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Bioscience > Renal II > Flashcards

Renal II Flashcards

1
Q

Anesthetic care of patients is determined by status of what?

A

Anesthetic care of patients is determined by status of preoperative renal function

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2
Q

Diseases affecting the kidneys are grouped into syndromes based what two things?

A

Diseases affecting the kidneys are grouped into syndromes based on common clinical and laboratory findings

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3
Q

Greatest derangements of renal function are caused by abnormalities of what??****

A

Greatest derangements are caused by abnormalities of glomerular function****

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4
Q

Most useful laboratory tests are those related to what?

A

Most useful laboratory tests are those related to GFR

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5
Q

Renal impairment may be due to what three things?

A

Renal impairment may be due to glomerular dysfunction, tubular dysfunction, or obstruction

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6
Q

When evaluating renal function, accurate assessment relies on what?

A

Accurate assessment relies on laboratory determinations

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7
Q

Most accurate lab for clinically assessing renal function and GFR is what?*

A

Most accurate lab for clinically assessing renal function and GFR is the creatinine clearance*

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8
Q

Primary source of urea is from what organ?

A

Primary source of urea is in the liver

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9
Q

Ammonia is produced from deamination of what?**

A

Ammonia is produced from deamination of amino acids**

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10
Q

Hepatic conversion of ammonia to urea prevents accumulation of what kind of toxic levels?

A

Hepatic conversion of ammonia to urea prevents accumulation of toxic ammonia levels

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11
Q

BUN directly related to protein catabolism, (BLANK) related to glomerular filtration*****

A

BUN directly related to protein catabolism, INVERSELY related to glomerular filtration*****

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12
Q

BUN not reliable indicator of GFR unless protein catabolism is normal and what???

A

BUN not reliable indicator of GFR unless protein catabolism is normal and constant

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13
Q

Normal BUN concentration??*****

A

Normal BUN concentration 10-20mg/dL*****

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14
Q

Is BUN a reliable indicator of GFR?

A

BUN is not a reliable indicator of GFR

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15
Q

Is Ammonia toxic to cells?

A

Ammonia is going to be toxic to cells

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16
Q

BUN concentration will vary will GFR.

BUN less than 8…

BUN between 20-40…

BUN greater than 50…

A
  • BUN less than 8 will indicate of over hydration or under production of urea
  • BUN levels between 20-40 will indicate dehydration and decrease GFR or high nitrogen level
  • BUN greater than 50, generally you can assume there is some renal issue going on and usually reflects GFR
  • BUN is generally a late indicator of renal impairment
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17
Q

Creatine product of muscle metabolism converted to what?

A

Creatine product of muscle metabolism converted to creatinine

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18
Q

Creatinine production is relatively constant and related to what?*

A

Creatinine production is relatively constant and related to muscle mass*

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19
Q

Creatinine is (BLANK) related to body muscle mass and (BLANK) related to glomerular filtration**

A

Creatinine is DIRECTLY related to body muscle mass and INVERSELY related to glomerular filtration**increase muscle mass, we will increase our creatinine

20
Q

What is generally reliable indicator of GFR?

A

Creatinine is generally reliable indicator of GFR

21
Q

GFR declines with increasing age yet serum creatinine remains (BLANK)*****

A

GFR declines with increasing age yet serum creatinine remains relatively normal*****

22
Q

Each doubling of serum creatinine represents a (what percent??) reduction in GFR*

A

Each doubling of serum creatinine represents a 50% reduction in GFR*

23
Q

What will increase serum creatinine without a change in GFR??

A

Large meat meals, cimetadine therapy, and increases in ketoacidosis will increase serum creatinine without a change GFR****

24
Q

Normal BUN : creatinine ratio???

A

Normal BUN : creatinine ratio is ~10:1

25
Q

Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result ratio does what?

A

Low renal tubular flow rates enhance urea reabsorption but do not affect creatinine handling. As a result ratio increases above 10:1

26
Q

Decreases in tubular flow can be caused by what two things?

A

Decreases in tubular flow can be caused by decreased renal perfusion or obstruction

27
Q

BUN : Creatinine ratios greater than 15:1 are seen with what four things??*******

A

BUN : Creatinine ratios greater than 15:1 are seen in volume depletion, disorders associated with decreased tubular flow, obstructive uropathies, and increases in protein catabolism*******

28
Q

what is the most accurate method available for clinically assessing overall renal function (GFR)???*****

A

Creatinine clearance is the Most accurate method available for clinically assessing overall renal function (GFR)*****

29
Q

Measurements of creatinine clearance are preformed over 24 hours, what else can be reasonably accurate and easier to obtain?

A

Two-hour creatinine clearance determinations are reasonably accurate and easier to obtain

30
Q

What is normal creatinine clearance???*

A

Creatinine clearance measurements:

Normal clearance: 110-150mL/min

40-60mL/min: mild renal impairment

25-40mL/min: moderate renal dysfunction

<25mL/min: indicative of overt renal failure

31
Q

Specific gravity related to urinary osmolality and indicative of renal concentrating ability, what is normal specific gravity?***

A

Specific gravity related to urinary osmolality and indicative of renal concentrating ability***1.025-1.030

32
Q

What is the result of a low tubular threshold for glucose or hyperglycemia???*****

A

Glycosuria is the result of a low tubular threshold for glucose or hyperglycemia*****

33
Q

Protein urea maybe seen without the presence of renal failure in what circumstances?*

A

Protein urea maybe seen without the presence of renal failure in things such as Stress, fever, deyhradtion, chf, exercise*

More likely to develop acute renal failure post operatively then those that do not have protein urea

34
Q

In regards to the effects of anesthetic agents on renal function, most drugs administered perioperatively are at least partly dependent on what?

A

Most drugs administered perioperatively are at least partly dependent on renal excretion

35
Q

Intravenous agents:

What are the effects of Barbiturates?

A

Barbiturates – patients with renal impairment have an increase sensitivity to induction, decrease protein binding

36
Q

Intravenous agents:

What are the effects of Propofol?

A

Propofol not signigicantly impaired by renal function

37
Q

Intravenous agents:

What are the effects of Benzodiazepines?

A

Benzodiazepines hepatic metabolism, conjugation prior to eliminations in urine

38
Q

Intravenous agents:

What are the effects of Opioids?

A

Opioids – most will be inactivated by the liver, most excreted by the kidneys

39
Q

Enflurane and sevoflurane has potential for (BLANK) accumulation

A

Enflurane and sevoflurane has potential for FLUORIDE accumulation

40
Q

What is the ideal gas to use for someone with renal impairment??***

A

Ideal choice will be isoflurane for someone with renal impairment***

41
Q

What are the effects of Atracurium and Cisatracurium on the kidneys?***

A

Atracurium tracrium degraded in the esterase hydrolasis and homans (histamine release) and Cisatracurium (nimbex, hoffman elminations)*

42
Q

What are the effects of Vecuronium on the kidneys?

A

Vecuronium (nurcium, primarly hepatic) prolong with renal impairment, 20%of drug will be eliminated in urine (.1mg/kg)*

43
Q

What are the effects of Rocuronium on the kidneys?

A

Rocuronium (zemuron, primarly hepatic) prolong with renal impairment

44
Q

What are the effects of Pancuronium on the kidneys?

A

Pancuronium metabolized by the liver, 60-80% renal excreation

45
Q

What are the effects of reversal agents on the kidneys?

A

Reversal agents: are going to be prolonged in renal impaired patients.

Bioscience (9 decks)

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