Kidney Flashcards
role of kidney
-Maintenance & regulation of fluid balance
-Acid / Base & electrolyte balance:
-Sodium
-Potassium
-Bicarbonate
-Calcium
-Phosphate
-magnesium
-conservation:
-glucose- we dont want to filter this -> if people have too high glucose -> leaks through basement membrane and we pee glucose
-amino acids
-proteins
-excretion of wastes*: essential -> dialysis if not
-Urea
-Creatinine
-Nitrogenous waste
-Hydrogen ions
-Production of erythropoietin- know this
-Production of 1,25 dihydroxyvitamin D- know this
renal panel
-BUN
-creatinine
BMP
-BUN- N2 in blood in form of urea
-CO2 (HCO3-) - buffer
-Creatinine- breakdown of product in muscle
-Glucose- energy
-Chloride- O2/CO2 exchange in RBC
-Potassium- acid-base balance, neuromuscular function, cardiac muscle contraction + conduction
-Sodium- fluid volume, nerve conduction, neuromuscular function
creatinine
-kidneys are not getting proper flow or filtration issue if creatinine is high
-too little creatinine - malnutrition and low muscle mass
-too much- kidney disease, dehydration, muscle breakdown
BUN
-too much- kidney disease, dehydration, heart failure
-too little- liver failure, malnutrition
electrolytes
-Sodium
-Potassium
-Bicarbonate
-Calcium
-Phosphate
-magnesium
-abnormal:
-dehydration
-kidney disease
-heart failure
-liver disease
-high BP
calcium
-abnormal:
-kidney/liver problems
-bone disease
-thyroid disease
-cancer
-malnutrition
glucose
-abnormal results:
-too much- diabetes, prediabetes
-too little- hypoglycemia
-chronic damage to basement membrane -> damaging nephron
renal failure
-symptoms:
-Malaise
-Headache
-Visual disturbances
-Nausea
-Vomiting
-dysuria
-wasting
-signs:
-Flank tenderness
-rash- nitrogen waste may deposit into skin -> irritation
-Volume of urine reduction <500 cc
-Anuria <100 cc
-Hematuria, Casts, Proteinuria (signs of basement membrane leaking), Pyuria (pus)
-Hypertension- if BP is not affected by meds or lifestyle -> consider renal artery stenosis -> activates ACE to increase pressure
-Change in color or odor
-Lab changes
-AV knicking- redness shows longstanding HTN and diabetes
-abdominal brewey- renal artery stenosis, AAA
-peripheral neuropathy
causes of renal failure
-basement membrane
-vascular disturbances
-low flow state- acute
-renal artery stenosis- obstruction
-kidney stones- obstruction
-obstruction alters fluid backup and disturbs osmotic gradients -> alters GFR
-MC -> diabetes, HTN
azotemia
-nitrogen byproducts in the blood
-Prerenal (MC cause): any issue before kidneys:
-Reduced flow to kidney- low BP
-CHF, hemorrhage, renal artery stenosis, dehydration
-Renal:
-Kidney is dysfunctional
-Disease of vessels, glomerulus, tubules, mesangium
-Autoimmune (lupus), infectious (glomerular nephritis), medication damage
-postrenal:
-Anatomic obstruction (narrow ureters, AAA, tumor)
-Ureter, bladder, or urethra stone
-Congenital anomaly
-Inflammatory lesion
-neoplasm
BMP, SMA 7, chem 7
-Sodium
-Potassium
-Chloride
-Bicarbonate
-Bun
-Creatinine
-glucose
eryhtropoietin
-effect on CBC
-kidney stops telling you to make EPO -> less RBC formation in marrow
-less O2 delivery
other lab tests
-Acid base with ABG
-Plasma calcium, albumin, phosphate, parathyroid hormone, Vitamin D panel
-Urinalysis
creatinine
-chemical waste molecule that is generated from muscle metabolism
-transported through bloodstream to kidneys
-kidneys filter out most of creatinine and dispose of it in urine
-Breakdown of creatine phosphate
-Produced in skeletal muscle, kidney, pancreas
-Clearance from the kidneys = GFR
GFR and CRCL
-Milliliters of body fluid cleared by the kidneys per minute, mL/min
-Reduction represents waste retention
-Usually based on creatinine clearance
-Estimated from Creatinine, age, sex and ethnicity.
-24 hr urine collection for accuracy- Uses urine creatinine, serum creatinine, urine volume and collection time in minutes
-For drug calculation use Cockcroft-Gault Creatinine clearance formula
Crockcroft-Gault formula for estimating creatinine clearance
-used for drug calculation
-adjust dose based on this
-impaired function, 1 kidney
-lower creatinine clearance-> increase risk for rhabdo
stage of chronic kidney disease
-stage 1- kidney damage with normal kidney function - GFR >= 90
-stage 2- kidney damage with mild loss of kidney function- GFR 89-60
-stage 3a- mild to moderate loss of kidney function- GFR 59-45
-stage 3b- moderate to severe loss of kidney function- GFR 44-30
-stage 4- severe loss of kidney function- GFR 29-15
-stage 5- kidney failure- GFR <15
-aggressively treat underlying issue once you see any signs
-potassium rise and no urine -> consider dialysis
BUN
-Blood urea nitrogen
-Amino acids -> Ammonia -> Urea produced by the liver
-Can be affected by hydration, protein intake, blood in GI tract*, liver failure, malnutrition
-absorbing the blood -> causes rise in BUN
dehydration
-Volume depletion results from loss of Na and water from the following anatomic sites:
-dehydration causes pre-renal azotemia
●Gastrointestinal losses- vomiting, diarrhea, bleeding, and external drainage
●Renal losses- diuretics, osmotic diuresis, salt-wasting nephropathies (nephrotic syndrome), and hypoaldosteronism
●Skin losses- sweat, burns, and other dermatological conditions
●Third-space sequestration- intestinal obstruction, crush injury, fracture, and acute pancreatitis -> a lot of edema -> lose fluid into extravascular space
symptoms of dehydration in pt
-General?
-Skin?
-Cardiac?
-Labs?:
-Low urine output- ADH holds onto water
-elevations in the BUN and the BUN/serum creatinine ratio-> greater than 20:1
-Low Sodium Excretion in urine
BUN: creatinine ratio
-blood urea nitrogen : creatinine (20:1) = normal = 12-20 (optimum 15)
-WNL- 10-20 to 1
-creatinine is another NPN
-BUN:creatinine ratio- LOW (< 20:1) -> acute tubular necrosis, low protein intake, starvation, severe liver disease
-HIGH (> 20:1) -> pre-renal uremia, high protein intake, after GI bleeding**
-HIGH with raised creatinine -> post renal obstruction, pre-renal uremia with renal disease
increased BUN/normal creat
-pre-renal increased BUN/creat ratio
-BUN is more susceptible to non-renal factors
-pre-renal uremia, high protein intake, after GI bleeding**