kidney Flashcards
endocrine funcion of kidey
erythropoieten (helps make red blood cells), renin, and prostaglandins
metabolic function of kidney
metabolism of vitamin D, insulin, and other small proteins
renal blood flow in L/min
1.3 L/min
renal plasma flow is what percentage of blood flow
60%
why is GFR so large
to maintain homeostasis of waste products present in plasma in low concentration (like urea)
normal GFR
80-120 cc/min
limitations of creatinine clearance
- incomplete urine collection – can underestimate
- ingestion of cooked meats – underestimates
- litle muscle mass / like in elderly can over-estimate as plasma levels are lower
- increased secretion of creatinine as renal function declines with age (over-estimate)
plasma creatine level in male vs female (normal)
male - 0.8-1.3
female - 0.6-1.0
where/ when do you see the major loss in GFR in relation to plasma creatinine?
initial elevation in the Pcr shows major loss in GFR
GFR is only accurate when?
in steady state
T/F most anibiotics need to be dose adjusted for patients with advanced renal failure?
TRUE
effect of NSAIDs with renal impaired patients
can decrease the GFR more and lead to life threatening hyperkilemia
acute renal failure manifested as?
increased BUN and increase in serum creatinine and sometimes with oliguria (decreased urine output)
breakdown of acute renal failure
- pre-renal
- renal
- post-renal
two severe manifestations of pre-renal failure
- acute tubular necrosis
2. acute cortical necorsis
pre-renal?
acute – due to “effective” volume depletion and the intrinsic function of the kidney is in tact - so is reversible if treated
elevation of Pcr and BUN due to volume depletion
causes of interstitial nephritis renal failure
NSAIDs and antibiotics (penicillen and analogous)
post-streptococcal GN?
common cause of glomerulonephroitis in children
post-renal failure associated with?
obstructive – like with the prostate inflammed
population to be careful with drug doses
ELDERLY
uremic effects with drug dosing
alters/ decreases the GI absorption
alter protein binding with drugs – leads to increased bio-available
cause chelation and formation of nonabsorbable complexes
patient risk profile with NSAIDs (who is at risk when aking these)
- pre-existing renal disease
- diabetes
- heart failure
- old age
- liver disease
- volume depletion
- patients on potassium dependent supplements and ACE inhibitors
goal BP of patient with diabetes or CKD
less than 140/90 (although new study shows 130/80 with large benefit )
essential and secondary hypertension breakdown in causes
90% are essential causes
2nd causes – Renal disease accounts for 80%
*may want to consider using what when treating hypertensive patients?
NO or naxiolytics
must continue their anti-hypertensive medications (like Diuretics, calcium channel blockers, ACE inhibitors, angiotesnsin receptor blockers, B-blockers, Alpha, 1 blockers)
over 160/100 –> refer for medical eval but tx isnt contraindicated
180/110 –> hospilization may be required
