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6901 > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

location of the kidneys

A
  • posterior part of abdomen
  • 12th thoracic to 3rd lumber
  • right is lower than left
  • perirenal fat and renal fascia
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2
Q

renal hilus

A
  • renal artery and vein
  • lymphatics
  • nerves
  • ureters
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3
Q

what is the functional unit of the kidney? how many?

A
  • nephron

- 1.25 million/kidney

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4
Q

types of nephrons

A
  • cortical = 70-80%

- juxtamedullary = 20-30%: concentrate urine

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5
Q

what is the cardiac output the kidney receives?

A
  • 20-25%

- 1100-1200 mL per minute

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6
Q

blood flow through kidney

A
  • renal artery
  • lobar artery
  • interlobar artery
  • arcuate artery
  • interlobular artery
  • afferent arteriole
  • glomerulus
  • efferent arteriole: smaller, increases pressure
  • peritubular capillaries
  • vasa recta: loop of Henle
  • interlobular vein
  • arcuate vein
  • interlobar vein
  • lobar vein
  • renal veins
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7
Q

renal blood flow equation

A

RBF = (MAP - VP) x VR

VP = venous pressure
VR = vascular resistance
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8
Q

regulation of RBF: autoregulation

A
  • blood flow remains normal despite changes in BP

- maintains RBF between 50 - 180 mmHg

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9
Q

regulation of RBF: neural regulation

A
  • innervated by sympathetic nervous system

- can be overridden by autoregulation

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10
Q

3 ways kidneys regulate urine formation?

A
  • filtration
  • reabsorption
  • secretion
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11
Q

what is the most important index of renal function?

A

GFR

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12
Q

juxtaglomerular complex

A
  • regulates GFR
  • macula densa: distal convoluted tubule lies between afferent and efferent arteriole
  • afferent and efferent arterioles consist of juxtaglomerular cells which contain renin
  • sensitive to osmolality
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13
Q

what do the juxtaglomerular cells secrete? when (3)?

A

-renin

  • sympathetic stimulation
  • decreased delivery of Na and Cl
  • decreased afferent arteriole perfusion
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14
Q

6 nephron segments

A
  • glomerular capillaries
  • proximal convoluted tubule
  • loop of henle
  • distal renal tubule
  • collecting duct
  • juxtaglomerular apparatus
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15
Q

renal: maximum transport

A
  • maximum reabsorption has occurred and excess filtered material is excreted
  • carrier is saturated
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16
Q

reabsorption/secretion: proximal tubule

A
  • Na: active transport, capillary Na/K pump
  • water and other electrolytes: co-transport
  • large amount of mitochondria to support movement
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17
Q

what increases reabsorption of sodium in the proximal tubule?

A
  • angiotensin 2

- norepinephrine

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18
Q

reabsorption/secretion: loop of Henle

A
  • solute and water reabsorption follows concentration and osmotic gradients
  • in thick ascending limb reabsorption of Na and Cl in excess of water – all four sites of carrier protein must be occupied, Cl is rate limiter
  • descending permeable to water, ascending permeable to urea
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19
Q

reabsorption/secretion: distal convoluted tubule

A
  • sodium reabsorbed under aldosterone
  • water reabsorbed only under ADH
  • potassium secreted for sodium
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20
Q

reabsorption/secretion: collecting duct

A
  • hydrogen secretion, bicarbonate reabsorption: acidifies urine
  • sodium reabsorbed under aldosterone
  • water reabsorption dependent on ADH
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21
Q

what percentage of filtrate is reabsorbed?

A

99%

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22
Q

renal hormones: aldosterone

A
  • increase Na and water reabsorption
  • acts in distal nephron
  • regulated by potassium and RAAS
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23
Q

renal hormones: ADH

A
  • acts on distal tubule and collecting ducts
  • inhibited by stretch of atrial baroreceptors
  • released due to high osmolarity, hypotension, hypovolemia, angiotensin 2
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24
Q

renal hormones: ANP

A
  • released by atria in heart due to stretch

- causes increase in sodium excretion, urine flow, RBF, GFR

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25
Q

renal hormones: EPO

A

-people will kidney disease develop anemia

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26
Q

renal hormones: prostaglandins

A
  • PGE2: vasodilator
  • Thromboxane A2: contraction of vascular smooth muscle
  • protective during hypotension and ischemia
27
Q

renal hormones: Vitamin D

A

-cholecalciferol converted to 25-hydrocholecalciferol in kidneys and then 1,25-dihydroxycholecalciferol in liver

28
Q

renal: sevoflurane

A
  • when reacted with soda lime, may create compound A which causes renal tubular necrosis
  • increased with high concentration, low flow rates, increased temperature, increased CO2
29
Q

renal failure: pain medications to avoid

A
  • morphine

- Demerol

30
Q

what is the only true physiologic diuretic?

A

water

31
Q

osmotic diuretics (4) types

A
  • mannitol
  • urea
  • glycerin
  • isosorbide
32
Q

avoid osmotic diuretics in which patients?

A

heart failure

33
Q

osmotic diuretics mechanism of action

A

-increases the osmolarity of tubular fluid and prevents reabsorption

34
Q

carbonic anhydrase inhibitors mechanism of action

A
  • limit secretion of H+ ions and increase the loss of bicarbonate
  • forms alkaline urine
35
Q

carbonic anhydrase inhibitors (1) type

A

-Diamox/acetazolamide

36
Q

avoid carbonic anhydrase inhibitors in which patients?

A

-renal and liver failure

37
Q

avoid what medication when taking loop diuretics?

A

-NSAIDS; inhibit prostaglandin synthesis

38
Q

loop diuretics mechanism of action

A
  • prevent chloride reabsorption

- increased prostaglandin production which promotes renal artery vasodilation

39
Q

aldosterone antagonists mechanism of action

A

-inhibit aldosterone: prevent the reabsorption of Na and water

40
Q

loop diuretic (4) types

A
  • bumex
  • Lasix
  • torsemide
  • ethacrynic acid
41
Q

aldosterone antagonists (2) type

A
  • spironolactone

- eplerenone (selective antagonists: fewer side effects)

42
Q

potassium sparing diuretics (4) types

A
  • spironolactone
  • eplerenone
  • triamterene
  • amiloride
43
Q

potassium sparing diuretics mechanism of action

A

-inhibit potassium and hydrogen ion secretion in distal tubule

44
Q

thiazide diuretics types

A

—thiazide

45
Q

thiazide diuretic mechanism of action

A

-inhibit reabsorption of sodium and chloride in the ascending loops of Henle and the proximal and distal tubules

46
Q

xanthines potentiate which diuretic?

A

-carbonic anhydrase inhibitors

47
Q

xanthines mechanism of action

A
  • naturally occurring
  • stimulate CNS and cardiac muscle, relax smooth muscle
  • increased GFR and increased sodium/chloride secretion
48
Q

symptoms of rhabdomyolysis seen under anesthesia (2) and lab tests

A
  • peaked T-waves
  • myoglobinuria
  • elevated serum CK, K, creatinine
  • hypocalcemia
  • lactic acidosis
49
Q

rhabdomyolysis treatment

A
  • fluid (NS over LR)

- electrolyte corrections

50
Q

fenoldopam

A
  • dopamine receptor agonist

- protective for situations that may lead to impaired renal function

51
Q

prevent of contrasted induced acute renal failure

A
  • fluid
  • no NSAIDS
  • newer contrast agents (iodixanol>isovue)
52
Q

all forms of anesthesia can depress renal function by?

A

30-40%

53
Q

fluoride ion renal toxicity

A
  • methoxyflurane

- interferes with transport of sodium and chloride, vasodilator, ADH inhibitor

54
Q

fluoride ion renal toxicity: symptoms

A
  • polyuria
  • hypernatremia
  • hyperosmolality
  • increased BUN, creatinine
55
Q

nonoliguric, oliguric, anuric volumes

A

nonoliguric >400
oliguric <400, <0.5 mL/kg
anuric <100

56
Q

major causes of kidney tubular injury

A
  • ischemia
  • endogenous/exogenous toxins
  • infections
57
Q

most common cause of AKI?

A

-prolonged renal hypoperfusion

58
Q

5 stages of CKD

A

1: kidney damage with normal GFR
2: GFR 60-89
3: GFR 30-59
4: GFR 15-29
5: GFR<15

59
Q

anesthetic considerations with CKD

A
  • anemia
  • pruritic
  • metabolic acidosis
  • electrolyte disturbances
  • coagulopathies
  • HTN
  • pulmonary congestion/edema
60
Q

what is the most reliable tool for renal function?

A

-creatinine clearance test

61
Q

creatinine clearance formula and normal number

A

GFR=(urine creatinine x urine volume) x serum creatinine

-normal 95-150 mL/min

62
Q

fluid for CKD?

A
  • use NS

- do not use LR because of high potassium

63
Q

brachytherapy

A
  • insertion of radioactive implant to treat cancer

- low EBL

64
Q

extracorporeal shock wave therapy

A
  • high energy shock waves sent through body to break up kidney stones
  • synced to R waves of heart: caution for arrhythmias

6901 (18 decks)

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