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AP II Test 2 > Renal Diseases > Flashcards

Renal Diseases Flashcards

1
Q

What % of cardiac output do the kidneys receive?

A

15-25%

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2
Q

The kidneys receive approximately ____-____ L/min blood flow.

A

1-1.5

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3
Q

Blood flow controlled by vascular smooth muscle with changes in vascular resistance. True or false?

A

true

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4
Q

Surgical sympathetic stimulation increases vascular resistance and increases renal blood flow. True or false?

A

false

decreases renal blood flow

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5
Q

How does anethesia affect renal blood flow?

A

decreases renal blood flow by decreasing CO

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6
Q

What are the kidneys responsible for? (7)

A

maintenance of H20/electrolyte balance
excretion of waste products
secretion of hormones
catabolism of peptide hormones
synthesis of glucose
regulation of arterial pressure
regulation of acid-base balance

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7
Q

What are tests to evaluate renal function? (6)

A

Glomerular Filtration Rate (GFR)
Blood Urea Nitrogen (BUN)
Serum Creatinine
Creatinine Clearance
BUN/Cr ratio
Urinalysis
pH, specific gravity, glucose, protein

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8
Q

Normal GFR is _____ml/min

A

125

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9
Q

Indications of decreased GFR do not occur until there is a 20% reduction. True or false?

A

false

50%

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10
Q

BUN is not elevated until GFR is decreased to almost ____ % of normal.

Normal BUN is: ______mg/dl

A

75

7-21

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11
Q

What is freely filtered by the kidneys and not reabsorbed?

A

creatinine

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12
Q

Serum creatinine measurements reflect ______ function.

A

glomerular

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13
Q

What is the most accurate measure of GFR and what period is it measured over?

A

creatinine clearance

over 24 hours

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14
Q

Normal creatinine clearance values range is? This is measured over 24 hour period:

A

90-140 ml/min

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15
Q

What is a hallmark sign of kidney failure?

A

increased proteins

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16
Q

What does get reabsorbed by the kidneys?

A

urea

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17
Q

Low tubular flow rates enhance urea reabsorption but do not affect creatinine handling. True or false?

A

true

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18
Q

What is the normal BUN/Cr ratio?

Abnormal BUN/Cr ratio?

A

10/1

-30

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19
Q

What may be seen in renal failure or diabetes?

A

high urine glucose

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20
Q

What is the normal range for urine pH?

A

4.5 - 8.0

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21
Q

How many H+ do the kidneys remove per day? ___ mEq

A

60 mEq

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22
Q

KNOW!

Anemia may be present in patients with renal disease because of abnormalities in the production of ________.

A

erythropoietin

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23
Q

Most patients with chronic renal disease have increased _______ as well as offset ________ balance.

A

body water

sodium/potassium

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24
Q

What is the deterioration of function over hours to days leading to the inability of the kidneys to excrete waste products and maintain fluid and electrolyte homeostasis?

A

Acute Renal Failure (ARF)

25
Q

What patients are highest at risk for acute renal failure?

A

Elderly
Diabetic
Baseline renal insufficiency

26
Q

Most commonly will cause a patient to go into acute renal failure:

A

SEPSIS

27
Q

What can occur as a result of acute renal failure?

A

decreased GFR

retention of nitrogenous waste products

28
Q

What are the 3 types of acute renal failure?

A

Prerenal (decreased renal blood flow)
Renal (intrinsic)
Postrenal (obstructive)

29
Q

What are causes of pre-renal ARF? (4)

A

anything that decreases renal perfusion

Hypotension

Hypovolemia

Congestive heart failure

Pre-renal aortic cross-clamping

30
Q

What are the causes of renal (intrinsic) ARF?

A

Intrinsic renal disease

Renal ischemia

Nephrotoxic drugs

31
Q

What are postrenal/obstructive causes of ARF?

A

Caused by obstruction of urinary outflow tracts (hydronephrosis)

A diagnosis made with renal ultrasound

32
Q

ON EXAM

What are risk factors for ARF? (8)

A
  • age
  • CHF
  • sepsis
  • nephrotoxic drugs
  • multiple drug transfusions
  • hemolysis
  • hypotension
  • perirenal surgery
33
Q

What are complications of ARF?

A

Neurological – confusion, somnolence, seizures

Cardiovascular – systemic hypertension, congestive heart failure, pulmonary edema

Gastrointestinal – anorexia, nausea, vomiting, ileus

Infection – respiratory, urinary tract and sites of indwelling catheters

34
Q

Most who survive an episode of ARF recover sufficient renal function. True or false?

A

true

35
Q

What is hepatorenal syndrome?

A

functional renal failure that occurs in severe cirrhosis

36
Q

What is characterized by tight constriction of renal arteries resulting in oliguria and sodium retention and is reversible?

A

hepatorenal syndrome

Kidneys function normally after liver function is restored.

37
Q

Deposits of antigen-antibody complexes in the glomeruli cause hematuria, proteinuria, HTN, and increased creatinine characterizes what kidney disease?

A

Glomerulonephritis

38
Q

What describes this kidney disease?

  • Progressive genetic (autosomal dominant) disease
  • Hypertension and proteinuria w/ eventual renal failure
  • Treatment options include lifelong dialysis or renal transplant
A

Polycystic renal disease

39
Q

What kidney disease is this?

  • Atherosclerosis of renal arteries accounts for most cases
  • May be unilateral or bilateral
  • May be the cause of secondary hypertension
A

renal artery stenosis

40
Q

What may be the cause of renal HTN?

A

aberration of renin-angiotensin-aldosterone system

41
Q

What is the most common cause of ESRD and results from albuminuria?

A

diabetic nephropathy

42
Q

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

A

chronic renal failure

43
Q

As GFR decreases to < ____ mL/min, end stage renal disease results in dialysis or transplant.

A

25

44
Q

KNOW

What are causes for chronic renal failure?

A

glomerulopathy

tubular interstitial disease

hereditary disease

vascular disease

45
Q

Kidney damage with normal or increased GFR > 90

A

Stage 1 renal disease

46
Q

Kidney damage with mildly decreased GFR around 60-89.

A

Stage 2

47
Q

Moderately decreased GFR around 30-95

A

Stage 3 renal disease

48
Q

Severely decreased GFR 15-29

A

Stage 4 renal failure

49
Q

kidney failure or GFR <15 or dialysis

A

Stage 5

50
Q

Chronic renal disease is rarely reversible and leads to progressive decline in renal function. True or false?

A

true

51
Q

What are some general feelings a person with CRF may have?

A

fatigue

weakness

malaise

loss of appetite

N/V

52
Q

What is the primary cause of renal failure and a risk factor for progression of disease?

A

HTN

53
Q

What are complications of CRF?

A

hypervolemia

electrolyte imbalance

metabolic acidosis

anemia

coagulopathy

neuro changes (irritability, seizures, encephalopathy)

cardiovascular changes (CHF, HTN)

54
Q

What are 2 types of treatment for chronic renal failure?

A

hemodialysis

peritoneal dialysis

55
Q

What are the complications of dialysis:

A

hypotension

infection

peritonitis

56
Q

What anesthetic drugs are excreteed by the kidneys? (6)

A

morphine

meperidine

diazepam

H2 receptor anagonists (pepcid)

sevoflurane

muscle relaxants

57
Q

During preop evaluation, what should you consider with a renal patient?

A

routine meds

current electrolyte balance

last dialysis

58
Q

What muscle relaxants are cleared independent of the kidneys?

A

cisatricurium

atracurium

59
Q

What is at risk in renal patients–hypo or hypertension?

A

both

AP II Test 2 (7 decks)

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