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Module 302 SBM RN > Metabolic 2: Renal function tests > Flashcards

Metabolic 2: Renal function tests Flashcards

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1
Q

describe the hierarchy of renal function tests from inaccurate to most accurate

A

s-Urea
24 h Creatinine Clearance
s-Creatinine
eGFR estimated from s-Creatinine
(EPI or MDRD or Cockcroft-Gault- formulas)
Direct GFR measurement used for research

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2
Q

what type of imbalance is there of K+ in DKA and why?

A

Decreased renal excretion

Shift of intracellular potassium

    - due to insulin lack
    - acidosis
    - tissue catabolism

Total body potassium lower

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3
Q

how do you calculate the anion gap?

A

AG = (Na+ + K+)–(Cl– + HCO3–)

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4
Q

what should you review in an AKI?

A 
Probably dehydrated – fluid saline
Review drugs: ACEI/ARB, NSAID, Diuretics
BP
Monitor urine output
Saline + insulin
Monitor Na, K, HCO3, eGFR, glucose
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5
Q

what are some complications of an AKI?

A

Volume overload, raised K+, H+, PO4,
Initial assessment:
Volume status: possible dehydration

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6
Q

how is proteinuria identified?

A

Urine dipstick

Quantitative measurement of urine albumin excretion Usually as ACR: Albumin Creatinine Ratio

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7
Q

what is the major clinical manifestation of diabetic nephropathy?

A

Major clinical manifestation is albuminuria

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8
Q

what are the key factors of nephrotic syndrome?

A 
Heavy albuminuria ACR >250 mg/mmol 
ACR > 70 mg/mmol =  1g protein/ 24h
(protein excretion > 3.5g/24h)
Low serum albumin < 30g/L
Peripheral oedema
Low oncotic pressure 
Kidney sodium retention 
Also frequently observed:
Hyperlipidemia
Thrombotic disease
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9
Q

explain the metabolism of protein and urea’s origin

A

Protein ∝ Amino acids ∝ Urea

Alanine            	Urea + Pruvate

Aspatate 		Urea + Oxalo-acetate

					Glucose
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10
Q

explain the origin of creatinine

A

Muscle mass ∝ Creatine ∝ Creatinine

Creatine + ATP Creatine~P + ADP

Constant decay

Creatinine

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11
Q

List the different kidney stone types

A 
Calcium oxalate - mc
Calcium phosphate
Uric acid 
Ammonium – infection
Cysteine – inborn error
Xanthine – very rare – inborn error
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12
Q

what causes calcium stones?

A

Calcium
Primary hyperparathyroidism
Renal tubular acidosis - distal
High sodium intake

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13
Q

what casues oxalate stones?

A

Low calcium/high oxalate diet

Low urine citrate

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14
Q

what causes uric acid stones?

A
  • high purine diet

- Alcohol. Obesity, drugs

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15
Q

what investigations would you carry out for a kidney stone?

A

Fluid intake especially Hot environment
Radiology – residual stones, nephrocalcinosis
Urine culture
Urine pH
Serum sodium, potassium, chloride, bicarbonate, creatinine, calcium, albumin, phosphate, alkaline phosphatase, uric acid, vitamin D, PTH,

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16
Q

what is the treatment of RTA?

A

Rx: potassium citrate

correct acidosis, potassium

17
Q

how is acid base balance maintained?

A

lungs via removal of CO2

kidneys via reabsoprtion of Hco3 and excretion of H+

18
Q

what is the extracellular buffers?

A

bicarbonate and albumin

19
Q

what are the intracellular buffers?

A

Hb and muscle protein

20
Q

what is the main extracellular cation?

A

Na+

21
Q

what is the main intracellular cation?

A

K+

22
Q

what are the causes of met acidosis ?

A

increase H+ = ketoacidosis, lactic, ehtelyen glycol
Decreased excretion: RTA, kidney failure/ AKI
Bicarb loss = diarrhoea, RTA
hypercholremic acidosis

23
Q

what causes a met acidosis with raised anion gap?

A

DKA
AKI
Lactic acidosis

24
Q

what causes a met acidosis with normal anion gap?

A

RTA
GIT diarrhoea
Ureterostomy

25
Q

what are the findings in vomiting

A 
low Cl
alkalosis with low K+
raised Cr
high urine osmolality 
urea high due to dehydration
26
Q

what causes a met alkalosis ?

A

loss of H+: vomiting, gastric aspiration

loss in the kidney: diuretics, Cushing’s, aldosteronism

27
Q

whta causes resp acidosis

A

neuromuscular disease

resp depression

28
Q

what causes a resp alkalosis

A

anaemia, hpyoxia, altitude, over ventilation such as emotional

29
Q

what influences potassium levels?

A

AKI, Met acidosis, aldosterone,

30
Q

what influences sodium levels?

A

water retention, AKI, polydipsia, high glucose (artefact), aldosterone

Module 302 SBM RN (39 decks)

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