Renal

Question 1

Afferent (arrive) arteriole caries blood

Answer 1

to the glomerulus

Question 2

Efferent (exit) tubule caries blood

Answer 2

from the glomerulus

Question 3

renal perfusion - what % of cardiac output?

Answer 3

20-25% of CO

Question 4

volume of renal blood flow?

Answer 4

600 mL/min

Question 5

a decrease in diastolic pressure is associated with

Answer 5

AKI, but decreased MAP isn’t.

Question 6

kidney functions

Answer 6

fluid balance, BP control (renin), acid base (H and bicarbonate), electrolyte balance, removal of wast, erythorpoetin, vitamin D activation

Question 7

angiotensin II - increases BP how? and what about heart and prosties?

Answer 7

vasoconstriction, increases myocardial contractility, prostaglandin release (lipids that control inflammation),

Question 8

angiotensin II - increases volume how? And what about ADH?

Answer 8

aldosterone, Na and water reabsorption, K excretion, and ADH release

Question 9

older adults and kidney function - blood flow? GFR?

Answer 9

Sclerosis of the glomerulus and renal vasculature
Decreased blood flow
Decreased GFR
Altered tubal function and acid–base balance

Question 10

older adults and kidneys - drug

Answer 10

decreased clearance, increased interactions

Question 11

older females

Answer 11

estrogen protects and slows progression of CKD

Question 12

older males

Answer 12

androgen deprivation slows progression of CKD

Question 13

specific gravity (the year 1000)

Answer 13

1.002 - 1.035

Question 14

pH

Answer 14

4.5 - 8.0

Question 15

BUN elevated with what? (steroid BUNS)

Answer 15

elevated with renal disease, steroids, dehydration, malnutrition

Question 16

creatinine - men vs women

Answer 16

men slightly higher than women due to muscle.

Question 17

creatinine elevated (creatins exercise and have low muscle mass)

Answer 17

Elevated with CKD, kidney obstruction, intense exercise, low muscle mass, pregnancy, certain meds (Bactrim), corticosteroids, Vitamin D

Question 18

BUN/Cr ratio - increased (buns get bigger with no water)

Answer 18

FVD or hypoperfusion of kidneys

Question 19

BUN/Cr ratio - decreased

Answer 19

FVE or malnutrition

Question 20

GFR decreased by

Answer 20

one mL/min/year after age 40

Question 21

abrupt decrease in GFR will show (africa down, cretins up)

Answer 21

increase in creatinine

Question 22

gradual decrease in GFR and renal blood flow with aging will show

Answer 22

little change in GFR

Question 23

is urea normal or abnormal?

Answer 23

normal constitute of urine

Question 24

normal capacity of bladder

Answer 24

300 - 500 mL

Question 25

palpate left kidney? (the left is left out)

Answer 25

rarely able to palpate

Question 26

kidney injury - inspect for

Answer 26

Bleeding: bruising, abdominal distention, guarding, urinary meatus

Question 27

kidney injury - JVD

Answer 27

Volume depletion or overload: JVD (first supine then @ 45-degree angle/semi-Fowlers)

Question 28

kidney injury - albumin/weight

Answer 28

Edema: dependent, eyes, hands, cheeks, feet, over bony prominences,
pitting (scale of 1-4)
check weight, hypoalbuminemia

Question 29

Auscultation for someone with kidney injury focuses on the

Answer 29

heart, lungs and blood pressure

Question 30

Heart

Answer 30

rate, rhythm and extra heart sounds (S3 & S4 FVE) use bell; pericardial friction rub (3rd intercostal space to the left of sternum, lean forward)

Question 31

Lungs

Answer 31

Crackles, new dyspnea upon mild exertion, orthopnea, PND (paroxysmal nocturnal dypnea)

Question 32

Blood pressure

Answer 32

FVD either fluid or hemorrhage losses. Orthostatic hypotension

Question 33

Kidneys examination

Answer 33

Patient side-lying or sitting, with examiner’s hand over the costovertebral angle; then striking the hand with the other fist which produces a normal dull thud.

Question 34

fluid assessment

Answer 34

skin turgor, mucous membranes, I and O, edema or ascites, engorged neck or hand, crackles, dyspnea, tachycardia, hypo/hypertension, S3 and S4, HA, blurred vision, vertigo when rising, mental changes, serum osmolality

Question 35

assessment of electrolyte and waste products

Answer 35

CBC, BUN, ECG, mental status, chvostek’s and trousseau, numbness, muscle strength, GI changes, itching

Question 36

hydrostatic is always

Answer 36

water

Question 37

itching can be

Answer 37

calcium

Question 38

kidneys can’t compensate when systolic gets below

Answer 38

80 or 70

Question 39

vitamin D

Answer 39

from sun, coverted to calcidiole in liver, calcidiole goes to kidneys where it’s converted to active form of vitamin D. Vitamin D is needed to absorb calcium in GI tract.

Question 40

calcium has inverse relationship with

Answer 40

phosphate, so if calcium is low from renal failure, phosphate is high.

Question 41

prostaglandins in kidneys (prostie is stingy)

Answer 41

cause vasodiation and increase blood flow to kidneys only

Question 42

bradykinin also released by

Answer 42

kidneys, and just increases permiability to let certain solutes in

Question 43

do kidneys get smaller when we age?

Answer 43

YES! they shrink

Question 44

if specific gravity never changes throughout the day, it means that

Answer 44

the kidneys are damaged

Question 45

for a UA, try to get the

Answer 45

first sample of the day and send it to the lab within an hour. if you can’t, it needs to be refrigerated.

Question 46

if BUN is elevated and everything else is normal, it’s

Answer 46

dehydration (fluid volume deficit)