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Person Renal > Renal Pathology, Diuretics and Anesthesia PP#5 Number 2 > Flashcards

Renal Pathology, Diuretics and Anesthesia PP#5 Number 2 Flashcards

1
Q

Describe how dialysis works

A
  • Blood passes across a membrane
  • On the other side of the membrane is dialyzing fluid
  • Undesired substance pass via diffusion
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2
Q

What 3 things determine rate of solute movement in dialysis?

A
  • Concentration gradient
  • permeability of membrane
  • Amount of time blood in contact w/ membrane
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3
Q

How much blood is in the dialysis machine at 1 time?

A

500cc

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4
Q

What is given to prevent coagulation during dialysis?

A

Heparin

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5
Q

What are the common causes of ESRD?

A
  • Diabetes 41%
  • HTN 28%
  • Other 18%
  • Glomerulonephritis 11%
  • Polycyctic kidney disease 3%
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6
Q

What are indications for dialysis?

A
  • Fluid overload
  • Hyperkalemia
  • Acidosis
  • Metabolic encephalopathy
  • Pericarditis
  • Coagulopathy
  • Refractory GI symptoms
  • Drug toxicity
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7
Q

What is a normal BUN?

A

10-20

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8
Q

how much urea is reabsorbed in the nephron?

A

40-50%

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9
Q

What causes an increase in urea reabsorption?

A

hypovolemia

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10
Q

What 4 things can increase BUN?

A
  • ↓ GFR
  • ↑ protein breakdown
  • Sepsis
  • blood degradation in GI tract
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11
Q

What is a normal creatinine value?

A

Men 0.8-1.3

Women 0.6-1.0

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12
Q

Creatinine is a byproduct of what?

A

Muscle meatbolism

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13
Q

Creatinine is directly related to what?

A

Muscle mass

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14
Q

Creatinine is inversely related to what?

A

GFR

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15
Q

Creatinine clearance is a way to measure what?

A

GFR

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16
Q

GFR decreases how much?

A

5% decline per decade after age 20

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17
Q

Why does creatinine levels remain stable with age?

A

Muscle mass declines with age

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18
Q

Low tubular flow rates _______ urea reabsorbtion

A

enhance

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19
Q

Name 3 conditions in which BUN Creatinine ratios are > 10:1

A
  • Volume depletion
  • Decreased tubular flow
  • Obstructive uropathy
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20
Q

Urinary pH > 7 with acidosis is suggestive of what?

A

renal tubular acidosis

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21
Q

Specific gravity is related to what?

A

urinary osmolality

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22
Q

A specific gravity of _______ after an overnight fast, indicates ________ urinary concentrating.

A

> 1.018

adequate

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23
Q

Low specific gravity + plasma hyperosmolality =

A

Diabetes

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24
Q

Why are renal patients more susceptible to barbiturates and Benzos?

A

Decreased protein binding (more free drug)

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25
Benzos are metabolized by the _______?
Liver
26
Active metabolites can happen with what meds?
- Diazepam - Morphine - Demerol
27
In anticholinergics (Atropine, Glyco) what can accumulate with repeated dosing?
metabolites
28
metoclopramide can be used safely with a _________ dose
Single
29
What volatile agents may accumulate fluoride?
- Enflurane | - Sevo
30
Succs is safe in patients with what?
K<5.0
31
Succs will transiently increase K by how much?
0.5
32
What muscle relaxer is the drug of choice and why?
Cis/Atracurium | Hoffman elimination
33
What muscle relaxants do you need to avoid due to renal elimination?
- Pipecuronium - Alc - Dox - Panc
34
Where is Vec and Roc are primarily eliminated?
Liver
35
Where are reversal agents excreted?
By kidney, but prolonged half time
36
Renal disease preop eval questions.
- Last dialysis - Most recent K - EKG - Dialysis access site
37
When would you consider blood for renal patients?
Hgb <6-7
38
What is the reason that ventilation is preferred w/ renal patients?
decrease risk of respiratory acidosis
39
What is the key factor in periop renal failure?
Hypovolemia
40
Post op renal failure has a mortality rate of?
50%
41
Prophylaxis with ______ may help with kidney preservation.
Mannitol (.5g/kg)
42
It is easier to treat ________ than to treat _________.
Fluid overload | Renal failure
43
Periop risk factors for renal failure.
- Sepsis - Hypovolemia - Jaundice - Aminoglycside ABX - Nsaids - Ace inhibitors - Dye injections
44
What 6 things would you do for intraop oliguria?
- Kinked foley? - Administer fluids - Check CVP - Increase BP if low - Lasix - Mannitol
45
Where do kidney stones generally obstruct?
-Ureter
46
What are the main symptoms of kidney stones?
Pain | Hematuria
47
Kidney occurrence rates
10-15% of population 10% recurrence Men 4x more than women
48
What is the most common type of stone?
Calcium Oxalate
49
What are struvite stones associated with?
Infection
50
How are struvite stone made?
Urea splitting bacteria that forms ammonia
51
When are uric stones seen?
Gout | Cell lysis
52
When are calcium phosphate stones seen?
Hyperparathyroid | renal tubular acidosis
53
When are cysteine stone seen?
Cysteinuria
54
What causes cysteinuria?
inadequate cysteine reabsorption
55
What size stones pass spontaneously?
<4mm
56
How do alpha blockers help stones?
Decrease ureter tone
57
When is surgery used for stones?
- >30 days | - Renal compromise
58
4 surgical procedures for stones.
- EWSL - Ureteroscopic fragmentation - Percutaneous nephrolithotomy - Double J Stents
59
What does double J stents do?
Urine drains around obstruction
60
ESWL is used for stones located where?
Kidney or ureter | - above illiac crest
61
What are contraindications to ESWL..
- Inability to position patient - Pregnancy - Infection - Obstruction below stone - Close to prosthetic device - Pacer/Defib
62
3 stone prevention tips.
- Drink water - Avoid soda - Limit protein, nitorgen and sodium in diet
63
What causes gout?
Build up uric acid in joints
64
Where are the majority of 1st gout attacks?
Big Toe
65
How is gout diagnoised
Microscopy of aspirated fluid
66
Where is uric acid excreted?
Kidney 2/3 | Gut 1/3
67
Gout risk factors.
- Males - Age 40-50 - Diet high in protein, fat and ETOH
68
What to use for gout pain relief?
- Nsaids - Steriod injection - Acetazolamide
69
How does acetazolamide work?
Alkalizing urine and trap weak acid
70
What med prevents gout?
Allopurinol
71
What do uricocurics do?
Promote uric acid excterion
72
How do uricocurics work?
Compete w/ uric acid for reabsorption at organic acid transporter
73
What may help gout?
Caffeine
74
How does CPAP help gout?
O2 starved cells die and release uric acid
75
What are 2 examples of uricocurics?
Sulfinpyrazone | Probenacid

Person Renal (6 decks)

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