Medicine (renal)

Question 1

What is GFR, how is it measured and why is it important?

Answer 1

-Glomerular filtration rate.
-Measures renal function
-Calculated by clearance of creatinine

Question 1

What is acute kidney injury/failure?

Answer 1

-Loss of renal function over hours to days that results in disturbances in fluid, electrolyte and acid-base homeostasis
-Diagnosed by serum creatinine increase 0.5 mg/dl

Question 2

What are the types of acute renal failure?

Answer 2

-Pre-renal (60%): Hypovolemia, hypotension, sepsis, dehydration

-Intrinsic (30%): Damage to structures of kidney. Toxins (NSAIDs), ischemia, septic

-Post-renal (10%): Obstructive. UTI, bladder dysfunction

Question 3

How can you manage a patient with an AKI that needs contrast dye for a CT scan?

Answer 3

-Pre-treatment with N-acetylcysteine or sodium bicarbonate (protective).
-Minimize contrast load and optimize hydration

Question 4

What is chronic kidney disease?

Answer 4

-A permanent renal insufficiency that develops over months-years caused by structural intrinsic damage of the glomerulus or tubulointerstitial system.
-Occurs with GFR is reduced to 50 mL/min
-Leads to ESRD

Question 5

What is ESRD?

Answer 5

-Irreversible loss of kidney function.
-GFR <15 mL/min
-Dependent on dialysis or renal transplant

Question 6

What are the stages of CKD?

Answer 6

Stage I-5 based on GFR.
1: 90
2: 60-89
3: 30-59
4: 15-29
5: < 15 (ESRD)

Question 7

What are comorbidities associated with CKD?

Answer 7

-Cardiovascular (major cause of mortality, CHF)
-Anemia
-Platelet dysfunction
-GI (nausea/vomiting, increased aspiration risk)
-Glycemic control
-Infection
-Hyperparathyroidism
-Electrolyte disturbances
-Uremia

Question 8

What drugs should be avoided in CKD patients?

Answer 8

-CT contrast
-Aminoglycosides
-Benzos
-Morphine
-Inhaled anesthetics
-Succinylcholine (OK if normal potassium)
-Non-depolarizing muscle relaxants (atracurium is OK to use)

Question 9

What is dialysis?

Answer 9

-Process of removing excess fluid, solutes and nitrogenous wastes
-Hemodialysis: 3 days/week. Blood filtered through port
-Peritoneal dialysis: 5 times/day at home

Question 10

How is a renal disease patient managed?

Answer 10

-Pt should undergo dialysis the day before surgery to minimize complications
-Optimize medical co-morbidities
-Antibiotic prophylaxis for new shunts
-Adequate hemostasis
-Don’t use shunt arm for BP