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Renal YSK Flashcards

1
Q

What is a relative contraindication for renal transplantation?

A

Relative contraindication – advanced age, severe cardiovascular disease**

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2
Q

What is the paralytic of choice for renal transplantation?

A

Roc – drug of choice****

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3
Q

When should immonsuppression therapy be started for someone receiving a renal transplantation?

A

Immunosuppression therapy started on day in surgery

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4
Q

Where should the Serum K be before renal transplantation?

A

Serum K should be less than 5.5 Coagulations corrected

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5
Q

Brisk urine / good urine / good urinary flow following anastomosis is indicative of good graft function, You may be asked to give what medication?

A

1Brisk urine / good urine / good urinary flow following anastomosis is indicative of good graft function, You may be asked to give mannitol

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6
Q

What drug may be given to prevent ischemic renal injury during surgeries involving retroperitoneal lymph node dissection??

A

Mannitol may be given to prevent ischemic renal injury***** during surgeries involving retroperitoneal lymph node dissection

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7
Q

What is a major disadvantage of regional anesthesia for lithothripsy?

A

Major disadvantage of regional anesthesia, is the inability to control diaphragmatic movement***

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8
Q

What level is good for a regional block for ESWL?

A

T6 ESWL anesthesia*** T6 anesthesia for neuraxial anesthesia for ESWL is adequate

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9
Q

What are the effects of immersion for ESWL?

A

Effects of immersion – result in vasodilation (decrease BP)***Intrathroacic will be increase, FRC will be decrease. Prone to hypoxemia.

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10
Q

What are the complications for ESWL?

A

Complication***** - Mild hematuria, occurs frequently

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11
Q

What are the contraindications to ESWL?

A

Contraindication to ESWL*****, Urinary obstruction below the stone, Pregnancy, Infection

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12
Q

Whats a major complication with a TURP?

A

Hypothermia is going to be a major complication with a TURP** related to large volumes of room temperature solution

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13
Q

Post op shivering will increase o2 consumption by how much with a TURP?

A

post op shivering, it will increase o2 consumption by 300%-400%

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14
Q

Absorption of irrigation fluid influenced by what?

A

Absorption of irrigation fluid***influenced by resection time (20mL/min), height and pressure of irrigation fluid 16-32 cm above the patient maximum

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15
Q

Treatment of TURP syndrome is with what drug?

A

Treatment of TURP syndrome: loop diuretics furosemide

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16
Q

What level of a block do you need for a TURP?

A

T10 epidural / spinal , decrease surgical blood loss

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17
Q

In a cysto, if you have injury to the common peroneal nerve, what will happen?

A

Injury to the common peroneal nerve, loss of dorsal flexion of the foot, if the lateral thigh rest on the rest support*****

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18
Q

What will happen if you rapidly lower the patients legs during a cystoscopy?

A

Rapid lowering of the legs will cause hypotension, check BP after legs are lowered*****

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19
Q

What level of a block would you need for a cystoscopy?

A

Sensory level at T10 will provide good anesthesia*****

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20
Q

What can Indago carmine cause? (in terms of BP)

A

Indigo carmine may cause hypotension or hypertension**

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21
Q

What is the most effective means for management of hyperkalemia?

A

Management of Perioperative Hyperkalemia:*

Hemodialysis most effective means**

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22
Q

For kidney patients, what is hypocalcemia secondary to???

A

Hypocalcemia secondary to the inability of the kidneys to respond to hydroxylate (the active form of vitamin D)

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23
Q

Increase in levels of 2-3 GDP causes what?

A

Increase in levels of 2-3 GDP causes a shift to the right oxy-hemoglobin dissociative curve, allowing for the release of O2

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24
Q

 Renal insufficiency occurs when (what %) the nephrons are functioning properly?

A

Renal insufficiency occurs when 10-40% the nephrons are functioning properly

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25
Q

Cardiovascular system hypotension contributing factors?

A

Cardiovascular system hypotension contributing factors, blunted sympathetic response associated with uremia, reduced plasma volume, dialysate in blood has cardiac depression and vasodilation, anemia should be corrected if hct < 20% decreased erythrocyte production as well as decreased lifespan of the erythrocyte, vasodilation

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26
Q

After renal failure is establish, what is the most frequent complication that results in death?

A

Infection most frequent complication resulting in death**(pts need to be treated aggressively with antibiotics)

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27
Q

What is the Initiation period in the intrarenal acute renal failure?

A

Initiation period – renal hypoperfusion or nephrotoxin insult may initiate renal failure to a previously health kidney

  • The result is decreased tubule function or tubule obstruction
  • Decreased renal blood flow and GFR
  • Decrease urine volume
  • Decrease in urine solutes
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28
Q

How is nonoliguric acute renal failure classified?

A

Nonoliguric acute renal failure** greater than 400 ml per day (urine will be poor) abnormalities will be less severe

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29
Q

How is Anuric acute renal failure classified?

A

Anuric acute renal failure (less than 100ml per day)

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30
Q

How is oliguric acute renal failure classified?

A

Oliguric acute renal failure (urine volume less than 400ml per day or intra op less than 0.5cc/kg/hr)

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31
Q

Intra renal failure is going to be more serious, that will often requiring what?

A

Intra renal failure is going to be more serious, that will often require dialysis***

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32
Q

Prerenal failure is related to what?

A

Prerenal failure – related to hemodynamic or endocrine factor, impair renal function**
which Causes decrease renal profusion pressure and cause increase renal vascular resistance

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33
Q

How will hypovolemia, decrease cardiac output, and hypotension effect renal profusion pressure?

A
  • Hypovolemia will cause a decrease renal profusion pressure
  • Decrease cardiac output will cause a decrease renal profusion pressure
  • Hypotension will cause a decrease renal profusion pressure
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34
Q

How is acute renal failure classified?

A

Classified according to predominant use or on basis of urine flow rates*

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35
Q

Bowmans capusle feed by what?***

A

Bowmans capusle – feed by a single afferent arterial and drained by a single efferent arterial*****

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36
Q

What is the tubular system?

A

Tubular system – proximal tubule, loop of henle, distal convoluted tubule, collecting duct (two portions, medullary and corticox)***

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37
Q

What is acute renal failure??

A

Acute renal failure – sudden inability of the kidneys to vary urine volume and content
This is dependent on many variables and factors, and usually will be self limiting** acute renal failure syndrome

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38
Q

Chronic renal failure is slow, progressive, irreversible, and occurs over how many months??

A

Chronic renal failure is slow, progressive, irreversible, and occurs over 3-6 months

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39
Q

What is the ideal inhalation agent for someone with renal impairment??

A

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

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40
Q

Which inhalation agents has the potential for fluoride accumulation?

A

Enflurane and sevoflurane has potential for fluoride accumulation

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41
Q

How is Atracurium (tracrium) metabolized?

A

Atracurium tracrium degraded by the esterase hydrolasis and hoffmans(histamine release)

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42
Q

How is Cisatracurium (nimbex) metabolized?

A

Cisatracurium (nimbex, hoffman eliminations)

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43
Q

How is vercuronium (nurcium) metabolized?

A

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

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44
Q

How do barbiturates effect patients with renal impairment?

A

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

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45
Q

What are normal albumin levels?

A

3.3-4.5 normal albumin levels

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46
Q

What is specific gravity related to?

A

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

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47
Q

What is normal specific gravity?

A

Normal specific gravity is 1.025-1.030**

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48
Q

Glycosuria is a result of what?

A

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

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49
Q

Protein urea maybe seen without the presence of renal failure in things such as what?

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**

50
Q

Creatinine clearance measurements:

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
51
Q

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

A

CREATININE CLEARANCE

52
Q

Normal BUN?

A

Normal BUN : creatinine ratio is ~10:1

53
Q

BUN : Creatinine ratios greater than 15:1 are seen in what?

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*******

54
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

55
Q

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

A

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

56
Q

What will increase serum creatinine without a change in GFR

A

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

57
Q

GFR declines with increasing age yet, what happens to serum creatinine?

A

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

58
Q

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

A

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

59
Q

Serum creatinine is directly related to body muscle mass and inversely related to what?

A

Directly related to body muscle mass and inversely related to glomerular filtration**increase muscle mass, we will increase our creatinine

60
Q

Creatinine production is relatively constant and related to what?

A

Creatinine production is relatively constant and related to muscle mass*

61
Q

Normal BUN concentration?

A

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

62
Q

BUN concentration will vary with GFR, what will happen if…

  • BUN less than 8 will….
  • BUN levels between 20-40 will…
  • BUN greater than 50, generally….
A
  • BUN concentration will vary with GFR
  • 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
63
Q

BUN directly related to protein catabolism and is inversely related to what?

A

BUN directly related to protein catabolism and inversely related to glomerular filtration*****

64
Q

Ammonia is produced from deamination of what?

A

Ammonia is produced from deamination of amino acids**

Ammonia is going to be toxic to cells

65
Q

Primary source of urea is where?

A

Primary source of urea is in the liver

66
Q

With evaluating renal function, the greatest derangements are caused by abnormalities of what?

A

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

67
Q

Most useful laboratory tests are those related to GFR, Most accurate lab for clinically assessing renal function and GFR is the what?

A

Most useful laboratory tests are those related to GFR , Most accurate lab for clinically assessing renal function and GFR is the creatinine clearance*

68
Q

How are diuretics classified as?

A

Classified according to their mechanism of action, Many diuretics have more than one mechanisms of action

69
Q

You can increase urinary output by decreasing reabsorption of what two things?

A

Increase urinary output by decreasing reabsorption of sodium and water

70
Q

With volatile agents, what should you watch out for?

A

Volatile agents – watch out for fluride (sevo), be aware of compound A (keep flow greater than 2L), watch out for the cardiac depressive effects of the gases

71
Q

What are the indirect endocrine effects of anesthesia on renal function?

A

Endocrine effects – reduced blood flow, reduced urinary blood flow, increase in catecholamine due to the stress response

72
Q

What are the indirect neuronal effects of anesthesia on renal function?

A

Neuronal effects – reduction in renal blood flow, caused by sympathetic system, this can be the stress response

73
Q

What are the indirect cardiovascular effects of anesthesia on renal function?

A

Cardiovascular effects - Keep MAP between 80-180 (outside these ranges will be pressure dependent)

74
Q

What are the effects of anesthesia on renal functions?

A
  • Reversible decrease in renal blood flow and GFR
  • Typically will be less if you provide regional anesthesia as long as hypotension is avoided.
  • Maintain hydration and pressure (give them a drink)
75
Q

Renal blood flow:

A

Renal blood flow: ~1200mL/minute 20-25%***

76
Q

Glomerular filtration rate:

A

Glomerular filtration rate: ~125mL/minute 180L/day***

77
Q

What is intrinsic regulation?

A

Intrinsic regulation - auto regulation of renal blood flow – occurs between MAP 80-180 (outside these limits it will be pressure dependent, the blood flow)

78
Q

Glomerular filtration will cease or stop during what pressure?

A

Glomerular filtration will cease or stop during 40-50torr

79
Q

Renal blood flow will be generally decrease if MAP less than what?

A

Renal blood flow will be generally decrease if MAP less than 70

80
Q

What is Tubuloglomerulo balance?

A

Tubuloglomerulo balance - (self limiting and feedback system), If it sense a increase in tubular flow, it will decrease GFR. If you have a decrease in tubular flow, it will send a message out to let more in.

81
Q

What is Hormonal regulation?

A

Hormonal regulation - Angiotensin II, epi and Noriepi, all will effect AFFERENT arterial tone, renal filtration rate will generally stay the same***

82
Q

What will dopamine do to the arterials?

A

Dopamine will dilate afferent as well as efferent arterials, this will increase GFR***

83
Q

What is neuronal regulation?

A

Neuronal regulation – (sympathetic innervations is responsible stressed induction in renal blood flow, this will decrease urinary output. Stress response to a decrease urinary output.)

84
Q

Combined blood flow through both kidneys accounts for (what %) of total cardiac output

A

Combined blood flow through both kidneys accounts for 20-25% of total cardiac output

85
Q

How is each kidney supplied?

A

(Renal blood flow is going to be 1200ml per min.* Each kidney is supplied by a single renal artery that will arise form abd aorta)

86
Q

Oxygen consumption is determined by what?

A

Oxygen consumption is determined by renal blood flow

87
Q

Normal urine output?

A

0.5cc/kg/ml is normal urine output

88
Q

What is the poor mans CVP?

A

Foley is poor mans CVP

89
Q

Renal function is intimately related to what?

A

Renal function is intimately related to renal blood flow (normal urine formation denotes normal renal blood flow)

90
Q

Major function of Juxtaglomerular apparatus?

A

Major function: secretion of renin*****

91
Q

Two ways to stimulate renin release?

A
  • Beta adranergic sympathetic stimulation can also release Renin
  • Changes in afferent arterial wall pressure can release renin release as well
92
Q

What is the MOA of Renin?

A
  • Renin is release into the blood stream (released by the juxtaglomerular cells),
  • act on angiotensinogen (a protein that is synthesized by the liver) to form angiotensin I,
  • angiotensin I is converted into angiotensin II (in the lungs) by the ACE (plays a major role in BP regulation)
93
Q

Juxtaglomerular cells contains what? and are innervated by the which part of the nervous system?

A

Juxtaglomerular cells contain renin and are innervated by the sympathetic nervous system***located near the afferent arterial, which is next to the glomerulus

94
Q

Where is the Juxtaglomerular cells located?

A

Juxtaglomerular cells located in the macula densa are Located near the afferent arteriole, major function is to sense sodium concentration amount and secret renin

95
Q

What is the macular densa?

A

The macula densa (area of closely pack cells)- Sensitive to NaCl concentration (this is a monitor), It will sense sodium chloride.

96
Q

If the macular densa senses a decrease in NaCl, what happens?

A

If there is a decrease in NaCl ->

  1. Decrease resistance to blood flow via the afferent arterial, leads to increase blow flow via vasodilation
  2. Increase renin release from juxtaflomerular cells
97
Q

If the macular densa senses a increase in NaCl, what happens?

A

If it sense an increase in NaCl -> increase resistance that will decrease blood flow, this will vaso constrict, and decrease renin release

98
Q

What is the collecting tubule known for?

A

Collecting tubule:

Known for it’s concentrating ability***This would be in the presence of ADH

99
Q

If we increase ADH, what happens to urine output?

A

If we increase ADH, decrease urine output (this is the concentrating ability)

100
Q

If we decrease ADH, what happens to urine output?

A

If we decrease ADH, increase urine output (this is the concentrating ability)

101
Q

What is the Loop of Henle responsible for???

A

Loop of Henle

Responsible for maintaining a hypertonic medullary interstium**

102
Q

What is the major function of Proximal tubule?

A

Proximal tubule:

Major function: reabsorption (retention) of sodium**

103
Q

Glomerular capillaries:
Glomerulus composed of tufts of capillaries that jut into Bowman’s capsule, what is the purpose of the tufts of capillaries?

A

Glomerular capillaries:

Glomerulus composed of tufts of capillaries (increases surface area) that jut into Bowman’s capsule**

104
Q

What % of plasmids are filtered as they pass through Glomerulus?

A

20% of plasmids are filtered as they pass through Glomerulus

105
Q

Glomerular filtration pressure is about what % of MAP***

A

Glomerular filtration pressure is about 60% of MAP***

106
Q

How is the glomerulus feed and drained?

A

Glomerulus is feed by one Afferent Arterial and drained by one efferent arterial**

107
Q

If Vasodilate afferent arterial, what will happen?

A

If Vasodilate afferent arterial, we will decrease arterial tone and decrease arterial resistance, will increase renal blood flow and increase GFR

108
Q

If we vasoconstrict afferent arterial, what will happen?

A

If we vasoconstrict afferent arterial, increase arterial tone and arterial resistance, this will decrease renal blood flow and decrease GFR

109
Q

Work force of the body, basic unit of the filtering system is what?

A

THE NEPHRON

110
Q

GFR is what?

A

GFR 125ml/min

111
Q

Where is Filtered fluid will convert to urine?

A

Tubule system is where Filtered fluid will convert to urine***

112
Q

What is the ratio for cortical nephron to the juxtamedullary nephrons?

A

7 to 1… cortical nephron to juxtamedullary nephrons

113
Q

What contains the longer loops of henle?

A

Juxtamedullary nephrons contain “longer loops of henle”**** located in the medulla

114
Q

What contains the short loops of henle?

A

Cortical nephrons contain “short loops of henle”***** (in the cortex of the kidney)

115
Q

Each kidney consists of what two portions?

A

Each kidney consists of cortical portion (outer) and medullary portion (inner)*****

116
Q

Three layers to the kidneys?

A

Three layers to the kidneys

  1. Fiberous membrane that covers the kidneys itself
  2. Adipose capsule
  3. Renal facisa – anchors the kidneys to the abdominal wall and surrounding structures
117
Q

What is the sympathetic innervation to the kidneys?

A

Sympathetic innervation: renal plexus

Nerves are vasomotor, they regulate circulation of blood in the kidneys

118
Q

What are the three essential functions of the kidneys?

A
  1. Glomerarly filtration – forcing of fluids through a membrane under pressure
    - GFR 125ml/min
    - 20% of CO are sent to the kidneys
    - Kidneys will bleed if you cut it, that will be the difference between a total nephrectomy vs. partial
  2. Tubular reabsorption – retention – movement of filtrate back into the blood form the renal tubule (these are the nutrients, such as amino acid and glucose)
  3. Execretion – secretion - Movement of substances from the blood to the filtrate such as urea, uric acid, and creatinine
    - Important to Calculate fluids carefully
    - Adequate hydration and maintain renal profusion during anesthesia
119
Q

What hormones does the kidneys secrete?

A

Secrete hormones Renin, erythropoetin activated form of Vitamin D**

120
Q

Excretion (secretion) of end products of metabolism from the kidneys are what?

A

Excretion (secretion) of end products of metabolism (urea)**** Uric acid, creatinine, and end products of hemoglobin break down

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