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AFN Health Assessment > Renal > Flashcards

Renal Flashcards

1
Q

What part of nephron regulates the fx of the nephron?

A

JGA

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2
Q

What 3 things can stimulate renin release from JGA cells

A

-Beta 1 stimulation

-decreased renal perf pressure

-decreased Na in filtrate (sensed my macula densa)

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3
Q

Cheif mineralocorticoid?

A

Aldosterone

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4
Q

Aldo does what and where in the nephron?

A

Reabsorbs Na (therfore H20 follows in collecting duct) in the DCT

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5
Q

Where is ADH synthesized and released?

A

Synthesized - hypothalamus

Release - post. pituitary

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6
Q

The most potent diuretic in human body

A

ANP (atrial natriuretic peptide)

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7
Q

Prostaglandins do what to the vasculature?

A

Vasodilate

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8
Q

Thromboxane A2 does what to the vasculature?

A

Vasoconstricts

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9
Q

What class of drugs should you hold w/ renal dysfunction

A

NSAIDs

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10
Q

3 Major mechanisms of kidney

A

-Filtration

-reabsorption

-tubular secretion

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11
Q

Normal RBF

A

1200mL/min

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12
Q

Normal GFR

A

125mL/min

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13
Q

What % of CO is RBF?

A

20-25%

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14
Q

MAP range for autoregulation to maintain RBF

A

50-180

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15
Q

W/ MAP < ___ renal filtration ceases

A

50

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16
Q

Does PNS affect RBF?

A

No

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17
Q

Decreased RBF = __________ GFR

A

Decreased

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18
Q

Most important part of H&P w/ renal pts

A

Past medical history

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19
Q

What labs to assess GFR

A

BUN/Cr

Cr clearance

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20
Q

What labs to assess tubular fx?

A

Urine specific gravity

Urine Osmolality

Urine Na

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21
Q

Chief product of protein metabolism

A

Urea

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22
Q

Where is urea formed

A

Liver

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23
Q

Normal BUN

A

10-20

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24
Q

Low BUN = what hydration status?

A

Hypervolemic

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25
Q

High BUN = what hydration status?

A

Hypovolemic

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26
Q

BUN > ____ = decreased GFR (almost always)

A

50

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27
Q

Is BUN a good early indicator of reduced GFR?

A

No

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28
Q

BUN does not increase until GFR is reduced by ____%

A

50%

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29
Q

Reliable marker of GFR

A

Creatinine

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30
Q

Creatinine is almost 100% removed by __________ filtration

A

Glomerular

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31
Q

Normal Cr

A

0.7-1.5

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32
Q

Normal BUN/Cr ratio

A

10:1

33
Q

Most specific test for GFR and most reliable for renal fx

A

Cr clearance

34
Q

Normal Cr clearance

A

95-150 mL/min

35
Q

Normal specific gravity

A

1.003-1.030

36
Q

Urine Na >___ indicates damage to the renal tubules; diuretics (AKA RENAL)

A

40

37
Q

Urine Na <___ indicates hypovolemia (AKA PRE-RENAL)

A

20

38
Q

FENa of <___% = pre-renal dx

A

1%

39
Q

FENa of >___% = renal dx

A

2%

40
Q

3 main renal protective strategies

A
  • goal-directed fluid therapy

-isotonic crystalloids

-hemodynamics within autoregulation limits

41
Q

What AKI stage?

UOP < 0.5mL/kg/hr for >6hrs

Cr increased >1.5x

GFR decreased > 25%

A

AKI stage 1

42
Q

What AKI stage?

UOP < 0.5mL/kg/hr for >12hrs

Cr increased >2x

GFR decreased > 50%

A

AKI stage 2

43
Q

What AKI stage?

UOP < 0.5mL/kg/hr for >24hrs
Anuria for >12hrs

Cr increased >3x

GFR decreased > 75%

A

AKI stage 3

44
Q

What is the leading cuase of AKI in hospital pts

A

Surgery

45
Q

List the 10 renal protective strategies w/ evidence

A
  1. correct anemia/minimize transfusions
  2. Maintain perfusion (MAP 80-160)
  3. Avoid nephrotoxins
  4. Use balanced crystalloids (avoid NS and HES solutions)
  5. Avoid diuretics
  6. Continue statin therapy
  7. Maintain normoglycemia
  8. Consider low-dose dexmedetomidine & NaHCO3 infusions
  9. Dexamethasone (protective effect)
  10. Early initiation of CRRT
46
Q

What meds do you hold DOS?

A

ACEI

ARBs

NSAIDs

Diuretics

47
Q

Low dose ___________ is NOT supported in the literature

A

dopamine

48
Q

What renal protective strategy provides the greatest protective benefit?

A

Maintaining perfusion within autoregulation & adminstering appropriate fluid therapy

49
Q

Should you postpone surgery w/ pt w/ active HF w/ elective surg

A

Yes

50
Q

GFR <___ for > 3months = CKD

A

60

51
Q

GFR <____ represents loss of at least 50% of kidney fx

A

60

52
Q

What GFR category jumps to a high risk?

A

G3b

(G3a is very moderate/low risk)

53
Q

What GFR for stage G3a?

A

45-59

54
Q

What GFR for stage G3b?

A

30-44

55
Q

Most common CV complication of CKD?

A

Systemic HTN

56
Q

Is sevoflurane ok for renal pts?

A

Yes, all inhalation agents are safe according to the literature

57
Q

GFR <15 = ?

A

ESRD

58
Q

What are the 2 leading causes of CKD & ESRD

A

HTN

DM

59
Q

What do you check w/ hyperkalemia in renal pts?

A

12 lead EKG

60
Q

What range should you keep your preop Hgb for renal pts?

A

11-12 (not over 13!)

61
Q

What is the most important way to prevent contrast induced nephropathy (CIN)

A

Ensuring pre-procedural hydration

62
Q

T/F, Pts should be dialyzed prior to elective surgery

A

True

63
Q

Maintain what UO for renal pts?

A

0.5ml/kg/hr

64
Q

Renal pts have __________ sensitivity to CNS depressants

A

increased

65
Q

What could you mix in w/ propofol to mitigate expected hypotension w/ induction?

A

Ketamine

66
Q

What co-ag test is best indicator of platelet fx?

A

Bleeding time

67
Q

Renal pts may have increased bleeding risk, even with normal coags d/t what?

A

Platelet dysfunction

68
Q

What can be done post op to help restore platelet fx?

A

Dialysis (within 24 hrs)

69
Q

What should you have readily available for induction hypotension w/ renal pts?

A

Pressors (don’t give a lot of fluids)

70
Q

What 2 drugs/drug types are less protein bound and are safer to use with pts w/ hypoalbunemia

A

Ketamine & benzos

71
Q

NMB is prolonged or shortened w/ renal pts?

A

Prolonged

72
Q

Which NMB is least effected by renal dysfunction?

A

Cis-atracurium (d/t hoffman elimination)

73
Q

Caution w/ SCh in renal pts why?

A

Increased serum K

74
Q

(t/f), SCh is ok in normo-K+ patients w/ recent dialysis

A

True

75
Q

List main anesthetic pharmacology considerations

A

-decrease propofol dose by mixing w/ ketamine

-Caution w/ SCh d/t hyperkalemia

-Cis-atracurium least effected d/t hoffman elimination

-w/ rocuronium, 1/3 renal excreted, so will have to use higher dose of suggamadex

-all inhalation agents are safe

-Opioid duration is prolonged, caution with long-acting meds

76
Q

LR ok to us w/ anuric pts?

A

NOOO

77
Q

Replace UO w/ what IV solution?

A

0.45% saline

78
Q

What is only definitive tx for hepatorenal syndrome?

A

Hepatic transplant

79
Q

List out pathophysiology steps for hepatorenal syndrome

A
  1. Portal HTN
  2. splanchnic (GI vessels) vasodilation
  3. reduced circulatory volume
  4. RAAS activiation
  5. Renal vasoconstriction
  6. Hepatorenal syndrome

AFN Health Assessment (12 decks)

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