Hyperglycemia, DM, and Renal Function Flashcards
Most important initial test after hypoglycemia, insulin/glucose ratio?
If High insulin and C peptide high; test for?
Most common drug cause of hypoglycemia?
Insulin and look at insulin/glucose ratio; if >0.03 indicates HYPERinsulinism; look at C-peptide
Drugs: Sulfonylureas melitinides (present drug overdose)–absent need to rule out Insulinoma and other B-cell diseases
-OH
What drugs rapidly raise glucose; slowly raise glucose?
Do liver and renal disease cause hypoglycemia?
Epinephrine and glugagon; growth hormone and cortisol (Addison’s)
Yes, kidney is rare (10% liver of glucose storage)
5 markers in T1DM, HLA’s associated?
HLA associated with rheumatoid arthritis?
HLA for MS and SLE?
Akylosing spondylitis?
HLA-DR3 and HLA-DR4, Islet cell cytoplasmic autoantibiodies, Autoantiboides to GAD, IA2, Insulin, ZNTA
DR4
MS, SLE: DR2
AS: B27
DM criteria?
DKA, HHS, or symptoms + random glu > or equal; 200 mg/dL;
if absent; Tx hyperglycemia 2 occassions
Fasting glucose: >126 mg/dL
2 h OGTT: >200 mg/dL
A1c: >6.5%
Is A1c useful in Sickle cell?
How do you measure diabetic control in patients who lack Hb A?
No you measure S1c!!!
Fructosamine, Glycated serum protein (aka albumin)
Good test in pregnancy; and Hb SS, CC, SC
No proven value outside of these disease
Most sensitive early marker of diabetic nephropathy?
Tx?
Microalbinuminura/minimal albumin excretion
Measure T2DM every year
T1DM: every year after 5 yrs
ACEI, ARBs, and improve glycemic control; decrease risk of diabetic necphropathy and ESRD
Where is bicarb absorbed in nephron?
What secrets H+ in nephron?
What are some kidney hormonal functions?
PCT
DCT (generates bicarb); from nitrogen, phosphate, and sulfuric acids
Degrades insulin
25(OH)D to 1,25 (OH)2D
Make EPO
and JG secrets renin when hyponatremic or decreased perfusion
What happens when GFR goes down?
How to calculate creatinine clerance from timed urine?
What can be used to estimate GFR?
Failure of waste excretion: Increased Cr and BUN
CrCl= (Urine volume x Ucr)/(Pcr); mL/min= 1440 mins
Age, race, creatinine, can be as accurate as GFR up to 60 mL: then report >60 mL
How is urea formed?
Nitrogen leads to?
Most common inborn error of Krebs /urea cycle?
Cause alkalosis or acidosis?
Glutamine—glutaminase—> glutamate + NH4+—-> urea via Krebs cycle in liver
CNS toxicity and encephalopathy; FLAPPING/ASTERIXIS
Ornitine transcarboaomylase; X-linked recessive
Alkalosis
Is urea freely filtered by kidney?
What increases BUN?
Decreases BUN?
How is it meaasured?
Convert urea to nitrogen?
Yes but half reabsorbed
Inc: Renal insufficnecy, GI bleed, high protein intake
Decrease: Liver failure (cannot make it), malnutrition
Chemical: (Diacetylmonoximine and acid) makes Diazone (540 nm)
Enzyme: Urease–> NH4+ + phenol–> indophenol (measureable)
BUN: Urea/2.14
BUN and Cr findings of renal insufficency?
Labs?
Oliguria (<500 mL/day)/ Anuria (<100 mL/day)
Inability to concentrate (Specific gravity fixed @ 1.010)
Fluid overload, increased K+, Phosphate retention, Decreased 1,25 (OH)2= hypocalcemia, plt dysfunction and ureamia
Increased Cr, BUN, declining GFR/CrCl
3 types of renal insufficiency?
How to use BUN/Cr ratio?
Decreased pre-renal perfusion (Low GFR due to low blood flow); 20:1 (more urea reabsorbed and Cr still exreted by tubules)
Intrinsic renal disease: Glomerular or tubular issues; 10:1 (Both increased)
Post renal/obstructive: Mechanical obstruction; (can be 20:1 early. 10:1 later)
BUN: CR 10-20:1 normal
Normal protein extretion?
Cutoff for nephrosis?
Major protein in normal urine?
Glomerular proteinuria urine electro shows?
Tubular proteinuria?
Overflow/ M-spike?
<150 mg/day
Nephrosis: >3.5 g/day; 150 to <1g/day minimal proeinuria
Albumin
Glomerular proinuria: Albumin and B- globulin
Tubular: Albumin + alpha-2 DOUBLET
Overflow: IgL or Ig or free light chains
Tubular dysfunction can cause?
Renal dysfunction differs by?
Hyponatremia, hypokalemia, hyphophosphatemia, RTA, renal glycosuria, aminoacidurias
Renal disorder caues phosphate and K+ to be retained leading to hyperphosphatemia and hyperkalemia
Measure protein function test, FeNa?
How to calculate?
If FENa >1 consider?
Are urine protein measurement sensitive for Bence Jones?
What is needed to test for non reduciing sugars in infants?
(UrineNa * Pcr)/(PNa/ Ucr) * 100= FeNa
Acute tubular necrosis
Not always
Benedict’s copper reduction
