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Clinical Science > Kidney > Flashcards

Kidney Flashcards

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1
Q

Complete metabolic panel

A

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

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2
Q

Sodium CMP

A

normal range is 136-142 mEq/L

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3
Q

Potassium CMP

A

Normal range is 3.5-5.0 mEq/L

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4
Q

Glucose CMP

A

Normal Range is 70-110 mg/dL

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5
Q

Creatinine CMP male

A

0.2-0.7 mg/dL

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6
Q

Creatinine CMP female

A

0.3-0.9 mg/dL

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7
Q

total Bilirubin CMP

A

0.3-1.2 mg/dL

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8
Q

Where is sodium?

A

In the ECF

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9
Q

Glucose is increased in

A 
Diabetes
acute stress response
pancreatitis
certain diuretics
corticosteroid therapy
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10
Q

Glucose is decreased in

A

insulinoma
insulin overdose
starvation
hypothyroidism

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11
Q

GFR

A

= number of mL of body fluid cleared by the kidneys per unit of time
=mL/minute

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12
Q

BUN

A

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

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13
Q

BUN increased in

A 
high protein diets
GI bleeding
Dehydration
Certain meds
Sepsis
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14
Q

BUN decreased in

A

Primary liver disease/failure
Low protein diets
Overhydration

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15
Q

Creatinine

A

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!

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16
Q

Creatinine increased in

A 
disorder of renal function
UT obstruction
Diabetic nephropathy
Rhabdomyolysis
Giagantism/acromegaly
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17
Q

Creatine decreased in

A

Debilitation

Decreased muscle mass

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18
Q

Where is Ca?`

A 
more abundant in ECF than ICF and is involved in:
Muscle contraction
Cardiac function
Neural transmission
Clotting cascade
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19
Q

Calcium forms

A

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

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20
Q

what regulates ca?

A

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

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21
Q

Elevated Ca warning

A

think Malignancy!
Bone mets
cancer can produce pth-like substances

22
Q

CA increased in

A

hyperparathyroidism
Vitamin D intoxication
TUMORS
acromegaly

23
Q

Ca decreased in

A

Hypoparathyroidism
Vitamin D deficiency
Hypoalbuminemia
Malabsorbtion

24
Q

Na regulation, plasma water Increases

A

Na and osmolality decreases –> ADH decreases –> water is not reabsorbed–> urination

25
Q

Na regulation, Plasma water decreases

A

Na and osmolality increases –> ADH increases –> collecting renal tubule absorbs more water

26
Q

Hypernaturemia

A

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

27
Q

Hyponaturemia

A

can be due to diet, but it is rare
Thiazide diuretics
Renal insufficiency – impaired free water excretion, retention of ingested water

28
Q

Where is potassium

A

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

29
Q

Increased potassium

A

From increased intake (IV)
From crush injuries, or infection
acidotic states

30
Q

Decreased potassium

A

insufficient intake (IV)
from fluid and electrolyte loss
Alkylotic states- Diuretics

31
Q

Bilirubin

A

the spleen breaks down RBCs –> heme + globin molecules
Heme–> biliverdin –> bilirubin

Measures liver function

32
Q

conjugated bilirubin

A

Once in the liver, the bilirubin becomes conjugated with glycuronide to become conjugated bilirubin

33
Q

Total bilirubin

A

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

34
Q

indirect (unconjugated) hyperbilirubinemia

A

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

35
Q

direct (conjugated) hyperbilirubinemia

A 
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%
36
Q

Hyperproteinemia

A 
Dehydration → less water →  increased concentration of proteins
Malignancy
(overproduction of immunoglobulins)
Infection
(overproduction of immunoglobulins)
37
Q

Hypoproteinemia

A

Hepatic failure or disease
Malnutrition states
Malabsorption states
Renal failure or disease

38
Q

Alkaline Phosphatase

A

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

39
Q

Alkaline phosphatase increase

A

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

40
Q

Aspartate Aminotransferase

A

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.

41
Q

AST elevation

A 
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
42
Q

Alanine Aminotransferase

A

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

43
Q

AST: ALT >1

A

alcoholic cirrhosis- frequently > 2
metastatic tumor of the liver.
*Dont make an AST out of yourself (alcohol)

44
Q

AST:ALT

A

Acute/viral hepatitis

Mononucleosis

45
Q

Basic Metabolic panel

A

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

46
Q

BUN: Creatinine ratio

A

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

47
Q

BUN: Creatinine > 20:1

A

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

48
Q

BUN: Creatinine

A

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

49
Q

Creatinine clearance calculation based off of 24 hour urine collection and serum creatine

A

urine creatine/plasma creatine x urine volume/time x 1.73/BSA

50
Q

Creatinine clearance based off of age

A

(140-age) x IBW or actual Weight / 72 x SCr

Clinical Science (15 decks)

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