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Co-Existing > Renal System > Flashcards

Renal System Flashcards

1
Q

Kidneys receive how much cardiac output

A

20-25%

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2
Q

Glomeruli will filter how much plasma a day

A

180L/day

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3
Q

Main function of kidney

A

Regulate water and sodium - volume hemostasis

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4
Q

Kindly auto regulation range

A

50-150mmhg achieved via the juxtaglomerular apparatus. Senses Cl- ion in distal tubule to adjust flow

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5
Q

RAAS

A

JGA cells release renin in response to hypotension. Renin enhances Angiotensin 2 production. Promotes ADH production, constricts efferent arterioles, increased sodium reabsorption from proximal tubule, and promotes aldosterone production. Aldosterone also increases sodium reabsorption

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6
Q

Significance of auto regulation

A

Demonstrates importance of: water and sodium hemostasis, management of ions, and elimination unwanted compounds. Mortality is 5-% when multi organ system failure includes AKI

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7
Q

Kidney assessment

A

GFR. Normal is >90ml/min. Decreases by 1% per year after age of 20. Symptoms of uremia appear once GFR <15. Cr and Cr clearance plus BUN

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8
Q

Creatinine

A

Easiest and most useful marker. Byproduct of muscle/protein breakdown. Only filtered by glomerulus - not secreted or excreted - so Cr level indicates how well plasma is being filtered by glomeruli

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9
Q

Normal Cr levels

A

Women: 0.6-1.0 mg/dL
Men: 1.0-1.3 mg/dL

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10
Q

Blood Urea Nitrogen

A

Indicates GFR level but can be reabsorbed from tubule unlike Cr

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11
Q

Elevated BUN but normal Cr

A

Dehydration - tubules reabsorbing urea to pull back in water
Increased catabolism - febrile illness
Increased protein consumption - protein shakes and GI bleeding
Value over 50 usually indicated decreased GFR

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12
Q

Renal tubule function

A

Assess ability to concentrate the urine once it has been filtered

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13
Q

Fractional Excretion of Sodium - FENa

A

Compares ratio of sodium in plasma and in the urine to ratio of Cr in the plasma and urine
FENa <1% then tubule reabsorbing Na appropriately
FENa >2% then tubule is failing to recapture Na - tubule dysfunction
FENa >3% suspect ATN - acute tubular necrosis

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14
Q

Urine specific gravity

A

If value is >1.018 then concentrating is intact

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15
Q

AKI Pre-renal

A

decreased perfusion/blood flow causing ischemia/damage

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16
Q

AKI Renal

A

Disease process that directly affects aspects of the kidney or nephron - glomerulus, tubule, renal interstitium, renal vasculature

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17
Q

AKI Post-renal

A

something blocking the outflow of urine

18
Q

Prerenal causes

A

Hemorrhage, GI loss, burns, cariogenic shock, surgery, sepsis

19
Q

Renal causes

A

Direct kidney damage; ATN, contrast dye, NSAIDs, antifreeze poisoning, acute glomerulonephritis, vasculitis, interstitial nephritis

20
Q

Postrenal causes

A

Nephrolithiasis - big stone blocking ureter
BPH - benign prostatic hypertrophy (hard to empty bladder)
Bladder malignancy - tumor blocking urethra
Cystic bleeding/clots - prostate cancer, surgery
Surgery

21
Q

AKI diagnosis

A

Cr increase of 0.3 in 48hrs or more than 50% increase over 7 days
Acute drop in urine production oliguria <100ml/day

22
Q

Common problems with CKD

A

Diabetes, HTN, HIV, focal segmental glomerulosclerosis, lupus

23
Q

CKD nephrotic syndrome

A

Indicates severe proteinuria - exceeds 3.5g daily accompanied by low albumin

24
Q

Stage 2 CKD

A

GFR 60-90 mild

25
Q

Stage 3a CKD

A

GFR 45-60 mild to moderate

26
Q

Stage 3b CKD

A

GFR 30-45 moderate to severe

27
Q

Stage 4 CKD

A

GFR 15-30 severe may need dialysis

28
Q

Stage 5 CKD

A

GFR <15 kidney failure needs dialysis

29
Q

Uremic syndrome

A

constellation of symptoms that manifest once CKD progresses to about 10% of normal kidney function. Effects every other organ system

30
Q

Uremic syndrome neuro

A

Encephalopathy
Autonomic dysfunction/polyneuropathy - midodrine may be required for BP support on dialysis days
Peripheral neuropathy - independent of presence of diabetes

31
Q
A
32
Q

Uremic syndrome pulmonary and GI

A

pulmonary edema and increased ventilation (respiratory compensation for metabolic acidosis. GI - delayed gastric emptying

33
Q

Uremic syndrome renal

A

Hyponatremia (can’t excrete water), hyperkalemia (can’t excrete potassium), hypo magnesium, hyperphosphatemia,
hypercalcemia and sometimes hypocalcemia, metabolic acidosis, volume overload

34
Q

Uremic syndrome heme

A

Anemia - damaged kidneys produce less EPO and platelet dysfunction

35
Q

Uremic syndrome endocrine

A

High phosphate levels lead to hyperparathyroidism, decreases calcium absorption, bone resorption occurs to restore calcium levels, over time results in bone demineralization

36
Q

ESRD and induction drugs

A

Propofol - unchanged
Etomidate - unchanged
Thiopental - decreased protein binding reduce dose
Benzo’s - decreased protein binding - potentiated effect

37
Q

ESRD and opioids

A

Morphine and codeine - renal extraction of metabolites prolonged use results in accumulation and over sedation
Meperidine - renal exertion of normeperidine and accumulation in ESRD can result in seizures not recommended

38
Q

ESRD and opioids

A

Hydromorphone and hydrocodone - renal excretion of metabolite can accumulate rarely results in seizures
Oxycodone - renal exertion of metabolites but accumulation does not appear to have significant effect. Metabolism of parent drug is slowed in uremic patients

39
Q

ESRD and muscle relaxants

A

Sux - no prolonged effect with single dose but K+ increase of 0.5meq/dL
Vecuronium - significant excretion of uncharged drug in urine and bile. Prolonged effect
Rocuronium - some prolonged recovery from roc
Atracurium and cis-atricuriam not prolonged in ESRD but cannot be revered by sugammadex

40
Q
A

Co-Existing (3 decks)

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