Kidney Flashcards
Complete metabolic panel
secondary to the CBC in importance
The CMP measures a variety of different proteins and electrolytes, gives the status of renal and liver function, and is useful in monitoring numerous diseases, such as diabetes and hypertension
Sodium CMP
normal range is 136-142 mEq/L
Potassium CMP
Normal range is 3.5-5.0 mEq/L
Glucose CMP
Normal Range is 70-110 mg/dL
Creatinine CMP male
0.2-0.7 mg/dL
Creatinine CMP female
0.3-0.9 mg/dL
total Bilirubin CMP
0.3-1.2 mg/dL
Where is sodium?
In the ECF
Glucose is increased in
Diabetes acute stress response pancreatitis certain diuretics corticosteroid therapy
Glucose is decreased in
insulinoma
insulin overdose
starvation
hypothyroidism
GFR
= number of mL of body fluid cleared by the kidneys per unit of time
=mL/minute
BUN
Blood urea nitrogen
Urea formation occurs primarily in the liver as a result of the catabolism of protein into amino acids → free ammonia is formed in process
BUN therefore reflects the metabolic functioning of the liver and excretory function of the kidneys
BUN increased in
high protein diets GI bleeding Dehydration Certain meds Sepsis
BUN decreased in
Primary liver disease/failure
Low protein diets
Overhydration
Creatinine
byproduct of catabolism of creatine phosphate, which is involved in the contraction of skeletal muscles
Secreted by the kidneys at a constant rate (not metabolized or reabsorbed)
A Marker for Kidney function!
Creatinine increased in
disorder of renal function UT obstruction Diabetic nephropathy Rhabdomyolysis Giagantism/acromegaly
Creatine decreased in
Debilitation
Decreased muscle mass
Where is Ca?`
more abundant in ECF than ICF and is involved in: Muscle contraction Cardiac function Neural transmission Clotting cascade
Calcium forms
Protein- bound - mostly albumin, but also to alpha, beta 1&2, gamma globin
Complexed – w/ phosphate, citrate, bicarbonate, sulfate
Ionized- “Free” Calcium in its active form
what regulates ca?
by parathyroid hormone (PTH), which is secreted by the parathyroid glands, which are located on the thyroid gland
As calcium levels decrease, PTH is released and calcium is reabsorbed by the kidneys, released from bone and absorption from GI tract is increased
Elevated Ca warning
think Malignancy!
Bone mets
cancer can produce pth-like substances
CA increased in
hyperparathyroidism
Vitamin D intoxication
TUMORS
acromegaly
Ca decreased in
Hypoparathyroidism
Vitamin D deficiency
Hypoalbuminemia
Malabsorbtion
Na regulation, plasma water Increases
Na and osmolality decreases –> ADH decreases –> water is not reabsorbed–> urination
Na regulation, Plasma water decreases
Na and osmolality increases –> ADH increases –> collecting renal tubule absorbs more water
Hypernaturemia
Usually, hypernatremia occurs in unreplaced water loss:
elderly patients who have impaired mental faculties and may have diminished thirst stimulation
Patients not given free access to water, given hypertonic saline solutions
Hyponaturemia
can be due to diet, but it is rare
Thiazide diuretics
Renal insufficiency – impaired free water excretion, retention of ingested water
Where is potassium
intracellular cation
minor changes in serum potassium can have dramatic effects on that potential across cell membrane, especially in muscle cells
Potassium is secreted, but not reabsorbed, by the kidneys
Increased potassium
From increased intake (IV)
From crush injuries, or infection
acidotic states
Decreased potassium
insufficient intake (IV)
from fluid and electrolyte loss
Alkylotic states- Diuretics
Bilirubin
the spleen breaks down RBCs –> heme + globin molecules
Heme–> biliverdin –> bilirubin
Measures liver function
conjugated bilirubin
Once in the liver, the bilirubin becomes conjugated with glycuronide to become conjugated bilirubin
Total bilirubin
direct + indirect
In order to determine the cause of the elevated bilirubin, we need to measure direct and indirect bilirubin as part of the total bilirubin
Depending on where the defect occurs in the bilirubin pathway, either indirect (unconjugated) or direct (conjugated) hyperbilirubinemia can result
indirect (unconjugated) hyperbilirubinemia
Can cause Jaundice
Unconjugated bilirubin can pass BBB, and if levels on unconjugated bilirubin are too high, mental retardation and encephalopathy can result (>15 mg/dL is critical!)
Caused by Hepatic dysfunction, any disease that increases RBC destruction, and medications
Normal % unconjugated is 70-85%, if it is >85% then it is due to one of the ^ pathologies
direct (conjugated) hyperbilirubinemia
Gallstones Obstruction of extrahepatic ducts by tumor or other cause Liver metastases (obstruction) Normal Conjugated is 15-30% it is obstructive if direct is >50%
Hyperproteinemia
Dehydration → less water → increased concentration of proteins Malignancy (overproduction of immunoglobulins) Infection (overproduction of immunoglobulins)
Hypoproteinemia
Hepatic failure or disease
Malnutrition states
Malabsorption states
Renal failure or disease
Alkaline Phosphatase
ALP
functions in growth and development of bones, teeth and many other tissues → essential for bone mineralization
Highest in liver, biliary tract and bone
Functions better at higher pH
important in detection of bone and liver cancers
Alkaline phosphatase increase
in liver disorders: cirrhosis, biliary tract obstruction, liver tumors
in bone disorders: cancers that have bone mets and primary bone cancers
Also increased in growing children
Aspartate Aminotransferase
AST
an enzyme that is found in highly metabolic tissue within the body, such as heart, liver, skeletal muscle
If damage occurs to any of these tissues, AST is released into the circulation and its level increases.
AST elevation
Any disease that causes cellular injury to the liver will usually result in an elevation in the AST. AST elevated in: Liver disease, such as hepatitis Tumors involving the liver Infectious mononucleosis
Alanine Aminotransferase
ALT
In the jaundiced patient, elevation of the ALT points to the liver as the source instead of RBC hemolysis.
ALT is found primarily in the liver
If ALT increased think LIVER ABNORMALITY! – more specific for liver
AST: ALT >1
alcoholic cirrhosis- frequently > 2
metastatic tumor of the liver.
*Dont make an AST out of yourself (alcohol)
AST:ALT
Acute/viral hepatitis
Mononucleosis
Basic Metabolic panel
Chem7
Includes:
4 to 5 electrolytes: Sodium, Potassium, Calcium, Carbon Dioxide, Chloride
2 tests of kidney function: BUN and Creatinine
1 test of Glucose
Does not include liver function tests
BUN: Creatinine ratio
manually calculate this, but would not bother if neither BUN nor creatinine are elevated
Tells you where the issue is that is resulting in an increase of nitrogen compounds in the blood- pre-renal, intrarenal or post-renal
BUN: Creatinine > 20:1
It is a pre-renal issue
volume depletion, sepsis, hypotension, CHF
Could also be early disease state of a post-renal issue, like an obstruction, Nephrolithiasis, Prostatic Hyperplasia, Metastatic Disease
BUN: Creatinine
It is an intra-renal issue
Nephrosclerosis or Glomerulonephritis
Could also be a late disease sate of a post-renal issue, like an obstruction, Nephrolithiasis, Prostatic Hyperplasia, Metastatic Disease
Creatinine clearance calculation based off of 24 hour urine collection and serum creatine
urine creatine/plasma creatine x urine volume/time x 1.73/BSA
Creatinine clearance based off of age
(140-age) x IBW or actual Weight / 72 x SCr
