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Clin Med Exam 4 > Renal Part 2: Schoenwald > Flashcards

Renal Part 2: Schoenwald Flashcards

1
Q

Electrolyte Panel: (includes)

A

Na K CL CO2

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2
Q

Kidney is the main regulator of water and _____

A

sodium

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3
Q

Sodium: normal range

A

Normal 136-145 mEq/L

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4
Q

Sodium is the primary circulating _____

A

cation (extracellular space)

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5
Q

Sodium is needed for?

A

neuromuscular function

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6
Q

Sodium: -how are serum levels balanced?

A

Serum levels are the balance between dietary intake and renal excretion

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7
Q

Sodium: -indicator of ____

A

*free body water -If free water increased, Na diluted and levels decrease -If free water decreased, Na concentrated and levels increased

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8
Q

Sodium is a major contributor to _____

A

plasma osmolality

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9
Q

Osmolality: normal serum

A

280-295 mOsm/kg H20

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10
Q

Osmolality is useful in which settings?

A

hyponatremia, evaluating ADH (antidiuertic hormone) related illnesses

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11
Q

Osmolality: -measures?

A

concentration of dissolved particles in blood

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12
Q

As amount of free water increases, amount of particles decreases= osmolality ______

A

osmolality decreases

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13
Q

As amount of free water decreases, amount of particles increases=osmolality

A

increases

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14
Q

Therefore, osmolality decreases with _____

A

overhydration, and increases with dehydration

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15
Q

Antidiuretic Hormone(ADH): -regulates?

A

body water and osmolality

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16
Q

ADH is stimulated by (3 things)

A

Increased osmolality Hypovolemia Thirst

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17
Q

ADH acts on the ______ ______ to increase permeability=increase water reabsorption=more concentrated urine

A

collecting tubule

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18
Q

Osmolality-Serum: -Is increased in:

A

-Hypernatremia -Hyperglycemia -Ketosis -Dehydration -Diabetes insipidus

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19
Q

Osmolality-Serum: -is decreased in:

A

-Overhydration -Syndrome of inappropriate ADH

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20
Q

Syndrome of inappropriate ADH=

A

=Abnormally high amount of ADH present –Increased water reabsorption leading to decreased serum sodium levels —Lose sodium in urine

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21
Q

Syndrome of inappropriate ADH: -What is a common cause of this syndrome?

A

drugs (commonly after anesthesia type drugs ie post surgery)

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22
Q

Diabetes insipidus= inadequate amount of ____ present

A

ADH

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23
Q

Diabetes Insipidus: -Sx? -Labs?

A

Sx: increased thirst and passage of large volumes of dilute urine -Hypernatremia present

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24
Q

Urine Osmolality: normal range

A

50-1200 mOsm/kg H20

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25
Q

Urine Osmolality: -measures? -Is more accurate than?

A

-Measures dissolved particles in urine -More accurate than specific gravity

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26
Q

T/F: Urine Osmolality Evaluates ability of kidney to concentrate urine

A

True

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27
Q

Urine Osmolality: -Is Increased in which conditions?

A

-SIADH -CHF

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28
Q

Urine Osmolality: -Is decreased in which conditions?

A

-Diabetes insipidus -Excess fluid intake

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29
Q

Hyponatremia is defined as:

A

Serum sodium <136mEq/L

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30
Q

Hyponatremia: 2 types

A

-Sodium depletion-free water loss -Dilutional-water intake greater than water output-(renal failure)

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31
Q

Hyponatremia: -most asymptomatic until ____

A

level<120 mEq/L

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32
Q

Hyponatremia: Sx?

A

-lethargy, nausea, mm cramps -**Cerebral edema (this can be lethal!!)

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33
Q

Hypernatremia is defined as

A

>145 mEq/L

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34
Q

Hypernatremia: -etiology

A

-Impaired thirst mechanism (ie stroke) or water loss without sodium loss (ie burns, or high fever) -dehydration

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35
Q

Which is more lethal, hyper or hyponatremia?

A

hyponatremia

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36
Q

Urine Sodium: -tests? -normal range?

A

-Spot testing or 24 hour urine –Normal values vary -Spot normal generally >20mEq/L

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37
Q

Urine sodium: -used for?

A

Helpful for distinguishing between renal and nonrenal causes of hyponatremia

38
Q

Urine Sodium: -Is increased in which conditions?

A

-Dehydration -Diuretic therapy -Adrenocortical insufficiency -SIADH -Chronic renal failure

39
Q

Urine Sodium: -is DECREASED in which conditions?

A

-CHF -Diarrhea

40
Q

Hyponatremia initial eval

41
Q

Eval of Hyponatremia: starting with osmolality

42
Q

Hypotonic Hyponatremia (eval)

43
Q

Potassium:

  • normal range:
  • Is a primaru intracellular ______
  • Function
A

  • Norm 3.5-5.5 mEq/L
  • Primary intracellular cation
  • Function of cardiac muscle depends on K
44
Q

Potassium:

-minor changes in concentration have ________

A

**significant consequences

45
Q

T/F: Potassium is not reabsorbed from the kidneys, it’s excreted

A

True

(important when we prescribe lasix (diuretic therapy) because they get K+ depleted. For life long Pts on this med they MUST have K+ monitored and taking K+ supplements

46
Q

Potassium:

-For Pts who are unable to eat and they are not yet on TPN (total parenteral nutrition), what is necessary to add to their treatment regimen?

A

**Necessary to supplement by IV in those that can’t eat

47
Q

As sodium is reabsorbed, ______ is lost

48
Q

hypokalemia:

  • range?
  • Sx?
  • EKG findings?
A
  • K < 3.5 mmol/L
  • Malaise, skeletal mm weakness, arrythmias
  • EKG flattened or inverted T waves
49
Q

Hypokalemia: causes?

A

Causes:

  • Deficient dietary intake
  • Diuretic usage (ie lasix!!!**)
  • Burns
  • Glucose administration
  • Licorice ingestion
  • Aldosterone excess-enhances potassium excretion
50
Q

Hyperkalemia:

  • K+ range ?
  • Associated complications?
A

  • K > 5.5 mmol/L
  • Associated with renal failure and acidosis-K driven out of cell
51
Q

Hyperkalemia:

  • Sx?
  • Associated EKG findings?
A
  • Sx include arrythmias and cardiac arrest, numbness, tingling, weakness
  • EKG: **peaked T waves
52
Q

Hyperkalemia:

-Causes? (list 4)

A
  • Excessive dietary intake
  • ACE inhibitors
  • Acute or chronic renal failure
  • hemolysis
53
Q

Chloride:

  • normal range?
  • it’s the most abundant ________ cation
A
  • Norm 96-106 mEq/L
  • Most abundant extracellular anion
54
Q

Chloride:

  • Is directly regulated by:
  • Indirectly regulated by?
A
  • Regulated by renal proximal tubules and exchanged for bicarb ions
  • Indirectly regulated by Na and H20
55
Q

T/F: Chloride test by itself does not provide much info

56
Q

Chloride:

-increased levels? (causes)

A
  • Dehydration
  • Metabolic acidosis
57
Q

Chloride:

-decreased levels? (causes)

A
  • Overhydration
  • SIADH
  • Vomiting
58
Q

Why do you need to know all these labs?

A
  • Acute Renal Failure
  • Chronic Renal Failure
  • Fluid Therapies
59
Q

Acute renal failure:

  • definition?
  • Accumulation of ______
A
  • Rapid deterioration of kidney function
  • ** nitrogenous wastes
60
Q

Acute Renal failure:

  • MC cause=
  • Prerenal causes=
A
  • MC caused by nephrotoxins-medications. (ABX are big culprits)
  • Prerenal causes-hypoperfusion

(prerenal causes- ie CHF leading to decreased blood flow to the kidney,

61
Q

T/F: acute renal failure is reversible in most cases

62
Q

Acute Renal failure:

-Sx?

A

Symptoms-nausea, vomiting, change in mental status, edema

63
Q

ARF Causes:

-Prerenal?

A
  • Hypovolemia
  • Hypotension
  • CHF
  • Renal artery stenosis (RAS)
64
Q

ARF:

-Renal causes?

A
  • Nephrotoxins
  • Autoimmune diseases
65
Q

ARF:

-Postrenal causes?

A

obstruction

66
Q

Acute kidney injury aka ____

A

=Acute renal failure (previous terminology)

67
Q

Define an acute kidney injury (aka acute renal failure)

-hint: serum creatinine=

A

-

=Acute increase in serum creatinine ≥ 0.5 mg/dl or more than 50% over baseline levels

68
Q

Acute Kidney Injury is classified by:

A

-Classified as prerenal, intrinsic renal, or postrenal

69
Q

Acute kidney Injury:

-what is the KEY parameter for renal function management?

A
  • **GFR(glomerular filtration rate)
  • BUN and Creatinine less reliable than GFR but easily measured
70
Q

Acute kidney injury:

-Criteria (RIFLE classification)

71
Q

Acute Kidney Injury:

-Diagnostic la findings for **prerenal causes:

A
  • Urine Na <20mEq/L
  • Fractional Excretion of Na(Fena)<1%
  • Urine osmolality 500 mOsm
  • ^BUN/Creat ration (20:1)
72
Q

Acute kidney injury:

-Diagnostic lab findings associated with Intrinsic renal causes:

A
  • Urine Na >40mEq?l
  • Fena>1-2%
  • Urine osm 250-300
  • Decreased BuN/Cr ration (<15:1)
73
Q

Acute kidney injury:

-diagnostic lab findings assoc. with Postrenal causes?

A

-Postrenal-results vary due to length of time of obstruction

74
Q

Acute kidney injury= (defined using the RIFLE criteria)

A

-Injury=. increased creatinine 2x of GFR >50% decrease from baseline

75
Q

Chronic kidney disease:

  • definition?
  • Stages?
A
  • Progressive and ongoing loss of kidney function
  • Staged: 1-5
76
Q

CKD:

-Stage 1=

A

Stage 1: kidney damage with normal GFR >90 mls/min

77
Q

CKD: Stage 2

A

Stage 2: kidney damage with mild decrease in GFR 60-89 mls/min

78
Q

CKD: stage 3

A

Stage 3:moderate decrease GFR 30-59 mls/min

79
Q

CKD: Stage 4

A

Stage 4: severe disease GFR 15-29 mls/min

80
Q

CKD: stage 5

A

Stage 5:kidney failure with GFR <15mls/min

81
Q

Summary of lab Results in ARF/AKI:

A

KNOW!!

  • BUN/Creat elevated, BUN/Creat ratio <15:1 =renal cause; BUN/Creat ratio >20:1=prerenal cause
  • Decreased creat clearance
  • Hyperkalemia
  • Urinalysis (UA) positive for protein and blood
82
Q

Chronic Renal Failure:

  • reversible or irreversible?
  • defined as?
A

  • Irreversible
  • Mild to moderate decrease in glomerular filtration rate over time without presence of uremic symptoms
83
Q

Chronic Renal Failure:

  • 2 MC causes?
  • Sx?
A
  • Hypertension and diabetes most common causes
  • At first asymptomatic, but progress to fatigue, malaise, vomiting
84
Q

Summary of labs/Results in CRF:

A
  • BUN and Creat elevated
  • UA and serum electrolytes generally normal until advanced stage
85
Q

Carbonic acid/bicarbonate system:

-Describe this system?

A

**=Primary buffer system of body

  • CO2=acid-regulated by lungs
  • Bicarb = base-regulated by kidneys
  • These parameters easily measured in lab
86
Q

Equation of Life =

A

HCO3¯+H+«—-»H2CO3«—-»CO2+H2O

87
Q

Equation of Life:

-is controlled by which organ systems?

A
  • Controlled by lungs and kidneys
  • Pathology in these organs associated with acid/base disorders
  • Lungs excrete CO2
  • Kidneys regulate HCO3 (bicarb)
88
Q

Increase in blood CO2 levels=

A

(lungs regulate CO2=respiratory)

=**respiratory acidosis

89
Q

Decrease in blood CO2 levels=

A

respiratory alkalosis

90
Q

Increase in blood bicarb=

A

(kidneys regulate HCO3 (bicarb))

=metabolic alkalosis

91
Q

Decrease in blood bicarb=

A

(remember kidneys regulate bicarb (metabolic disorders)

=metabolic acidosis

92
Q

Recommend review of Acid/Base arterial blood gas interpretation

  • Especially metabolic acidosis/alkalosis
  • Anion gap
  • MUDPILES acronym for metabolic acidosis –>M-methanol, U-urea, D-DKA, P-paraldehyde, isoniozid/or iron overload, L=lactic acidosis, E-Ethanol, S-salicyclate
A

Go over!!

(no test questions, but will help your understanding of kidneys)

Clin Med Exam 4 (14 decks)

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