Renal & Urologic Flashcards
What is the most common etiology of acute renal failure in surgical patients? what is it? what causes it?
acute tubular necrosis; death of epithelial tubule cells; typical causes are HoTN and nephrotoxic drugs
What is the best tool for measuring kidney function? how does it work?
creatinine clearance test; measures Cr lvls in both blood and urine over a 24hr period (2hr can be done as well)
What’s the limitation of serum BUN and Cr in measuring renal function? what about perioperatively?
influenced by non-renal variables; perioperatively is a late sign of renal dysfunction
A stress response is characterized by a shift of blood flow to the ______ of the kidney.
medulla
Normal GFR is ____; GFR can be reduced to about ____ before a patient needs dialysis.
125cc/min; 10cc/min
Oliguria is defined as less than ___.
0.5cc/kg/hr
What is prerenal azotemia? what causes it?
high levels of nitrogenous waste in the blood (urea, nitrogen, Cr etc.) caused by insufficient filtering of the kidneys; due to renal hypoperfusion or ischemia
What is post-renal failure?
acute renal failure caused by obstruction of the outflow of urine
What is GFR at the 5 stages of chronic renal failure?
Stage 1 - 90cc/min, 2 - 60-89cc/min, 3 - 30-59cc/min, 4 - 15-29cc/min, 5 - <15cc/min
What is an option for an ESRD patient who no longer has any graft/fistula sites for dialysis?
peritoneal dialysis
Why does ESRD result in anemia?
inadequate production of erythropoetin in the kidneys to signal RBC production in the bone marrow
What is the most common bleeding problem associated w/ ESRD?
prolonged bleeding time
In what types of ABX would you want to make dosing adjustments for ESRD?
aminoglycosides and vancomycin
What drug can cause direct renal tubular epithelial damage?
iodine contrast dye
What drugs have active metabolites? what are the names of the metabolites?
demerol (normeperidine) and morphine (morphine-6-glucuronide)
What is ESWL?
extracorporeal shock wave lithotripsy - breaking up kidney stones w/ sound waves
What percent of people experience renal calculus in their lifetime? what percent require open surgical intervention?
12%; 5%
What is urethral stricture? What’s the most common cause?
narrowing of urethra, UTI
What level spinal would be appropriate for a cystoscopy that is longer in duration?
T10
What is VLAP?
visual laser ablation of the prostate
What is water intoxication? what is it seen in?
dilutional hyponatremia; seen in TURP syndrome (excessive uptake of irrigation fluid)
What is the typical TURP irrigation fluid?
glycine
What GU procedure involves the implantation of radioactive seeds?
brachytherapy
Radical nephrectomy has a pain score of __.
10
Why is the urethra more prone to taking up irrigation fluid than the bladder?
It is more vascular
What are the CNS effects of TURP syndrome and how does it occur? What Na level indicates severe TURP syndrome?
Hypotonic blood shifts fluid intracellularly, causing swelling of the brain; 120mmol/L
