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CCRN Study Deck > Renal System 5% > Flashcards

Renal System 5% Flashcards

1
Q

Myoglobin

A
  • Muscle protein / heavy pigment
  • Seen in urine after extensive muscle injury (electrical burns, status epilepticus, crush injuries)
  • May cause acute tubular necrosis by having direct toxic effect on tubule epithelial cells or inducing intratubular cast formation
  • Prevent damange to tubules by forcing diuresis with fluids and osmotic diuretics
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2
Q

Recombinant Human Erythropoietin

A

Treats anemia resulting from reduced renal production of erythropoietin.

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3
Q

Erythropoietin

A

Hormone that promotes the production of red blood cells.

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4
Q

What causes anemia in a patient with chronic renal failure?

A

Decreased renal production of erythropoietin.

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5
Q

What Does Acute Pancreatitis Cause

A

Hypocalcemia -> Muscle Spasm -> Prolonged QT interval -> torsades de pointes

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6
Q

Hypocalcemia Causes …

A
  • Muscle Spasms
  • Stridor
  • Paresthesias
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7
Q

Hypomagnesemia Causes …

A

Respiratory Arrest

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8
Q

Hypokalemia Causes …

A
  • Asystole
  • Premature Ventricular Contractions
  • Paralytic Ileus
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9
Q

Hyponatremia Causes …

A

Seizures

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10
Q

Cardiac Output (CO) = ?

A
  • Stroke Volume (SV) x Heart Rate (HR)
  • (4 to 8 L/min)
  • Predicts oxygen delivery to cells
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11
Q

Cardiac Index (CI) = ?

A
  • Cardiac Output (CO) / Body Surface Area (BSA)
  • (2.5 to 4 L/min/m2)
  • Assessment of cardiac output value based on patient’s size
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12
Q

Kidneys receive what percentage of Cardiac Output?

A
  • 20% to 25% (approx 1200 ml/min)
  • Without sufficient CO, kidneys cannot perfuse properly and filtration cannot be effective
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13
Q

Rhabdomyolysis

A
  • Acute muscle destruction
  • Associated with myoglobinuria
  • Common cause for acute tubular necrosis (ATN) in normotensive patients with crush injuries
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14
Q

Increase in urine specific gravity is indicative of …

A

Dehydration

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15
Q

Prerenal Acute Kidney Injury

A
  • “Before”
  • Result of inadequate perfusion of a normal kidney > decreased glomerular filtration rate
  • Significant cause: dehydration
  • BUN/creatinine ration greater than 10:1 -Hemorrhage
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16
Q

Hyperkalemia Causes …

A
  • Gastric motility (Diarrhea)
  • Flaccid paralysis (Partially depolarizing the muscle cell membrane, preventing further depolarization)
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17
Q

Hypermagnesemia Causes …

A
  • Diminished deep tendon reflexes Muscle weakness
  • Smooth muscle relaxation
  • Hypotension
  • Respiratory Muscle Paralysis Respiratory arrest
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18
Q

Calculating Fluid Volumes for Acute Kidney Injury (ARF) patients on Fluid Restrictions

A

Replace what was previously lost and add an allotment for insensible losses that cannot be tracked (approx 500ml)

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19
Q

What is indicated when Blood Urea Nitrogen (BUN) is greater than 100 mg/dl for a patient in acute tubular necrosis (ATN)?

A

DIalysis

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20
Q

Loop Diuretics

A
  • Most potent diuretic
  • Block the reabsorption of sodium chloride at the thick segment of the medullary ascending loop of Henle.
  • Results in large diuresis of isotonic urine
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21
Q

Loop Diuretic Meds

A

Furosemide (Lasix)

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22
Q

Osmotic Diuretic Meds

A

Mannitol

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23
Q

Aldosterone Antagonists Diuretic Meds

A

Spironolactone (Aldactone)

24
Q

Dialysis Disequilibrium Syndrome

A
  • Occurs when urea is removed from the blood at a rate faster than it is removed from the brain tissue.
    • Greater amount of urea in the brain causes a fluid shift resulting in cerebral edema
  • During dialysis/hemodialysis treatments
  • Headache, nausea, agitation, confusion, twitching
  • Prevent by slowing blood flow rate which slows the rate at which solute is removed from the vascular space
25
Q

Hyposmolar Hyponatremia

A
  • Hyponatremia -> Psychogenic Polydipsia
  • Neurologic manifestations are hallmark of hyponatremia
  • Swelling of brain cells results from the intracellular movement of water
  • Lethargy, confusion, and even coma
26
Q

Acute Kidney Injury Risk Factors

A
  • Any cause of hypoperfusion
    • Cardiogenic shock
    • Duration of cardiopulmonary bypass
    • Antibiotic therapy
27
Q

Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • Block the conversion of angiotensin I to angiotensin II.
  • Angiotensin II causes vasoconstriction and blocks aldosterone.
    • Aldosterone causes the retention of sodium and water and the excretion of potassium.
  • ACE Inhibitors cause the excretion of sodium and water and the retention of potassium
28
Q

Hypovolemia Concerns

A
  • Sympathetic Nervous System stimulation
    • Narrowed pulse pressure
    • Tachycardia
    • Volume Depletion
    • Temperature elevation
    • Dry, sticky mucous membranes
    • Small volumes of dark, concentrated urine
29
Q

Reciprocal Condition to Hypocalcemia

A

Hyperphosphatemia

30
Q

Hyperphosphatemia

A
  • Impaired sensitivity of the skeleton to the bone-resorbing action of parathyroid hormone
  • Reduced absorption of calcium
    • Calcium trapped in insoluble form as calcium phosphate complexes
  • Common problem in chronic kidney disease
31
Q

Why is Albumin prescribed for patients with alcoholic cirrhosis that has peripheral edema and ascites?

A
  • To reduce third-spacing
  • Decrease in serum albumin (Primary intravascular protein) results in third-spacing
  • Replacing albumin increases intravascular colloidal oncotic pressure to hold and pull fluid into vascular space
32
Q

Antagonist for Hypermagnesemia

A

Calcium

33
Q

Metabolic Acidosis is a result of the kidneys inability to do what?

A

Excrete the acid by-products of cellular metabolism

34
Q

Metabolic Alkalosis is a result of the kidneys inability to do what?

A

Inability to excrete bicarbonate ions

35
Q

Damage to the glomerulus causes what?

A
  • Loss of protein and proteinuria
  • Ex: glomerulonephritis, Goodpasture syndrome, and nephrotic syndrome
36
Q

Electrolyte Imbalances in Acute Renal Injury and Chronic Kidney Disease

A
  • Hypermagnesemia
  • Hypocalcemia
  • Hyperkalemia
  • Hyperphosphatemia
37
Q

Intrarenal or Intrinsic Acute Kidney Injury

A
  • Problems “within”, changes to, and injury of the nephron -Intrarenal failure due to injury within the kidney
  • Intrarenal-cortical: caused by an infectious or inflammatory process within the kidney
  • Intrarenal-medullary: caused by prolonged ischemic injury or a nephrotoxin
38
Q

Postrenal Acute Kidney Injury

A
  • Problems “after” and relates to obstructive processes
  • Renal failure caused by problem after the kidney
  • Tumor, stone
  • Involving the bladder
39
Q

Potassium Movement with pH Changes

A
  • Acidosis: Potassium leaves the cell and increases serum potassium levels
  • Alkalosis: Potassium enters the cell and decreases serum potassium
  • 0.1 pH change = 0.5 mEq/L potassium change
40
Q

Cause of Acute Tubular Necrosis (ATN)

A

Nephrotoxic drugs

41
Q

Indications of Dehydration in Elderly Patients

A
  • Tachycardia
  • Hypotension
  • Oliguria
  • Dry Mucous Membranes
  • Poor Skin Turgor
42
Q

Anion Gap Equation

A
  • Anion gap = (Na + K) - (Cl + HCO3)
  • (Normal < 15 mEq/L)
43
Q

Immediate management for a patient requiring elimination of excess fluid in a patient with chronic kidney disease includes …

A

Dialysis

44
Q

Best parameter to evaluate effectiveness of fluid removal during hemodialysis

A
  • Postdialysis weight
  • 1 pound = 500ml
45
Q

Myoglobinuria occurs in what cases?

A
  • Electrical burns
  • Status epilepticus
  • Muscle ischemia
  • Statins
  • Crush injuries (leading to muscle destruction and rhabdomyolysis)
46
Q

Urine Creatinine Clearance

A

Comparison between the creatinine in the blood and the creatinine excreted in the urine

47
Q

Glomerular Filtration Rate (GFR)

A
  • Evaluationes the ability of kidneys to filter a waste product (creatinine) that is neither reabsorbed nor secreted.
  • Passive filtration of blood through the glomeruli
48
Q

Refeeding Syndrome

A
  • Nutritional support allows cells to begin making more adenosine triphosphate (ATP)
  • Phosphate supplies are depleted
49
Q

What should not be restricted during the oliguric phase of acute kidney injury?

A
  • Carbohydrates
  • Inadequate carbohydrate intake can cause catabolism
50
Q

Peritoneal Dialysate Color Change

  • Clear/Pale Yellow
  • Amber
  • Brownish
  • Red/Pink
  • Cloudy
A
  • Clear/Pale Yellow: Normal
  • Amber: Bladder Perforation
  • Brownish: Bowel Perforation
  • Red/Pink: Bleeding in the peritoneal cavity
  • Cloudy: Infection in the peritoneal cavity
51
Q

Acute Renal Failure Prevention

A
  • Comorbidities
    • Diabetes
    • Heart failure
    • Hypternsion
  • Avoid potentially nephrotoxic substances
    • Antibiotics
    • NSAIDs
    • Ace inhibitors, ARBs
    • Antineoplastics
    • Contrast media
    • Diuretics
  • Careful assessment and monitoring
    • Fluid balance
    • Hemodynamics, hypotension
    • Renal function, labs
    • Urine output
52
Q

Blood Urea Nitrogen (BUN)

A
  • Measures the amount of nitrogen in the blood that comes from the waste product urea (formed in liver)
  • Dehydration and shock may elevate BUN, not best parameter for monitoring renal function or glomerular filtration rate (GFR)
  • Normal 10-23 mg/dL
53
Q

Creatinine

A
  • Non-protein waste product of creatinine phosphate metabolism by skeletal muscle tissue
  • Better indicator of renal function (GFR) than BUN
  • Normal: males 0.8 - 1.4 mg/dL; females 0.6 - 1.1 mg/dL
54
Q

24-hour Urine for Creatinine Clearance

A
  • Best indicator of glomerular filtration rate (GFR)
  • Variables needed to calculate include urine creatinine, serum creatinine, and volume of urine
55
Q

Glomerular Filtration Rate (GFR)

A
  • Volume of plasma filtered from the glomerular capillaries into Bowman’s capsule per minute
  • Normal GFR = 125 mL/minute, total blood volume filtered - 60 times per day
  • Normal urine volume is ~1000 mL/day
  • GFR inversely related to the serum creatinine (NOT the BUN)
56
Q

RIFLE Criteria for Renal Failure

A

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