Card Set Information

2013-11-06 20:06:19
Critical Care Test

Renal A&P and assessment
Show Answers:

  1. The kidneys receive _____ % of CO
  2. The functional unit of the kidney is the
  3. RBC's or protein in the urine usually indicates
    damaged or diseased glomerular basement membrane

    because basement membrane is semipermeable and generally only small particles are filtered through
  4. what is key to kidneys performing their function?
    blood flowing into and out of the glomerulus
  5. Solutes usually completely reabsorbed
    • glucose
    • amino acids
    • bicarbonate
    • large percentage of water
    • K
    • Na
    • Ca
  6. solutes not absorbed (excreted in urine)
    urea, nitrogen, creatinine
  7. solutes reabsorbed in
    proximal convoluted tubule
  8. urea-
    by-product of the breakdown of amino acids (protein metabolism)

    results from breakdown of ammonia in the liver
  9. creatinine-
    end product of protein metabolism produced by the muscles

    normally completely filtered by kidneys and excreted in urine
  10. fx of loop of henle
    concentrate and dilute urine
  11. Distal convoluted tubules contains cells of macula densa that regulate-
  12. If ADH is present in DCT then
    DCT impermeable to water and reabsorbs some solutes-concentrates urine
  13. If ADH absent in DCT then-
    DCT more permeable to water and filtrate becomes less concentrated- dilutes urine
  14. acidification of urine occurs in
    collecting duct
  15. in collecting duct composition of urine occurs because of transport of
    • K
    • Na
    • H2O
  16. acidification of urine in collecting ducts is accomplished by
    transport of bicarb and hydrogen
  17. ____ are responsible for removing unwanted metabolic substances and wastes and retaining electrolytes and water.
  18. what is GFR?
    The amount of filtrate formed in the nephrons
  19. normal GFR is
    125 mL/min
  20. What happens in glomerular capillary bed when MAP drops
    afferent arterioles dilate, efferent constricts to maintain pressure in the glomerular capillary bed. = more blood going in and harder to get out to maintain pressure. 

    Increased pressure in bowman's space decreases filtration because the increased pressure resists movement solutes and water- amount of cellular debree, tubules get blocked and create back pressure into bowman's space. GFR goes down and urine output decreases
  21. effect of proteins on fluid?
    proteins hold fluid in the vascular space.  when not enough proteins (plasma oncotic pressure low) fluid leaks out of vascular space-third spacing
  22. What causes urea and creatinine to be too high?
    if glomerulus can't filter urea out of blood and out in the form of urine then urea builds up in the blood
  23. fx of aldosterone
    increases retention of Na and H2O to increase BP - part of RAAS system
  24. fx of erythropoietin
    • hormone that controls RBC production
    • stimulates bone marrow to increase RBC production
  25. erythropoietin produced by kidneys  in response to
    decrease in amount of O2 delivered to kidneys
  26. Kidneys regulate acid base balance by
    reabsorbing or excrete hydrogen and bicarb in the tubules

    kidneys do not fx rapidly in regulating acid-base balance
  27. fx of ADH
    controls ECF volume (acts on DCT and collecting ducts to resorb water)
  28. ___ stimulates release of ADH
    osmoreceptors (sense osmolality of serum) in hypothalamus and liver send message to release ADH
  29. ADH is released when serum osmolality is _____
  30. ADH is stopped when serum osmolality is _____
  31. hyperosmolality=
  32. ANP is secreted in response to ?
    stretch receptors in the heart, increased pressure in the heart, and hypernatremia
  33. fx of ANP
    blocks aldosterone and ADH production which causes increase sodium and water excretion
  34. Predisposing factors to renal issues
    • nsaids
    • use of aminoglycosides
    • iodine based dyes
    • muscle damage (rhabdomyolysis r/t trauma or strenuous physical exercise)
  35. sx commonly present with renal issues
    • n/v
    • metallic taste
    • weight gain
    • orthopnea
  36. physical signs of renal issues
    • grey-turner's sign
    • abd distention
    • abd guarding
    • neck veins flat or distended
    • hand vein pumped up
    • skin turgor- tight, edema
    • oral cavity-signs of volume depletion or overload
  37. ways to check fluid volume
    neck veins flat or distendedhand, hand vein pumped up, skin turgor- tight, edema, oral cavities
  38. criteria for orthostatic hypotension
    drop in bp of more than 20 mmhg or rise in pulse more than 20 beats/min from lying to sitting or sitting to standing
  39. how to check for ascites
    fluid wave- put pressure on midline of abd, place other hand on rt or lft flank, tap the opposite side- if can feel a wave of fluid in the opposite side then ascites
  40. 1 L of fluid = _ kg
    1 kg
  41. oliguria is less than __ml/hr of urine
    30 ml
  42. BUN elevation decrease in
  43. BUN is renal specific
    false- BUN is a by product of amino acid and protein metabolism (formed in liver)
  44. normal BUN
    5-25 mg/dl
  45. normal creatinine
    0.7 to 1.5 mg/dL
  46. creatinine is renal specific
    true-it is entirely excreted by the kidneys
  47. Best lab test to indicate overall kidney function
    creatinine clearance
  48. creatinine clearance is a measure of
  49. how is creatinine clearance measured
    24 hr urine w/ corresponding blood test
  50. normal creatinine clearance
    80-139 mL/min
  51. when BUN and Cr rise at same rate-
    suggestive of renal dysfunction
  52. when BUN rises faster than Cr
    suggestive of dehydration, hypoperfusion, protein catabolism, GI bleeds
  53. if increased hct  and normal hgb
    volume deficit and hemoconcentration
  54. decreased hct and normal hgb
    volume excess and hemodilution
  55. low hct and hgb
    bleedin, anemia, liver damage, hemolytic reactions, inadequate erythropoietin
  56. S&S of acute pyelonephritis
    sudden onset of fever, chills, flank or groin pain, frequency, elderly may have general malaise and low grade fever
  57. s&s of chronic pyelonephritis
    HTN, a lot of flank pain, dysuria , frequency
  58. s&s of glomerulonephritis
    • hematuria with RBC casts
    • proteinuria exceeding 3-5g/day with albumin
    • oliguria
    • HTN-kidneys ability to regulate bp altered
    • edema-from 3rd spacing
  59. findings in nephrotic syndrome
    • 3.5 g or more of protein/day in urine
    • hypoalbuminemia
    • edema-3rd spacing
    • hyperlipidemia and lipiduria
    • vitamin D deficiency
  60. difference between chronic and acute renal failure
    acute RF is reversible and still have functioning of kidneys (only declined functioning)
  61. acid base findings in RF
    metabolic acidosis - bicarb coming out in urine
  62. labs RF
    • high levels of K
    • GFR falls
    • plasma creatinine increases
    • proteinuria and uremia
    • Na deficit and oliguria
    • increased phosphorus
    • anemia
    • serum ca decreases
  63. if ARF secondary to something else 80% more likely to die
  64. causes of prerenal AKI
    • prolonged hypotension (sepsis, vasodilation)
    • prolonged low CO (HF, cardiogenic shock)
    • prolonged volume depletion (dehydration, hemorrhage)
    • renovascular thrombosis (thromboemboli)

    think b4 kidneys
  65. causes of intrarenal AKI
    • kidney ischemia (advanced stage of prerenal AKI)
    • endogenous toxins (rhabdomyolysis, tumor lysis syndrome)
    • *exogenous toxins (radiocontrast dye, nephrotoxic drugs)*
    • infection (acute glomerulonephritis, interstitial nephritis)

    something causing injury inside kidney parynchyma
  66. cause of postrenal AKI
    obstruction in urethra, prostate, or bladder

    after the kidney
  67. best way to check fluid gain or loss
    daily weights
  68. treatment for abnormal labs and AKI
    diet- avoid potato chips, leafy green vegetables, dried fruits, avocados, bananas, ,diuretics, kayexalate, very high D50 and insulin 10 units
  69. treatment for abnormal labs and AKI
    phosphorus and ca
    • iv ca replacement will bring phosphorus down
    • diet- avoid dairy, green leafy vegetables, phosphorus- no dark carbonated beverages
  70. fluid replacement in renal pts
    • NS AND 1/2 NS
    • albumin and hetastarch
  71. diet for AKI AND ESRD
    • low protein
    • tube feeding-nepro
    • get white tray
  72. sites for temporary hemodialysis
    • subclavian- most common
    • femoral
  73. permanent hemodialysis sites
    • AV Fistula
    • AV grafts-for end stage patients
    • tunneled catheter-if circulatory system not good thru jugular or subclavian vein
  74. indications for CRRT
    • acute renal failure
    • hemodynamic instability
    • sepsis

    24/7 dialysis much slower and easier on pt/ better outcomes with sepsis
  75. complications of CCRT
    • biggest-hypotension
    • access dislodgment
    • infection
    • decreased ultrafiltration rate
    • filter clotting
    • fluid and electrolyte change
    • bleeding
  76. complications of peritoneal dialysis
    most significant- infection
  77. s&s peritonitis
    • rise in wbc
    • increased temp
    • malaise/lethargy
    • fluid draining out no longer clear-cloudy
    • signs of localized catheter or abd infection
  78. hemodialysis works by
    diffusion and thru pressure gradient