kidney

Question 1

endocrine funcion of kidey

Answer 1

erythropoieten (helps make red blood cells), renin, and prostaglandins

Question 2

metabolic function of kidney

Answer 2

metabolism of vitamin D, insulin, and other small proteins

Question 3

renal blood flow in L/min

Answer 3

1.3 L/min

Question 4

renal plasma flow is what percentage of blood flow

Answer 4

60%

Question 5

why is GFR so large

Answer 5

to maintain homeostasis of waste products present in plasma in low concentration (like urea)

Question 6

normal GFR

Answer 6

80-120 cc/min

Question 7

limitations of creatinine clearance

Answer 7

1. incomplete urine collection – can underestimate
2. ingestion of cooked meats – underestimates
3. litle muscle mass / like in elderly can over-estimate as plasma levels are lower
4. increased secretion of creatinine as renal function declines with age (over-estimate)

Question 8

plasma creatine level in male vs female (normal)

Answer 8

male - 0.8-1.3

female - 0.6-1.0

Question 9

where/ when do you see the major loss in GFR in relation to plasma creatinine?

Answer 9

initial elevation in the Pcr shows major loss in GFR

Question 10

GFR is only accurate when?

Answer 10

in steady state

Question 11

T/F most anibiotics need to be dose adjusted for patients with advanced renal failure?

Answer 11

TRUE

Question 12

effect of NSAIDs with renal impaired patients

Answer 12

can decrease the GFR more and lead to life threatening hyperkilemia

Question 13

acute renal failure manifested as?

Answer 13

increased BUN and increase in serum creatinine and sometimes with oliguria (decreased urine output)

Question 14

breakdown of acute renal failure

Answer 14

1. pre-renal
2. renal
3. post-renal

Question 15

two severe manifestations of pre-renal failure

Answer 15

1. acute tubular necrosis

2. acute cortical necorsis

Question 16

pre-renal?

Answer 16

acute – due to “effective” volume depletion and the intrinsic function of the kidney is in tact - so is reversible if treated

elevation of Pcr and BUN due to volume depletion

Question 17

causes of interstitial nephritis renal failure

Answer 17

NSAIDs and antibiotics (penicillen and analogous)

Question 18

post-streptococcal GN?

Answer 18

common cause of glomerulonephroitis in children

Question 19

post-renal failure associated with?

Answer 19

obstructive – like with the prostate inflammed

Question 20

population to be careful with drug doses

Answer 20

ELDERLY

Question 21

uremic effects with drug dosing

Answer 21

alters/ decreases the GI absorption

alter protein binding with drugs – leads to increased bio-available

cause chelation and formation of nonabsorbable complexes

Question 22

patient risk profile with NSAIDs (who is at risk when aking these)

Answer 22

1. pre-existing renal disease
2. diabetes
3. heart failure
4. old age
5. liver disease
6. volume depletion
7. patients on potassium dependent supplements and ACE inhibitors

Question 23

goal BP of patient with diabetes or CKD

Answer 23

less than 140/90 (although new study shows 130/80 with large benefit )

Question 24

essential and secondary hypertension breakdown in causes

Answer 24

90% are essential causes

2nd causes – Renal disease accounts for 80%

Question 25

*may want to consider using what when treating hypertensive patients?

Answer 25

NO or naxiolytics

must continue their anti-hypertensive medications (like Diuretics, calcium channel blockers, ACE inhibitors, angiotesnsin receptor blockers, B-blockers, Alpha, 1 blockers)

over 160/100 –> refer for medical eval but tx isnt contraindicated

180/110 –> hospilization may be required