Random Flashcards
Cl- INDEPENDENT metabolic alkalosis
(direct stimulus to H+ secretion)
- hypERaldolsteronism
- Cushing’s
- steroid admin
- ectopic ACTH prod (pituitary tumor)
- adrenogenital syndrome
- licorice
- bartter’s sundrome
- severe hypOkalemia
Cl- DEPENDENT metabolic alkalosis
(extracellular volume and Cl- depletion)
- vomiting
- NG suction
- diuretics
- pillow adenoma
- post-hypercapnia
AKI
- acute fall in GFR
- INC serum BUN/Creatinine
- comm prob in hospitalized pts
uremic pericarditis tx
URGENT dialysis
*EKG might be wnl
hyperaldosteronism
hypOkalemic with metabolic ALKALOSIS
malignant HTN
- encephalopathy
- papilledema
- hematuria, proteinuria, kidney failure
EMERGENCY –> cerebral infarcts, MI
essential HTN
primary HTN
- 40-50s
- failed PRESSURE natures, high HP not corrected by dumping NA to urine
- MOST COMM of all HTN
secondary HTN
vol stat (kidney disease -> poor Na handling ang II (renal a. stenosis, bod senses hypo perfusion --> ang II --> htn aldosterone adrenergic tone
vomiting –> Cl- ____ metabolic _____
urine is
vomiting –> Cl- DEPENDENT metabolic ALKALOSIS
urine is ACIDIC
glomerular filtration is det by
Starlings forces (PGC, PBS, and ΠGC)
the intrinsic membrane properties (Kf, S)
the total number of nephrons (N) according to the equation:
GFR = N x Kf x S x (PGC – PBS – ΠGC)
increase cellular K+ uptake
insulin
beta-agonists
bicarbonate
NSAIDS arterial action
constrict afferent a.
low FeNa
intact tubules responding to vol depletion
perfusion related AKI
hypOcalcemia –> which diuretic?
LOOP
hypERcalcemia –> which diuretic?
THIAZIDE
ECV det by ________
Na excretion! (FeNa, urine Na)
tells you whether being perfused or not
Na in urine
Kidney perfusion status?
well-perfused
No Na in urine
Kidney perfusion status?
UNDERPERFUSED kidney
body is holding on to all the Na it can
what is most directly regulating kidney perfusion
ECV
plasma osmolality
2*Na+(glu/18)+(BUN/2.8)
need ___ if vol depleted
need ___ if hyperosmolar and thirsty
need SALT if vol depleted
need WATER if hyperosmolar and thirsty
Na content
volume
a CLINICAL assessment
[Na]
water
chronic kidney disease criteris
any present for 3+ mo or more
- GFR <60
- kidney transplant
- marker of kidney damage
- proteinuria
- abnl urine sediment
- abnl imaging
- renal tubular syndromes
target BP for low risk pt
<140/90
target BP for high risk pt
<130/80
first line in uncomplicated HTN
diuretics
blockade of RAAS proves addnl benefit above bp lowering in pts w/
HF
nephropathy
diabetes
high plasma osmolality
water depleted
still dilute urine
diabetes insipidus
K shift out of cells
hyperosmolarity
exercise
cell lysis
K shift in
insulin
B-agonists
when see Cl look for which units?
VOLUME cleared over time
osmolality of 560
ADH activation
aquaporins
concentrating urine
stim for ADH in HF
low ECV detected by aortic/carotid bodies
signs of volume depletion
hypotension
orthostasis
skin tenting
albuminuria stages
A1: <30
A2: 30-300
A3: >300
____ blockade slows progression of CKD
RAAS blockade
pelvic kidney inc risk of
infection of ureter and kidneys
