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Anesthesia Practice T3 > Renal and Urologic > Flashcards

Renal and Urologic Flashcards

1
Q

glomerular filtration pressure is what % of mean arterial pressure?

A

60%

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2
Q

where is the majority of glucose reclaimed in the kidney?

A

90% proximal via SGLT2

*10% distal tubules SGLT1

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3
Q

what is the major function of the proximal tubule?

A

Na reabsorption

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4
Q

when are renal failure symptoms detectable?

A

when less than

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5
Q

how is creatinine clearance calculated?

A

((140-age)x(lean body wt))
______________
(72 x plasma creatinine)

= creatinine clearance

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6
Q

what is normal creatinine clearance?

A

100-200 cc/min

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7
Q

where is the majority of glucose reclaimed in the kidney?

A

90% proximal via SGLT2

*10% distal tubules SGLT1

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8
Q

what creatinine clearance indicates end stage renal failure?

A
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9
Q

normal creatinine levels

A
  1. 8-1.3 M
  2. 6-1.0 F
    * proportional to muscle mass
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10
Q

what creatinine clearance shows moderate renal insufficiency?

A

25-40 cc/min

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11
Q

how can you treat renal artery stenosis?

A
  • renal shunt or angioplasty

- control HTN

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12
Q

what is a normal BUN?

A

10-20 mg/dL

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13
Q

what is Acute Glomerular nephritis?

A

antibody-antigen rxn, glomeruli become inflamed

  • causes flomeruli blockage
  • causes protein leakage in unblocked glomeruli
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14
Q

what is Polycystic Kidney Disease?

A

autosomal genetic disease that causes cysts on the kidneys

  • associated with
  • aortic aneurysms
  • brain aneurysms
  • other cysts
  • diverticulae of the colon
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15
Q

what will you see in PTs with polycystic kidney disease?

A
  • HTN
  • UTI
  • bleeding or ruptured cysts
  • eventually renal failure
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16
Q

what is Renal artery stenosis?

A
  • narrowing of the arteries feeding the kidneys
  • leads to decrease BP at afferent arteriole and renin release
  • leads to HTN, kidney failure
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17
Q

why do most perioperative AKI (acute kidney injuries) occur?

A
  • renal ischemia caused by hypotension/hypovolemia

* avoid with volume loading to surpress renin

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18
Q

what is diabetic renal neuropathy?

A

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

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19
Q

how do you treat diabetic renal neuropathy?

A

treat HTN with ACE inhibitors

control blood sugar

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20
Q

what is hepatorenal syndrome?

A

rapid loss of kidney function secondary to liver failure

- alters blood flow to kidneys, they secrete renin, gets worse

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21
Q

how do you treat hepatorenal syndrome?

A

liver transplant, dialysis

*kidney can recover after a transplant

22
Q

what is azotemia?

A

rapid deterioration of kidney funtion

- results in nitrogenous waste in blood

23
Q

what are 3 types of azotemia?

A

pre-renal - decreased renal perfusion
renal - due to intrinsic renal disease or ischemia
post-renal - due to urinary tract obstruction

24
Q

why do most perioperative AKI (acute kidney injuries) occur?

A
  • renal ischemia caused by hypotension/hypovolemia

* avoid with volume loading to surpress renin

25
Q

diamox drug type and dose

A

carbonic anhydrase inhibitor

250-500 mg

26
Q

what MAP level is associated with AKI?

A
27
Q

what is oliguria?

A

low urine production

28
Q

what is considered non-oliguric renal failure?

A

> 400cc/hr urine (poor quality)

*better hospital stays than oliguric renal failure

29
Q

what drugs may reduce AKI risk?

A

statins

30
Q

furosemide/lasix drug type and dose

A

loop diuretic

10-100 mg

31
Q

bumetetanide/bumex drug type and dose

A

0.5-1 mg

loop diuretic

32
Q

ethycrynic acid drug type and dose

A

50-100 mg

lupe diuretic

33
Q

diuril drug type and dose

A

500 mg

inhibits Na resorption in distal tubule

34
Q

name an aldosterone antagonist

A

spironalactone

35
Q

what are metabolic signs of renal failure?

A
  • hyperkalemia
  • hypermagnesemia
  • hyperuricemia
  • hypoalbunemia
  • hypocalcemia
  • hypophosphatemia
36
Q

increased angiotensin can do what to the heart?

A
  • increase LVH

- lead to CHF

37
Q

what is dialysis?

A

removing solute from the body (toxins, electrolytes and water)

38
Q

what is hemodialysis?

A

hooked up to a machine, usually anticoagulated

39
Q

what is peritoneal dialysis?

A

wastes and water are removed from blood inside the body using the peritoneal membrane
*dialystate instilled and removed to get toxins and water out

40
Q

what is intestinal dialysis?

A

using soluble fibers to help aid bacterial growth in GI, leads to nitrogen that is eliminated in fecal wastes

41
Q

what is myoglobinuria?

A

clogging of the kidney system by the breakdown of proteins (i.e. myoglobin) that filtered in the kidney

42
Q

what is the best treatment for myoglobinuria?

A

fluids and diuretics

  • mannitol
  • flushing out the kidneys, alkanalize the urine with sodium bicarb
43
Q

what is a concern for anesthesia for PTs just off dialysis?

A
  • they are anticoagulated

- blood gas for K+, glucose

44
Q

when is it okay to use Sux in a renal PT?

A

if K is

45
Q

why would cisatracurium be good for a renal PT?

A

hoffman elimination

46
Q

what are some quick treatments for hyperkalemia?

A

calcium chloride
sodium bicarb
glucose/insulin
hyperventilation

47
Q

what fluids do you use for renal PTs?

A

0.9% NaCl

48
Q

what can result do to too much irrigation?

A

TURP syndrome

49
Q

how do you confirm TURP?

A
50
Q

how do you fix TURP?

A

loop diuretics
restrict fluids
hypertonic saline
intubate

51
Q

what are anesthetic considerations for using shock waves to break up kidney stones?

A
  • can cause dysrhythmias

- PTs w/ pacemakers and AICDs can be damaged

52
Q

what relaxants are okay to use for renal PTs?

A
  • atracurium, cisatracurium
  • rocuronium if putting in another kidney
  • NOT sux

Anesthesia Practice T3 (6 decks)

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