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Renal (Exam 3) Flashcards

1
Q

Percentage of the body weight that is water?

A

60% TBW

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2
Q

2 components of ECF

A
  • ISF
  • Plasma
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3
Q

Name the body fluids that is more immediately altered by kidneys

A

ECF

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4
Q

What mediates Osmolar homeostasis?

A
  • Osmolarity sensors in anterior hypothalamus
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5
Q

Name (3) actions of Osmolar Homeostasis

A
  1. Stimulates Thirst
  2. Causes Pituitary Releases of Vasopressin (ADH)
  3. Cardiac Atria releases ANP–> acts on kidneys to release Na+/H20 and promote excretion.
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6
Q

Volume homeostasis is mediated by _____________.

A

Juxtaglomerular apparatus.

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7
Q

How does the Juxtaglomerular appartatus mediated volume homeostasis?

A
  1. JGA senses changes in volume
  2. ↓Vol @ JGA triggers–> RASS→Na+/H20 reabsorption
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8
Q

Normal Sodium Level

A

135-145

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9
Q

Sodium Levels that are acceptable for Surgery

A

125-155

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10
Q

Underlying causes for Abnormal Sodium levels

A
  • hypovolemia
  • Euvolemic
  • Hypervolemic
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11
Q

Na/H20 loss, diuretics, GI loss, burns and trauma cause __________.

A

Hypovolemia

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12
Q

Salt restriction, endocrine related – hypothyroid and SIADH all cause ________

A

Euvolemia

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13
Q

What percentage of hospitalize patients are hyponatremic?

A
  • 15%
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14
Q

Over fluid-resuscitation and ↑endogenous vasopressin are 2 common cause of __________ in the hospital.

A
  • hyponatremia
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15
Q

Asymptomatic, headaches, nausea, vomiting, fatique, confusion, muscle cramps and depressed reflexes are all symptoms of a Sodium level of ____ - ______ mEq/L.

A
  • 130-135 mEq/L
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16
Q

Malaise, unsteadiness, headache, nausea, vomiting, fatique, confussion and muscle cramps are all symptoms of a Sodium level of ___ - _____ mEq/L

A
  • Sodium 120-130 mEq/L
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17
Q

Headache, restlessness, lethargy, seizures, brain-stem herniation, respiratory arrest and death are all symptoms of a Sodium level < _______ mEq/L.

A

< 120 mEq/L

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18
Q

The most severe consequences of hyponatremia include….

A
  • Seizures
  • coma
  • death
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19
Q

You can treat ______ by treating underlying conditions (volume status), electrolyte drinks, normal saline, diuretics and hypertonic saline.

A

Hyponatremia

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20
Q

Hypertonic Saline/3% NaCl is given at a rate of ___ ml/hr over ___ hours.

A
  • 80 ml/hr over 15 hours
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21
Q

Maximal amount of Na correction is ___ mEq/L/hr.

A

1.5 mEq/L/hr

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22
Q

________________ syndrome is the rapid correction of sodium, > 6mEq in 24 hours.

A
  • Osmotic Demyelination Syndrome.
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23
Q

Consequences of Osmotic Demyelination Syndrome

A
  • Permenant Neuro damage
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24
Q

Hyponatremic Seizures are treated with _____ ml/kg of 3% over ____ minutes until seizure has resolved.

A
  • 3-5 ml/kg
  • 30 minutes
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25
Q

How often should you check NA levels while replacing?

A
  • Every 4 hours
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26
Q

Excessive evaporation, Poor oral intake, overcorrection of hyponatremia, Diabetes Insipidus, GI loss and Excessive sodium bicarb are all causes of ___________________

A

hypernatremia

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27
Q

Orthostasis, Restlessness, lethargy, tremor/muscle twitching/spasticity, seizures, and death are symptoms of ______________.

A
  • Hypernatremia
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28
Q

Treatment of Hypervolemia

A
  • Hypovolemia: Normal Saline
  • Euvolemic: water replacement (po or D5W)
  • Hypervolemic: diuretics
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29
Q

VS, UOP, Turgor and CVP are (4) ways to assess _______ ________.

A

volume status

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30
Q

Na levels should be reduced at a rate of <____ mmol/L/hr and < ____ mol/L/day to avoid cerebral edema, seizures and neurologic damage.

A
  • ≤0.5 mmol/L/hr,
  • ≤ 10 mmol/L per day
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31
Q

Normal Potassium Levels

A

3.5 - 5.5

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32
Q

____ percentage of potassium is found in the ECF?
Serum Potassium reflects ________ potassium regulation more than total body potassium.

A
  • < 1.5%
  • transmembrane
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33
Q

Name the relationship between Aldosterone and Potassium

A

↑Aldosterone = ↓Potassium

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34
Q

In renal _______, potassium excretion declines and excretion shifts towards ____ system

A
  • failure
  • GI system
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35
Q

Low PO intake, Renal Loss, GI loss, Intracellular shifts, DKA, HCTZ, and Excessive Licorice are all common causes of _____________.

A
  • Hypokalemia
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36
Q

(3) Major Causes of ________ are renal loss, GI loss and transcellular shifts

A

hypokalemia

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37
Q

____can cause muscle weakness/cramps, illeus, dysrhthmias and U-waves

A

Hypokalemia

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38
Q

Best ways to correct Hypokalemia is to treat _________ causes, ____> IV replacement and ___-____ mEq/L/hr IV

A
  • Undelying causes
  • PO > IV
  • 10-20 mEq/L/hr IV
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39
Q

10 mEq IV K increased Serum K+ by _____ mmol/L

A

0.1

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40
Q

Excessive insuline, beta blockers, Bicarb, hyperventilation and diuretics should all be avoided in patient’s with __________.

A

Hypokalemia

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41
Q

The following are all causes of _________:
1. Renal Failure
2. Hypoaldosteronism
3. Drugs that inhibit RASS
4. Drugs that inhibit K excretion
5. Depolarizing NMB (Succs)
6. Acidosis (Respiratory/Metabolic)
7. Cell death (trauma/tourniquet)
8. Massive blood transfusion

A

Hyperkalemia

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42
Q

____ can cause malaise, and upset stomache chronically, while acute can cause skeletal muscle paralysis, decreased fine motor movements and cardiac dysrhythmias.

A

Hyperkalemia

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43
Q

EKG progressionof Hyperkalemia

A
  • peaked T wave (1)
  • P wave disappearance (2)
  • prolonged QRS complex (3)
  • sine waves (4)
  • asystole (5)
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44
Q

Dialyze (24 hrs prior to surgery), Calcium, hyperventilation, insulin w/glucose, Bicarb loop diuretics and Kayexalate are all treatments for ________________.

A

Hyperkalemia

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45
Q

_________ is the 1st initial treatment of hyperkalemia

A

Calcium

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46
Q

______ is the fastest treatment for Hyperkalcemia.

A

Hyperventilation

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47
Q

Hyperventilation corrects pH: ↑pH by 0.1, ↓K+ by ______ mmol/L

A
  • 0.4-1.5 mmol/L
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48
Q

Succinycholine, hypovolemia, LR, and Potassium containing IV fluids should all be avoid with _________.

A

hyperkalemia

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49
Q

___% of calcium is in the ECF and ____ % of calcium is in the bones

A
  • 1% in ECF
  • 99% in bones
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50
Q

Normal iCal levels

A

1.2 - 1.38 mmol/L

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51
Q

____and ___ can affect Ionized Calcium levels

A
  • albumin
  • pH
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52
Q

Parathyroid hormones, Vitamin D and Calcitonin are hormones that regulate _________.

A

Calcium

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53
Q

Parathyroid Hormone increases ____ absorption, Renal reabsorption and _____ absorption of calcium

A
  • GI
  • Renal
  • bone
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54
Q

Vitamin D augments_________ Ca++ absorption.

A
  • intestinal
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55
Q

Calcitonin _____bone reabsorption of Calcium

A

inhibits

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56
Q

↑ Parathyroid hormone (PTH) secretion, magnesium deficiency, low Vitamin D, renal failure and massive Blood transfusion are all common causes of ___________ .

A

Hypocalcemia

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57
Q

Majority of patients with hypercalcemia have ______- parathyroid or ____________.

A
  • hyper-parathyroid: Cal <11
  • cancer: Cal >13
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58
Q

Vitamin D intoxication, Milk-alkali syndrome, and Granulomatous disease are all less common causes of ______________ .

A

Hypercalcemia

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59
Q

Confusion, lethargy, hypotonia/↓DTR, abd pain, N/V, short QT and hypercalciuria and nephrolithias area all signs/symptoms of ____________ .

A

Hypercalcemia

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60
Q

Parasthesias, irritability, HoTN, seizures, myocardial depression, Prolonged Qt and Post-Parathyroidectomy– lanyngospasm are signs and symptoms of ____________ .

A

hypocalcemia

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61
Q

Low dietary intake or absorption and renal wasting are (2) Causes of _____.

A

Hypo-magnesium

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62
Q

Muscle weakness or excitation, seizures, and ventricular dysrhythias are all symptoms of ________ .

A

hypomagnesium

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63
Q

Hypomagnesium is given in _____ infusion for less severe symptoms and ___ grams Mag Sulfate for Torsades/seizures

A

Depends on degress of severity
* slow infusions for less severe
* Torsades/seizures –> 2Gr Mag Sulfate

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64
Q

____ is very uncommon and is generally due to overtreatment.

A

Hypermagnesium

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65
Q

Name (2) disease processes that are at risk of hypermagnesium

A
  • Pre-eclampsia/Eclampsia
  • Pheochromocytoma
66
Q

Lethargy, N/V, and flushing are all symptoms of Hypermagnesium
___ - ___ mEq/L

A

4 -5 mEq/L

67
Q

HoTN, and decreased DTR are all symptoms of Hypermagnesium
>__ mEq/L

68
Q

Paralysis, apnea, heartblocks and cardiac arrest are all signs of Hypermagnesium
>____ mEq/L

69
Q

Name (3) treatments for Hypermagnesium

A
  1. Diuresis
  2. IV calcium
  3. Dialysis
70
Q

Kidneys are located ________ btw T12 -L4. Right kidney is slightly _____ to left to accommodate liver.

A
  • Retroperitoneal
  • caudal
71
Q

What is the primary Strucural/Function Unit of the Kidney?

72
Q

How many nephrons does each kidney have?

73
Q

Glomerulus, bowman capsule, proximal tubule, loop of henles, distal tubule and collecting ducts are all part of the ____________ .

74
Q

Each kidney receives ___ % of the CO, which amounts to ___ - ____ L/min of blood.

A
  • 20%
  • 1-1.25 L/min
75
Q

The Outer layer/Cortex of the kidney receives ___ - ____ % of the blood flow to the kidneys.

76
Q

The ____ ___ _____ is the most vulnerable part of the kidney to HoTN.

A
  • Loop of Henle
77
Q

Primary Functions of the ______ :
* Regulate EC volume, osmolarity, composition
* Regulate BP
* Excrete toxins/metabolites
* maintain acid/base balance
* Produce hormones
* Blood Glucose hemostasis

78
Q

Renin, Erythropoietin, Calcitriol and Prostoglandins are homones produced by the _________.

79
Q

Name (3) Renal Functional Labs

A
  • Glomerular Filtration Rate
  • Creatine Clearnace
  • Serum Creatine
80
Q

Glomerular Filtration Rate (GFR) normal

A

125-140 mL/min

81
Q

The best way to measure renal function time and is heavility influenced by hydration is the ___________ .

82
Q

Creatine Clearance Normal

A
  • 110-140 mL/min
  • 24 hour urine test
83
Q

_____ ____ is the most reliable measure of GFR . _ is freely filtered and not reabsorbed.

A
  • Creatine Clearance
  • Creatine
84
Q

Serum Creatine normal

A
  • 0.6 - 1.3 mg/dL
  • correlates with muscle mass
85
Q

______ __ can be influenced by high protein diet, supplements and muscle breakdown. Need to have a baseline for acute monitoring and is inversely related to GFR

A

Serum Creatine

86
Q

What happens to the GFR if you double Serum Creatine?

A

drops GFR by 50%

87
Q

Blood Urea Nitrogen normal

A
  • 10-20 mg/dL
88
Q

Urea Nitrogen is ______ into blood and is affected by ____ and IV volume.

A
  • reabsorbed
  • diet
89
Q

What does a low BUN mean?

A
  • malnurished
  • volume diluted
90
Q

↑protein diet, dehydration, GI bleed, trauma, and muscle wasting are all causes of _______ _______.

91
Q

BUN: Creatine ratio normal

92
Q

What does a BUN:Creatine ratio measure?

A

Hydration status

93
Q

Proteinuria normal

A
  • <150 mg/dL
94
Q

Proteinuria >750mg/dL indicates

A
  • Glomerular injury
  • UTI
95
Q

Specific Gravity Normal

A
  • 1.001 - 1.035
96
Q

This lab values compares 1 mL urine to 1 mL distilles water and measure the ability to concentrate urine.

A

Specific Gravity

97
Q

Edema, rales, orthostatic pressure changes, ↓BE, ↑Lactate and drop in UOP can indicate a change in _____ - ______ status.

A

Renal-Volume Status

98
Q

Describe a normal UOP

A
  • 30 mL/hr
  • 0.5-1 ml/kg/hr
99
Q

Define Oliguria

A
  • <500ml in 24 hours
100
Q

Ultrasound of IVC, CVP, PAP, LAP, PCWP, PAP, and SVV can all monitor ___________ __________

A

Volume status

101
Q

What does percentage (%) of IVC collapse indicates fluid deficit?

A
  • > 50%
  • consider passive leg raise to determine fluid responsiveness
102
Q

Failure to excrete nitrogenous waste products or maintain fluid/electrolyte homeostatis with deteriation over hours to days is the definition of _________________ .

A

Acute Kidney Injury

103
Q

AKI effects ________% of hospitalizations pts and ________% ICU patients.

104
Q

Hypotension/hypovolemia and nephrotoxins are (2) main causes of ______________.

A

Acute Kidney Injury

105
Q

_____ is the buildup of nitrogenous products such as urea and creatine and is a hallmark of AKI.

106
Q

Mortality rate of AKI w/ Multi-System Organ Failure requiring dialysis

A
  • > 50% mortality
107
Q

Pre-existing renal disease, advance age, CHF, PVD, Diabetes, Sepsis, jaundice, major operative procedures, and IV contrast are Risk Factors of _________.

A

Acute Kidney Injury

108
Q

AKI Diagnostic Criteria
* ↑SCr by ___ mg/dL within 48 h
* ↑SCr by ____ within 7 days
* ↓Creatinine clearance by ___%
* Abrupt oliguria (although not always seen in AKI)

A
  • 0.3 mg/dL
  • 50%
  • 50%
109
Q

Asymptomatic (initially), malaise, HoTN, hypovolemic or hypervolemic are all physical symptoms of ________________ .

A

Acute Kidney Injury

110
Q

Hemorrhage, GI fluid loss, trauma, surgery, burns, cardiogenic shock, sepsis, aortic clamping and thromboembolism are all causes of _______Azotemia.

A

Pre-Renal Azotemia

111
Q

Acute glomerulonephritis, vasculitis, intestinal nephritis, ATN, contrast dye, nephrotoxic drugs, and myoglobinuria are all causes of _________ Azotemia.

A

Renal Azotemia

112
Q

Nephrolithialasis, BPH, Clot retention, and bladder carcinoma are all causes of ________ Azotemia.

A

Postrenal Azotemia

113
Q

Name the most common form of AKI

A

Pre-renal azotemia

114
Q

_______ accounts for 1/2 of hospital-acquired AKI cases

A
  • pre-renal azotemia
115
Q

Fluids, mannitol, diuretics, maintaining MAP and use of pressors to maintain Renal Blood Flow is the treatment for ____________ Azotemia.

A

Pre-Renal Azotemia

116
Q

Lab work that can indicate a Pre-Renal AKI

A
  • BUN: Cr >20:1
117
Q

Name the most common cause of ATN (acute tubular necrosis)

A
  • Untreated Pre-Renal AKI
118
Q

What type of Renal disease is Renal Azotemia?

A

Intrinsic renal disease

119
Q

Is Renal azotemia reversible?

A
  • Yes.
  • Just not as reversible as Pre-Renal
120
Q

Following Labwork indicates:
* ↓GFR(late sx)
* ↓urea reabsorption in prox tubule →↓BUN
* ↓Creatinine filtration→↑blood creatinine
* BUN:Cr often < 15

A

Renal Azotemia

121
Q

Outflow obstruction and ↑Nephron tubular hydrostatic pressure are causes of ______________ .

A

Post-Renal Azotemia

122
Q

Treatment for Post-Renal Azotemia

A
  • Remove obstruction if possible
  • Persistent obstruction damages the tubular epithelium
123
Q

Neurological complications of ____ are related to protein/amino acid buildup in blood:
Uremic Encaphalopathy
* Mobility disorders
* neurapthise
* myopathies
* seizures
* strokes

A

Acute Kidney Injury

124
Q

Systemic HTN, Left Ventricular hypertrophy, CHF, pulmonary edema, uremeic cardiomyopathy and arrythmias are cardiovascular Complication of ________.

A

Acute Kidney Injury

125
Q

Anemia from ↓ EPO production, ↓ red cell production, ↓ red cell survival, Platelet dysfunction , and vWF disrupted by urmeia are Hemological Complications of _________ .

A

Acute Kidney Injury

126
Q

Hyperkalemia, metabolic acidosis, malnutrition, hypoalbuminemia, and hyperparathyroidism are
____________ Complications of AKI.

127
Q

Anesthetic Implications of an AKI

A
  • Correct fluid, electrolyte, acid/base status
  • Volume – NS is prefered
  • careful with colloids
  • Maintain MAP
  • Vasopressin
  • Sodium Bicarb
128
Q

Reason to give Prophylatic Sodium Bicarb to an AKI pt before anesthesia

A
  • decreases formation of free-radicals
  • Prevents Acute Tubular Necrosis from causing renal failure
129
Q

Reason Vasopressin is pressor of choice for AKI patients because it constricts _____ arterioles and mantains ____.

A
  • Efferent arterioles
  • Maintains RBF
130
Q

In anesthesia for ________ patients, consideration for:
* low threshold for hemodynamic montoring
* Prefer preop dialysis
* Recent Labs (K) within 1 hour of surgery
* POC equipment available
* Tailor drug choices
* avoid drugs with active metabolites that ↓RBF and renal toxins

A

Kidney Patients

131
Q

Name the (2) Leading causes of CKD

A
  • Diabetes
  • hypertension
132
Q

Is CKD reversible?

A
  • NO
  • It is also progressive
133
Q

GFR decreases ____ per decade starting from age 20

134
Q

Stages of CKD:
Kidney damage with normal or increased GFR

A
  • Stage 1
  • GFR >90
135
Q

Stages of CKD:
Kidney Damage with mildly decreased GFR

A
  • Stage 2
  • GFR 60-89
136
Q

Stages of CKD:
Moderately decreased GFR

A
  • Stage 3
  • GFR 30-59
137
Q

CKD Stage:
Severely decreased GFR

A
  • Stage 4
  • GRF 15-29
138
Q

CKD Stage:
Kidney Failure

A
  • Stage 5
  • GFR <15
139
Q

CKD can cause Systemic HTN by causing _______ of sodium and water and activation of ________.

A
  • retention
  • activation of RAAS
140
Q

______diuretics are the 1st line Treatment of Cardiovvascular effects of CKD, followed by _____ and ARBs

A
  • 1st line: Thiazide Diuretics
  • ACE-I/ARB
141
Q

CKD in combination with these (2) medications can cause:
* ↓systemic BP and glomerular pressure
* ↓proteinuria by reducing glomerular hyperfiltration
* ↓glomerulosclerosis

142
Q

When should ARBs and ACE-I be held before surgery?

143
Q

What medications might need to be given if ACE-I or ARB were taken prior to surgery?

A
  • Vasopressin
  • NE
  • EPI
144
Q

What population are high risk for silent MI

A
  • Womens
  • Diabetics
145
Q

CKD Cardiovascular Effects: Dyslipidemia

A
  • Triglycerides > 500
  • LDL > 100
  • Predisposed to Silent MI
146
Q

CKD Hematolgic Effects: Anemia

A
  • Responsive to exogenous erythropoietin – target Hgb 10
  • Platelet dysfunction
147
Q

What (2) conditions are associated with blood transfusion

A
  • Acidosis
  • Hyperkalemia
148
Q

Volume overload, severe hyperkalemia, metabolic acidosis, symptomatic uremia and failure to clear medications are indications to consider ______________.

149
Q

What is the most common SE of HD?

150
Q

What is the leading cause of death in dialysis patients?

151
Q

Is HD or PD more effective?

152
Q

Anesthesia concerns for ________ patients:
* Access stability
* Body weight pre/post dialysis
* well-controlled BP
* Glucose Management
* Aspiration precautions
* Pressors
* Uremic bleeding

153
Q

Treatment for Uremic Bleeding

A
  • Cryo. FVIII, vWF
  • Desmopressin
154
Q

Desmopressin peaks in _ - __ hours; lasts __-__ hours and can cause tachyphylaxis.

A
  • Peak 2-4 h
  • lasts 6-8 hours
  • Tachyphylaxis
155
Q

Anesthesia and CKD

A
  • Many anesthetic agents are lipid soluble
  • Reabsorbed by renal tubular cell
  • Lean towards agents not dependent on renal elimination
  • Avoid active metabolites
156
Q

Name (2) Drugs to avoid with CKD patients due to active metabolites

A
  • Morphine
  • Demerol
157
Q

Why should we avoid lipid soluble medications in CKD patients?

A
  • Elimination is unchanged in urine
  • Prolonged DOA
158
Q

Name (4) types of drugs that should be Renal dosed based on GFR

A
  • Thiazide diuretics
  • Loop Diuretics
  • Digoxin
  • Antibiotics
159
Q

Morphine is ___% cleared through urine and has 2 metabolites ( morphine - __ glucuronide and morphine -___ glucuronide)

A
  • 40%
  • morphine -3 glucuronide and morphine -6 glucuronide
  • Can cause life-threatening respiratory depression
160
Q

Noremeperidone is an active metabolite of ________ than has analgesis and CNS effects and has a __________ half-life.

A
  • Demerol
  • longer
161
Q

The following are PreOperative Concerns for ____ patients.
* K+ < 5.5 mEq/L on elective surgery
* Dialysis pts should be dialyzed within 24 h preceding elective surgery
* Aspiration prophylaxis, especially in DM — Give high dose Roc for RSI
* Anesthesia & surgery decrease RBF & GFR
Blood loss activates baroreceptors→↑SNS outflow.
Catecholamines activate α1-Rs→↑afferent arteriole constriction→↓RBF
* Longer periods of hypotension (cross-clamping, hemorrhage, sepsis) →↓RBF

A

Renal Patients

Health Assessment Exam 3 (5 decks)

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