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94 Cards in this Set
- Front
- Back
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renal tubule consist of
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proximal convoluted tubule
loop of henle distal conv. tubule |
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prox con. tubule is responsible for absorption of what
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water
na k glucose cl ca |
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loop of henle is responsible for what
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formation of hypertonic fluid
reabsorbs some na & cl |
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distal conv. tubule does what
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reabsorbs water- influence of ADH
secretes H, K |
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where is renin secreted
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juxtaglomerular apparatus
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where is insulin metabolized
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kidney
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what does angiotensin II do to GFR, RBF, Aldosterone?
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decrease GFR and RBF
releases aldosterone from adrenal cortex |
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hydrostatic pressure minus plasma oncotic pressure
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filtration pressure
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kidneys are_______% of total body weight and receive _____% of resting cardiac output
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0.5%
20-25% |
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outside of 60-160 torr, renal blood flow becomes what
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pressure dependent
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test for GFR
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BUN
Plasma creatinine Creatinine clearance |
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normal BUN
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10-20 mg/dL
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normal creatinine
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07-1.5 mg/dL
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normal creatinine clearance
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110-150 mL/min
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test for renal tubular function
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urine specific gravity
urine osmolarity |
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normal urine specific gravity
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>1.018
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Urine osmolarity <300 after fasting means what
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makes impaired renal tubular dysfunction likely
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how does BUN vary with GFR
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inversely
Higher GFR= lower BUN |
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factors that produce an increase in BUN with decrease GFR
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CHF
Dehydration |
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Factors that produce an increase in BUN with normal GFR
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high protein diet
GI bleed increase catabolism with febrile illness |
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factors that produce a decrease in BUN
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Excess total body water
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a BUN > 50 almost always indicates what
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decrease in GFR
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what is a specific indicator of GFR
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plasma creatinine
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a modest increase in plasma creatinine should suggest what
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significant renal disease
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what is the most reliable and specific clinical estimate of GFR
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creatinine clearance
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normal urine specific gravity
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>1.018
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how does BUN vary with GFR
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inversely
Higher GFR= lower BUN |
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factors that produce an increase in BUN with decrease GFR
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CHF
Dehydration |
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Factors that produce an increase in BUN with normal GFR
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high protein diet
GI bleed increase catabolism with febrile illness |
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factors that produce a decrease in BUN
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excess total body water
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a bun >50 always reflects what
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decrease in GFR
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modest increase in plasma creatinine suggest what
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significant renal disease
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most reliable and specific clinical estimate of GFR
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creatinine clearance
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creatinine clearance less than what is moderate renal dysfunction
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25 ml/min
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creatinine clearance less than 10 ml/min can be considered what
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anephric and require hemodialysis
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another name for high output renal failure
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nephrogenic diabetes insipidus
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6 things that can cause nephrogenic DI
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lithium
Amphotericin B osmotic diuretics hypercalcemia hypokalemia old (enflurane, methoxyflurane) |
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excretion of Na > than what indicates renal failure
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40 mEq/L
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what is the earliest sign of diabetic nephropathy
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micro-albuminuria
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what do volatile anesthetics do to normal autoregulation of GFR or RBF
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do not interfere- only depress renal function by producing decrease CO and BP
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level of plasma fluoride required to produce nephrotoxicity
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50 mM/L
if exposure is prolonged may be as low as 15 |
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do you have to be careful of what drug to use if pts kidneys do not function at all
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no it doesnt matter
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what agent are we careful with if pt has renal disease
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Sevo
(enflurane)- not in US |
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Changes charachteristic of chronic renal failure
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chronic anemia
pruitis coagulopathies altered hydration and electrolyte balance metabolic acidosis systemic htn increased susceptibility to infection |
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can be asymptomatic as long as ______% of nephrons are functioning
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40
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develops uremia with <_% functioning nephrongs
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10
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renal insufficiency - what percent nephrons continue to function
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10-40%
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what is a good indicator of severity of uremic syndrome
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BUN
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in chronic anemia will see
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increaed CO
right shift oxy hgb curve |
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treat bleeding problems with
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desmopressin 0.3 to 0.4 mg/kg IV over 30 min
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what is the most serious electrolyte abnormality
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hyperkalemia
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postpone surgery until K is what
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<5.5
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treatment of hyperkalemia
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hyperventilation
glucose with insulin IV calcium |
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for every 10 torr drop in PaCO2 can drop K by what
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0.5 mEq/L
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problems with hypermagnesemia
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coma
hypotension hypoventilation potentiation of depolarizing and nondepolarizing muscle relaxants |
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rapid correction of acidosis can lead to what
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seizure
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formula for bicarb administration
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dose = 0.3 x kg x BE
divide dose in half and thats what to administer |
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HTN is the most significant risk factor for the development of what
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CHF
MI CVA |
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what is the principle life threating complication of uremic pericarditis
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acute pericardial tamponade
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treatment of acute pericardial tamponade
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hemodialysis and/or pericardiocentesis
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most common nerves for renal pts to have a polyneuropathy are
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median nerves of hands
common peroneal in lower legs and feet |
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what is the most serious problem facing pts with chronic renal failure
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infection
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the most common cause of death in renal pts is
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sepsis- usually pulmonary infection
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best indicator of determining the stage fo renal disease
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plasma conc. of creatinine
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what meds do you need to give pre-op because of uremia
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uremia causes delayed gastric emptying
bicitra reglan zantac |
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keep nitrous where in renal pts
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50% or less
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how should ventilations be controlled with renal pts
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smaller TV with increased RR
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how much fluid should you give your renal pt preop
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10-20 ml/kg IV
dont give LR or other K containing fluid if anuric |
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maintain u/o where
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> 0.5 ml/kg/hr
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if you need to bolus to increase u/o give what
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3-5 ml/kg/hr- NS
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how much dopamine to increase RBF
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0.5 to 3 mcg/kg/min
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how much dopamine to treat CHF induced oliguria
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3 to 10 mcg/kg/min
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in the dialysis dependent pt what are teh replacement requirements
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insensible loss only 5-10 ml/kg - NS or D5W
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what extra monitors are needed for major procedures
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art line
CVP Pulm artery cath |
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what to watch for post op renal pts
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recurization
HTN Excessive sedation after opiod administration |
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what is the most common cause of acute renal failure
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prolonged (30-60 min) renal hypoperfusion
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hemodialysis is recommended when BUN exceeds
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100 mg/dL
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pre-renal causes of oliguria
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hypovolemia
decreased CO |
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renal causes of oliguria
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renal ischemia d/t prerenal causes
nephrotoxic drugs release of hgb or myoglobin |
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post renal causes of oliguria
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bilateral ureteral obstruction
Extravasation due to bladder rupture |
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keep hr where for ESWL procedure
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high 80 to low 90's
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what type of ventilation is used for ESWL
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jet ventilation 100-110 breaths/min
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how much glycine can be absorbed during TURP
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as much as 30 ml/min leading to dilutional hyponatremia
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symptoms of acute hyponatremia are seen with levels less than what
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120 mEq/L
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what is glycine
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inhibitory neurotransmitter
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hydrostatic pressure should not exceed what when doing TURP- procedure should last no longer than
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70 cmH2O- usually don't know this
60 min |
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signs of hyponatremia at 120
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widening QRS
restlessness confusion |
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signs of hyponatremia at 115
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widened QRS
nausea somnolence |
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signs of hyponatremia at 110
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ventricular tachycardia
ventricular fib seizures coma |
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what is anesthetic of choice for TURP
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spinal anesthesia- need shoot for T6 so will have T10 by the end
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what are the first two signs seen with excessive intravascular fluid overload
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increased BP
decreased HR |
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how to treat intravascular fluid overload
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mannitol
lasix hypertonic saline |
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what do you need to watch for when new kidney is unclamped during transplant
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hypotension
hyperkalemia |
