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Principles > Principles-Renal/GU disease and procedure management > Flashcards

Principles-Renal/GU disease and procedure management Flashcards

1
Q

Renal pain sensation is conveyed to which spinal cord segments

A

T10-L1

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2
Q

Sympathetic innervation is supplied by preganglionic fibers from

A

T8-L1

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3
Q

The vagus nerve provides PS invervation to the kidney, but what PS fibers supply the ureters

A

S2-S4

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4
Q

The bladder receives its innervation from sympathetic nerves originating

A

T11-L2

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5
Q

PS fibers transmit bladder stretch sensations and motor function to

A

S2-S4

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6
Q

Describe the Renin-Angiotension-Aldosterone System’s responds to hypovolemia, hypotension, and hyponatremia

A

Liver hepatocytes constantly produce angiotensinogen which circulates in the plasma

Juxtamedullary apparatus is composed of afferent arteriales and macula densa cells in distal convoluted tubules. Macula densa (chemoreceptors) sense decreased sodium and relase renin.

Renin convertes angiotensinogen to angiotension I. Angiotensin I is converted to Angiostensin II by ACE found in lungs.

Angiotensin II stimulates hypothalmus’ thirst center and signals it to cause posterior pituitary to release ADH.

ADH increase aquaporin presence in collecting tubule to reabsorb water

Angiotensin II stimulate the adrenal cortex to release Aldosterone

Aldosterone increases NaCL channels in ascending loop of henle, and collecting ducts while causing potassium to be excreted

Angiotension II is a potent vasoconstrictor which increase blood pressure

Net result is a increase in plasma volume and bp

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7
Q

What mechanisms antagonize the RAAS

A

Atrial Natriuretic peptide

  • blocks reabsorption of sodium in DT and CD
  • increases GFR
  • inhibits the release of renin

Nitric Oxide
-opposes renal vasoconstrictor effects of angiotensin II and SNS

Renal prostaglandin system
-during times of stress, opposes ADH and RAAS

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8
Q

Assessing kidney fx is best done by observing the

A

filtration rate

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9
Q

Acute declines in the filtration capacity indicate

A

kidney injury and predict a more complicated clinical course

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10
Q

What is the normal GFR

A

90-140 mL/min

  • GFR < 60= impaired
  • GFR< 15= uremia and dialysis need
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11
Q

What is the most useful clinical marker to assess renal filtration

A

creatinine

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12
Q

what is the normal serum creatinine level

A
  1. 8-1.3 mg/dL men

0. 6-1.0 mg/dL women

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13
Q

Can renal dysfunction exist with normal creatinine levels

A

Yes, because serum creatinine does not usually rise until GFR fall bellow 50 mL/min

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14
Q

Should you expect an increase in creatinine as you age

A

No, because although GFR declines with age, so does muscle mass

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15
Q

Following acute kidney injury, should you expect an immediate increase in creatinine

A

No, In the early stages of severe acute renal failure, the serum creatinine may be low even though the actual GFR is markedly reduced

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16
Q

Anesthetist use urinalyisis to assess

A

urine drug screen
urine pregnancy test
protein analysis

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17
Q

Is it possible to have renal failure without oliguria

A

Yes- the majority of perioperative renal failure demonstrate this

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18
Q

During times of stress (trauma and shock), how does the SNS influence the kidney to restore intravascular volume and maintain blood pressure

A

release of NE which constricts renal arterioles
activates RAAS»aldosterone & ADH

*Net result is a blood flow shit from renal cortex to renal medulla, sodium and water reabsorption, and decreased UO

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19
Q

What will result if the stress response is not reversed

A

ischemic damage and acute renal failure

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20
Q

What is the most common cause of AKI

A

Acute tubular necrosis

21
Q

List the three primary nephrotoxic agents discussed

A

NSAIDS

Myoglobin/Hemoglobin

Inhalation Anesthetics

22
Q

NSAIDS are harmful to the kidneys in a distinct population of individuals, namely

A 
advanged age
hypovolemia
the very sick
overdose
renal hypoperfusion or vasoconstriction

*NSAIDS (ketorolac) prevent prostaglandins formation

23
Q

Myoglobin is harmful to the kidneys because it

A

readily filters at the glomerulus and reabsorbs by the renal tubule, where it chelates NO and induces medullary vasoconstriction and ischemia

24
Q

The effects of anesthesia on the kidneys are usually r/t

A 
CV depressant (bp) effects of anesthesia 
*less marked during regional anesthesia

SNS activation assoc. with light anesthesia, surgical stimulation causes autoregulatory mechanisms of kidney to vasoconstrict which would decrease RBF

Endocrine responses via stress response which causes catecholamine surge and decreased RBF

25
Q

The negative effects of anesthesia on the kidneys can be blunted by maintaining

A

adequate intravascular volume and a normal blood pressure

26
Q

Name two inhalation agents that can theoretically cause renal toxicity in high doses

A

methoxyflurane and sevoflurane

27
Q

Of the induction and sedation agents, which drugs will least likely cause an increase in free circulating drug in kidney disease patients

A

propofol
ketamine
etomidate

*Not highly protein bound

28
Q

The opioid meperidine can increase risk for what in renal disease

A

seizure r/t active metabolite normeperidine

29
Q

What two opioids are best for patients with renal failure

A

Fentanyl

Remifentanil-metabolized rapidly by ester hydrolysis in blood

30
Q

What type of drug is more likely than any drug used in anesthesia to cause prolonged effects in ESRD patients

A

muscle relaxants

31
Q

What NDMB will not accumulate in patients with renal failure

A

Cisatricurium

  • undergoes Hoffman elimination
  • increase pH and Temp causes increase in metabolism
32
Q

Patients with ESRD typically cannot excrete potassium resulting in hyperkalemia. Is succinylcholine safe for patient’s with ESRD

A

Yes, if potassium is < 5.5 mEq/L

33
Q

What are the two highest risk surgical patients for renal complicatons

A

by-pass cardiac patients

STAT surgical/trauma patients

34
Q

How do you best prevent AKI in STAT surgeries

A

management of intravascular volume and shock

  • restore euvolemia
  • maintain CO and renal blood flow
  • maintain 02 delivery
  • maintain UO > 0.5 mL/kg/hr
  • avoid NSAIDS, myoglobin leak, contrast media
  • IV hemodynamic monitoring
35
Q

Is it ok to give furosemide or mannitol in the early resuscitative phase of trauma management

A

NO
-decreases intravascular volume

*except in the case of head injury with elevated intracranial pressure or massive rhabdomyolysis

36
Q

Dialysis of renal failure patients should be done how long before surgery

A

preferablly the day before

37
Q

Which induction agent has minimal effects on CO

A

Isoflurane

38
Q

What is the most common nerve injury associated with lithotomy position

A

brachial plexus

39
Q

Excessive flexion at the thigh can cause damage to which nerves

A

F.O.S

femoral, obturator, sciatic nerves

40
Q

What nerve can be injured laterally b/c of the thigh rest

A

common peroneal nerve-foot drop

41
Q

What nerve can be injured medially b/c of the thigh rest

A

saphenous nerve-medial calf numbness

42
Q

Regional techniques for patient’s undergoing major cysto procedures require sensory level blockade of what level

A

T10

43
Q

Name three absolute contraindications for ESWL

A

bleeding disorders
anticoagulation therapy
pregnancy

44
Q

What is the gold standard for treating BPH

A

TURP

45
Q

What is TURP syndrome

A

a term used to describe the symptoms that occur with excess absorption of irrigating solutions, r/t water intoxication

46
Q

Symptoms of TURP syndrome include

A

respiratory distress (rapid fluid expansion)
HTN
Altered mental status
hypoosmolarity of plasma
symptoms specific to the type of fluid used

early symptoms- HTN, bradycardia
later symptoms-left HF, pulmonary edema

47
Q

What factors predict TURP syndrome

A

Number and size of open venous sinuses (bleeding)
duration of resection
hydrostatic pressure of irrigating fluid
venous pressue at the irrigant-blood interface

48
Q

What are the advantages of a regional approach over a general technique for TURP

A

allows patient to remain awake to dx TURP syndrome and bladder perforation
decreased blood loss
decreased need for analgesics

49
Q

Patients undergoing radical retropubic prostatectomy are likely to be positioned in

A

hyperextended supine position with trendelenberg

Principles (8 decks)

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