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Health Assessment (2) > Renal Diseases (Exam III) > Flashcards

Renal Diseases (Exam III) Flashcards

1
Q

Which vertebrae are the kidney’s typically situated between?

A

T12 - L3

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2
Q

Which kidney is slightly more posterior? Why?

A

Right kidney is more posterior to accommodate the liver.

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3
Q

What stimulates erythropoietin release from the kidneys?

A

Inadequate O₂ to the kidneys

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4
Q

How much of CO do the kidneys receive?

A

20 - 25% ( 1-1.25L/min)

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5
Q

What is Azotemia?
What causes it?

A
  • Abnormally high levels of nitrogen containing compounds such as Urea and Creatinine.
  • Azotemia is causes by dysfunctional kidneys.
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6
Q

Where are your osmolality sensors located?
What occurs when you have hyperosmolality?

A
  • Anterior Hypothalamus
  • Hypothalamus signals pituitary gland to stimulate thirst and secrete ADH.
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7
Q

What degree of hyponatremia would give you pause for surgery?

A

Less than 125 mg/dL

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8
Q

What are some conditions (discussed in lecture) that can cause hyponatremia?

A
  • Prolonged sweating
  • Vomiting/diarrhea
  • Insufficient aldosterone
  • Excessive H₂O intake
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9
Q

How would hyponatremia be treated?

A

This is highly dependent on underlying pathology.

  • Treatment of underlying disease
  • NS
  • Hypertonic Saline
  • Lasix
  • Mannitol
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10
Q

What pathology could occur with rapid over-correction of hyponatremia?

A

Osmotic Demyelination Syndrome (“Locked-in Syndrome”)

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11
Q

At what degree of hypernatremia would you typically cancel surgery?

A

155 mg/dL or greater

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12
Q

What is the most common cause of hypernatremia?

A

Insufficient replacement of water loss

Rarely caused by excessive Na⁺ intake

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13
Q

What is the complication from rapid correction of hypernatremia?

A

There is little evidence of morbidity from rapid hypernatremia correction. 0.5 mmol/L/hr to an absolute change of 10 mmol/L/day would be best to avoid cerebral edema, seizures, and other neurological sequelae.

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14
Q

Severe hyponatremia/hypernatremia both result in what?

A

Seizures, coma, and death

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15
Q

What are normal levels of serum potassium?

A

3.5 - 5 mg/dL

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16
Q

Excessive intake of what food is known to cause hypokalemia?

A

Licorice

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17
Q

When does hypokalemia need to be treated with K⁺ repletion?

A

Serum K⁺ < 3 mg/dL

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18
Q

What types of symptoms are generally seen with hypokalemia?

A

Cardiac & neuromuscular

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19
Q

What EKG sign is seen with hypokalemia?

A

“U”-waves

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20
Q

What other lab needs to be check when replenishing K⁺ ?

A

Serum Phosphorus

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21
Q

A patient presents with a gun shot wound to the thorax necessitating exploratory thoracostomy. The patient’s serum K⁺ level is 5.7 mg/dL, what do you do?

A
  • Emergent surgery so proceed and treat the hyperkalemia

If the surgery was not emergent you would treat the K⁺ til it was below 5 mg/dL.

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22
Q

What are hyperkalemia’s effects on on EKG?
What about on the cardiac cellular membrane?

A
  • Peaked “T” Waves
  • ↓ Vᵣₘ and ↓ APD (action potential duration)
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23
Q

What is the treatment for hyperkalemia?

A

“C BIG K”

  • Calcium gluconate (1° treatment)
  • Bicarbonate
  • Insulin
  • Glucose
  • Kayexelate
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24
Q

What is a normal GFR?

A

125 - 140 mL/min

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25
Q

What is normal serum creatinine?

A

0.6 - 1.2 mg/dL

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26
Q

What is better for acute monitoring of renal function, GFR or creatinine?

A
  • Creatinine for acute monitoring
  • GFR for chronic/trending
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27
Q

A 100% increase in creatinine is indicative of a _____ decrease in GFR.

A

50%

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28
Q

What populations would have lower creatinine levels?
Who would have higher?

A
  • ↓ in women and elderly
  • ↑ in body builders
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29
Q

What is the normal BUN:Creatinine ratio?

A

10:1

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30
Q

What is normal urine specific gravity?

A

1.001 - 1.035

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31
Q

What is normal BUN?

A

8 - 20 mg/dL

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32
Q

Large amounts of what macromolecule would be suggestive of glomerular injury?

A

protein

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33
Q

What is the primary metabolite of protein metabolism in the liver?

A

Urea

Amino acids → ammonia → urea

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34
Q

Which of these two compounds is subject to filtration at the glomerulus?
- Creatinine
- Urea

A

Trick question. Both are subject to filtration

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35
Q

Which of these two compounds is subject to reabsorption in the nephron?
- Creatinine
- Urea

A

Urea is reabsorbed unlike creatinine ( and therefore can’t be used to measure GFR)

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36
Q

What would a BUN:Creatinine ratio of greater than 20:1 indicate?

A

Pre-renal Azotemia

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37
Q

What is normal urine output in adults?

A

1 mL/kg/hr

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38
Q

Your pre-operative patient has had less than 500 mLs of urine output in the past 24 hours. How would you classify this patient?

A

Oliguric

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39
Q

What’s the greatest risk factor for AKI?

A

Pre-existing renal disease

40
Q

What lab values would be indicative of acute renal failure?

A
  • Serum creatinine > 0.5 mg/dL
  • 50% decrease in creatinine clearance
41
Q

What is a typical BUN:Creatinine ratio in pre-renal AKI?

A

> 20:1

42
Q

What is the most common cause of pre-renal AKI?

A

Renal Hypoperfusion

shock, burns, trauma, blood loss, aortic clamping, etc.

43
Q

Differentiate pre-renal oliguria from Acute Tubular Necrosis.

A
44
Q

What is a typical BUN:Creatinine ratio in intra-renal AKI?

A

< 15:1

45
Q

Why are urea levels higher in intra-renal AKI?

A

Whole nephron is failing so urea is not being reabsorbed in the PCT.

46
Q

What is the cause of intra-renal AKI?

A

Renal parenchymal (inner kidney) damage

ATN, glomerulonephritis, CKD, etc.

47
Q

What is the cause of post-renal azotemia?

A

Urinary tract blockage

48
Q

what does a low BUN indicate

A

malnutrition, liver damage, too much resucitation?

49
Q

What does BUN: creatinne ratio help us determine?

A

fluid hydration status

50
Q

what causes renal azotemia

A

reperfusion injury… cytokines, oxygen free radical, inflammatory cells

51
Q

What BUN:Creatinine ratio is typically seen in post-renal AKI?

A
  • Initial: > 15:1
  • Persistent creates decreased BUN:Cr
52
Q

What is the most common neurological complication of AKI?

A

Uremic Encephalopathy

53
Q

which anesthetic is not dependent on renal excretion?

A

nimbex (plasma cholinesterase)

54
Q

Which types of medications should you avoid for these patients?

A

lipid insoluble due to limited excretion (I.e. thiazide, loops, digoxin, lots of antibiotics, muscle relaxants, morphine, demerol

55
Q

What are the most common cardiac complications of AKI?

A
  • HTN
  • LV hypertrophy
  • CHF
  • Pulm Edema
56
Q

What are the most common hematologic complications of AKI?

A
  • Anemia
  • Plt dysfunction
57
Q

What are the most common metabolic complications of AKI?

A
  • Hyperkalemia
  • H₂O & Na⁺ retention
  • ↓ albumin
  • Metabolic acidosis
58
Q

What drug is given prophylactically to prevent acidemia and its complications in kidney patients?

A

Sodium bicarb

59
Q

What are the leading causes of ESRD?

A
  • DM
  • HTN
60
Q

What does the acronym RIFLE stand for?

A

Risk
Injury
Failure
Loss
End-stage

61
Q

What labs indicate “Risk” according to the rifle criteria for kidney disease?

A
  • Creatinine 1.5x base
  • UOP < 0.5 mL/kg/hr for more than 6 hours
62
Q

What labs indicate “Injury” according to the rifle criteria for kidney disease?

A
  • Creatinine 2x base
  • UOP < 0.5 mL/kg/hr for more than 12 hours
63
Q

What labs indicate “Failure” according to the rifle criteria for kidney disease?

A
  • Creatinine 3x base
  • UOP < 0.3 mL/kg/hr for > 12 hours or total anuria for > 12 hrs
64
Q

What labs indicate “Loss” according to the rifle criteria for kidney disease?

A

Renal replacement therapy needed for > 4 weeks

65
Q

What labs indicate “End-stage” according to the rifle criteria for kidney disease?

A

Renal replacement therapy needed for > 3 months

66
Q

On average, GFR decreases by _____ per decade starting from age 20.

A

10 ml/min

67
Q

Which population is more likely to have kidney failure compared to other americans?

A

Hispanic Americans

Mario :(

68
Q

It is usually helpful to assume that everyone with CKD also has this condition.

A

CAD

69
Q

What drugs are often used to combat chronic kidney disease?

A

ACEi’s and ARBs

70
Q

How do ACEi’s and ARBs help treat CKD?

A
  • Decrease systemic & glomerular HTN
  • Decrease proteinuria
  • Decrease glomerular sclerosis
71
Q

What antihypertensive drugs need to be held on the day of surgery to decrease the risk of intraoperative hypotension?

A

ACEi’s & ARBs

72
Q

Which populations are at a higher risk for silent MI?

A

Women and diabetics

73
Q

What lab values reflect dyslipidemia?

A
  • Triglycerides > 500
  • LDL > 100
74
Q

What are the indications for dialysis?

A
  • Volume overload
  • ↑K⁺
  • Severe metabolic acidosis
  • Symptomatic uremia
  • Drug overdose
75
Q

What is the most common adverse event associated with dialysis?

A

Hypotension

76
Q

What is the leading cause of death in dialysis patients?

A

Infection

77
Q

When would peritoneal dialysis be preferred to hemodialysis?

A

PD is preferred for patients who can’t tolerate large fluid shifts (CHF or unstable angina)

78
Q

What two things reduce the risk of pre-renal azotemia?

A
  • Maintain MAP > 65mmHg
  • Appropriate hydration
79
Q

Excessive use of 0.9% NaCl leads to what condition?

A

Hyperchloremic metabolic acidosis

80
Q

Which of the following fluids are associated with increased risk of renal injury?
- Crystalloids
- Colloids
- Starches

A

Starches

81
Q

Treating oliguric AKI patients with diuretics helps improve their condition via diuresing toxic metabolic byproducts of the AKI. T/F?

A

False. Diuretics in a oliguric AKI can further the renal injury.

82
Q

This drug maintains GFR and urine output better than norepinephrine and neosynephrine via preferential constriction of the efferent arteriole.

A

Vasopressin

83
Q

What type of anesthesia is common for TURPs?

A

Neuraxial (Spinal to T10, usually)

84
Q

What are the risks and benefits of NaCl used as irrigation fluid for TURPs?

A
  • Risk: electric shock with unipolar cautery (only use bipolar electrocautery)
  • Benefit: Very few side effects, good visibility
85
Q

What are the risks and benefits of distilled water used as irrigation fluid for TURPs?

A
  • Risk: ↑ risk of TURP syndrome
  • Benefit: Very good visibility
86
Q

What are the risks and benefits of glycine solution used as irrigation fluid for TURPs?

A
  • Risk: ↑ ammonia = ↓LOC and blurry vision
  • Benefit: ↓ risk of TURP syndrome
87
Q

What are the risks and benefits of sorbitol solution used as irrigation fluid for TURPs?

A
  • Risk: ↑BG, osmotic diuresis, and acidosis
  • Benefit: ↓ risk of TURP syndrome.
88
Q

What are the risks and benefits of Mannitol used as irrigation fluid for TURPs?

A
  • Risk: Osmotic diuresis and transient plasma expansion.
  • Benefit: Renally filtered and excreted (doesnt mess with the liver at all).
89
Q

What is TURP syndrome?
What are its characterizing symptoms?

A
  • Absorption of large volume of hypo-osmolar irrigation fluid.
  • HTN, ↓HR, & LOC changes
90
Q

How is TURP syndrome treated?

A
  • Stop case
  • If Na⁺ > 120mEq/L → Lasix
  • If Na⁺ < 120mEq/L → 3% NaCl until at 120mEq/L.
  • Benzos if seizing
91
Q

How do urolithiasis patients typically present?

A
  • Ca⁺⁺ stones
  • Colicky pain in the ipsilateral flank & upper abdomen
  • UTI and/or hematuria
92
Q

What drugs are given with MET (medical expulsive therapy) for kidney stones?

A
  • CCBs
  • α-blockers
  • corticosteroids
93
Q

What is ESWL?

A

Extracorporeal ShockWave Lithotripsy

94
Q

What is a patient getting a PCNL at high risk for?

A

pulmonary trauma (surigical procedure putting in stents before nephrostomy)

95
Q

What cardiac considerations exists for ESWL?

A
  • Avoid R-on-T phenomena
  • Pacemakers/ICDs
  • Calcified Aortic aneurysms
96
Q

How is idiopathic hypercalciuria treated/

A

Thiazide diuretics

97
Q

Why might you want to do regional or GA with paraplegic patients undergoing bladder surgeries?

A

To avoid autonomic dysreflexia. specifically pts with SCI of T7 or higher (deficits below T6)

Health Assessment (2) (22 decks)

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