Renal Physiology Flashcards
what is the normal range of Na+?
135-145
what is the normal range of K-?
what is the major concern of high potassium levels?
3.5-5
increases risk of arrhythmia
what is the normal range of Cl-?
96-106
what is the normal range of HCO3-?
23-30
what is the normal range of Ca2+?
8.5-11
what is the normal range of Mg2+?
around 2
what is normal SCr level?
around 1
what is the normal range of BUN?
8-20
what is the approximate level of glucose that would be considered too high?
over 200
what is the normal range of hemoglobin A1C?
below 5.7%
what A1C level would indicate diabetes?
6.5% or more
A 45-year-old patient comes to the emergency department
because 5-days history of worsening swelling in his legs and
numbness in his hands and feet. He first noticed the
symptoms 5 years ago, and they have continued to gradually
worsen.
His temperature is 37°C (98.7°F), blood pressure is 165/105
mmHg, pulse is 60/min, respirations are 16/min.
He has smoked 20 cigarettes daily for the past 20 years. A
repeat blood pressure reading 5 minutes later shows 170/105
mmHg. The patient appears to be alert and responsive to
questioning. Physical examination shows 2+ pitting edema in
his lower extremities and 1+ pitting edema in the upper
extremities. Neurologic examination shows decreased
sensation to touch in both hands and forearms, and feet and
ankles. Laboratory studies show normal values except for Cr of 4, urea nitrogen 50, glucose 350, and A1C 9%
Based on this information, the patient is likely suffering from? what diagnosis would you give this patient? is their condition reversible? what is the treatment plan?
neuropathy due to type 2 diabetes which is irreversible. Treatment is to slow progression and reduce edema
A 55-year-old patient comes to the emergency department because of a 2-day
history of decreased urinary frequency. He was hospitalized for an episode of acute
pyelonephritis 2 weeks ago and was treated empirically with ceftriaxone and
gentamicin. His symptoms and laboratory abnormalities were completely resolved
by day 5 of treatment and he was discharged from the hospital 10 days ago. He says
that since his discharge he has been drinking lots of water but has not yet urinated.
He has no other known medical history and does not take any medications. His
temperature is 37°C (98.7°F), blood pressure is 152/98 mmHg, pulse is 60/min, and
respirations are 19/min. Physical examination shows 3+ pitting edema in both lower
extremities and bibasilar crackles in the lungs. There is no flank pain or abdominal
tenderness. A basal metabolic panel and complete blood count, urinalysis, and
glomerular filtration rate on his day of hospital discharge were within normal limits.
***pts potassium level is 6
What is acute pyelonephritis? what adverse reactions from gentamicin may be causing the pts inability to urinate? What could explain the pts extremely high BP if he has no known medical history? what is the diagnosis/treatment plan?
bacterial kidney infection causing inflammation.
Gentamicin is renal and ototoxic, so it may be damaging the pts kidney function.
kidney function affects BP, so if kidney is damaged it will impact the bodies BP.
Acute nephrotoxicity due to gentamicin. pt needs dialysis STAT to decrease potassium levels. patient needs to start a diuretic to reduce edema, but it won’t work effectively if kidney is damaged.
T/F patients with AKI are more likely to die prematurely after hospitalization unless their renal function returns to baseline within 7 days
False, mortality increases even if renal function returns to baseline
*slide 11-15 know anatomy
.
A 65-year-old man goes to his primary care physician because of trouble initiating
urination, a problem that has slowly progressed over the last 6 months. A digital
rectal examination reveals a uniformly large, rubbery mass. This patient’s urinary
problems are likely due to which of these?
A. Compression of the bladder
B. Compression of the external urethral sphincter
C. Compression of the membranous urethra
D. Compression of the penile urethra
E. Compression of the prostatic urethra
E
kidneys receive what percentage of cardiac output at rest?
25%
where does most reabsorption occur in the kidney?
at the proximal convoluted tubule
the afferent arteriole ______ blood whereas the efferent arteriole ______ blood
brings, takes
what vitamin does the kidney help produce which helps with calcium absorption?
vitamin D
if the kidney is damaged and produces less vitamin D, what is the main risk factor?
increases risk of bone disease
what hormone does the kidney produce which has the primary role of increasing RBCs?
erythropoietin
what does high glucose in the urine indicate?
high glucose plasma concentrations (insulin impairment)
if a patient is admitted with edema and foamy urine, what is likely occurring?
more protein than normal is in the urine which leads to decreased plasma protein causing liquid to leak (edema)
What is the term used to describe a substance moving from a peritubular capillary into the renal tubule?
A. Reabsorption
B. Excretion
C. Filtration
D. Secretion
D
Which of the following components of a nephron perform the function of filtration?
A. Glomerulus
B. Proximal convoluted tubule
C. Medulla
D. Thin ascending limb
E. Thin descending limb
A
sodium reabsorption occurs in the ____ limb of the loop of henle
ascending
water reabsorption occurs in the ____ limb of the loop of henle
descending
A patient presents to his physician with a 3-week history of frothy urine as well as
edema. He also has a history of chronic hepatitis B. A urine dipstick is positive for
protein, and a 24-hour urine shows 4 g of protein per day. A renal biopsy demonstrates
subepithelial deposits with a spike and dome appearance. The positive urine dipstick for
protein is most likely due to damage to what part of the glomerulus?
A. Bowman capsule
B. Capillary endothelial cells
C. Glomerular basement membrane
D. Juxtaglomerular cells
E. Macula densa
C
