Renal/AKI

Question 1

What percentage of cardiac output do the kidneys receive.?

Answer 1

20-25%

Question 2

What are the 4 main functions of the renal system.?

Answer 2

Removal of metabolic wastes, fluid andelectrokte maintenance, acid-base balance, endocrine functions such as RBC Production und BP control.

Question 3

What is rhadodomyolysis?

Answer 3

Complication of skeletal music lysis that leads to myoglobin build in the blood stream.

Question 4

What does myoglobinuria suggest?

Answer 4

• Intra renal toxic injury. Myoglobin is filtered in the glomeruli and transported to the proximal convoluted tubule, the tubal becomes blocked leading to toxic in jury.

Question 5

Common tests for renal function.

Answer 5

Urine volume (decrease may suggest poor renal function)–urinalysis (may help locate damage in the kidney) –sodium (retention may indicate poor renal perfusion)

Bun,creatinine, creatinine clearance, serum osmolality

Question 6

What is the most accurate lab value for renal function.

Answer 6

Creatinine clearance — measures the amount of creatinine excreted by the urine and provides an accurate measure of GFR

Question 7

What is the anion - gap?

Answer 7

[Na] - ([CI] + [HCO3])

Refers to the difference between measurable positive ions and anions in serum.

Normal range 1-12 mmol/L

AN increased anion gap suggests increased acid production or decrease removal of acids.

Question 8

What are three subsets of acute kidney injury?

Answer 8

Pre-renal, internal, post renal

Post-renal is least common, mostly caused by acute abdominal compartment syndrome.

Question 9

Define a pre-renal injury

Answer 9

Arises from decreased renal perfusion, originated outside of the kidney.

Question 10

What are the two subsets of intra-renal injury?

Answer 10

Ischemic and nephrotoxic

Question 11

Define ischemic intra-renal AKI

Answer 11

Occurs after prolonged ischemia to the kidney
25 min or less is reversible, 60-90 min is irreversible ischemia.

Question 12

Define nephrotoxic injury

Answer 12

Intra-renal in jury due to toxin build Up within the tubule

Question 13

4 strategies to prevent AK l

Answer 13

Monitor perfusion status, hydration /volume status, infection + sepsis prevention, encourage Oz supply to nephron.

Question 14

What is the functional unit of the kidney?

Answer 14

The nephron

Question 15

What is the movement of molecules from high to low concentration called?

Answer 15

Diffusion

Question 16

Where does concentration and dilution of urine occur?

Answer 16

In the juxtamedullary nephrons

Question 17

Where does concentration and dilution of urine occur?

Answer 17

In the juxtamedullary nephrons

Question 18

If ______is found in the urine, there could be damage to the glomerular membrane

Answer 18

Albumin

Question 19

What is the primary function of aldosterone?

Answer 19

Control of sodium and water

Question 20

When renin is released what is the physiologic effect?

Answer 20

Vasoconstriction

Question 21

When hypotension occurs, what occurs to maintain adequate glomerular pressure?

Answer 21

Constriction of the efferent arteriole

Question 22

Where does the beginning of filtering occur at each nephron?

Answer 22

The Glomerulus

Question 23

Reduced pressure in _____ will result in an increased release of renin

Answer 23

Reduced pressure in the glomerulus

Question 24

After angiotensin 1 is converted to angiotensin 2, what do the adrenal glands secrete?

Answer 24

Aldosterone

Question 25

For active transport to occur, what two factors are needed?

Answer 25

An electromagnetic gradient and adenosine triphosphate

Question 26

Increased secretion of ADH results in….?

Answer 26

Increased reabsorption of water in collecting duct

Question 27

What primarily influences GFR?

Answer 27

Blood flow through the glomerulus

Question 28

What are the three factors that will potentially decrease the GFR

Answer 28

1. Low BP
2. Obstruction in the tubules
3. Low plasma oncotic pressure

Question 29

What signs/symptoms would you expect to see if the Loop of Henle was damaged?

Answer 29

Dilute Urine

Question 30

What are the functions of the proximal convoluted tubule ?

Answer 30

Reabsorption of H2O, NA+, K+ Cl, HCO3, Glucose, amino acids and urea

Question 31

What are the 3 main functions of the collecting duct

Answer 31

1 water absorption in the presence of ADH
2. Reabsorption/secretion of H+ and HCO3
3. Concentration of urine by reabsorption of water by osmosis