Term
| Approximately ___% of cardiac output goes to the kidneys? |
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Definition
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Term
| If you decrease the blood flow to the kidneys they will... |
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Definition
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Term
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Definition
1. Filtration
2. Reabsorption
3. Secretion
4. Acid/Base balance
5. BP regulation
6. Erythropoietin |
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Term
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Definition
| Network of capillaries that filters blood |
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Term
| What is the main function of the proximal convoluted tubule? |
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Definition
| To reabsorb H2O, Na, amino acids and glucose |
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Term
| What is the main function of the Loop of Henle? |
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Definition
| Reabsorbs Na, water and concentrates urine |
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Term
| What is the main function of the Distal Convoluted Tubule? |
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Definition
It is the fine tuner
Regulates pH, K, Na, and Ca |
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Term
| Primary job of the Collecting duct? |
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Definition
| Collects urine from the nephrons |
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Term
Purpose of Aldosterone?
If you increase ___ it triggers release of Aldosterone. |
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Definition
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Term
| Renin Angiotensin Aldosterone System (RAAS) when activated.... |
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Definition
| Causes constriction. Kidneys hold onto Na and H2O |
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Term
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
The breakdown of muscle
-has a 12 hour lag time
-Urine output is better indicator of injury |
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Term
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Definition
-abrupt decrease in glomerular filtration rate
-results in retention of metabolic waster
-causes increase in K, Mg, P, acidosis
-Decrease Ca
-fluid overload |
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Term
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Definition
1. low perfusion
2. medications
3. parenchymal disease
4. sepsis
5. HF
6. trauma
*reversible if prompt treatment |
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Term
| Protein and albumin in urine indicates... |
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Definition
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Term
| Casts present in urine indicates |
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Definition
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Term
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Definition
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Term
| Most accurate way to estimate GFR is by assessing... |
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Definition
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Term
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Definition
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Term
Post Renal AKI:
Causes
Examples |
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Definition
Caused by disruption of urine flow
Examples: urethral obstruction, prostatic disease, infection, neurogenic problems, stones |
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Term
| Post Renal AKI Bun:Cr ratio |
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Definition
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Term
| Acute Tubular Necrosis (intrarenal injury) |
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Definition
Injury occurs at nephron
Causes structural damage |
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Term
| Acute Tubular Necrosis (Intrarenal Injury) BUN:Cr Ration |
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Definition
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Term
| Two types of acute tubular necrosis |
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Definition
1. Toxic ATN
2. Ischemic ATN |
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Term
Toxic ATN:
-caused by
-UA?
-Treatment |
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Definition
-caused by drugs of bacteria
-Recovery more rapid (less than 8 days)
-UA: cast present, protein and albumin
-Tx: take away cause and hydrate
*reversible |
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Term
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Definition
-irregular damage along tubular membranes
-tubular cell death and cast formation
-no perfusion to kidneys
-recovery long (greater than 8 days) |
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Term
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Definition
1. Oliguric
2. Diuretic
3. Recovery |
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Term
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Definition
-inability of excrete fluids and metabolic wastes
-sig. increase in BUN and Cr
-fluid overload, acidosis
-electrolyte imbalance
-Urine Na < 10 b/c conserving Na
-Urine specific gravity > 1.1010
-often requires dialysis |
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Term
| General Treatment Goals for AKI |
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Definition
-hemodynamic stability
-improve renal perfusion
-correct chemistry
-electrolyte imbalances
-adequate hydration |
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Term
| Monitor drug levels in what drugs? |
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Definition
Vanco
Gentamycin
Digoxin
Dilantin |
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Term
Chronic Kidney Disease:
What is it?
GFR |
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Definition
Slow progression of deterioration of renal function
GFR < 60ml/min and/or albuminuria |
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Term
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Definition
1. Anemia
2. Increase BUN, Cr, PO4
3. Decrease Ca, HCO3, protein
*spill a lot of albumin |
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Term
| Main risk factors for CKD |
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Definition
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Term
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Definition
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Term
| Dialysis Disequilibrium Syndrome |
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Definition
-can occur after dialysis
-LOC changes
-increase amount of BUN on one side of BBB than the other
-monitor, no active intervention |
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Term
| Treatment of an air embolus |
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Definition
1. Turn patient on left side (isolates air embolism in R ventricle)
2. Trendelenburg position
3. 100% Fi02 (accelerates removal of nitrogen) |
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Term
| When do we use CRRT instead of HD? |
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Definition
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Term
| What would it mean if you saw blood in CRRT effluent (waste) bag and what would you do? |
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Definition
membrane rupture
stop treatment and disconnect circuit |
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Term
| Complications of peritoneal dialysis |
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Definition
1. Peritonitis (glucose breads bacteria)
2. Hyperglycemia
3. Diaphragmatic pressure/Resp. complications
4. Pleural effusion - third spacing
5. Visceral herniation or perforation |
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Term
| Contraindications of Peritoneal Dialysis |
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Definition
-recent abdominal surgery
-abdominal adhesions
-need for emergent dialysis |
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Term
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Definition
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Term
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Definition
1. dehydration
2. excess NaCl or NaHCO3
3. Hypertonic enteral feedings |
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Term
| Treatment of hypernatremia |
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Definition
1. fluid hydration
2. free H2O
3. Diuretics |
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Term
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Definition
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Term
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Definition
1. NG tube suction
2. SIADH
3. Diarrhea
4. Intestinal surgery
5. Heart failure
6. diuretics
7. liver or renal disease |
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Term
| Treatment of hyponatremia |
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Definition
***slow correction or could cause demyelination syndrome if correct to fast
1. Na+ Phos
2. Hypertonic Saline
3. Na+ tabs |
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Term
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Definition
-lasts 7-14 days
-UO 2-5L/day
-kidneys can often clear volume, but not solute or waste
-waste electrolytes (K,Na)
-Urine specific gravity < 1.010
-Urine Osmo < 350
-Urine Na > 20-40 |
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Term
Contrast induced Nephropathy:
Treatment
Prevention |
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Definition
Treatment: hydration
Prevention: N - acetylcysteine |
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Term
Indications for Dialysis
AEIOU |
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Definition
A- Acid/base imbalance
E- electrolyte imbalance
I- Intoxication (ODs/toxins)
O- Overload (fluid)
U- uremic symptoms |
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Term
| Lab profile associated with renal failure |
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Definition
- decrease Ca
- increase K
- increase Cr |
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Term
Pre Renal AKI:
What is it?
Examples?
Urine Na? |
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Definition
-injury occurs before blood reaches the kidney
-hypoperfusion
-no structural damage if reversed
Examples: sepsis, HR, trauma, hypovolemia
Urine Na < 10 mEq/L b/c kidneys conserve Na and H2O |
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Term
| Pre-Renal AKI BUN:Cr Ratio |
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Definition
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Term
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Definition
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Term
Development of a "u" wave on the ECG indicates..
May also see ST segment depression |
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Definition
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Term
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Definition
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Term
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Definition
1. increases loss (GI: vomiting, suctioning, diarrhea, fistula, ileostomy)
2. excessive urinary loss
3. Inadequate intake (anorexia, ETOH, mag depletion)
4. Intracellular shift (pH and K have inverse relationship, insulin) |
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Term
| Tall peaked T waves can indicate... |
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Definition
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Term
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Definition
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Term
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Definition
1. renal failure
2. acidosis (DKA)
3. decrease cardiac output
4. Elderly taking K+ sparing diuretics
5. Severe trauma and burns (muscle damage causes K to be released into serum)
6. infection
7. Addison's disease
8. Increased consumption of substitute table salt of antacids |
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Term
Hyperkalemia Symptoms:
K+ and Mg go together
Hint: If high- Mag drag |
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Definition
-N/V
-diarrhea
-tingling skin
-numbness in hands and feet
-flaccid paralysis
-cardiac signs
-apathy
-confusion |
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Term
| Cardiac changes in Hyperkalemia |
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Definition
-tall tented P waves
-Widened QRS
-Prolonged PR
-Widened P wave
-P waves disappear, QRS merges with T to form Sine wave (Looks like monomorphic VT) |
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Term
Hyperkalemia Treatment
Move then remove |
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Definition
Emergency
1. Move potassium:
-Regular insulin
2. Calcium Gluconate: stabilizes action potential membrane but no effect of K levels)
3. NaHCO3
4. Nebulized Albuterol - speeds up Na/K pump
Remove K
-dialysis
-loop diuretics
-kayexalate |
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Term
| What electrolyte is commonly deficient with chronic alcoholism and can lead to what dysrhythmia? |
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Definition
| Magnesium, Torsades De Pointes |
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Term
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Definition
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Term
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Definition
1. Increased excretion
-NG suctioning, diarrhea, fistulas
-diuretics
-osmotic diuresis
-antibiotics
-hypercalcemia
2. decreased intake
3. chronic alcoholism
4. malabsorption
5. acute pancreatitis |
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Term
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Definition
-Prolonged QT
-PACs/PVCs
-hypotension
-Twitching, cramps, tremors
-mentation changes, seizures
-hypokalemia |
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Term
| What happens if you correct Mg too quickly? |
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Definition
| flushed and hypotensive because causes dilation |
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Term
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Definition
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Term
Hypermagnesemia: extremely rare
Patient pop.?
Clinical presentation?
Treatment? |
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Definition
Population: renal failure, OB patients, DKA
Clinical presentation: vasadilation, hypotensive, flushed, drowsy, lethargy
Treat: increase excretion, fluids and diuretics |
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Term
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Definition
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Term
Hypocalcemia:
Follow which lab value?
Causes? |
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Definition
-Follow ionized (active) Ca++
-normal 1.1-1.35 mmol/L
-Causes: diarrhea, diuretics, malabsorption, chronic renal failure, alkalosis |
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Term
| Ca++ and PO4 have an ____ relationship |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
arm and hand muscles spasm
-Ca low
-PO4 high |
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Term
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Definition
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Term
| Electrolytes and acid/base |
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Definition
Acidosis- hyper
Alkalosis-hypo |
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