Renal Flashcards
Type II RTA
Proximal
Defect in bicarbonate reabsorption, usually associated with features of Faconi syndrome, including glycosuria, aminoaciduria, phosphaturia, and uriscoruria(indicating PT dysfunction)
What causes isolated proximal RTA(type II)
Hereditary dysfunction of the basolateral sodium-bicarbonate cotransporter.
Faconi may be inherited or acquired due to myeloma, chronic IN, or drugs (tenofovir, ifofamide)
Treat proximal RTA ((type II)
Large doses of bicarbonate which may aggravate hypokalemia
Type IV RTA
May be due to hyporeninemic hypoaldosteronism or to resistance of the distal nephron to aldosterone.
Hyporeninemic hypoaldosteronism is typically associated with volume expansion nand most commonly seen in elderly and/diabetic patients with CKD
Hyperkalemia associated with NSAIDS and cyclosporine
Partially due to hyporeninemic hypoaldosteronism
Patients with hyporeninemic hypoaldosteronism are typically __kalemic; they may also exhibit ___ acidosis, with urine ph<5.5 and a ___ urinary ion gap
Hyper
Mild non anion gap
Positive
In type IV, acidosis often improves with reduction in serum _ (treatment)
K
Hyperkalemia appears to interfere with medullary concentration of ammonium by the renal countercurrent mechanism
How treat type IV if acidosis doesn’t improve with reduction of K
Oral bicarbonate or citrate
Type IV and various forms of distal tubular injury and tubulointerstitial disease (interstitial nephritis)
Associated with distal insensitivity to aldosterone; urine pH is classically >5.5, again with a positive urinary anion gap
Definition of urinary tract infection
Encompasses a variety of clinical entities: cystitis, pyelonephritis, prostatis, asymptomatic bacteriuria
Uncomplicated UTI
Acute disease in non pregnant outpatient women
Without an atomic abnormalities or instrumentation of the urinary tract; ____ ___ refers to all other types of UTI
Complicated UTI
Calculate and interpret anion gap in an acid/base disorder
Interpret blood gas and correctly name the acid/base disorder
Identify compensatory mechanisms for metabolic acidosis
Identify the most common causes of high anion gap metabolic acidossi
Know
Henderson hasselbalch equation
Bicarbonate and pCO2 are the drivers of pH
Acidemia
<7.35
Alkalemia
> 7.45
Acidemia metabolic acidosis or respiratory acidosis
Metabolic
HCO3<20
Respiratory
PCO2>45
Alkalemia metabolic or respiratory
Metabolic
HCO3>30
Respiratory alkalosis pCO2<35
Increased endogenous acids
Ketoacidosis Lactic acidosis -diabetic -alcoholic -starvation
Increased ingestion of acids
Ethylene glycol
Methanol
Propylene glycol
Salicylate
Loss of bicarbonate
Diarrhea
Decreased secretion of acids
AKI
-defined by serum Cr
Chronic kidney disease
-defined as increase in GFR
Signs and symptoms of acidosis
Headaches
Ab pain
Malaise
“I have the flu”
Change in mental status-confusion, stupor, coma
Increased respiration’s
Variable changes in bp
Tachycardia-catecholamie release
Pulmonary need,s-changes in pulmonary compliance
Increased serum glucose-this is reactive be careful
Anion gap
Na-(Cl+HCO3)
BMP
Na K Bicarb CO2(when see CO2 it means bicarbonate)
Normal anion gap is 10, why positive
Albumin is primary unmeasured anion
* there are unmeasured anions!!!!!!
Total cations
Measured cations MC and unmeasured cations UC
Total anions
Measured anions MA and unmeasured anions (UA)
Normally MC+UC=MA+UA_> (Na+K)-(Cl+HCO3)
(MC+UC)-MA)=UA
Anion gap is a way of demonstrating accumulation of the __
UA
Elevation of anion gap suggests what
Metabolic acidosis itch circulating anion
Compensation
Respiration goes up under stress bc CO2 is very easy to blow off. It’s an immediate response
Respiratory changes take minutes
Metabolic take longer
So start blowing off CO2 with acidosis
Sometimes body will blow off so much CO2 that what happens
Get respiratory alkalosis-use equation for compensation
PCO2=(1.5xHCO3)+8(+/-2)
If calculated doesn’t match, then there is a respiratory alkalosis
Compensation always exists
However it will not completely reserve the primary problem. It is the normal physiologic response to attenuate the problem
Compensation can be appropriate, inadequate, or excessive
MUD PILES- most common causes of anion gap increase
Methanol, metformin
-wood alcohol-solvent
Uremia->renal failure
Diabetic ketoacidosis (type I, also includes starvation ketoacidosis
Paraldehyde, propylene glycol, phenformin
Isoniazid/iron toxicity
Lactic acidosis
->includes cyanide and CO poisoning, seizures, sepsis, ischemia
Ethanol/ethylene glycol
Salicylate
Glue a pain huffing?
Toluene first high anion gap then low! Weird acidosis picture
A 72 yo male presents with acute illness and leg pain. He sustained a cut on his lef while working in the years 10 days ago. Over 3 days, pain increased. He has fever, chills, nausea, and vomiting. He has only been able to tolerate small amounts of quirked over 24 hours he has not urinated for 12 hours.
BP 90/60, HR 125, RR 24, T 101.3
WBC up
Cloudy urine with pH 5.5, specific gravity 1.01
Casts muddy brown-tubular necrosis **-THIS IS WY GET URINE MICROSPY
PH 7.5, PCO2 30, CO2 15
BUN:Cr-prerenal?
Acid or base?
Why is Na high-Na not being reabsorbed have tubular dysfunction
1.01—-same concentration as serum, NOT CONCENTRATED!!! Something wrong with kidney
We would expect to be super concentrated
7.35 is normal—-compensation!!! Did you calculate PCO2?
Prerenal azotemia
High anion gap Metabolic acidosis, appropriately compensated (pH and pCO2 nearly the same-usually sign for scompensated but doesn’t always work use