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Renal > Green PANCE book > Flashcards

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
Q

Treatment= achievement of normal hemodynamics (IV fluids, improving cardiac output)

This is for what type of ARF?

A

Pre renal

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26
Q

Treatment= adjustment and avoidance of medications and nephrotoxic agents

This is for what type of ARF?

A

Intrinsic

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27
Q

Treatment= relief of urinary tract obstruction (ureteral stents, urethral catheter)

This is for what type of ARF?

A

Post renal

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28
Q

Short term dialysis should be implemented when serum creatinine exceeds…

A

5-10 mg/dL

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29
Q

The progression of ongoing loss of kidney function (GFR)

A

chronic kidney disease (CKD)

30
Q

Kidney damage with normal GFR greater than 90 and persistent albuminuria

A

Stage 1 CKD

31
Q

Kidney damage with mild decrease in GFR 60-89

A

Stage 2 CKD

32
Q

Moderate decrease in GFR from 30-59

A

Stage 3 CKD

33
Q

Severe decrease in GFR from 15-29

A

Stage 4 CKD

34
Q

Kidney failure with GFR less than 15

A

Stage 5 CKD

35
Q

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

A

Stage 1 and 2

36
Q

These CKD pts may still be asymptomatic; however, serum creatinine and BUN increase. Other hormones (PTH, erythropoietin, calcitriol) become abnormal

A

Stage 3 CKD

37
Q

These CKD pts may become symptomatic with anemia, acidosis, hyperkalemia, hypocalcemia and hyperphosphatemia

A

Stage 4 CKD

38
Q

These CKD patients are candidates for renal replacement therapy

A

Stage 5 CKD

39
Q

Diabetes
Hypertension
Glomerulonephritis
Polycystic kidney disease

are the most common causes of…..

A

CKD

40
Q

Patients with CKD generally progress to…

A

chronic renal failure

41
Q

5 year survival rate for chronic renal failure

A

35%

42
Q

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

A

Stages 3-5 CKD

43
Q

Signs include: cachexia, weight loss, muscle wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis, Kussmaul respirations

A

CKD

44
Q

Gold standard diagnostic for CKD?

A

GFR!*

45
Q

This formula requires the patient age, body weight and serum creatinine

A

Cockcroft-Gault

46
Q

Proteinuria is a marker for..

A

kidney damage

47
Q

BUN and creatinine are elevated in

A

CKD

48
Q

Serum biomarker cystatin C is _____ when the GFR is less than 88

A

elevated

49
Q

These 2 drug classes slow the progression of renal dysfunction, particularly in proteinuric patients

A

ACE inhibitors

ARBs

50
Q

May result from cellular redistribution from the intracellular to the extracellular compartment, potassium retention, impaired potassium excretion, or elevations caused by increased tissue breakdown**

A

HYPERkalemia

51
Q

most commonly associated with renal failure, ACE inhibitors, hyporeninemic hypoaldosteronism, cell death and metabolic acidosis

A

HYPERkalemia

52
Q

Can result in dysrhythmias and cardiac arrest

*numbness, tingling, weakness, flaccid paralysis

A

severe HYPERkalemia

53
Q

ECG changes evolve as potassium rises to greater than 6. The earliest ECG manifestation is…

A

peaking of T waves

54
Q

Flattening of the P wave, prolongation of the PR interval, and widening of the QRS complex are seen with severe…

A

HYPERkalemia

55
Q

Can result from a shift of potassium into the intracellular compartment or from potassium losses of extra-renal or renal origin

A

HYPOkalemia

56
Q

Can cause: ventricular arrhythmias, hypotension and cardiac arrest
*also..malaise, skeletal muscle weakness, cramps, smooth muscle involvement (leading to constipation)

A

HYPOkalemia

57
Q

increased ____ levels result in increased serum calcium and decreased phosphorus

A

PTH

58
Q

Parathyroid disorders, chronic renal failure, and malignancy are the most common disorders of….

A

Calcium and Phosphorus

59
Q

one of the most common disorders, especially in hospitalized patients with malignancy

A

HYPERcalcemia

*Vitamin D intoxication, hyperparathyroidism and sarcoidosis can also cause

60
Q

Drink plenty of fluids
Strain urine
Analgesics (NSAIDs, Opiods)
Alpha blocker or CCB may help w passage

A

Tx for majority of nephrolithiases (renal calculi)

61
Q

Elective lithotripsy or uretoscopy may be used in stones measuring….

A

5-10mm

62
Q

Gold standard for stones greater than 10 mm if RENAL FUNCTION IS JEOPARDIZED

A

Urethral stent or percutaneous nephrostomy

63
Q

Typically results from chronic disease (most common cause is CKD) or HYPOparathyroidism

  • Trousseau sign
  • Chvostek sign
A

HYPOcalcemia

64
Q

Carpal tunnel spasm after BP cuff applied for 3 minutes

*seen in hypocalcemia

A

Tousseau sign

65
Q

Spasm of facial muscle after tapping facial nerve in front of ear

*seen in hypocalcemia

A

Chvostek sign

66
Q

This electrolyte disorder commonly seen secondary to CKD or excessive use of phosphate-containing laxative or enemas

A

HYPERphosphatemia

67
Q

vitamin D deficiency
respiratory alkalosis
burns
hyperparathyroidism

can do what to phosphate levels?

A

DECREASE

*hypophosphatemia

68
Q

Most magnesium is stored in..

A

bones and muscles

69
Q

Reduced deep tendon reflex
Muscle weakness, hypotension, respiratory depression..CARDIAC ARREST
N/V and flushing

A

HYPERmagnesemia

70
Q

IV calcium gluconate is the tx for…

A

Hypermagnesemia

71
Q

What happens to bleeding and clotting times in Hypermagnesemia

A

Increased/prolonged

72
Q

What can a CKD pt develop if given laxative or antacid

A

HyperMg

Renal (15 decks)

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