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Concepts in Critical care > Renal > Flashcards

Renal Flashcards

1
Q

How much cardiac output is directed towards the kidneys?

A

20-25% ‘

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2
Q

What is a healthy GFR?

A

100-120 ml/minute

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3
Q

What is the function of the kidneys?

A

Filter the blood of waste products and excrete urine

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4
Q

What is bowmans capsule permeable to?

A

Water
Ions
Glucose
Amino acids

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5
Q

What is bowmans capsule not permeable to?

A

Proteins
RBCs
Other large molecules

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6
Q

What is the descending loop of henle permeable to?

A

Only permeable to water

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7
Q

What is the ascending loop of henle permeable to?

A

Only permeable to ions

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8
Q

What are the indications for diuretics?

A

Heart failure
Pulmonary edema
Liver cirrhosis
Hypertension
Raised intracranial pressure

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9
Q

What is the mechanism of action for loop diuretics?

A

Inhibit ion reabsorption along the ascending loop of henle

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10
Q

What is the most common diuretic used for heart failure?

A

Loop diuretics

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11
Q

What are examples of loop diuretics?

A

Furosemide
Bumetanide
Todemide

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12
Q

What are adverse effects associated with loop diuretics?

A

Metabolic alkalosis
Hypokalemia
Hypochloremia

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13
Q

What is the mechanism of action for thiazides?

A

Inhibit ion transport along the distal tubule

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14
Q

When are thiazides typically used?

A

As a secondary or adjunct diuretic for congestive heart failure

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15
Q

What are examples of thiazides?

A

Hydrochlorothiazide

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16
Q

What are adverse effects associated with thiazides?

A

Hyponatremia

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17
Q

Describe the mechanism of action for potassium sparing diuretics

A

Inhibits ion reabsorption at the collecting duct
Limits the amount of potassium lost

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18
Q

What is a drawback of potassium sparing diuretics?

A

Not a powerful diuretic

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19
Q

What is typically administered with potassium sparing diuretics?

A

Loop diuretics
Helps limit the amount of potassium lost

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20
Q

What is an example of a potassium sparing diuretic?

A

Spironolactone

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21
Q

What are some adverse effects of potassium sparing diuretics?

A

Hyperkalemia
Metabolic acidosis

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22
Q

What is the mechanism of action for osmotic diuretics?

A

Inhibits sodium and water reabsorption in the proximal tubule and loop of henle
Pulls fluid out of intracellular compartment into extracellular compartment

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23
Q

What are the common uses for osmotic diuretics?

A

Cerebral edema
Drug toxicity overdose

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24
Q

What is an example of an osmotic diuretic?

A

Mannitol

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25
What are adverse effects of osmotic diuretics?
Increase plasma volume leading to increased cardiac workload
26
What is being examined during a urinalysis?
Color Clarity Concentration Content Chemical analysis
27
When analyzing kidney function, what values are we looking for?
BUN Creatinine
28
Which is more accurate for determining kidney function, creatinine or BUN?
BUN will increase earlier in renal disease, but creatinine is a more accurate assessment
29
What creates creatinine?
Creatinine is a by-product of creatine-phosphate in muscle which is produced at a constant rate
30
What is urea a product of?
Protein metabolism
31
Describe what baroreceptors are
Nerve endings that feel or sense our blood pressure
32
What effects does the sympathetic nervous system have on the cardiogenic system?
Increase HR Increase stroke volume Increase contractility Increase BP by vasoconstriction
33
What effects does the parasympathetic nervous system have on the cardiogenic system?
Decrease HR Decrease stoke volume Decrease contractility Decrease BP by vasodilation
34
What does the juxtaglomerular apparatus have that helps regulate blood pressure?
Houses specialized cells that participate in RAAS Renin angiotensin aldosterone system
35
What is the renin angiotensin aldosterone system responsible for?
Critical regulator of blood volume, electrolyte balance, and system vascular resistance
35
What are the specialized cells located in the juxtaglomerular apparatus?
Juxtaglomerular cells Macula densa cells Mesangial cells
35
What do the macula densa cells do?
Chemoreceptor Distal convoluted tubule Senses changes in filtrate concentrations
36
What do the mesangial cells do?
Provide structural support to the nephron
36
What do juxtaglomerular cells do?
Baroreceptor Smooth muscle around the arteriole Senses changes in pressure in the afferent arteriole
37
What causes the release of renin?
Juxtaglomerular cells sense decrease in blood pressure in the afferent arteriole Macula densa cells sense a low sodium contraction in the filtrate of the DCT
37
What are the organs involved in the renin angiotensin aldosterone system?
Kidneys Liver Lungs Adrenal gland
38
Where is angiotensinogen stored? And it what state?
Liver Inactivated
39
What activates angiotensinogen in the liver?
Renin
40
What does renin turn angiotensinogen turn into once activated by renin?
Becomes angiotensinogen 1
41
Where does angiotensin 1 become angiotensin 2?
It becomes angiotensin 2 in the lungs when it interacts with angiotensin converting enzyme
42
What does angiotensin 2 do?
Generalized vasoconstrictor Constricts afferent arteriole Stimulates adrenal gland to produce aldosterone
43
What are the targets of aldosterone?
Distal convoluted tubule Hypothalamus
44
What effect does aldosterone have on the DCT?
Promotes more sodium reabsorption
45
What effect does aldosterone have on the hypothalamus?
Activates antidiuretic hormone Tells kidneys to reabsorb more water
46
What is the sympathetic nervous systems response to low blood pressure?
Secretes adrenaline which is a potent vasoconstrictor including the afferent and efferent arterioles
47
What is autoregulation in regards to the kidneys?
Local mechanism withing the kidney that maintain a consistent GFR over a range of systemic MAP
48
How does the kidney achieve autoregulation?
Myogenic mechanism Tubular glomerular mechanism
49
What is the myogenic mechanism?
Baroreceptor
50
What is the tubular glomerular mechanism?
A chemoreceptor
51
What are the 3 types of acute renal injury?
Prerenal Intrinsic renal Postrenal
52
Describe prerenal injury
Issues arising before the kidney Decreased blood flow, volume depletion
53
Describe intrinsic renal injury
Caused by a process within the kidneys Damage to the tissue associated with trauma, infection and/or toxicity
54
Describe postrenal injury
Issue arising after the kidney Obstruction of urine outflow
55
How is acute kidney injury diagnosed?
Decreased GFR Increased Creatinine Increased BUN Lack of urine output
56
What is the time course for acute kidney injury?
Usually reversible 2 weeks - 2 months
57
What are the 4 phases of acute kidney injury?
Initial Oliguria Diuresis Recovery
58
Describe chronic kidney failure
Progressive process Gradual onset (months to years) Deterioration inevitable, leading to dialysis/transplant
59
Describe the epidemiology of chronic renal disease
Increases as rates of DM and HTN increase Incidence increases with age Significantly greater in african americans
60
What is the pathophysiology of chronic kidney disease?
Characterized by nephron deterioration Rate is dependent on etiology Progression usually occurs in 5 distinct stages
61
What is the normal GFR?
>90 ml/min
62
What are complications associated with end stage renal disease?
Fluid retention Uremia/azotemia
62
What is the GFR of stage 5 renal disease?
<15 ml/minute
63
What the result of the fluid retention caused by kidney failure?
Respiratory compromise Hypertension Encephalopathy
64
What is the result of uremia/azotemia caused by kidney failure?
Toxins building up in the blood
65
What is the purpose of dialysis?
Removal of wastes and fluids from the blood
66
What are the three options for dialysis?
Continuous renal replacement Hemodialysis Peritoneal dialysis
67
Where is hemodialysis performed?
ICU Inpatient or outpatient areas
68
How often is hemodialysis performed?
4 hour treatment 3 times a week
69
What is needed to perform hemodialysis?
Catheter or fistula
70
Where is continuous renal replacement therapy performed?
ICU only
71
What does hemodialysis cause?
Large fluid shifts
72
What is required for continuous renal replacement therapy?
Specialized nurses Central dialysis catheter
73
What are the benefits of continuous renal replacement therapy?
Improved tolerance Less fluid shifts
74
Where is peritoneal dialysis performed?
At home on patient schedule
75
What are concerns associated with continuous renal replacement therapy?
Clotting
76
Describe how peritoneal dialysis is performed
Permanent catheter placed in abdomen Peritoneal cavity is filled with hypertonic solution to eliminated solutes and extra water into drainage bag
77
Why is peritoneal dialysis feasible?
The peritoneum is highly vascularized allowing for fluid exchange
78
When is peritoneal dialysis generally performed?
Overnight Generally takes 8-9 hours
79
What are the risks associated with peritoneal dialysis?
Infection Patient compliance
80
What is contraction alkalosis?
Occurs when there is a large loss of extracellular fluid Plasma HCO3 concentration rises due to lack of fluid
81
What can cause contraction alkalosis?
Loop diuretics Sweat losses in CF
82
What are interventions for contraction alkalosis?
Diamox Chloride Fluids

Concepts in Critical care (7 decks)

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