RENAL

Question 0

WHAT EXITS THE HILUS?

Answer 0

RENAL ARTERIES, VEINS, NERVES, LYMPHATICS AND URETERS.

Question 1

WHERE DOES FILTRATION TAKE PLACE?

Answer 1

THE GLOMERULUS

Question 2

WHAT ARE THE 4 PARTS OF THE NEPHRON?

Answer 2

• GLOMERULUS
• GLOMERULAR (BOWMANS) CAPSULE
• RENAL TUBULE (PCT, LOOP OF HENLE, DCT)
• COLLECTING DUCT

Question 3

WHERE DOES FILTRATION TAKE PLACE AND WHAT GETS FILTERED?

Answer 3

IN GLOMERULUS.
FILTERS…SMALL MOLECULES IE: IONS H2O GLUCOSE UREA
MACROMOLECULES (PROTEIN) IS UNTOUCHED.

Question 4

WHAT HAPPENS IN THE PCT?

Answer 4

THE BULK OF FLUID/CONTENTS ARE REABSORBED. OSMOTIC GRADIENT STAYS THE SAME.

Question 5

WHAT DOES THE LOOP OF HENLE DO?

Answer 5

REABSORB WATER CHLORIDE AND SODIUM.
DESCENDING LIMB: ESTABLISHES A COUNTERCURRENT BY LETTING BOTH SODIUM AND H2O OUT OF LUMEN.
ASCENDING LIMB: IMPERMEABLE TO H2O SO WATER STAYS IN LUMEN AS MORE NA IS PUMPED OUT CREATING A HYPOOSMOTIC LUMEN.

Question 6

WHAT IS HAPPENING IN DCT?

Answer 6

NA REABSORBED CONTROLLED BY ALDOSTERONE
K SECRETED
PROTONS SECRETED
H2O PERMEABILITY CONTROLLED BY ADH

Question 7

WHAT IS NET FILTRATION PRESSURE AND HOW DO YOU CALCULATE IT?

Answer 7

10 MM HG
BLOOD PRESSURE (HYDROSTATIC) - PROTEIN PRESSURE IN PLASMA (ONCOTIC) AND FLUID PRESSURE IN BOWMANS CAPSULE.
55-(30 + 15) = 10

Question 8

WHAT MAP DOES RENAL BLOOD FLOW REMAIN CONSTANT AT?

Answer 8

50-150

Question 17

WHAT 3 THINGS REGULATE GFR?

Answer 17

FILTRATION PRESSURE (BP AND RESISTANCE)
TUBULOGLOMERULAR FEEDBACK.
ANS/HORMONES (ACE/PROSTEGLANDIN)

Question 18

WHAT IS GLOMERULAR TUBULAR BALANCE?

Answer 18

WHEN THERE IS A DECREASE IN GFR THERE IS A DECREASE IN TUBULE FLOW.

Question 19

WHAT MAJOR HORMONES CONTRIBUTE TO GFR?

Answer 19

INCREASE GFR: ANP, NO, PROSAGLANDIN E2. ALL VASODILATE.

DECREASE GFR: ANGIOTENSIN 2, ENDOTHELIN. VASOCONSTRICT.

Question 20

WHAT DOES SNS STIM. DO TO GFR?

Answer 20

DECREASE GFR BY VASOCONSTRICTION. THIS HAPPENS DURING EXERCISE AND HEMMORHAGE.

Question 21

WHAT DOES ERYTHROPOIETIN DO?

Answer 21

STIM. RBC PRODUCTION. PRODUCED IN KIDNEYS….CRF PT HAS DECR. ERTYHROPOETIN AND DECREASED HGB.

Question 22

WHAT DOES ALDOSTERONE DO?

Answer 22

PRODUCED BY ADRENALS AND NA/H2O RETENTION. RELEASE REGULATED BY RENIN-ANGIOTENSIN.

Question 23

WHAT DOES ADH DO?

Answer 23

WITH ADH….TUBULAR PERMEABILITY INCREASED AND WATER REABSORBED. TRIGGERS FOR ADH=STRESS, PAIN, HYPOTENSION.

Question 24

DO PROSTAGLANDIN AND THROMBOXANE A2 HAVE OPPOSING EFFECTS?

Answer 24

YES.

PROSTEGLANDIN VASODILATES AND INHIBITS PLT AGGREGATION.

Question 25

HOW DOES VIT D AFFECT CALCIUM?

Answer 25

VIT D IS NEEDED TO ABSORB CALCIUM. RENAL PTS CANT DO THIS. LOW CA.

Question 26

WHAT IS SPASTIC BLADDER DYSFUNCTION?

Answer 26

FAILURE TO STORE.

Question 27

WHAT IS FLACCID BLADDER DYSFUNCTION?

Answer 27

FAILURE TO EMPTY.

Question 28

WHAT ARE THE 4 PHASES OF ARF?

Answer 28

INITIATING=INSULT TO S/S.
OLIGURIC= U/O < 400 /24 HRS.
DIURETIC = KIDNEYS INABILITY TO CONCENTRATE URINE. LOW GFR. LABS BEGIN TO NORMALIZE.
RECOVERY = BEGINS WHEN GFR INCREASES.

Question 29

WHAT IS THE #1 CAUSE OF CRF?

Answer 29

DIABETES

Question 30

HOW MANY NEPHRONS NEED TO STOP WORKING BEFORE S/S OF KIDNEY DISEASE APPEAR?

Answer 30

80%

DIALYSIS IS NEEDED WHEN 90% ARE LOST.

Question 31

WHAT IS THE FIRST SIGN OF DIABETIC NEPHROPATHY?

Answer 31

PROTEIN IN THE URINE. BASEMENT MEMBRANE THICKENS. GLOMERULUS ENLARGES.

Question 32

WITH RENAL PTS WHAT DO YOU NEED TO THINK ABOUT RELATING TO BP?

Answer 32

THEY ARE INTRAVASCULARLY DRY SO VASODILATION FROM ANESTHESIA CAUSES BP TO BOTTOM OUT. CONSIDER ETOMIDATE FOR INDUCTION.

Question 33

WHAT ARE SIDE EFFECTS OF DIALYSIS?

Answer 33

HYPOXEMIA, HYPOTENSION, MUSCLE CRAMPS

Question 34

ARE RENAL FAILURE PREDISPOSED TO BLEEDING?

Answer 34

YES. DECREASED PLT FXN. CONSIDER DDAVP AND CRYO.

Question 35

WHAT IS MOST EFFECTIVE TREATMENT FOR HYPERKALEMIA?

Answer 35

DIALYSIS. FOR K > 6.

ALSO: BICAR, HYPERVENTILATE, INSULIN/GLUCOSE, CALCIUM.

Question 36

S/S OF HYPERMAGNESEMIA?

Answer 36

HYPOTENSION, HYPOVENT, COMA.

MUSC. RELATORS POTENTIATED.

Question 37

WHAT IS NORM BUN/CR?

Answer 37

BUN: 10-20. LATE INDICATOR OF RENAL DX.
CR: 0.7-1.5. MOST COMMONLY USED MARKER. INVERSELY RELATED TO GFR.

Question 38

WHAT IS THE MOST RELIABLE ASSESSMENT TOOL OF RENAL FX?

Answer 38

CREATININE CLEARANCE. NORM= 95-150

Question 39

WHAT TO DO PREOP FOR A RENAL PT?

Answer 39

LABS: LYTES MG PHOS. CBC.  
TAKE HOME MEDS
ENSURE NPO....DELAYED GASTRIC EMPTYING.
GET CARDIAC CLEARANCE.
GOOD VASCULAR ACCESS.  
LAST DIALYSIS.

Question 40

IS REGIONAL OK FOR RENAL PTS?

Answer 40

YES AS LONG AS COAGS ARE NORMAL WITH ADEQUATE BP.