renal

Question 1

Fluids for renal disease

Answer 1

If the patient demonstrates volume tolerance,

• maintenance rates (40–60 mL/kg/day) of isotonic crystalloids and/or
• bolus infusions of hyperosmolar solutions (7.2% hypertonic saline [2–4 mL/kg]; or
• mannitol 20% solution [0.25–1 g/kg])

may be useful to promote renal perfusion, tubular flow, and nephron recruitment.

Question 2

Mechnism of toxicity of aminoglycosides in the kideny

Answer 2

In low tubular flow states (e.g., dehydration), aminoglycosides are actively taken up by proximal convoluted tubular cells and stored in lysosomes.

Drug accumulation exceeds drug disposition and leads to rupture of PCT cells and acute tubular necrosis

Question 3

Effect of myoglobin and hemoglobin on kidney

Answer 3

several mechanisms including

• physical plugging of nephron tubules via polymerization,
• reflexive renal vasoconstriction causing ischemia, and
• free radical injury via reduction-oxidation reactions from iron-containing pigments and genesis of reactive species

Question 4

Urinary indicators of tubular damage include

Answer 4

• granular casts in urine,
• increased urinary γ-glutamyl transferase-to creatinine ratio (>25),
• abnormal fractional clearance of electrolytes such as sodium and potassium

Question 5

Influences of blood pressure on renal disease

Answer 5

Autoregulation begins to fail at a MAP <60 mm Hg.

Maintaining an MAP ≥65 mm Hg is recommended to minimize reduced urine output and kidney injury

dobutamine (1–5 μg/kg/ min)

dopamine therapy (2–5 μg/kg/min)

Question 6

When do i use renal replacement therapy?

Answer 6

in acute kidney injury unresponsive to fluids and /or diuretics

continual flow peritoneal dialysis

LRS with 1.5% dextrose and 1 unit of unfractionated heparin per milliliter

3L per hour

half of it should be drained through second cath