Renal 2

Question 1

normal serum creatinine

Answer 1

0.6-1.2 mg/dl

Question 2

normal serum BUN

Answer 2

blood urea nitrogen
(remember 50% excreted)
*8-20 mg/dl

Question 3

what is standard GFR

Answer 3

• *is age related
• ie/ 20-29 yrs if 116 mL/min
• nephrons die as you get older (have fewer the older you get)

Question 4

how much nephron death if renal failure

Answer 4

> 80%

Question 5

GFR tells you…

Answer 5

what rate blood should flow over glomerulus

Question 6

what happens to kidney function as you get older

Answer 6

begins to function less effectively, urine output is less concentrated when older

Question 7

what is the anion gap

Answer 7

more negative than positive anions (metabolic acidosis)

Question 8

estimation for an individual’s GFR is based on what

Answer 8

Based on age, male/female, and African American or not

Question 9

renal failure is…

Answer 9

-the loss of function r/t nephron damage

Question 10

common causes of CRF

Answer 10

Diabetes (43%), HTN (25%), glomerulonephritis (8%)

Question 11

describe acute renal failure

Answer 11

• only 50% decrease in nephrons can cause failure
• ARF is a sudden onset and may last < 3 mos
• good prognosis

Question 12

describe chronic renal failure

Answer 12

-In CRF, 90-95% of the nephrons are lost before failure is obvious

Question 13

what is acute kidney injury

Answer 13

is a sudden decrease in kidney function that causes disturbances in fluid, electrolyte and acid/base balance

Question 14

what are the severity grades of AKI

Answer 14

• RIFLE
• Risk : Cr increased 1.5 times or GFR decreased >25%
• Injury: Cr increased 2 times or GFR decreased > 50%
• Failure: Cr increased 3 times or GFR decreased > 75%
• Loss: complete loss of renal function for >4 wks
• End-stage kidney disease: need for renal replacement therapy for > 3 months

Question 15

treatment of chronic kidney injury

Answer 15

longterm dialysis

Question 16

how do you determine the severity (generally speaking) of AKI

Answer 16

• look at the Cr and GFR

- no injury until Cr is 3x normal or GFR decreased >75% (about 30 or 40)

Question 17

treatment of AKI

Answer 17

• *fluid, get fluid up (fix GFR), save nephrons, see if fluid challenge will help
• want fluid output to increase
• If does not help, short term dialysis is necessary

Question 18

types of ARF

Answer 18

Prerenal azotemia and intrarenal

Question 19

describe prerenal ARF

Answer 19

• lost blood flow to kidneys

- sudden and severe drop in blood pressure (SHOCK)

Question 20

treatment of prerenal ARF

Answer 20

-correct by increasing BP, giving volume, improve C.O. -prolonged damage can lead to intrarenal failure

Question 21

describe intrarenal ARF

Answer 21

• death to nephrons and direct damage to kidneys d/t infection, inflammation, toxins, drugs, and reduced blood flow
• *aka ATN (acute tubular necrosis)

Question 22

onset of ARF

Answer 22

Hours to days, precipitating event until oliguria, BUN and Cr increase

Question 23

onset of ARF only takes ____ if in shock

Answer 23

Onset only takes about 6 hrs to stop functioning if in shock

Question 24

describe oliguric phase of ARF

Answer 24

• Urine output of 100-400ml/day
• does not respond to diuretics or fluid challenges
• BUN and CR increase, K, Magnesium and Phosphate increase, Na is retained, but masked with fluid, dilutional -lasts 8-15 days

Question 25

what is the treatment if oliguric

Answer 25

fluid challenge

Question 26

stages of ARF

Answer 26

onset, oliguric, diuretic, recovery

Question 27

AKI has a high _____

Answer 27

* *mortality rate | - In critically ill patients, 50-80% mortality rate for those who develop ATN

Question 28

describe the diuretic phase of ARF

Answer 28

- Urine output increases rapidly, can be 10L/day of dilute urine - electrolyte losses occur, BUN decreases last 2-6 weeks, until BUN falls, - renal tubular function return

Question 29

describe the recovery phase of ARF

Answer 29

Functions at lower level, may take up to 12 months to return to normal

Question 30

what is acute tubular necrosis

Answer 30

- results from prolonged hypoperfusion - ischemic ATN comes from prerenal AKI * *It is important to recognize this early - Tubular epithelial cells become hypoxic and damaged so that it is difficult to repair

Question 31

generally speaking what is ATN

Answer 31

- Hypoperfusion and death to nephrons | - causes Ischemia, swelling, problems in cell