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Renal and acid-base disorders Flashcards

1
Q

What do the kidneys produce that regulate blood cell count?

A

Erythropoeitin

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2
Q

What do the kidneys produce that affects Vit D synthesis?

A

1 alphahydroxylase (activates VitD)

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3
Q

How can kidney function be known?

A

How much fluid is being filtered? (GFR i.e how much fluid is it filtering per minute)

How leaky is the kidney?

How good is the kidney at clearing waste

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4
Q

How is GFR assessed?

A

Creatinine

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5
Q

What is the limitations of using creatinine clearance for understanding renal function?

A

It can not detect rapid, acute, injury to the kidney because creatinine levels take time to reflect changes in overall state of the kidneys.

Someone who has more muscle will produce more creatinine and elderly have higher creatinine clearance than younger people.

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6
Q

What are the 3 main functions of the kidney?

A

Excretory

Regulatory

Endocrine

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7
Q

What is GFR?

A

Amount of blood cleared through kidney per minute and this cna only be done through the kidney.

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8
Q

Formula for renal clearance

A

C = UV/P

C = clearance
U = Urine concentration (mmol/L)
V = Urine volume flow rate (ml/min)
P = Plasma concentration (mmol/L)
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9
Q

How can GFR be estimated?

A

Creatinine

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10
Q

What affects renal clearance of creatinine clearance? How can this knowledge be used?

A

Meat intake

Muscle mass

Some drugs

(Muscle breakdown elevates creatinine levels)

Instead of looking at standard levels finding history of creatine level changes within a single individual is a good way of measuring its changes.

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11
Q

What is being done to measure changes in eGFR more accurately?

What are the limitation?

A

Being standardised for age, race, and sex.

Routinely reported with creatinine which is unreliable for short term changes.

Not reliable for extremes of body size/age or acute kidney to injury

Not validated in children or pregenancy

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12
Q

What is the Cockroft and Gault Creatinine Clearance?

A

A way to estimate GFR. 1.23(140-age) x Mass (kg) / pCreatining(umol/L)

In females x1.04

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13
Q

What is the Cockroft and Gault Creatine Clearance formula used for?

A

Drug dosing

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14
Q

What is Cr Clearance formula?

A

Cr Cl (ml/min/1.73m2) = U Cr x u Vol x 1.73 /P Cr x T x BSA

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15
Q

Creatine Clearance

A

Corrected for surface area (height and weight)

Reference intervals based on plasma and urine samples which makes it inaccurate due to inaccurate timing on samples.

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16
Q

What is the problem with using urea to estimate GFR?

A

Rate of production is not constant; 40 - 50% of urea is reabsorbed which makes it less useful as a measurement.

It is affected by
Volume status/hydration
protein intake
tissue breakdown
steroids
GI haemorrhage
Liver disease
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17
Q

How can tubular function be tested?

A

Blood gas

Plasma U + E’s

Urine volume

Urine pH, anion gap, Na, Cl, HCO3, aminoacids

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18
Q

How much protein gets into urine each day?

A

Normally only a small amount of protein gets into the urine (20 - 150mgs/day) This is predominantly albumin.

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19
Q

What are the mechanisms of proteinuria?

A

Glomerular

Tubular

Overflow (lots in the blood emptying into urine)

Benign

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20
Q

What happens to urine when it is high in protein?

A

Becomes frothy and bubbly

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21
Q

What is the cause of glomerular proteinuria?

A

Glomerulonephritis

Diabetes

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22
Q

What happens during glomerular proteinuria?

A

Loss of large proteins of increasing molecular weight starting with albumin.

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23
Q

What is lost during tubular proteinuria?

A

Loss of increasing amounts of low MW proteins that don’t include albumin

24
Q

What are conditions that cause tubular proteinuria?

A

Fanconi syndrome and lead toxicity

25
What is lost during overflow proteinuria?
Loss of low MW proteins with high plasma concentrations Free haemoglobin, myoglobin, immunoglobulin light chains and amylase
26
What are the types of benign proteinuria?
Orthostatic proteinuria is proteinuria caused by change in position from supine to standing. Other benign glomerular proteinurias such as fever or exercise induced proteinuria (<1g/day loss)
27
How much protein is typically lost by a young adult from benign orthostatic proteinuria?
The proteinuria can be up to 1g/day
28
How is protein checked for in urine?
ACR - albumin / creatinine ratio (on first morning spot urine sample recommended screening test
29
What are some other tests for detection of proteinuria?
Spot protein/Cr ratio 24 hour urine albumin/protein concentration which is an inaccurate collection Dipstick test which is semi-quantitative protein non-specific or albumin specific
30
What is microalbuminuria associated with?
Associated with increased renal and CV risk
31
What kind of proteinuria does nephrotic syndrome cause?
Glomerular proteinuria
32
What causes nephrotic syndrome?
Minimal change disease Focal Segmental Glomerulosclerosis Membranous Glomerulonephritis
33
How is nephrotic syndrome diagnosed?
Proteinuria (>3g/day) Hypoalbuminuria and in turn peripheral oedema Other features include hypercholesterolaemia, lipiduria, thrombosis, and infection
34
What is the difference between renal factors and rerenal factors for acute kidney disease?
Caused by problems with glomeruli and tubules Prerenal is due to drop in blood pressure in the kidneys
35
What happens if the cause of acute kidney injury is pre-renal?
The kidney tries to reabsorb as much sodium and water as possible resulting in concentrated urine production and elevated BP
36
What is chronic kidney disease defined as?
GFR < 60 for more than 3 months Or evidence of kidney damage with or without decreased GFR that is present for more than 3 months
37
What is used as evidence of chronic kidney disease?
Albuminuria Haematuria after exclusion of urological causes Structural abnormalities Pathological abnormalities
38
What are the most common causes of End Stage KD in Australia?
Diabetes Glomerulonephritis Hypertension Polycystic kidney disease Reflux nephropathy
39
How is Chronic Kidney Disease staged?
Stage 1 (>90 GFR with evidence of kidney damage) Stage 2 (60 - 89 with evidence of kidney damage) Stage 3a (45 - 59) Stage 3b (30 - 44) Stage 4 (15- 29) Stage 5 (ESKD <15) *it starts to get severe from 3b onwards
40
What changes in the body during CKD?
In the blood we have more Urea, Creatinine, potassium, urate, and phosphate. Water drinking must be monotiored more closely due to inability to regulate water levels. Sodium reabsorption may decrease increase in parathyroid horomone Decrease in haemoglobin as a result of less EPO production Low albumin
41
What are the most common causes of renal stones?
Calcium oxalate or phosphate stones Struvite stones associated with infection (Proteus UTI) Uric acid stones Cystine stones
42
What are the risk factors for renal stones?
Low urine flow Increased urine calcium, oxalate, uric acid, cysteine Decreased citrate, Mg, glycoproteins Abnormal pH (alkaline risk increases Calcium oxalate and struvite stones, acidic risk increases uric acid and cystine stones) UT abnormalities Infection (such as proteus which produces urease) Diet high in oxalate, animal protein and salt or low in calcium
43
How can renal stones be investigated?
Stone analysis Test for plasma Calcium phosphate, and uric acid. 24 hour urinary calcium and oxalate Spot urine microscopy, culture, pH
44
How is acid removed from the body?
Breathing out CO2 (to remove volatile acids) this method eliminates 10000 mmol of H+ per day Nonvolatile acids are eliminated by the kidneys such as sulphuric and phosphoric acid. Organic acids are too negligable to affect pH of the blood much but they are often oxidised into CO2 and H2O
45
What are the 3 main methods for pH balance in the body?
Blood buffers which act within seconds such as HCO3, proteins, and HPO4 Lungs through CO2 excretion Kidneys which take days to ramp up and allow absorption of bicarb and excretion of other stuff
46
What does analysis of pH tell us?
If it is high then it means high blood alkalosis If it is low acidosis
47
What does analysis of PCO2 tell us?
High means respiratory acidosis Low means respiratory alkalosis
48
What does analysis of bicarb tell us?
High means alkalosis Low means acidosis
49
What does analysis of base excess tell us?
Negative means metabolic acidosis Positive means metabolic alkalosis
50
How can you tell if alkalosis/acidosis metabolic or respiratory?
Bicarb means metabolic CO2 means respiratory Compensation is possible from one system or the other
51
What causes metabolic acidosis?
Increased production of acid through lactica acidosis, ketoacidosis, or toxins such as ethanol, methanol, salicylate, ethylene glycol Decreased excretion of acid Loss of bicarbonate
52
What are the causes of Metabolic Acidosis?
Increased anion gap metabolic acidosis ``` Methanol Uraemia Diabetic ketoacidosis Propylene glycol and other glycols Iron, isoniazid, inborn errors of metabolism Lactic acidosis Ethanol and other alcohols Salicylates ``` Normal anion gap metabolic acidosis ``` Diarrhoea RTA Addisons Acetazolamide Ammonium Cl ```
53
What causes metabolic alkalosis?
Loss of acid (GIT - vomiting, nasogastric suction, kidney - diuretic therapy, mineralocorticoid excess or high dose hydrocorticosterone) Increased exogenous bicarbonate (Oral/IV bicarbonate, antacid therapy, organic acid salts)
54
What causes metabolic alkalosis? (Pneumonic
Antacids Diuretics Bartters Liddles, licorice Upper GI loss Endocrine (conns, cushings, CAH)
55
What causes respiratory alkalosis?
Central stimulation Anxiety Pregnancy (Due to progesterone) Hypxaemia Salicylate overdose Infection, trauma hyperventilating Pulmonary pathology: Embolism Acute pulmonary oedema Asthma, pneumonia

IMED3002 (46 decks)

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