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30 Cards in this Set
- Front
- Back
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What are the 3 ways to classify Acute Renal Failure?
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1. By cause
2. By urine flow rate 3. Stages |
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List the 3 categories of ARF when classified by "cause"
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1. prerenal
2. Renal 3. postrenal |
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What physiologic changes occur during the prerenal phase of ARF.
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a. impaired renal perfusion
b. can progress to renal tissue damage c. conservation of salt and water |
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During ARF -in the prerenal phase- what are the factors that cause "impaired renal perfusion"
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Hemodynamic factors: hypovolemia and hypoperfusion
Endocrine factors: increased catecholamines, ADH, aldosterone |
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What causes conservation of salt and water in the pre-renal phase?
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urine has a low sodium and high osmolality
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The "renal" phase of ARF is also termed?
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acute tubular necrosis
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What happens to the renal system during acute tubular necrosis?
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Tissue damage:
-nephrotoxins, renal ischemia, diseases (nephritis) |
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What are the phases of acute tubular necrosis?
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1. initiation
2. maintenance 3. recovery (however, once in maintenance phase they don't usually recover)` |
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In acute tubular necrosis...How do sodium and osmolality levels compare to the pre-renal phase
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In ATN; you have high sodium and low osmolality....it's opposite in pre-renal phase
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A person with a high sodium and low osmolality would have..
a. difficulty concentrating urine b. conservation of salt & water |
a
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A person with a low sodium level and high osmolality would have...
a. difficulty concentrating urine b. conservation of salt and water |
b
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What lab changes would someone see in a patient presenting with acute tubular necrosis
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1. progressive rise in BUN, Cr, uric acid and K+
2. Decreased sodium, calcium and protiens (albumin) |
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What is typically the cause of the post-renal phase?
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1. urinary tract obstruction
2. edema 3. surgical ligation |
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What terms are used to classify acute renal failure by "urine flow rate"
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1. oliguric
2. nonoliguric or polyuric |
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Oliguric is classified by?
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<0.5ml/kg/hr urine
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Nonoliguric or polyuric is classified by?
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> 2.5 L/day; and elevated BUN & Cr
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What are the 4 stages of Acute Renal Failure
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1. onset
2. oliguric 3. diuretic (onset of recovery) 4. Recovery (gradual) |
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Name 10 risk factors of Acute Renal Failure
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1. Age (dec. renal reserve)
2. preexisting renal disease 3. cardiac & hepatic failure 4. diabetes 5. Urinary tract OBS (BPH, stones) 6. Anesthesia 7. Intraoperative factors 8. surgical procedures 9. sepsis 10. complications of pregnancy |
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What 3 surgical procedures increase to "risk" of developing acute renal failure?
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1. cardiac
2. AAA: clamping above renal arteries 3. angiography (dye) |
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What is the best way to avoid acute renal failure
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Prevention is the best strategy
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What are 3 ways to prevent (prophylaxis) your patient from going into acute renal failure
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1. identify at risk patients
2. correct hypovolemia and other reversible causes 3. Maintain normovolemia |
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The 3 preventive strategies used intraop to prevent the occurrence of acute renal failure are?
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1. prophylaxis
2. limit magnitude and duration of renal ischemia 3. management of intraoperative oliguria |
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Limiting magnitude and duration of renal ischemia during surgery involves what?
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1. adequate monitoring (foley, and invasive monitoring if indicated)
2. maintain cardiac output and renal perfusion 3. hourly UO 4. Diuretics 5. fenoldpam |
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Compare the use of "diuretics" in the patient who is hydrated vs. the patient who's UO is low
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Hydrated: diuretics may prevent ARF in hydrated patients
Low UO: Diuretics may worsen hypo perfusion and hypovolemia |
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What is capable of converting oliguric to nonoliguric failure
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large doses of lasix (100mg) can convert oliguric to nonoliguric failure
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What is the MOA of Fenoldpam
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selective DA1 agonist
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How does Fenoldpam effect the renal and systemic arteries
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arteriol vasodilator
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How does Fenoldpam effect DA2, alpha and beta receptors
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it has no effect on them
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What is the difference between fenoldpam and high dose Dopamine
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high dose dopamine causes renal arteriole vasoconstriction; fenoldpam doesn't
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How should the CRNA manage a patient intraoperatively who presents with oliguria?
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1. assume it's prerenal
2. maximize RBF: maintain CO & BP: + give "fluid challenges"; maintain normovolemia 3. avoid diuretics unless pt is obviously overloaded 4. start invasive monitoring if fluid challenges don't work 5. institute other pharmacologic agents 6. Early hemodialysis 7. maintain fluid and electrolyte status |
