Renal and Urologic Flashcards
glomerular filtration pressure is what % of mean arterial pressure?
60%
where is the majority of glucose reclaimed in the kidney?
90% proximal via SGLT2
*10% distal tubules SGLT1
what is the major function of the proximal tubule?
Na reabsorption
when are renal failure symptoms detectable?
when less than
how is creatinine clearance calculated?
((140-age)x(lean body wt))
______________
(72 x plasma creatinine)
= creatinine clearance
what is normal creatinine clearance?
100-200 cc/min
where is the majority of glucose reclaimed in the kidney?
90% proximal via SGLT2
*10% distal tubules SGLT1
what creatinine clearance indicates end stage renal failure?
normal creatinine levels
- 8-1.3 M
- 6-1.0 F
* proportional to muscle mass
what creatinine clearance shows moderate renal insufficiency?
25-40 cc/min
how can you treat renal artery stenosis?
- renal shunt or angioplasty
- control HTN
what is a normal BUN?
10-20 mg/dL
what is Acute Glomerular nephritis?
antibody-antigen rxn, glomeruli become inflamed
- causes flomeruli blockage
- causes protein leakage in unblocked glomeruli
what is Polycystic Kidney Disease?
autosomal genetic disease that causes cysts on the kidneys
- associated with
- aortic aneurysms
- brain aneurysms
- other cysts
- diverticulae of the colon
what will you see in PTs with polycystic kidney disease?
- HTN
- UTI
- bleeding or ruptured cysts
- eventually renal failure
what is Renal artery stenosis?
- narrowing of the arteries feeding the kidneys
- leads to decrease BP at afferent arteriole and renin release
- leads to HTN, kidney failure
why do most perioperative AKI (acute kidney injuries) occur?
- renal ischemia caused by hypotension/hypovolemia
* avoid with volume loading to surpress renin
what is diabetic renal neuropathy?
glucose lvls too much for kidneys,
they secrete renin,
causes vasoconstriction and less blood flow to kidney, ultimately more renin worsening kidney function to failure
how do you treat diabetic renal neuropathy?
treat HTN with ACE inhibitors
control blood sugar
what is hepatorenal syndrome?
rapid loss of kidney function secondary to liver failure
- alters blood flow to kidneys, they secrete renin, gets worse
how do you treat hepatorenal syndrome?
liver transplant, dialysis
*kidney can recover after a transplant
what is azotemia?
rapid deterioration of kidney funtion
- results in nitrogenous waste in blood
what are 3 types of azotemia?
pre-renal - decreased renal perfusion
renal - due to intrinsic renal disease or ischemia
post-renal - due to urinary tract obstruction
why do most perioperative AKI (acute kidney injuries) occur?
- renal ischemia caused by hypotension/hypovolemia
* avoid with volume loading to surpress renin
diamox drug type and dose
carbonic anhydrase inhibitor
250-500 mg
what MAP level is associated with AKI?
what is oliguria?
low urine production
what is considered non-oliguric renal failure?
> 400cc/hr urine (poor quality)
*better hospital stays than oliguric renal failure
what drugs may reduce AKI risk?
statins
furosemide/lasix drug type and dose
loop diuretic
10-100 mg
bumetetanide/bumex drug type and dose
0.5-1 mg
loop diuretic
ethycrynic acid drug type and dose
50-100 mg
lupe diuretic
diuril drug type and dose
500 mg
inhibits Na resorption in distal tubule
name an aldosterone antagonist
spironalactone
what are metabolic signs of renal failure?
- hyperkalemia
- hypermagnesemia
- hyperuricemia
- hypoalbunemia
- hypocalcemia
- hypophosphatemia
increased angiotensin can do what to the heart?
- increase LVH
- lead to CHF
what is dialysis?
removing solute from the body (toxins, electrolytes and water)
what is hemodialysis?
hooked up to a machine, usually anticoagulated
what is peritoneal dialysis?
wastes and water are removed from blood inside the body using the peritoneal membrane
*dialystate instilled and removed to get toxins and water out
what is intestinal dialysis?
using soluble fibers to help aid bacterial growth in GI, leads to nitrogen that is eliminated in fecal wastes
what is myoglobinuria?
clogging of the kidney system by the breakdown of proteins (i.e. myoglobin) that filtered in the kidney
what is the best treatment for myoglobinuria?
fluids and diuretics
- mannitol
- flushing out the kidneys, alkanalize the urine with sodium bicarb
what is a concern for anesthesia for PTs just off dialysis?
- they are anticoagulated
- blood gas for K+, glucose
when is it okay to use Sux in a renal PT?
if K is
why would cisatracurium be good for a renal PT?
hoffman elimination
what are some quick treatments for hyperkalemia?
calcium chloride
sodium bicarb
glucose/insulin
hyperventilation
what fluids do you use for renal PTs?
0.9% NaCl
what can result do to too much irrigation?
TURP syndrome
how do you confirm TURP?
how do you fix TURP?
loop diuretics
restrict fluids
hypertonic saline
intubate
what are anesthetic considerations for using shock waves to break up kidney stones?
- can cause dysrhythmias
- PTs w/ pacemakers and AICDs can be damaged
what relaxants are okay to use for renal PTs?
- atracurium, cisatracurium
- rocuronium if putting in another kidney
- NOT sux
