Renal Diseases (Exam III) Flashcards
Which vertebrae are the kidney’s typically situated between?
Retroperitoneal at T12 - L4
The ____ kidney is slightly more caudal to ____. Why?
Right; left (right is slightly lower)
To accommodate the liver.
How much of CO do the kidneys receive?
20% ( 1-1.25L/min)
What is Azotemia?
Azotemia is the hallmark sign for ______
- Abnormally high levels of nitrogen containing compounds such as Urea and Creatinine.
- AKI
Osmolar homeostasis is mainly mediated by osmolality sensors in the _______.
This will signal the pituitary gland to 1.______, 2. _______, 3. ________.
- Anterior Hypothalamus
- Hypothalamus signals pituitary gland to;
1. stimulate thirst
2. secrete ADH
3. Cardiac atria will release ANP to act on kidneys to decrease Na and H2O absorption
What degree of hyponatremia would give you pause for surgery?
Less than 125 mg/dL
What are some conditions (discussed in lecture) that can cause hyponatremia?
- Prolonged sweating
- Vomiting/diarrhea
- Insufficient aldosterone
- Excessive H₂O intake
How would hyponatremia be treated?
This is highly dependent on underlying pathology.
- Treatment of underlying disease
- NS
- Hypertonic Saline
- Lasix
- Mannitol
What pathology could occur with rapid over-correction of hyponatremia?
Osmotic Demyelination Syndrome (“Locked-in Syndrome”)
At what degree of hypernatremia would you typically cancel surgery?
155 mg/dL or greater
What is the most common cause of hypernatremia?
Insufficient replacement of water loss
Back home we called this dehydration.
What is the complication from rapid correction of hypernatremia?
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.
Severe hyponatremia/hypernatremia both result in what?
Seizures, coma, and death
What are normal levels of serum potassium?
3.5 - 5 mg/dL
Excessive intake of what food is known to cause hypokalemia?
Licorice
When does hypokalemia need to be treated with K⁺ repletion?
Serum K⁺ < 3 mg/dL
What types of symptoms are generally seen with hypokalemia?
Cardiac & neuromuscular
What EKG sign is seen with hypokalemia?
“U”-waves
What other lab(s) needs to be check when replenishing K⁺ ?
Serum Phosphorus and Mg⁺⁺
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?
- 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.
What are hyperkalemia’s effects on on EKG?
What about on the cardiac cellular membrane?
- Peaked “T” Waves
- ↑ Vᵣₘ and ↓ APD (action potential duration)
What is the treatment for hyperkalemia?
“C BIG K”
- Calcium gluconate (1° treatment)
- Bicarbonate
- Insulin
- Glucose
- Kayexelate
What is a normal GFR?
125 - 140 mL/min
What is normal serum creatinine?
0.6 - 1.2 mg/dL
