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Health Assessment Exam 4 > Renal > Flashcards

Renal Flashcards

1
Q

Front

A

Back

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2
Q

What percentage of total body water (TBW) is water?

A

~60%

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3
Q

Where is extracellular fluid (ECF) found?

A

Outside cells (ISF + Plasma)

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4
Q

Which compartment is more immediately altered by the kidneys?

A

ECF

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5
Q

What mediates osmolar homeostasis?

A

Osmolality sensors in anterior hypothalamus

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6
Q

What does vasopressin (ADH) do in osmoregulation?

A

Promotes water reabsorption

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7
Q

What cardiac hormone acts on kidneys to reduce Na+/H2O reabsorption?

A

ANP

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8
Q

What organ senses volume changes to activate RAAS?

A

Juxtaglomerular apparatus (JGA)

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9
Q

What triggers RAAS activation?

A

↓ Volume at JGA

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10
Q

Normal sodium range?

A

135–145 mEq/L

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11
Q

Sodium level contraindicating surgery?

A

<125 or >150 mEq/L

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12
Q

Most common cause of hyponatremia in hospitals?

A

Over-resuscitation + ↑vasopressin

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13
Q

Symptoms of sodium imbalance are primarily ___.

A

Neurological

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14
Q

Key symptoms of severe hyponatremia (<120)?

A

Seizures, respiratory arrest, death

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15
Q

Risk of rapid sodium correction?

A

Osmotic demyelination syndrome

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16
Q

Hyponatremic seizures treatment?

A

3% NaCl at 3-5 mL/kg over 20 min

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17
Q

Max Na+ correction rate?

A

1.5 mEq/L/hr

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18
Q

Common causes of hypernatremia?

A

Evaporation, ↓ intake, DI, NaHCO₃, GI loss

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19
Q

Symptoms of hypernatremia?

A

Lethargy, tremor, seizures, death

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20
Q

Hypernatremia treatment in hypovolemia?

A

Normal saline

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21
Q

Hypernatremia treatment in euvolemia?

A

Water replacement (PO or D5W)

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22
Q

Hypernatremia treatment in hypervolemia?

A

Diuretics

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23
Q

Safe sodium reduction rate?

A

≤0.5 mmol/L/hr or ≤10 mmol/L/day

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24
Q

Normal potassium level?

A

3.5–5.0 mEq/L

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25
Q

What percentage of K+ is extracellular?

A

<1.5%

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26
Q

How does aldosterone affect potassium?

A

↑K+ excretion in distal nephron

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27
Q

Common renal causes of hypokalemia?

A

Diuretics, hyperaldosteronism

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28
Q

GI causes of hypokalemia?

A

N/V/D, malabsorption

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29
Q

What shifts potassium intracellularly?

A

Alkalosis, insulin, beta-agonists

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30
Q

Unique food causing hypokalemia?

A

Excess licorice

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31
Q

EKG finding in hypokalemia?

A

U wave

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32
Q

Best way to administer potassium?

A

PO > IV (if absorbable)

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33
Q

IV K+ dosing guideline?

A

10-20 mEq/hr via CVC

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34
Q

Effect of 10 mEq IV K+ on serum K+?

A

↑ ~0.1 mmol/L

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35
Q

First-line treatment for hyperkalemia?

A

IV calcium

36
Q

Effect of hyperventilation on potassium?

A

↑pH by 0.1 ↓K+ by 0.4–1.5 mmol/L

37
Q

Insulin dose for hyperkalemia?

A

10u IV insulin ± 25g D50

38
Q

EKG progression in hyperkalemia?

A

Peaked T → no P → wide QRS → sine wave

39
Q

Avoid these in hyperkalemia

A

Succinylcholine, hypoventilation, LR

40
Q

Normal ionized calcium level?

A

1.2–1.38 mmol/L

41
Q

Most calcium is stored in the ___.

A

Bone (99%)

42
Q

What affects ionized calcium levels?

A

Albumin & pH

43
Q

↑pH effect on ionized Ca++?

A

↓ Ionized Ca++ (more albumin-bound)

44
Q

Key hormones regulating calcium?

A

PTH, Vitamin D, Calcitonin

45
Q

Major cause of hypocalcemia post-op?

A

↓PTH from thyroid/parathyroid surgery

46
Q

Why does blood transfusion cause hypocalcemia?

A

Citrate binds calcium

47
Q

Classic emergency from low calcium post-thyroidectomy?

A

Laryngospasm

48
Q

First-line treatment for Torsades?

A

2g IV magnesium sulfate

49
Q

Hypermagnesemia cause?

A

Over-treatment (e.g., OB Mg drips)

50
Q

Symptoms of high Mg++ (>10 mEq/L)?

A

Paralysis, apnea, cardiac arrest

51
Q

Treatment of high Mg++?

A

Diuresis, IV calcium, dialysis

52
Q

Where are kidneys located?

A

Retroperitoneal, T12–L4

53
Q

Functional unit of kidney?

54
Q

% of CO to kidneys?

A

20% (~1–1.25 L/min)

55
Q

Part of kidney most vulnerable to ischemia?

A

Medulla (LOH area)

56
Q

Main kidney functions?

A

Regulate EC fluid/osmolarity, BP, acid-base, excrete waste

57
Q

Hormones made by kidney?

A

Renin, EPO, Calcitriol, Prostaglandins

58
Q

Best test for long-term renal function?

59
Q

Normal GFR?

A

120–140 mL/min

60
Q

Most accurate GFR measurement?

A

Creatinine clearance (110–150 mL/min)

61
Q

Normal serum creatinine?

A

0.6–1.3 mg/dL

62
Q

Normal BUN?

A

10–20 mg/dL

63
Q

Normal BUN:Creatinine ratio?

A

0.41736111111111107

64
Q

High BUN:Cr ratio (>20:1) suggests ___.

A

Pre-renal azotemia

65
Q

Normal urine output?

A

0.5–1 mL/kg/hr or 30 mL/hr

66
Q

Definition of oliguria?

A

<500 mL/day

67
Q

Significance of >50% IVC collapse on US?

A

Volume depletion

68
Q

Definition of AKI?

A

Rapid decline in kidney function over hrs–days

69
Q

Classic AKI markers?

A

↑SCr by 0.3 in 48h, 50% rise in 7 days, ↓CrCl 50%

70
Q

Most common hospital AKI type?

71
Q

Treatment for pre-renal AKI?

A

Fluids, pressors, maintain MAP

72
Q

Diagnostic clue for pre-renal AKI?

A

BUN:Cr > 20:1

73
Q

Clue for intrinsic (renal) AKI?

A

BUN:Cr < 15:1

74
Q

Clue for post-renal AKI?

A

Obstruction + variable BUN:Cr

75
Q

Most dangerous AKI complication in anesthesia?

A

Uremic bleeding

76
Q

CKD leading causes?

A

Diabetes, hypertension

77
Q

When is dialysis indicated?

A

Volume overload, hyperkalemia, acidosis, uremia

78
Q

Best IV fluid in AKI/CKD?

A

Normal saline

79
Q

Avoid these drugs in CKD?

A

Morphine, Demerol, drugs with active metabolites

80
Q

Key pre-op lab for CKD surgery?

A

K+ < 5.5 mEq/L

81
Q

Dialysis timing before elective surgery?

A

Within 24h

82
Q

Best reversal combo in CKD?

A

Neostigmine + glycopyrrolate

83
Q

Why avoid ACE-I/ARBs on day of surgery?

A

↑Risk of hypotension

84
Q

Morphine metabolite of concern in CKD?

A

Morphine-6-glucuronide

85
Q

Toxic Demerol metabolite?

A

Normeperidine

Health Assessment Exam 4 (10 decks)

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