Interpreting U+Es Flashcards
the creatinine baseline is highest physiologically in which people?
people with high muscle mass eg a bodybuilder
where is creatinine made?
liver
what is creatinine’s actual function?
is an energy store for fast twitch muscle fibres
what does creatinine phosphate break down into?
ATP and creatinine (waste product)
creatinine blood conc is used to determine….
the severity of kidney injury
where does the conversion of ammonia to urea take place?
liver
urea blood conc is used to determine kidney injury T or F
F
high urea would suggest..
dehydration
GI bleed
protein breakdown eg infection/drugs/trauma
low urea would suggest..
malnutrition
liver disease
pregnancy
how much higher than the baseline should creatinine be to confirm AKI?
> 50%
how low should urine output be and for how long for it to be a sign of AKI?
less than 0.5ml per kg per hr for 6hrs straight
what blood tests do all patients need if they are suspected to have an AKI?
FBC U+Es CRP PTH VENOUS blood gas
immediate management of an AKI?
prompt urinalysis take blood and do a VBG renal USS start fluids insert catheter and monitor UO on a fluid balance chart STOP any nephrotoxic drugs manage the cause
patient has +++ urea and ++ creatinine, what type of renal failure do you suspect?
pre-renal
which form of renal failure is most likely to show blood and protein on urinalysis?
intrinsic renal
a urine protein-creatinine ratio under what value is considered normal?
15mg/mmol
a urine protein-creatinine ratio over what value indicates nephrotic syndrome?
> 300mg/mmol
if glomerulonephritis is suspected, what additional tests should be done?
immunological screen: ANA ANCA anti-GBM complement RF and other rheumatological Ab's hepatitis serology
PLUS a renal biopsy
what test should be done if you suspect rhabdomyolysis?
CK
if your patient is old, has an AKI and reports deteriorating symptoms over the past few months what additional test would you do?
myeloma screen
uraemia is classed as a urea value over…
60
potassium >__ indicates hyperkalaemia?
6.5
if a patient is hypovolaemic, their Na levels will be __
low
if Na is low in the body, will urinary osmolarity be high or low?
high because it will all be excreted in the urine
urine sodium over _mmol/l indicates a renal cause for hypovolaemia
20
what tests should be done to check Na levels and why?
plasma osmolality to confirm hyponatraemia
urine sodium to confirm/negate a renal cause
aldosterone causes ___ of K+
excretion
what 2 substances cause cellular K+ uptake?
insulin and catecholamines
renal excretory causes of hypokalaemia?
diuretics conn's cushing's renal tubular acidosis hypomagnesaemia
what endocrine conditions cause hypokalaemia and why
cushings due to excess steroid
conn’s due to excess aldosterone
Tx of hypokalaemia?
potassium chloride (tablets or IV depending on severity)
renal retention causes of hyperkalaemia?
AKI
CKD
drugs eg K sparing diuretics, NSAIDs, ACEi
addison’s
appearance of hyperkalaemia on ECG?
flat p waves
wide QRS
tall tented T waves
why is insulin used in hyperkalaemia?
pushes K back into cells
high ALP, high PTH and low Ca indicates __calcaemia. what could cause this result?
hypocalcaemia; loop diuretics CKD rhabdomyolysis (basically any renal cause)
PTH should ___ in response to hypocalcaemia
increase
high ALP, low PTH and low Ca indicates __calcaemia. what could cause this result?
hypoparathyroidism
hypomagnesaemia
PTH resistance
low ALP, high PTH and low Ca indicates __calcaemia. what could cause this result?
bisphosphonate use
vitamin d deficiency
tests for hypocalcaemia?
renal function
PTH
ALP
magaesium
what calcium level is the marker between a mild or severe hypocalcaemia
1,9mmol/l
eg if it was 2mmol/l it would be mild, if it was 1.8mmol/l it would be severe
what drugs can act on the kidneys to cause hypercalcaemia?
thiazides
dehydration would present with what 2 markers being raised?
urea
albumin
if ALP and Ca are high, what should be suspected?
malignancy
severe hypercalcaemia is a Ca level of…
3.5mmol/l or more
low albumin indicates…
capillary leak from liver damage
what causes high urea?
renal failure
excessive protein overload
