Clinical Introduction to Renal Disease Flashcards
Normal urine pH
7.35-7.45
Normal urine pH
7.35-7.45
Acidemia
7.35-7.4
Alkalemia
7.4-7.45
Acidosis
Alkalosis
> 7.45
Normal urine output
1.5L/24 hours
Oliguria
Anuria
Absence of urine output
Polyuria
> 3 L/24 hours
Azotemia
Elevation in renal indices
BUN (technically)
Uremia
Syndrome
Accompanies kidney failure
Usually when advanced/severe
Fatigue, anorexia, nausea, mental status changes, itching
Serositis (pericarditis, pleural effusions)
Platelet dysfunction (anemia)
Acute decline in renal function
Old school: Acute Renal Failure (ARF)
New: Acute Kidney Injury (AKI)
Chronic decline in renal function
Old school: Chronic Renal Insufficiency (CRI)/ Chronic Renal Failure (CRF)
New: Chronic Kidney Disease (CKD)
Most advanced renal dysfunction
Still called End Stage Renal Disease (ESRD)
AKI
Acute Kidney Injury
Abrupt (within 48 hours) reduction in kidney function
CKD
Chronic Kidney Disease
Progressive decline in GFR over time
Duration at least 3 months
with or w/o albuminuria
Stage 2 CKD
Kideny damage with mild decrease in GFR 60-89
Stage 2 CKD
Kideny damage with mild decrease in GFRY 60-89
Stage 3 CKD
Moderate decrease in GFR 30-59
Stage 5 CKD
Kidney failure GFR
Stage 5 CKD
Acidemia
7.35-7.4
Alkalemia
7.4-7.45
Acidosis
Alkalosis
> 7.45
Normal urine output
1.5L/24 hours
Oliguria
Anuria
Absence of urine output
Polyuria
> 3 L/24 hours
Nephritic Syndrome
INFLAMMATORY renal biopsy Active urinary sediment (hematuria, dysmorphic RBCs, RBC casts) Variable proteinuria Azotemia, oliguria Mild/moderate HTN
Uremia
Syndrome
Accompanies kidney failure
Usually when advanced/severe
Fatigue, anorexia, nausea, mental status changes, itching
Serositis (pericarditis, pleural effusions)
Platelet dysfunction (anemia)
Acute decline in renal function
Old school: Acute Renal Failure (ARF)
New: Acute Kidney Injury (AKI)
Chronic decline in renal function
Old school: Chronic Renal Insufficiency (CRI)/ Chronic Renal Failure (CRF)
New: Chronic Kidney Disease (CKD)
Most advanced renal dysfunction
Still called End Stage Renal Disease (ESRD)
AKI
Acute Kidney Injury
Abrupt (within 48 hours) reduction in kidney function
CKD
Chronic Kidney Disease
Progressive decline in GFR over time
Duration at least 3 months
with or w/o albuminuria
Stage 1 CKD
Kidney damage with normal or increased GFR >90
Stage 2 CKD
Kideny damage with mild decrease in GFRY 60-89
Stage 3 CKD
Moderate decrease in GFR 30-59
Stage 4 CKD
Severe decrease in GFR 15-29
Stage 5 CKD
Normal Urinary Protein
Total
Nephrotic Range Proteinuria
Nephrosis
> 3-3.5 g/24 hours
Nephrolithiasis
Kidney stone
Present with moderate to severe colic
Calcium oxalate and Ca phosphate
Kidney’s defense system causes ducts to contract to try and expel the stone, this is what causes the pain
Epithelial Casts
Muddy brown casts
Acute tubular necrosis
Fatty Casts
Lipiduria
Usually seen in nephrotic syndrome
Granular Casts
Chronic kidney disease
Nonspecific finding otherwise
Hyaline Casts
Dehydration
Exercise
Diuretic therapy
Waxy Casts
Advanced kidney disease
Nephrotic Syndrome
> 3-3.5 mg/24 hours protein Hypoalbuminemia Peripheral edema Hyperlipidemia (liver tries to compensate for decreased oncotic pressure by making more lipids) Thrombophilia Bland urinary sediment NONINFLAMMATORY renal biopsy
Nephritic Syndrome
INFLAMMATORY renal biopsy Active urinary sediment (hematuria, dysmorphic RBCs, RBC casts) Variable proteinuria Azotemia, oliguria Mild/moderate HTN
Intracellular Water
2/3 of TBW
Extracellular Water
1/3 TBW
Interstitial Space
3/4 ECW
Plasma Volume
1/4 of ECW
Intravenous Crystalloid solutions
Disperse across ECW
0.9% Normal Saline is used in internal medicine
Lactated Ringer’s Solution is used in surgery
Intravenous Colloid solutions
Tend to remain in plasma volume
Packed RBCs
Albumin
Synthetic solutions (costly and often impractical)
Erythropoietin
Regulates HGB/HCT concentration
Vitamin D
Regulates Ca absorption
Maintains normal levels of Ca and phosphorus
Chronic Erythropoietin Deficiency
Advanced Kidney Disease
Anemia of chronic disease, typically normocytic
Iron transport/storage dysregulation also contributes
Chronic Hyperphosphatemia
Decreased renal activation of vitamin D3
Hyperparathyroidism
Renal Osteodystrophy