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302 Scientific basis of medicine > Renal 3) Acid-base and electrolyte disturbances > Flashcards

Renal 3) Acid-base and electrolyte disturbances Flashcards

1
Q

What is urea?

A

Produced by liver from excretion of ammonia and breakdown products of amino acids
Excreted in urine

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2
Q

What can increase urea levels?

A

Intravascular depletion
Blood
Food
Renal failure

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3
Q

What are the normal serum urea levels?

A

1.7-8.3mmol/L

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4
Q

What symptoms occur when urea is above 20?

A 
Nausea
Decreased appetite
Itchiness
Tiredness
Smelly breath
Metallic taste in mouth
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5
Q

What symptoms occur when urea is above 60?

A

Extreme uraemia frost
Uraemic pericarditis
Encephalopathy

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6
Q

What is creatinine?

A

Breakdown product of creatinine phosphate in muscle

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7
Q

What are normal creatinine levels?

A

62-106umol/L depending on muscle mass

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8
Q

What is the MDRD formula for eGFR?

A

186 x (creatinine /88.4)^-1.154 x (age)^-0.203 x (0.742 if female) x (1.210 if black)

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9
Q

What is the normal eGFR?

A

> 90mls/min

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10
Q

What is the eGFR in CKD stage 1?

A

> 90mls/min

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11
Q

What is the eGFR in CKD stage 2?

A

> 60mls/min

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12
Q

What is the eGFR in CKD stage 3a?

A

> 45mls/min

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13
Q

What is the eGFR in CKD stage 3b?

A

> 30mls/min

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14
Q

What is the CKD stage if eGFR is >15mls

A

Stage 4

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15
Q

What is the CKD stage if eGFR is <15mls?

A

Stage 5

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16
Q

What is the average eGFR when starting dialysis in UK?

A

8

17
Q

What are the 3 factors that can cause hyponatraemia?

A

Intra-renal factors
Defect with NaCl transporter out of thick ascending limb / distal convoluted tubule
Continued secretion of ADH stimulated by non-osmotic mechanisms

18
Q

What can decrease glomerular filtration?

A 
Age
Renal disease
Congestive heart failure
Cirrhosis
Nephrotic syndromes
Volume depletion
19
Q

What can reduce NaCl reabsorption in the TAL and DCT?

A 
Loop diuretics
Osmotic
Diuretics
Interstitial disease
Thiazide diuretics (DCT only)
20
Q

What can increase permeability of the collecting duct?

A

Vasopressin

Drugs

21
Q

What are normal serum K levels?

A

3.2-5.1mmol/L

22
Q

What are the causes of hypokalaemia?

A

Redistribution
Non-renal loss
Poor diet
Renal loss >20mmol/L

23
Q

What can cause a renal loss of potassium?

A

Drugs - diuretics, ahminoglycosides, amphotericin
Renal tubular acidosis or metabolic acidosis
Low BP in Bartter’s or Gitelman’s
High BP
High /low aldosterone

24
Q

What are the complications of chronic hypokalaemia?

A 
Cardiovascular
 - hypertension
 - ventricular tachyarrhythmias
Endocrine - impairs insulin activity and sensitivity
Muscular - impairs muscle contraction
Renal
 - mild tubulointerstitial fibrosis
 - renal cyst formation
 - metabolic alkalosis
 - polyuria
Liver - increases renal ammonia production
25
Q

What are the causes of hyperkalaemia?

A 
Impaired renal excretion
 - drugs impairing secretion 
 - increased K load
Increased intake
Pseudohyperkalaemia + haemolysis
26
Q

What drugs can impair renal excretion of K?

A

Spironolactone
Amiloride
ACEi
ARB

27
Q

What can increase K load?

A

Rhabdomyolysis
Haemolysis
GI bleed

28
Q

What is the treatment of hyperkalaemia?

A 
Put K back into cells:
 - salbutamol
 - insulin and dextrose
 - sodium bicarbonate
Stabilisation - calcium gluconate
Removal - IV fluids and diuretics, dialysis
29
Q

What are the causes of metabolic alkalosis?

A

Excess alkali
K+ depletion
Cl- depletion

30
Q

What are the normal levels of serum calcium?

A

2.2-2.6mmol/L

31
Q

Where in the kidneys is calcium reabsorbed?

A

Loop of Henle

Distal tubule

32
Q

What hormone controls calcium levels?

A

Parathyroid hormone

33
Q

What are the normal levels of phosphate?

A

0.85-1.6mmol/L

34
Q

Describe electrolyte levels in an AKI

A 
Normal Na
High K
Low bicarb
Low pH
High urea
High creatinine
Normal Ca, phosphate, PTh
35
Q

Describe electrolyte levels in CKD

A 
Normal Na
High K
Low Bicab
Normal pH
High urea
High creatinine
High calcium, phosphate and PTH levels

302 Scientific basis of medicine (28 decks)

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