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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
Q

What are adverse effects of osmotic diuretics?

A

Increase plasma volume leading to increased cardiac workload

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26
Q

What is being examined during a urinalysis?

A

Color
Clarity
Concentration
Content
Chemical analysis

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27
Q

When analyzing kidney function, what values are we looking for?

A

BUN
Creatinine

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28
Q

Which is more accurate for determining kidney function, creatinine or BUN?

A

BUN will increase earlier in renal disease, but creatinine is a more accurate assessment

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29
Q

What creates creatinine?

A

Creatinine is a by-product of creatine-phosphate in muscle which is produced at a constant rate

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30
Q

What is urea a product of?

A

Protein metabolism

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31
Q

Describe what baroreceptors are

A

Nerve endings that feel or sense our blood pressure

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32
Q

What effects does the sympathetic nervous system have on the cardiogenic system?

A

Increase HR
Increase stroke volume
Increase contractility
Increase BP by vasoconstriction

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33
Q

What effects does the parasympathetic nervous system have on the cardiogenic system?

A

Decrease HR
Decrease stoke volume
Decrease contractility
Decrease BP by vasodilation

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34
Q

What does the juxtaglomerular apparatus have that helps regulate blood pressure?

A

Houses specialized cells that participate in RAAS
Renin angiotensin aldosterone system

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35
Q

What is the renin angiotensin aldosterone system responsible for?

A

Critical regulator of blood volume, electrolyte balance, and system vascular resistance

35
Q

What are the specialized cells located in the juxtaglomerular apparatus?

A

Juxtaglomerular cells
Macula densa cells
Mesangial cells

35
Q

What do the macula densa cells do?

A

Chemoreceptor
Distal convoluted tubule
Senses changes in filtrate concentrations

36
Q

What do the mesangial cells do?

A

Provide structural support to the nephron

36
Q

What do juxtaglomerular cells do?

A

Baroreceptor
Smooth muscle around the arteriole
Senses changes in pressure in the afferent arteriole

37
Q

What causes the release of renin?

A

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
Q

What are the organs involved in the renin angiotensin aldosterone system?

A

Kidneys
Liver
Lungs
Adrenal gland

38
Q

Where is angiotensinogen stored? And it what state?

A

Liver
Inactivated

39
Q

What activates angiotensinogen in the liver?

A

Renin

40
Q

What does renin turn angiotensinogen turn into once activated by renin?

A

Becomes angiotensinogen 1

41
Q

Where does angiotensin 1 become angiotensin 2?

A

It becomes angiotensin 2 in the lungs when it interacts with angiotensin converting enzyme

42
Q

What does angiotensin 2 do?

A

Generalized vasoconstrictor
Constricts afferent arteriole
Stimulates adrenal gland to produce aldosterone

43
Q

What are the targets of aldosterone?

A

Distal convoluted tubule
Hypothalamus

44
Q

What effect does aldosterone have on the DCT?

A

Promotes more sodium reabsorption

45
Q

What effect does aldosterone have on the hypothalamus?

A

Activates antidiuretic hormone
Tells kidneys to reabsorb more water

46
Q

What is the sympathetic nervous systems response to low blood pressure?

A

Secretes adrenaline which is a potent vasoconstrictor including the afferent and efferent arterioles

47
Q

What is autoregulation in regards to the kidneys?

A

Local mechanism withing the kidney that maintain a consistent GFR over a range of systemic MAP

48
Q

How does the kidney achieve autoregulation?

A

Myogenic mechanism
Tubular glomerular mechanism

49
Q

What is the myogenic mechanism?

A

Baroreceptor

50
Q

What is the tubular glomerular mechanism?

A

A chemoreceptor

51
Q

What are the 3 types of acute renal injury?

A

Prerenal
Intrinsic renal
Postrenal

52
Q

Describe prerenal injury

A

Issues arising before the kidney
Decreased blood flow, volume depletion

53
Q

Describe intrinsic renal injury

A

Caused by a process within the kidneys
Damage to the tissue associated with trauma, infection and/or toxicity

54
Q

Describe postrenal injury

A

Issue arising after the kidney
Obstruction of urine outflow

55
Q

How is acute kidney injury diagnosed?

A

Decreased GFR
Increased Creatinine
Increased BUN
Lack of urine output

56
Q

What is the time course for acute kidney injury?

A

Usually reversible
2 weeks - 2 months

57
Q

What are the 4 phases of acute kidney injury?

A

Initial
Oliguria
Diuresis
Recovery

58
Q

Describe chronic kidney failure

A

Progressive process
Gradual onset (months to years)
Deterioration inevitable, leading to dialysis/transplant

59
Q

Describe the epidemiology of chronic renal disease

A

Increases as rates of DM and HTN increase
Incidence increases with age
Significantly greater in african americans

60
Q

What is the pathophysiology of chronic kidney disease?

A

Characterized by nephron deterioration
Rate is dependent on etiology
Progression usually occurs in 5 distinct stages

61
Q

What is the normal GFR?

A

> 90 ml/min

62
Q

What are complications associated with end stage renal disease?

A

Fluid retention
Uremia/azotemia

62
Q

What is the GFR of stage 5 renal disease?

A

<15 ml/minute

63
Q

What the result of the fluid retention caused by kidney failure?

A

Respiratory compromise
Hypertension
Encephalopathy

64
Q

What is the result of uremia/azotemia caused by kidney failure?

A

Toxins building up in the blood

65
Q

What is the purpose of dialysis?

A

Removal of wastes and fluids from the blood

66
Q

What are the three options for dialysis?

A

Continuous renal replacement
Hemodialysis
Peritoneal dialysis

67
Q

Where is hemodialysis performed?

A

ICU
Inpatient or outpatient areas

68
Q

How often is hemodialysis performed?

A

4 hour treatment 3 times a week

69
Q

What is needed to perform hemodialysis?

A

Catheter or fistula

70
Q

Where is continuous renal replacement therapy performed?

A

ICU only

71
Q

What does hemodialysis cause?

A

Large fluid shifts

72
Q

What is required for continuous renal replacement therapy?

A

Specialized nurses
Central dialysis catheter

73
Q

What are the benefits of continuous renal replacement therapy?

A

Improved tolerance
Less fluid shifts

74
Q

Where is peritoneal dialysis performed?

A

At home on patient schedule

75
Q

What are concerns associated with continuous renal replacement therapy?

A

Clotting

76
Q

Describe how peritoneal dialysis is performed

A

Permanent catheter placed in abdomen
Peritoneal cavity is filled with hypertonic solution to eliminated solutes and extra water into drainage bag

77
Q

Why is peritoneal dialysis feasible?

A

The peritoneum is highly vascularized allowing for fluid exchange

78
Q

When is peritoneal dialysis generally performed?

A

Overnight
Generally takes 8-9 hours

79
Q

What are the risks associated with peritoneal dialysis?

A

Infection
Patient compliance

80
Q

What is contraction alkalosis?

A

Occurs when there is a large loss of extracellular fluid
Plasma HCO3 concentration rises due to lack of fluid

81
Q

What can cause contraction alkalosis?

A

Loop diuretics
Sweat losses in CF

82
Q

What are interventions for contraction alkalosis?

A

Diamox
Chloride
Fluids

Concepts in Critical care (5 decks)

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