Renal Flashcards
Causes of rhabdomyolisis
- Traumatic/Compressions: crush injuries/ prolonged immobilisation; burns; electrocution 2.Exertional: prolonged seziures; hyperthermia; heat stroke; 3. Non exertional: drugs (malignant hyperthermia; NMS) infections; electrolyte disroders (esp hypo K; hypo Po4
Define dialysis
movement of a solute from a compartment in which it is ina high concentration to one in which it is in a low concentration
Define filtration fraction
the fraction of plasma H2O that is removed from blood during hemofiltration optimal FF is 20-25%- above this Hct is too high and increase clotting risk of filter
Define sieving coefficient
ratio of concentration of a solute in ultrafiltrare compared to concentration of solute in plasma want it close to 1 for molecules you wish to remove
Define ultrafiltration
movement of solute carried in solution across a semipermeable membrane due to a transmembrane pressure gradient
Features to diagnose hepatorenal syndrome
2x creatinine in < 2 weeks and creatinine>220 Liver failure Portal hypertension Exclusion of other causes of renal failure: bening urinary sediment; no proteinuria; very low Urinary Na
methods to improve solute clearance in CVVHDF
increase dialysate flow rate increase blood flow rate increase membrane surface area change composition of dialysate to increase concentration gradient
Points to consider to prevent contrast induced nephropathy
- Identify high risk patients: age, baseline renal function; diabetes; hypovolemia 2. Consider need for contrast; alternate means of imaging 3. contast agent: better if isotonic; small volume; IV versus intra-arterial 4. volume expansion has an established role 5. pharmacological agents: unclear role. NAC decreases creatinine but unclear effect on outcomes 6. Dialysis and hemofiltration
Treatment for hepatorenal syndrome
Norad to increase MAP by 10 mmHg Albumin: 2 days at 1g/kg/d Terlipressin/Vasopressin Coniderration of TIPS if liver transplantation not a viable option
