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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
What patients are highest at risk for acute renal failure?
Elderly Diabetic Baseline renal insufficiency
26
Most commonly will cause a patient to go into acute renal failure:
SEPSIS
27
What can occur as a result of acute renal failure?
decreased GFR retention of nitrogenous waste products
28
What are the 3 types of acute renal failure?
Prerenal (decreased renal blood flow) Renal (intrinsic) Postrenal (obstructive)
29
What are causes of pre-renal ARF? (4)
anything that decreases renal perfusion Hypotension Hypovolemia **Congestive heart failure** Pre-renal aortic cross-clamping
30
What are the causes of renal (intrinsic) ARF?
Intrinsic renal disease Renal ischemia Nephrotoxic drugs
31
What are postrenal/obstructive causes of ARF?
Caused by obstruction of urinary outflow tracts (hydronephrosis) A diagnosis made with renal ultrasound
32
ON EXAM What are risk factors for ARF? (8)
* age * CHF * sepsis * nephrotoxic drugs * multiple drug transfusions * hemolysis * hypotension * perirenal surgery
33
What are complications of ARF?
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
Most who survive an episode of ARF recover sufficient renal function. True or false?
true
35
What is hepatorenal syndrome?
functional renal failure that occurs in severe cirrhosis
36
What is characterized by tight constriction of renal arteries resulting in oliguria and sodium retention and is reversible?
hepatorenal syndrome Kidneys function normally after liver function is restored.
37
Deposits of antigen-antibody complexes in the glomeruli cause hematuria, proteinuria, HTN, and increased creatinine characterizes what kidney disease?
Glomerulonephritis
38
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
Polycystic renal disease
39
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
renal artery stenosis
40
What may be the cause of renal HTN?
aberration of renin-angiotensin-aldosterone system
41
What is the most common cause of ESRD and results from albuminuria?
diabetic nephropathy
42
Progressive, irreversible deterioration of renal function that occurs over months or years...
chronic renal failure
43
As GFR decreases to \< ____ mL/min, end stage renal disease results in dialysis or transplant.
25
44
KNOW What are causes for chronic renal failure?
glomerulopathy tubular interstitial disease hereditary disease vascular disease
45
Kidney damage with normal or increased GFR \> 90
Stage 1 renal disease
46
Kidney damage with mildly decreased GFR around 60-89.
Stage 2
47
Moderately decreased GFR around 30-95
Stage 3 renal disease
48
Severely decreased GFR 15-29
Stage 4 renal failure
49
kidney failure or GFR \<15 or dialysis
Stage 5
50
Chronic renal disease is rarely reversible and leads to progressive decline in renal function. True or false?
true
51
What are some general feelings a person with CRF may have?
fatigue weakness malaise loss of appetite N/V
52
What is the primary cause of renal failure and a risk factor for progression of disease?
HTN
53
What are complications of CRF?
hypervolemia electrolyte imbalance metabolic acidosis anemia coagulopathy neuro changes (irritability, seizures, encephalopathy) cardiovascular changes (CHF, HTN)
54
What are 2 types of treatment for chronic renal failure?
hemodialysis peritoneal dialysis
55
What are the complications of dialysis:
hypotension infection peritonitis
56
What anesthetic drugs are excreteed by the kidneys? (6)
morphine meperidine diazepam H2 receptor anagonists (pepcid) sevoflurane muscle relaxants
57
During preop evaluation, what should you consider with a renal patient?
routine meds current electrolyte balance last dialysis
58
What muscle relaxants are cleared independent of the kidneys?
cisatricurium atracurium
59
What is at risk in renal patients--hypo or hypertension?
both

AP II Test 2 (7 decks)

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