Ap Ii: Exam 2 Renal Disease And Urologic Surgery

Front 1

AP 2: EXAM 2 RENAL DISEASE and UROLOGIC SURGERY

Back 1

AP 2: EXAM 2 RENAL DISEASE and UROLOGIC SURGERY

Front 2

How much of cardiac output do the kidneys

Back 2

15-25% of CO

~1-1.5L/min blood flow

Front 3

What is the effect of surgical sympathetic stimulation on vascular resistance and renal flow?

Back 3

Increases vascular resistance

Decreases renal blood flow

Front 4

How does anesthesia affect renal blood flow?

Back 4

Decreases it by decreasing cardiac output.

Front 5

What are the functions of renal system?

Back 5

1. water/electrolyte balance
2. excretion of wastes (i.e. urea)
3. secretion of hormones
4. catabolism of peptide hormones
5. glucose synthesis
6. reg. acid/base
7. reg. arterial pressure

Front 6

Which factor gives the best measure of renal function?

Back 6

GFR

125 ml/min

Front 7

What does BUN measure?

Back 7

A measure of the amount of nitrogen in the blood in the form of urea

A measurement of renal function.

A greatly elevated BUN (>60 mg/dL) generally indicates a moderate-to-severe degree of renal failure.

Normal value: 7-21 mg/dL

Front 8

Which is the best assessment of GFR?

Back 8

Creatine clearance

Front 9

BUN:Cr ratio

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The ratio may be used to determine the cause of acute kidney injury.

Normal range: 10:1

Front 10

What do we look for in Urinalysis?

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1. pH
2. specific gravity
3. glucose
4. protein (should not be present because it was not supposed to be filtered).

Front 11

GFR value?

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125 ml/min

Front 12

How much reduction of GFR until there is indication of a decreased GFR?

Back 12

50%

Front 13

When would the blood urea nitrogen (BUN) be elevated w.r.t level of GFR?

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GFR would have to decrease to almost 75% of normal.

In other words, it would have decrease about 25%.

Range: 5-25 mg/dL

Front 14

Creatine

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Freely filtered by kidneys

Not reabsorbed

Serum creatine REFLECTS GFR.

Front 15

Men and women creatine value?

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Men: 0.8-1.3 mg/dL

Women: 0.6-1 mg/dL

Front 16

Creatine clearance

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Most accurate measure of GFR.

Front 17

Creating clearance values for men and women?

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Men: 95-140 ml/min

Women: 85-125 ml/min

Front 18

Urine pH

Back 18

4.5-8.0 as normal.

Important in acid-base balance

Front 19

What hormone do the kidneys produce?

Back 19

Erythropoietin

Therefore, anemia can result in pts with renal disease.

Front 20

Acute Renal Failure (ARF)

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Malfunction of kidneys over hours to days.

Can't excrete waste products.

Front 21

What are the highest risk groups for ARF?

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1. elderly
2. diabetic
3. baseline renal insuf.

Front 22

Clinical manifestations of ARF?

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Decreased GFR

Retention of nitrogenous waste products.

Front 23

What are the types of ARF?

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1. prerenal (dec. renal flow)
2. renal (intrinsic)
3. postrenal (obstructive)

Front 24

What are the causes of prerenal ARF?

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Anything that decreases renal perfusion.

1. hypotension
2. hypovolemia
3. CHF
4. pre-renal aortic cross-clamping

Front 25

Causes of renal ARF?

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1. intrinsic renal disease
2. renal injury
3. nephrotoxic drugs

Front 26

Causes of post-renal ARF?

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Obstruction of urinary outflow tracts.

Front 27

Diagnosis of Post-renal ARF?

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With renal ultrasound

Front 28

Complications of ARF?

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1. neurological
2. CV
3. GI
4. infection

Front 29

Prognosis of ARF?

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20-50% mortality rate

Front 30

Treatment of ARF?

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1. PREVENTION!!!
2. no specific Tx
3. early correction of water, electrolyte, and acid base derangement.

Front 31

What muscle relaxants are good for renal disease pts?

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1. Cis
2. Vec

NOTE: Sux is not good due to K+ release.

Pan is not good b/c it's too long acting.

Front 32

Primary diseases of the kidney?

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1. glomerulonephritis
2. polycystic renal disease
3. renal artery stenosis
4. renal HTN
5. diabetic nephropathy

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Glomerulonephritis

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1. deposits of antigen-antibody complexes in the glomeruli.
2. immunosuppressive drugs help

Front 34

Polycystic renal disease

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1. progressive genetic disease
2. autosomal dominant
3. HTN and proteinuria
4. Tx includes lifelong dialysis

Front 35

Renal artery stenosis

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1. atherosclerosis of renal arteries
2. may cause secondary HTN

Front 36

Which primary disease of the kidney is the most common cause of ESRD?

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Diabetic nephropathy

NOTE: this dz. also causes albuminuria.

Front 37

Chronic renal failure (CRF)

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Progressive and irreversible

Front 38

At what GFR would ESRD would result in dialysis?

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GFR < 25 mL/min

Front 39

Stages of Chronic Renal Disease

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1. GFR > 90 ==> kidney damage with normal GFR.

2. GFR = 60-89 ==> kidney damage with mildly dec. GFR.

3. GFR = 30-95 ==> moderately dec. GFR.

Front 40

Some causes of CRF

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1. glomerulopathy
2. tubular interstitial disease
3. hereditary dz
4. vascular dz

Front 41

Clinical findings of CRF

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Rarely reversible

Onset may be slow and nonspecific.

Front 42

What is the primary cause of renal failure AND a risk factor for progression of disease?

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Hypertension

Front 43

Complications of CRF?

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1. hypervolemia
2. metabolic acidosis
3. electrolyte imbalance (hyperkalemia, hypermagnesemia, HYPOcalcemia)
4. anemia
5. coagulopathy
6. neurologic prob
7. CV (CHF, HTN)

Front 44

Why is dialysis performed?

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Tx of chronic renal failure

Front 45

Two types of dialysis?

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1. hemodialysis

2. peritoneal dialysis

Front 46

Complications of dialysis?

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1. hypotension
2. infection
3. peritonitis (lining of abdominal cavity).

Front 47

Choosing muscle relaxants for renal patients?

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Choose ones that are INDEPENDENT of renal function.

Cis

Atracurium

Front 48

During induction, what should you be monitoring more closely?

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Blood pressure: hypertension AND hypotension.

Avoid hyperkalemia (arrythmias)

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How do you treat hyperkalemia

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Glucose and insulin

Hyperventilation

Give bicarb

Get them dialyzed

Front 50

What other drugs should avoided?

Back 50

Morphine

Merperidine

Front 51

Morphine's considerations in renal pts?

Back 51

Morphine-6-glucuronide

Meperidine

Front 52

Morphine-6-glucuronide

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A potent sedative

Accumulates 10-15 times normal in the CFS of pts with CRF.

Front 53

Meperidine

Back 53

Normeperidine (metabolite) accumulates.

Front 54

Postop management of renal pts should include?

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1. HTN
2. Hyperkalemia
3. Supplemental O2 should be given.

Front 55

Urologic Surgeries

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1. transurethral resection of the prostate
2. lithotripsy
3. cystoscopy
4. radical prostatetomy
5. radical nephrectomy
6. renal transplantation

Front 56

Benign Prostatic Hypertrophy (BPH)

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1. nonmalignment enlargement of prostate
2. bladder obstruction

Front 57

Treatment options of BPH?

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1. medical therapy
2. minimally invasive therapy
3. surgical therapy

Front 58

Transurethral Resection of the Prostate (TURP)

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1. DEFINITIVE treatment for BPH
2. cutting of excessive prostate tissue.
3. CONTINUOUS irrigation fluid to distend tissues and provide visibility.

Front 59

Irrigating solutions

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Ideally, should be:

1. ISOTONIC
2. nonhemolytic
3. inexpensive

Front 60

Some examples of irrigating solutions

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1. distilled water
2. NS/LR
3. glycine
4. sorbitol
5. mannitol

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TUR syndrome

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Intravascular vol expansion

Hypoosmolality results

Front 62

Treatment for TUR syndrome

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For fluid overload: diuretic

For hyponatremia: hypertonic saline

For seizures: versed or thiopental

Front 63

What are some recommendations for TUR syndrome?

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Procedure < 1hr

Irrigant = 2 ft above table (max)

Front 64

Anesthesia plan for TURP

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General or Regional is fine

Front 65

Nephrolithaisis

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Renal stones

Tx: ultrasonic waves or pass them on their own.

Front 66

Lithotripsy (ESWL)

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Treatment of kidney stones

Repetitive shocks to break up stones

Front 67

Choice of anesthesia for lithotripsy

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MAC

Regional (but T6 is required)

Front 68

Contraindication of lithotripsy

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1. pregnancy
2. urinary obstruction
3. abdominal pacemaker generators
4. poor pt position

Front 69

Indications for cystoscopy

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1. recurrent UTI
2. urinary obstruction
3. hematuria

Front 70

Position for cystoscopy procedure

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Lithotomy

Front 71

Radical prostatectomy

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For removal of prostate

Laproscopic method

Open method

Front 72

Open method for radical prostatectomy procedure

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1. retropubic
2. perineal (lithotomy or T-burg)

Front 73

Types of nephrectomy

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3 Types
1. simple
2. partial
3. radical

Front 74

Simple nephrectomy

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Excision of kidney and small segment of proximal ureter.

Front 75

Partial nephrectomy

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Excision of segment of kidney

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Radical nephrectomy

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Excision of kidney, proximal 2/3 of ureter, lymph nodes.

For excision of renal carcinoma

Approach via midline, flank, transabdominal, or transthoracic approach.

Front 77

Complications of radical nephrectomy

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Extensive blood loss

Pneumothorax

Front 78

Anesthetic considerations for renal transplant: Pre-op

Back 78

Watch for K+ level. Need to be normal.

Is the pt. diabetic?

Front 79

Anesthetic considerations for renal transplant: Intraop

Back 79

1. CVP monitoring
2. Hypotension
3. Give mannitol

Front 80

Anesthetic considerations for renal transplant: Postop

Back 80

1. susceptibe for infection
2. watch for rejection of transplant