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Co-Exisiting Disease 2 > Renal > Flashcards

Renal Flashcards

1
Q

5 characters for pre-renal impairment?

A
  1. Deceased BF
  2. Low BP
  3. HF
  4. Hepatorenal syndrome
  5. Toxins
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2
Q

What is used to buy time during definitive treatment?

A

Dialysis

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3
Q

Form of impaired kidney function that occurs in individuals with advanced liver disease. Do not have any identifiable cause of kidney dysfunction and the kidneys themselves are not structural damaged.

A

Hepatoreanl syndrome (HRS)

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4
Q

What 3 things/tests are used to evaluate renal function?

A
  1. Serum creatinine
  2. Creatinine clearance
  3. Blood urea nitrogen (BUN)
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5
Q

Non-protein nitrogenous waste product that is produced by the breakdown of creatine do to the normal wear and tear on muscles of the body

A

Creatinine

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6
Q

A rise in serum creatinine levels is a late marker, observed only with marked damage to what?

A

Functioning nephrons

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7
Q

Serum creatinine levels may increase or decrease when an ACEI is taken for HF and renal insufficiency?

A

Increase

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8
Q

Normal serum creatinine values for men and women?

A

Men: .8-1.3 mg/dL
Women: .6-1 mg/dL

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9
Q

The higher the blood creatinine level, the lower the what are (2)?

A
  1. Estimated GFR

2. Creatinine clearance

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10
Q

Amount of blood the kidneys can make creatinine free each minute

A

Creatinine clearance

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11
Q

Creatinine clearance helps to estimate what?

A

GFR

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12
Q

GFR increase or decrease with age?

A

Decrease

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13
Q

Normal creatinine clearance in men and women?

A

Men: 97-137 ml/min
Women: 88-128 ml/min

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14
Q

Why do men have greater creatinine clearance?

A

Because greater muscle mass

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15
Q

Is creatinine reabsorbed?

A

NO

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16
Q

As renal function declines, creatinine clearance goes up or down?

A

Down

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17
Q

2 main ways to use creatinine tests to measure kidney function?

A
  1. Measure amount of creatinine present in urine sample over 24 hrs
  2. GFR estimated by single blood level
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18
Q

Creatinine clearance formula

A

(140-pts age) x (wt) x (1(men) or .85(women)) / 72 x serum creatinine level

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19
Q

GFR 90 or greater

A

Stage 1

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20
Q

GFR 60-89

A

Stage 2

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21
Q

GFR 45-59

A

Stage 3a

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22
Q

GFR 30-44

A

Stage 3b

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23
Q

GFR 15-29 (preparation transplant)

A

Stage 4

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24
Q

GFR <15 (require dialysis)

A

Stage 5

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25
Q

Is a waste product formed in liver when protein is metabolized into amino acids to produce ammonia

A

Urea

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26
Q

Urea is released by the liver into the blood and is carried to the kidneys, where it is filtered out of the blood and released into the what?

A

Urine

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27
Q

Is there a small but stable amount of urea nitrogen in the blood?

A

Yes

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28
Q

Renal function decreases, BUN level rise or falls?

A

Rise

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29
Q

Significant liver damage or disease inhibits the production of urea, then BUN concentrations may rise or fall?

A

Fall

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30
Q

Normal BUN values?

A

10-20 mg/dL

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31
Q

Is BUN a reliable indicator of GFR?

A

NO

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32
Q

Greater than what BUN value indicate renal impairment?

A

50

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33
Q

Normal BUN:Creatinine ratios?

A

10: 1
20: 1

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34
Q

Abrupt deterioration in kidney function with an increase in serum creatinine level with or without reduced urine output

A

Acute kidney injury

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35
Q

Decreased renal perfusion (often from hypovolemia) leading to decrease in GFR

A

Prerenal AKI

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36
Q

Is prerenal AKI reversible?

A

YES

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37
Q

Intrinsic kidney damage; acute tubular necrosis most common due to ischemic/nephrotoxic injury

A

Intrarenal AKI

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38
Q

Extrinsic/intrinsic obstruction of the urinary collection system

A

Postrenal AKI

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39
Q

AKI is usually what classification?

A

Prerenal

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40
Q

Oliguria in adults:

A

Too much pee

<400cc/day

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41
Q

Anuria

A

Too little pee

<100 cc/day

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42
Q

Most common causes of death in AKI (3)?

A
  1. Sepsis
  2. CV dysfunction
  3. Pulmonary complications
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43
Q

Management of AKI (3)?

A
  1. Fluid resuscitation
  2. Avoid nephrotoxic medications and contrast media exposure
  3. Correction of electrolyte imbalances
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44
Q

2 main steps to drug dosing considerations with renal impairment:

A
  1. Estimate ECF volume
  2. Tailoring drug dosing to estimate the creatinine clearance (since rate of elimination of drugs excreted bu kidneys is proportional to GFR)
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45
Q

If ECF is contracted, increase or decrease loading dose?

A

Decrease

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46
Q

If ECF is expanded, increase or decrease loading dose?

A

Increase

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47
Q

For meds with wide therapeutic ranges/long plasma half lives, the interval between doses is generally increased or decreased?

48
Q

For meds with narrow therapeutic ranges/short plasma half lives, the interval between doses is generally increased or decreased?

49
Q

Chronic renal failure GFR value?

A

<25 ml/min and/or dependent on dialysis

50
Q

What percent of loss of function is considered CRF?

51
Q

2 main causes of CRF?

52
Q

Main complication from CRF?

A

Iron deficiency anemia

53
Q

2 pulmonary problems from renal failure?

A
  1. Hyperventilation

2. Edema

54
Q

2 neurological problems with renal failure?

A
  1. Uremic encephalopathy

2. Autonomic and peripheral neuropathies

55
Q

2 hematological problems with renal failure?

A
  1. Anemia

2. Platelet and leukocyte dysfunction

56
Q

Endocrine problem with renal failure?

A

Abnormal glucose tolerance

57
Q

5 GI problems with renal failure?

A
  1. Nausea
  2. Vomit
  3. Peptic ulcer
  4. Hemorrhage
  5. Delayed gastric emptying
58
Q

Unique sign of CRF?

A

Uremic frost

59
Q

Latrogenci components that predispose to AKI (4):

A
  1. Inadequate fluid replacement
  2. Hypotension
  3. Delayed treatment of sepsis
  4. Administration of nephrotoxic drugs or dyes
60
Q

CRF causes hyperkalemia or hypokalemia?

A

Hyperkalemia

61
Q

Cats of hypocalcemia?

A

C-convulsion
A-arrhythmias
T-tetany
S-spasm and stridor

62
Q

CRF causes hypercalcemia or hypocalcemia?

A

Hypocalcemia.

63
Q

Involuntary contraction of muscles in the hand and wrist that occurs after the compression of the upper arm with a blood pressure cuff

A

Trousseau’s sign

64
Q

Increased irritability of the facial nerve, manifested by twitching of the ipsilateral facial muscles on percussion over the branches of the facial nerve

A

Chvostek sign

65
Q

2hr OGTT results for normal, preDM/IGT, DM:

A

Normal: <140
PreDM/IGT: 140-199
DM: >200

66
Q

Hemodialysis must be drawn from what and returned to what?

A

Drawn from an artery

Returned to a vein

67
Q

3 types of hemodialysis:

A
  1. AV fistula
  2. AV graft
  3. Central venous catheter
68
Q

Artery (usually in forearm) is sewn into vein, and the high pressure from the artery enlarges the vein in the forearm

A

AV fistula

69
Q

Advantage: mature faster than fistulas
Disadvantage: more likely to narrow and clot, higher incidence of infection

70
Q

One lumen draws blood out to the dialysis machine, while the other lumen reinfuses the filtered blood back to the pt
-short term solution until fistula or graft can be established

A

Central venous catheter

71
Q

3 advantage to peritoneal dialysis:

A
  1. Can be done at home
  2. Relatively easy to learn
  3. Fluid balance is usually easier than hemodialysis
72
Q

4 disadvantages to peritoneal dialysis:

A
  1. Infection is more common
  2. Long term PD can change permeability of visceral peritoneum
  3. Risk of hernias
  4. Fluid leaks into surrounding tissue
73
Q

Neurological signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis

A

Dialysis disequilibrium syndrome (DDD)

74
Q

Common CV complication?

A

LV hypertrophy

75
Q

What 2 invasive hemodynamic monitoring is mandatory?

A

Frequent BG analyses

Electrolyte measurements

76
Q

Does administration of diuretics to maintain urine output in pts who are not oliguric show improvement?

77
Q

What 2 main things are caused by renal failure?

A
  1. Decreased protein binding

2. Greater brain penetration due to breach of blood-brain barrier

78
Q

What 3 induction agents are not too significantly affected by impaired renal function?

A
  1. Propofol
  2. Etomidate
  3. Ketamine
79
Q

Chronic renal failure AND severe anemia (Hb<5) does what to B:G partition coefficient and induction?

A

Decrease

Accelerate induction

80
Q

Opioids agents:

A

Accumulation of morphine and meperidine metabolites which prolongs respiratory depression

81
Q

Atropine use:

A

Accumulation following repeated doses

82
Q

Sux is safely used in renal failure when serum K is less than what?

83
Q

Neostigmine use:

A

Renal excretion is principle route of elimination; half live prolonged

84
Q

Preop evaluation (5)

A
  1. Time since last dialysis
  2. ABG
  3. ECG
  4. Cardiac echo
  5. CBC
85
Q

Induction needs to be RSI or not?

86
Q

During induction, what should you be prepared for with BP?

87
Q

What fluids should you avoid and why?

A

LR due to K+

88
Q

Normally during spontaneous inspiration, what happens with SBP and pulse?

A

SBP: decreases by <10mmHg
Pulse: slightly increase

89
Q

Why does spontaneous inspiration affect SBP and pulse?

A

Inspiration makes intra-thoracic pressure more negative to atmospheric pressure, which increases systemic venous return to RA by reducing back-pressure on veins (vena cava)

90
Q

What prevents the septum of R and L ventricles from bulging dramatically into the LV during inspiration?

A

Large pressure gradient between L>R ventricles

91
Q

Reduced L-heart filling leads to a reduced SV which manifests as a decrease in SBP, leading to a faster what due to the baroreceptor reflex, which stimulates sympathetic outflow to the heart?

92
Q

Naturally occurring phenomenon in which the arterial pulse pressure falls during inspiration and rises during expiration due to changes in intra-thoracic pressure secondary to negative pressure ventilation (spontaneously breathing)

A

Stroke volume variation

93
Q

Normal range of variation in spontaneously breathing pts is btn:

94
Q

Variations over 10mmHg have been referred to as what?

A

Pulses paradoxus

95
Q

With normal lung compliance and a regular HR, a SVV >13% suggest that the pt is what?

96
Q

Mechanism of SVV:

A

Large negative intra-thoracic pressure (spontaneous ventilation) increases the pressure across the wall of the LV

97
Q

Arterial pressure rises during inspiration and falls during expiration due to changes in intra-thoracic pressure secondary to positive pressure ventilation

A

Reverse pulses paradoxus

98
Q

Traditional CVV calculation:

A

SVmax - SVmin / SVmean

99
Q

Difference between maximal and minimal values of the SBP during one mechanical breath

A

Systolic pressure variation (SPV)

100
Q

Systolic pressure variation has been shown to be a valuable indicator of what?

A

Cardiac preload

101
Q

SPV was considered to be a sensitive indicator of what

A

Hypovolemia

102
Q

Desirable urinary output?

A

> .5 ml/kg/h

103
Q

ESWL shock waves can produce what?

104
Q

Occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation

A

TURP syndrome

105
Q

Result of TURP syndrome:

A

Fluid overload and disturbed electrolyte balance and hyponatremia

106
Q

Regional vs general anesthesia preferred for TURP syndrome?

107
Q

What types of fluids can be toxic to the CV and CNS for TURP syndrome?

A

Fluids containing glycine

108
Q

Ideal surgery times for TURP syndrome?

A

Under 1 hr

109
Q

Pt positioning for TURP syndrome?

A

Horizontal

110
Q

Suggested optimum ht of irrigating fluid bag ht for TURP syndrome?

111
Q

Correction of hyponatremia for TURP syndrome?

A

Hypertonic saline

112
Q

Rapid increase in serum sodium concentration may lead to what?

A

Central pontine myelinolysis

113
Q

Slow administration of what can correct the sodium concentration for TURP syndrome?

A

Diuretics like furosemide

114
Q

Can giving diuretics paradoxically cause a reduction in serum sodium concentration?

115
Q

Raising the sodium at what rate is considered safe?

A

1 moo/L/hr

Co-Exisiting Disease 2 (11 decks)

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