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
Urine Osmolality: -measures? -Is more accurate than?
-Measures dissolved particles in urine -More accurate than specific gravity
26
T/F: Urine Osmolality Evaluates ability of kidney to concentrate urine
True
27
Urine Osmolality: -Is Increased in which conditions?
-SIADH -CHF
28
Urine Osmolality: -Is decreased in which conditions?
-Diabetes insipidus -Excess fluid intake
29
Hyponatremia is defined as:
Serum sodium \<136mEq/L
30
Hyponatremia: 2 types
-Sodium depletion-free water loss -Dilutional-water intake greater than water output-(renal failure)
31
Hyponatremia: -most asymptomatic until \_\_\_\_
level\<120 mEq/L
32
Hyponatremia: Sx?
-lethargy, nausea, mm cramps -\*\*Cerebral edema (this can be lethal!!)
33
Hypernatremia is defined as
\>145 mEq/L
34
Hypernatremia: -etiology
-Impaired thirst mechanism (ie stroke) or water loss without sodium loss (ie burns, or high fever) -dehydration
35
Which is more lethal, hyper or hyponatremia?
hyponatremia
36
Urine Sodium: -tests? -normal range?
-Spot testing or 24 hour urine --Normal values vary -Spot normal generally \>20mEq/L
37
Urine sodium: -used for?
Helpful for distinguishing between renal and nonrenal causes of hyponatremia
38
Urine Sodium: -Is increased in which conditions?
-Dehydration -Diuretic therapy -Adrenocortical insufficiency -SIADH -Chronic renal failure
39
Urine Sodium: -is DECREASED in which conditions?
-CHF -Diarrhea
40
Hyponatremia initial eval
Slide 16
41
Eval of Hyponatremia: starting with osmolality
42
Hypotonic Hyponatremia (eval)
slide 18
43
Potassium: - normal range: - Is a primaru intracellular \_\_\_\_\_\_ - Function
## Footnote - Norm 3.5-5.5 mEq/L - Primary intracellular cation - Function of cardiac muscle depends on K
44
Potassium: -minor changes in concentration have \_\_\_\_\_\_\_\_
\*\*significant consequences
45
T/F: Potassium is not reabsorbed from the kidneys, it's excreted
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
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?
\*\*Necessary to supplement by IV in those that can’t eat
47
As sodium is reabsorbed, ______ is lost
Potassium
48
hypokalemia: - range? - Sx? - EKG findings?
- K \< 3.5 mmol/L - Malaise, skeletal mm weakness, arrythmias - EKG flattened or inverted T waves
49
Hypokalemia: causes?
Causes: - Deficient dietary intake - Diuretic usage (ie lasix!!!\*\*) - Burns - Glucose administration - Licorice ingestion - Aldosterone excess-enhances potassium excretion
50
Hyperkalemia: - K+ range ? - Associated complications?
## Footnote - K \> 5.5 mmol/L - Associated with renal failure and acidosis-K driven out of cell
51
Hyperkalemia: - Sx? - Associated EKG findings?
- Sx include arrythmias and cardiac arrest, numbness, tingling, weakness - EKG: \*\*peaked T waves
52
Hyperkalemia: -Causes? (list 4)
- Excessive dietary intake - ACE inhibitors - Acute or chronic renal failure - hemolysis
53
Chloride: - normal range? - it's the most abundant ________ cation
- Norm 96-106 mEq/L - Most abundant extracellular anion
54
Chloride: - Is directly regulated by: - Indirectly regulated by?
- Regulated by renal proximal tubules and exchanged for bicarb ions - Indirectly regulated by Na and H20
55
T/F: Chloride test by itself does not provide much info
True
56
Chloride: -increased levels? (causes)
- Dehydration - Metabolic acidosis
57
Chloride: -decreased levels? (causes)
- Overhydration - SIADH - Vomiting
58
Why do you need to know all these labs?
- Acute Renal Failure - Chronic Renal Failure - Fluid Therapies
59
Acute renal failure: - definition? - Accumulation of \_\_\_\_\_\_
- Rapid deterioration of kidney function - \*\* nitrogenous wastes
60
Acute Renal failure: - MC cause= - Prerenal causes=
- 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
T/F: acute renal failure is reversible in most cases
TRUE
62
Acute Renal failure: -Sx?
Symptoms-nausea, vomiting, change in mental status, edema
63
ARF Causes: -Prerenal?
- Hypovolemia - Hypotension - CHF - Renal artery stenosis (RAS)
64
ARF: -Renal causes?
- Nephrotoxins - Autoimmune diseases
65
ARF: -Postrenal causes?
obstruction
66
Acute kidney injury aka \_\_\_\_
=Acute renal failure (previous terminology)
67
# Define an acute kidney injury (aka acute renal failure) -hint: serum creatinine=
- ## Footnote =Acute increase in serum creatinine ≥ 0.5 mg/dl or more than 50% over baseline levels
68
Acute Kidney Injury is classified by:
-Classified as prerenal, intrinsic renal, or postrenal
69
Acute kidney Injury: -what is the KEY parameter for renal function management?
- \*\*GFR(glomerular filtration rate) - BUN and Creatinine less reliable than GFR but easily measured
70
Acute kidney injury: -Criteria (RIFLE classification)
71
Acute Kidney Injury: -Diagnostic la findings for \*\*prerenal causes:
- Urine Na \<20mEq/L - Fractional Excretion of Na(Fena)\<1% - Urine osmolality 500 mOsm - ^BUN/Creat ration (20:1)
72
Acute kidney injury: -Diagnostic lab findings associated with Intrinsic renal causes:
- Urine Na \>40mEq?l - Fena\>1-2% - Urine osm 250-300 - Decreased BuN/Cr ration (\<15:1)
73
Acute kidney injury: -diagnostic lab findings assoc. with Postrenal causes?
-Postrenal-results vary due to length of time of obstruction
74
Acute kidney injury= (defined using the RIFLE criteria)
-Injury=. increased creatinine 2x of GFR \>50% decrease from baseline
75
Chronic kidney disease: - definition? - Stages?
- Progressive and ongoing loss of kidney function - Staged: 1-5
76
CKD: -Stage 1=
Stage 1: kidney damage with normal GFR \>90 mls/min
77
CKD: Stage 2
Stage 2: kidney damage with mild decrease in GFR 60-89 mls/min
78
CKD: stage 3
Stage 3:moderate decrease GFR 30-59 mls/min
79
CKD: Stage 4
Stage 4: severe disease GFR 15-29 mls/min
80
CKD: stage 5
Stage 5:kidney failure with GFR \<15mls/min
81
Summary of lab Results in ARF/AKI:
KNOW!! ## Footnote - 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
Chronic Renal Failure: - reversible or irreversible? - defined as?
## Footnote - Irreversible - Mild to moderate decrease in glomerular filtration rate over time without presence of uremic symptoms
83
Chronic Renal Failure: - 2 MC causes? - Sx?
- Hypertension and diabetes most common causes - At first asymptomatic, but progress to fatigue, malaise, vomiting
84
Summary of labs/Results in CRF:
- BUN and Creat elevated - UA and serum electrolytes generally normal until advanced stage
85
Carbonic acid/bicarbonate system: -Describe this system?
\*\*=Primary buffer system of body - CO2=acid-regulated by lungs - Bicarb = base-regulated by kidneys - These parameters easily measured in lab
86
Equation of Life =
HCO3¯+H+«----»H2CO3«----»CO2+H2O
87
Equation of Life: -is controlled by which organ systems?
- Controlled by lungs and kidneys - Pathology in these organs associated with acid/base disorders - Lungs excrete CO2 - Kidneys regulate HCO3 (bicarb)
88
Increase in blood CO2 levels=
(lungs regulate CO2=respiratory) =\*\*respiratory acidosis
89
Decrease in blood CO2 levels=
respiratory alkalosis
90
Increase in blood bicarb=
(kidneys regulate HCO3 (bicarb)) =metabolic alkalosis
91
Decrease in blood bicarb=
(remember kidneys regulate bicarb (metabolic disorders) =metabolic acidosis
92
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
Go over!! (no test questions, but will help your understanding of kidneys)