Renal Disease & Urologic Surgery Flashcards
What percent of cardiac output goes to the kidneys?
15-25%
Anesthesia Increases or decreases renal bloodflow?
Decreases by decreasing cardiac output
Blood urea nitrogen is not elevated until GFR is decreased to almost __% of normal
75
Serum creatinine measurements reflect what?
Glomerular function
What are the normal creatinine levels for men and women?
Men: 0.8-1.3 mg/dL
Women: 0.6-1 mg/dL
What is the most accurate measure of glomerular filtration rate?
Creatinine clearance
What is a normal GFR for men and women?
Men: 95-140 mL/min
Women: 85-125 mL/min
Decreasing flow does what to the BUN/Cr ratio?
Increases it
What is the normal pH range for urine?
4.5-8.0
Anemia may be present in patients with renal disease because of abnormalities in the production of what?
Erythropoietin
Most patients with chronic renal disease have increased body water as well as ____ Na/K balance
Increased
Which groups are at highest risk for developing acute renal failure?
Elderly
Diabetic
Baseline renal insufficiency
Deterioration of function over hours to days leading to the inability of the kidneys to excrete waste products and maintain fluid and electrolyte homeostasis
Acute renal failure
What are the three types of acute renal failure?
Prerenal (decreased renal flow) Renal (intrinsic) Post renal (obstructive)
What are the primary risk factors for acute renal failure?
Advanced age Congestive heart failure Sepsis Nephrotoxic drugs Multiple blood transfusions Hemolysis Hypotension Perirenal surgery
What are some causes of prerenal ARF?
Hypotension
Hypovolemia
Congestive heart failure
Prerenal aortic crossclamping
What are some renal causes of ARF?
Intrinsic renal disease
Renal ischemia
Nephrotoxic drugs
What are some causes of post renal ARF?
Caused by an obstruction of urinary outflow
The in-hospital mortality rate among patients with ARF ranges from _____ to ____%
20-50%
What is hepatorenal syndrome?
Functional renal failure that occurs in severe cirrhosis
Characterized by tight constriction of renal arteries resulting in oliguria and sodium retention
What are the five primary diseases of the kidney?
Glomerulonephritis Polycystic renal disease Renal artery stenosis Renal hypertension Diabetic nephropathy
What is glomerulonephritis?
Deposits of antigen-antibody complexes in the glomeruli causes hematuria, proteinuria, hypertension and increased creatinine
What is polycystic renal disease?
Progressive genetic disease characterized by hypertension and proteinuria with eventful renal failure
What is renal artery stenosis?
Athlerosclerosis of renal arteries accounts for most cases
may be unilateral or bilateral
What Is the most common cause of end-stage renal disease?
Diabetic nephropathy
What is chronic renal failure?
Progressive irreversible deterioration of renal function that occurs over months or years
What are some causes of chronic renal failure?
Glomerulopathy
Tubular interstitial disease
Hereditary disease
Vascular disease
What are some of the clinical symptoms of CRF?
General: fatigue, weakness & malaise
GI: anorexia, N/V
Neurological: Irritability, subtle memory defects, difficulty concentrating
What type of catheter is large and stiff and associated with dialysis
Perverts! it’s a vas cath
What type of catheter has central access to multiple ports?
Central line
What type of catheters are under the skin and commonly in the subclavian.
usually stay in longer
Portacaths
What are the two types of dialysis?
Hemodialysis
Peritoneal dialysis
What type of dialysis can be done at home?
Peritoneal dialysis
What type of dialysis is done three days a week?
Hemodialysis
What type of muscle relaxants can be used on induction for renal patients?
Choose NMBs with clearance independent of renal function
What are three important considerations to remember in the maintenance of anesthesia for renal patients?
Fluid management
Muscle relaxation
Hyperkalemia
Why should you avoid or use caution when administering morphine and meperidine to CRF patients?
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
What is BPH?
Benign prostatic hypertrophy
-Nonmalignant enlargement of the prostate
What is the definitive treatment for BPH?
Transurethral resection of the prostate (TURP)
What is TURP syndrome?
When too much fluid is absorbed and intravascular volume expansion and hypo-osmolality occur
What is lithotripsy?
Using repetitive shocks to break up stones
What is the definitive surgical treatment for patients with end-stage renal disease who are on chronic dialysis?
Renal transplantation
How long can a donor kidney survive?
Up to 48 hours
