Pathology, Diuretics, & Anesthesia - Final Wrap Up Flashcards
What do Natriuretic Peptides do ?
Long-Term Sodium-Water, Blood Volume, and Arterial Pressure Regulation by Vasodilation and Renal Natriuresis & Diuresis.
How do Natriuretic Peptides affect the CV System?
↑Venous Compliance
↓Preload & ↓CVP
↓CO
↓SVR
↓PCWP
How do Natriuretic Peptides affect the Kidneys?
↑GFR
Inhibits Renin Release
Inhibits Aldosterone Secretion
Inhibits ADH Secretion
↓Angiotensin II
What stimulates Atrial Natriuretic Peptide release?
Atrial Stretch or ↑ECF
Where in the Kidney does ANP act to Decrease Sodium Reabsorption?
Collecting Duct
Where is Brain Natriuretic Peptide synthesized?
Heart Ventricles
What happens w/ the Chronic use of Diuretics?
Decreased Effects
Where in the Kidneys do Loop Diuretics, like Bumex & Lasix work?
Thick Ascending Limb of Loop of Henle
Where in the Kidney do Thiazides work?
Distal Convoluted Tubule
Where do Potassium-Sparing Diuretics work?
Distal Tubule & Collecting Duct
Where in the Kidney does Mannitol & Diamox work?
Proximal Tubule
How do Osmotic Diuretics like Mannitol & Urea work?
Gets filtered & stuck in the Tubules and draws in fluid with them
How do Loop Diuretics like Lasix, Bumex, and Ethacrynic Acid work?
Inhibits the Na-2Cl-K pump in the TAL and stops the Countercurrent System
Thiazides are most commonly used & stops Sodium Reabsorption in the DCT. How do they affect Potassium Levels?
Can cause Hypokalemia & Alkalosis b/c increased Sodium in the DCT stimulates Aldosterone sodium pump to exchange Potassium & H+ for Sodium
How do Carbonic Anhydrase Inhbitors, like Diamox, work?
↓Na Reabsorption in PCT by decreasing the Bicarb Reabsorption that is coupled to the Sodium, which can cause Acidosis
What is the main use for Diamox?
Treats Glaucoma
How do Aldosterone Antagonist like Spironolactone work?
Spares Potassium via a decrease in Na Reabsorption & K+ Secretion by competing for aldosterone binding sites in the DCT.
Which class of Diuretics are Amiloride & Triamterene?
Sodium Channel Blockers
How do Na Channel Blockers work?
Decrease Na Reabsorption by decreasing Na/K-ATPase in the Collecting Tubule, which also spares Potassium
What is the difference b/t Acute Kidney Injury vs. Chronic Kidney Disease?
AKI: Acute decline or complete loss of kidney function that eventually recovers back to normal
CKD: Irreversible decrease in Functional Nephrons
What are the leading causes of ESRD?
1 - Diabetes
When would you start to see symptoms of CKD?
When there are < 70% of Functional Nephrons
How is Chronic Kidney Disease defined?
Kidney Damage or Decreased Kidney Function lasting 3 months or more
How much of a decrease in functioning nephrons would result in abnormal electrolytes & body fluid volumes?
A decrease below 20-25% of normal
What causes CKD?
Renal Vasculature Injury
Glomerulonephritis
Infection
Nephrotic Syndrome
What are some causes of Renal Vasculature Injury?
Atherosclerosis
Fibromuscular Dysplasia
Nephrosclerosis
What are some causes of Glomerulonephritis?
Antigen-Antibody Complexes
Strep Infection
Lupus
What is Nephrotic Syndrome?
Loss of Negative Charge in Basement Membrane from Proteinuria
What is Pyelonephritis?
E. Coli Infection, affecting the Renal Medulla & Impairs Ability to concentrate Urine
What are the effects of Uremia?
Edema
Anemia
Acidosis
↑Nitrogenous Waste
↑K, Phosphates & Phenol
↑CO for more O2 Carrying Capacity
What are the signs of Uremic Syndrome?
Anorexia
N/V
Pruritis
Anemia
Fatigue
Coagulaopathy
What is the biggest risk factor for ESRD?
Obesity b/c it causes DM & HTN
How does Renal Failure affect Minute Ventilation
Increase Minute Ventilation to compensate for Acidosis
How does Renal Failure cause Osteomalacia?
Vitamin D is converted by Liver & Kidneys. Inablity to do this causes Secondary Hyperparathyroidism to get calcium from bones
How does Renal Failure affect the GI?
Gastroparesis
&
Gastric Acid Hypersecretion –> Ulcers
What happens to the other Kidney if one of them gets damaged?
Renin & Angiotensin II from the damaged kidney affects the good kidney
During Dialysis, what does the Rate of Solute Movement depend on?
Concentration Gradient
Membrane Permeability & Surface Area
Length of Time
How much blood is there in the Dialysis Machine at any given time?
500 cc
What does Dialyzing Fluid NOT have in it?
Phosphate
Urea
Urate
Sulfate
Creatinine
When is Hemodialysis indicated?
Metabolic Encephalopthy
Coagulopathy
Pericarditis
Refractory GI Problems
HyperKalemia
Fluid Overload
Acidosis
Drug Toxicity
What can cause an Increased BUN?
↓GFR
↑Protein Breakdown
Sepsis
GI Bleed
What is the Normal BUN & Creatinine?
BUN: 10-20 mg/dL
Creatinine: 0.8 - 1.3 mg/dL
Creatinine Concentration is ______ related to Muscle Mass & _______ related to GFR
Creatinine Concentration is DIRECTLY related to Muscle Mass & INVERSELY related to GFR
How is the GFR affected by age?
5% decrease per decade after 20
With Renal Tubular Acidosis, what would you exepct the Urinary pH to be?
Urinary pH > 7.0
How would impaired Renal Function affect Barbiturates?
More Senstive d/t ↓Protein Binding
How does impaired Renal Function affect Propofol, Ketamine, & Etomidate?
No Difference
How are Benzos affected by impaired Renal Function?
↑Duration
How does impaired Renal Function affect Precedex?
↑Duration
Which Opioids are safe to use with impaired Renal Function?
Fentanyl
Other opioids may accumlate d/t metabolites
How are Reglan & Anticholinergics affected by Impaired Renal Function?
Ok for 1 time dose, but can accumulate if more
What can happen when using Sevoflurane in the setting of Impaired Renal Function?
Flouride Accumulation
Which NMBs should be avoided in pts. w/ impaired renal function?
Pancuronium
Pipercuronium
Doxacurium
Alcuronium
What are the NMBs of choice w/ Impaired Renal Function?
Cis-Atracurium d/t Hoffman Elimination
How is Suggamadex viewed in the setting of ESRD?
Should be avoided, but not much data
What is the main cause of Peri-Op Renal Failure?
Hypovolemia
What are the main symptoms of Kidney Stones?
Pain & Hematuria
Calcium Oxalate is the most common type of Kidney Stone. What caues this buildup?
Not enough Dietary Calcium
What size Kidney Stones can usually pass on their own?
< 4mm
What drugs can help pass the stone by decreasing Ureter Tone?
Alpha Blockers - Terazosin
What procedures are used to treat Kidney Stones?
ESWL
Ureteroscopic Fragmentation
Perc. Nephrolithotomy
Double J Stents
What are contraindications to ESWLs?
Can’t Position
Pregnancy
Infection
Obstruction Below Stones
Prosthesis Near Stones
How are kidney stones prevented?
Hydration
Avoid Soda
Limit Dietary Protein, Nitrogen, & Sodium
What kind of diet may cause Gout?
Diet rich in Protein, Fat, & Alcohol
How is Gout Treated?
NSAIDs
Steroids
Acetazolamide
Colchincine
What drugs can prevent Gout?
Allopurinal
Uricocurics
Caffeine
CPAP (since gout associated w/ Sleep Apnea)
