-29
Stage 4 CKD
34
Kidney failure with GFR less than 15
Stage 5 CKD
35
These CKD pts are typically asymptomatic without an increase in BUN or serum creatinine; acid base maintenance is adaptive through an increase in remaining nephron function
Stage 1 and 2
36
These CKD pts may still be asymptomatic; however, serum creatinine and BUN increase. Other hormones (PTH, erythropoietin, calcitriol) become abnormal
Stage 3 CKD
37
These CKD pts may become symptomatic with anemia, acidosis, hyperkalemia, hypocalcemia and hyperphosphatemia
Stage 4 CKD
38
These CKD patients are candidates for renal replacement therapy
Stage 5 CKD
39
Diabetes Hypertension Glomerulonephritis Polycystic kidney disease are the most common causes of.....
CKD
40
Patients with CKD generally progress to...
chronic renal failure
41
5 year survival rate for chronic renal failure
35%
42
Uremic symptoms may develop insidiously and include: fatigue, malaise, anorexia, nausea, vomiting, metallic taste, hiccups, dyspnea, orthopnea, impaired mentation, insomnia, irritability, muscle cramps, restless legs, weakness, pruritus, easy bruising and altered consciousness
Stages 3-5 CKD
43
Signs include: cachexia, weight loss, muscle wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis, Kussmaul respirations
CKD
44
Gold standard diagnostic for CKD?
GFR!*
45
This formula requires the patient age, body weight and serum creatinine
Cockcroft-Gault
46
Proteinuria is a marker for..
kidney damage
47
BUN and creatinine are elevated in
CKD
48
Serum biomarker cystatin C is _____ when the GFR is less than 88
elevated
49
These 2 drug classes slow the progression of renal dysfunction, particularly in proteinuric patients
ACE inhibitors | ARBs
50
May result from cellular redistribution from the intracellular to the extracellular compartment, potassium retention, impaired potassium excretion, or elevations caused by increased tissue breakdown**
HYPERkalemia
51
most commonly associated with renal failure, ACE inhibitors, hyporeninemic hypoaldosteronism, cell death and metabolic acidosis
HYPERkalemia
52
Can result in dysrhythmias and cardiac arrest *numbness, tingling, weakness, flaccid paralysis
severe HYPERkalemia
53
ECG changes evolve as potassium rises to greater than 6. The earliest ECG manifestation is...
peaking of T waves
54
Flattening of the P wave, prolongation of the PR interval, and widening of the QRS complex are seen with severe...
HYPERkalemia
55
Can result from a shift of potassium into the intracellular compartment or from potassium losses of extra-renal or renal origin
HYPOkalemia
56
Can cause: ventricular arrhythmias, hypotension and cardiac arrest *also..malaise, skeletal muscle weakness, cramps, smooth muscle involvement (leading to constipation)
HYPOkalemia
57
increased ____ levels result in increased serum calcium and decreased phosphorus
PTH
58
Parathyroid disorders, chronic renal failure, and malignancy are the most common disorders of....
Calcium and Phosphorus
59
one of the most common disorders, especially in hospitalized patients with malignancy
HYPERcalcemia *Vitamin D intoxication, hyperparathyroidism and sarcoidosis can also cause
60
Drink plenty of fluids Strain urine Analgesics (NSAIDs, Opiods) Alpha blocker or CCB may help w passage
Tx for majority of nephrolithiases (renal calculi)
61
Elective lithotripsy or uretoscopy may be used in stones measuring....
5-10mm
62
Gold standard for stones greater than 10 mm if RENAL FUNCTION IS JEOPARDIZED
Urethral stent or percutaneous nephrostomy
63
Typically results from chronic disease (most common cause is CKD) or HYPOparathyroidism * Trousseau sign * Chvostek sign
HYPOcalcemia
64
Carpal tunnel spasm after BP cuff applied for 3 minutes *seen in hypocalcemia
Tousseau sign
65
Spasm of facial muscle after tapping facial nerve in front of ear *seen in hypocalcemia
Chvostek sign
66
This electrolyte disorder commonly seen secondary to CKD or excessive use of phosphate-containing laxative or enemas
HYPERphosphatemia
67
vitamin D deficiency respiratory alkalosis burns hyperparathyroidism can do what to phosphate levels?
DECREASE *hypophosphatemia
68
Most magnesium is stored in..
bones and muscles
69
Reduced deep tendon reflex Muscle weakness, hypotension, respiratory depression..CARDIAC ARREST N/V and flushing
HYPERmagnesemia
70
IV calcium gluconate is the tx for...
Hypermagnesemia
71
What happens to bleeding and clotting times in Hypermagnesemia
Increased/prolonged
72
What can a CKD pt develop if given laxative or antacid
HyperMg

Renal (15 decks)

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