Renal Disease & Urologic Surgery

Question 1

What percent of cardiac output goes to the kidneys?

Answer 1

15-25%

Question 2

Anesthesia Increases or decreases renal bloodflow?

Answer 2

Decreases by decreasing cardiac output

Question 3

Blood urea nitrogen is not elevated until GFR is decreased to almost __% of normal

Answer 3

75

Question 4

Serum creatinine measurements reflect what?

Answer 4

Glomerular function

Question 5

What are the normal creatinine levels for men and women?

Answer 5

Men: 0.8-1.3 mg/dL
Women: 0.6-1 mg/dL

Question 6

What is the most accurate measure of glomerular filtration rate?

Answer 6

Creatinine clearance

Question 7

What is a normal GFR for men and women?

Answer 7

Men: 95-140 mL/min
Women: 85-125 mL/min

Question 8

Decreasing flow does what to the BUN/Cr ratio?

Answer 8

Increases it

Question 9

What is the normal pH range for urine?

Answer 9

4.5-8.0

Question 10

Anemia may be present in patients with renal disease because of abnormalities in the production of what?

Answer 10

Erythropoietin

Question 11

Most patients with chronic renal disease have increased body water as well as ____ Na/K balance

Answer 11

Increased

Question 12

Which groups are at highest risk for developing acute renal failure?

Answer 12

Elderly
Diabetic
Baseline renal insufficiency

Question 13

Deterioration of function over hours to days leading to the inability of the kidneys to excrete waste products and maintain fluid and electrolyte homeostasis

Answer 13

Acute renal failure

Question 14

What are the three types of acute renal failure?

Answer 14

Prerenal (decreased renal flow)
Renal (intrinsic)
Post renal (obstructive)

Question 15

What are the primary risk factors for acute renal failure?

Answer 15

Advanced age
Congestive heart failure
Sepsis
Nephrotoxic drugs
Multiple blood transfusions
Hemolysis
Hypotension
Perirenal surgery

Question 16

What are some causes of prerenal ARF?

Answer 16

Hypotension
Hypovolemia
Congestive heart failure
Prerenal aortic crossclamping

Question 17

What are some renal causes of ARF?

Answer 17

Intrinsic renal disease
Renal ischemia
Nephrotoxic drugs

Question 18

What are some causes of post renal ARF?

Answer 18

Caused by an obstruction of urinary outflow

Question 19

The in-hospital mortality rate among patients with ARF ranges from _____ to ____%

Answer 19

20-50%

Question 20

What is hepatorenal syndrome?

Answer 20

Functional renal failure that occurs in severe cirrhosis

Characterized by tight constriction of renal arteries resulting in oliguria and sodium retention

Question 21

What are the five primary diseases of the kidney?

Answer 21

Glomerulonephritis
Polycystic renal disease
Renal artery stenosis
Renal hypertension
Diabetic nephropathy

Question 22

What is glomerulonephritis?

Answer 22

Deposits of antigen-antibody complexes in the glomeruli causes hematuria, proteinuria, hypertension and increased creatinine

Question 23

What is polycystic renal disease?

Answer 23

Progressive genetic disease characterized by hypertension and proteinuria with eventful renal failure

Question 24

What is renal artery stenosis?

Answer 24

Athlerosclerosis of renal arteries accounts for most cases

may be unilateral or bilateral

Question 25

What Is the most common cause of end-stage renal disease?

Answer 25

Diabetic nephropathy

Question 26

What is chronic renal failure?

Answer 26

Progressive irreversible deterioration of renal function that occurs over months or years

Question 27

What are some causes of chronic renal failure?

Answer 27

Glomerulopathy Tubular interstitial disease Hereditary disease Vascular disease

Question 28

What are some of the clinical symptoms of CRF?

Answer 28

General: fatigue, weakness & malaise GI: anorexia, N/V Neurological: Irritability, subtle memory defects, difficulty concentrating

Question 29

What type of catheter is large and stiff and associated with dialysis

Answer 29

Perverts! it's a vas cath

Question 30

What type of catheter has central access to multiple ports?

Answer 30

Central line

Question 31

What type of catheters are under the skin and commonly in the subclavian. usually stay in longer

Answer 31

Portacaths

Question 32

What are the two types of dialysis?

Answer 32

Hemodialysis | Peritoneal dialysis

Question 33

What type of dialysis can be done at home?

Answer 33

Peritoneal dialysis

Question 34

What type of dialysis is done three days a week?

Answer 34

Hemodialysis

Question 35

What type of muscle relaxants can be used on induction for renal patients?

Answer 35

Choose NMBs with clearance independent of renal function

Question 36

What are three important considerations to remember in the maintenance of anesthesia for renal patients?

Answer 36

Fluid management Muscle relaxation Hyperkalemia

Question 37

Why should you avoid or use caution when administering morphine and meperidine to CRF patients?

Answer 37

Morphine is a very potent sedative and can accumulate 10 to 15 times normal Normeperidine is the active metabolite in accumulates within the patient causing seizures

Question 38

What is BPH?

Answer 38

Benign prostatic hypertrophy | -Nonmalignant enlargement of the prostate

Question 39

What is the definitive treatment for BPH?

Answer 39

Transurethral resection of the prostate (TURP)

Question 40

What is TURP syndrome?

Answer 40

When too much fluid is absorbed and intravascular volume expansion and hypo-osmolality occur

Question 41

What is lithotripsy?

Answer 41

Using repetitive shocks to break up stones

Question 42

What is the definitive surgical treatment for patients with end-stage renal disease who are on chronic dialysis?

Answer 42

Renal transplantation

Question 43

How long can a donor kidney survive?

Answer 43

Up to 48 hours