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Urinary Pathophysiology > Lab Abnormalities with Renal Disease > Flashcards

Lab Abnormalities with Renal Disease Flashcards

1
Q

what is the grading of AKI by the international renal interest society based on?

A

level of azotemia and urine output

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2
Q

what are the SDMA values for CKD by the international renal interest society?

A

<14: normal
14-18: equivacol
>18: likely renal disease

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3
Q

when does creatinine and BUN rapidly rise in terms of how much of the kidney is functioning?

A

when GFR is 20% of normal

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4
Q

there is more energy expended in the kidney on __________________ than on any other single entity

A

Na reabsorption

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5
Q

what does the proximal tubule transport system depend on?

A

Na transport

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6
Q

the sodium gradient drives entry of sodium at apical membrane, along with the cotransport of what things?

A

glucose
amino acids
phosphate
secretion of H, absorption of bicarbonate

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7
Q

what is the importance of Na reabsorption in the loop of henle?

A

creates medullaruy hypertonic gradient essential for concentrating urine

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8
Q

what happens in the distal tubule with Na?

A

pumped out of cell
filtrate to cytoplasm through Na/Cl cotransporter and Na channels: exchanged for K or H or cotransported with Cl

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9
Q

what does aldosterone do with Na channels?

A

increases Na channels in luminal membrane of distal tubular cells

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10
Q

what sodium levels do we see with acute kidney injury?

A

normal to increased by decreased GFR

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11
Q

which organic acids and bases is the proximal tubule important for excreting?

A

bile salts
oxalate
urate
catecholamines

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12
Q

what acid-base disturbance in common with renal disease?

A

metabolic acidosis

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13
Q

why is metabolic acidosis common with renal disease?

A

loss of ability to generate and secrete H
loss of ability to reabsorb bicarbonate
loss of ability to generate NH3 from glutamine
holds protons in filtrate (as NH4+)
loss of ability to secrete organic acids

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14
Q

what are the adverse effects of chronic metabolic acidosis?

A

lethargy
anorexia and vomiting
muscle wasting and weight loss
negative potassium balance
bone demineralization

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15
Q

what acid-base disturbance is common in cattle with renal disease?

A

metabolic alkalosis

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16
Q

how is K handled by the loop of henle?

A

works with Na to create concentration gradient
some K leaks back into lumen

17
Q

what happens with K in the distal nephron?

A

can be secreted
negative luminal charge as Na moves into cell: K moves through channels into filtrate

18
Q

is AKI usually associated with hyperkalemia or hypokalemia?

A

hyperkalemia

19
Q

why is AKI usually associated with hyperkalemia?

A

decreased filtration, secretion, acidosis
most significant with oliguria or anuria

20
Q

why is hyperkalemia exacerbated by acidosis?

A

K and H are exchanged in tissues

21
Q

what is polyuric AKI and CKD associated with?

A

hypokalemia

22
Q

why is polyuric AKI and CKD associated with hypokalemia?

A

diuresis increases K secretion
decreased intake

23
Q

are cattle with kidney disease are more likely to be hypokalemic or hyperkalemic?

A

hypokalemic

24
Q

why are cattle with kidney disease more likely to be hypokalemic?

A

anorexia
increased salivary excretion of K
impaired intestinal absorption of K

25
Q

what serum potassium concentration is expected in a dog with a ruptured bladder?

A

high

26
Q

what happens to most filtered calcium?

A

normally reabsorbed

27
Q

what regulates active transport of calcium in the distal tubule?

A

parathyroid hormone
vitamin D
both increase Ca reabsorption

28
Q

what happens to calcium with renal disease?

A

may stay normal, decrease, or increase

29
Q

how does renal disease cause an increase in calcium?

A

uremia causes downregulation vitamin D receptor and calcium-sensing receptor
persistent, inappropriate increase in parathyroid hormone

30
Q

who is hypocalcemia most often seen in?

A

small animals

31
Q

horses with kidney disease are more likely to have __________________

A

hypercalcemia

32
Q

where is phosphorous primarily reabsorbed?

A

proximal tubule

33
Q

carnivores and omnivores excrete excess dietary phosphate, which requires _________________

A

normal GFR

34
Q

what is fibroblast growth factor 23 produced by and in response to?

A

bone
rising phosphorous

35
Q

what happens in small animals with decreased GFR and phosphorous?

A

hyperphosphatemia
meat eaters have excess phosphate: excrete

36
Q

what is anemia seen with CKD like?

A

nonregenerative
decreased erythropoietin
shortened red blood cell lifespan
direct suppression of red blood cell production by uremic toxins

37
Q

what is an important differentiating factor for CKD vs AKI?

A

lack of anemia in AKI

Urinary Pathophysiology (11 decks)

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