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Apex Review > Kidney 4 > Flashcards

Kidney 4 Flashcards

1
Q

Loop diuretics include

A

furosemide
bumetanide
ethacrynic acid

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2
Q

lasix dosing is

A

20-200 mg

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3
Q

Bumetanide dosing is

A

0.5-2 mg

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4
Q

Ethacyrnic acid dosing is

A

25-100 mg

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5
Q

Clinical uses of loop diuretics includes

A

acute pulmonary edema
AKI
CHF
hypercalcemia
HTN
anion overdose
intracranial HTN (not as effective as mannitol)
mobilization of edema fluid

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6
Q

Complications of loop diureticcs include

A

hypokalemic, hypochloremic metabolic alkalosis
hypocalcemia
hypomagnesemia
hypovolemia
ototoxicity
hypokalemia
reduced lithium clearance

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7
Q

Thiazide diuretics include

A

hydrochlorothiazide
chlorthialidone
metolazone
indapamide

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8
Q

The hydrochlorothiazide dose is

A

12.5-50 mg

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9
Q

Clinical uses of thiazide diuretics include

A

essential HTn
mobilize edema fluid
CHF
osteoporosis

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10
Q

Complications of thiazide diuretics include

A

hyperglycemia
hypercalcemia
hyperuricemia
hypokalemic, hypochloremic metabolic alkalosis
hypovolemia
HLD
sexual dysfunction

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11
Q

Potassium-sparing diuretics include

A

spironolactone
amiloride
triamterene

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12
Q

Spironolactone exists in a subclass of potassium-sparing diuretics called

A

aldosterone antagonists

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13
Q

Clinical uses of potassium-sparing diuretics include

A

secondary hyperaldosteronism
to reduce K+ loss in a patient receiving a loop or thiazide diuretic

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14
Q

Complications of potassium-sparing diuretics include

A

hyperkalemia
metabolic acidosis
gynecomastia
libido changes
nephrolithiasis

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15
Q

Identify the BEST tests of tubular function. (select 2)
a. blood urea nitrogen
b. urine osmolality
c. fractional excretion of sodium
d. creatinine clearance

A

b. urine osmolality
c. fractional excretion of sodium

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16
Q

Renal function tests provide an assessment of either

A

glomerular function or tubular function

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17
Q

Test of glomerular function include

A

BUN
serum creatinine
creatinine clearance

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18
Q

Tests of tubular function (concentrating ability) include

A

fractional excretion of sodium
urine osmolality
urine sodium concentration
urine specific gravity

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19
Q

Normal BUn is

A

10-20 mg/dL

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20
Q

Normal serum creatinine is

A

0.7-1.5 mg/dL

21
Q

Normal creatinine clearance is

A

110-150 mL/min

22
Q

Normal fractional excretion of sodium is

A

1-3%

23
Q

Normal urine osmolality is

A

65-1,400 mOsm/L

24
Q

Normal urine sodium concentration is

A

130-260 mEq/day

25
Q

Normal urine specific gravity is

A

1.003-1.030

26
Q

The best indicator of GFR is

A

creatinine clearance

27
Q

_______ is the primary metabolite of protein metabolism in the liver

A

Urea

28
Q

A BUN of <8 mg/dL is indicative of

A

overhydration
decreased urea production- malnutrition, severe liver disease

29
Q

A BUN of 20-40 mg/dL is indicative of

A

dehydration
decreased GFR
increased protein input- increased diet, GI bleed, hematoma breakdown
catabolism- trauma, sepsis

30
Q

A BUN of >50 mg/dL is indicative of

A

a decreased GFR

31
Q

________ is produced by skeletal muscle and __________ is a metabolic byproduct of ________ breakdown

A

creatine; creatinine, creatine breakdown

32
Q

Normal BUN: Cr ratio is

A

10:1

33
Q

A BUN: Cr ratio of __________ suggests prerenal azotemia

A

> 20:1

34
Q

Working kidneys_________ sodium, while failing kidneys _______ sodium

A

conserve; waste

35
Q

If the fractional excretion of sodium is <1%, this suggests

A

prerenal azotemia
(more sodium is conserved relative to the amount of creatine cleared)

36
Q

If the fractional excretion of sodium is >3%, this suggests

A

impaired tubular function (more sodium is excreted relative to the amount of creatinine cleared

37
Q

A large amount of protein in the urine indicates

A

glomerular injury (>750 mg/day or +3 by urinalysis)

38
Q

_________ is a better test of tubular function than specific gravity

A

Urine osmolality

39
Q

What are the diagnostic test values for prerenal oliguria?

A

Fractional excretion of Na+ <1
Urinary Na+ <20
Urine osmolality >500
BUN: creatinine ratio >20:1
Sediment: normal, possible hyaline casts

40
Q

What are the diagnostic test values for acute tubular necrosis?

A

fractional excretion of Na+: >3
urinary Na+: >20
urine osmolality <400
BUN:Creat ration: 10-20:1
sediment: granular casts, tubular epithelial cells

41
Q

Anesthetic considerations for AKI include (Select 2:)
a. prerenal azotemia can cause acute tubular necrosis
b. hydroxyethyl starches are associated with an increased risk of renal morbidity
c. renal dose dopamine prevents AKI
d. diuretics should be used to convert oliguric to nonoliguric AKI

A

a. prerenal azotemia can cause acute tubular necrosis
b. hydroxyethyl starches are associated with an increased risk of renal morbidity

42
Q

The most significant source of perioperative morbidity and mortality is

A

acute kidney injury

43
Q

The most common cause of perioperative kidney injury is

A

ischemia-reperfusion injury

44
Q

Patients at greatest risk for AKI include

A

those with pre-existing kidney disease
CHF
advanced age
sepsis

45
Q

The problem with using urine output as a surrogate of renal perfusion is that oliguria is often the result of

A

the physiologic response to perioperative stress (increased ADH release during surgey)

46
Q

We can classify AKI on the basis of

A

prerenal
intrinsic
or post renal injury

47
Q

Prerenal injury is indicative of

A

hypoperfusion

48
Q

Intrinsic injury is indicative of

A

parenchymal

49
Q

Postrenal injury is indicative of

A

obstruction

Apex Review (224 decks)

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