Renal Workshop 3

Question 1

Briefly describe nephrotic syndrome

Answer 1

It is a disorder where protein enters the urine e.g. albumin (found in egg whites)
Causes pee to become frothy

Question 2

What happens to sodium levels in patients when in hospital?

Answer 2

Decreases Sodium levels, usually due to INCREASE water when in hospital
Fluid overload
Is a medical emergency
Increase ADH secretion (inappropriate) - caused by pneumonia, cancers and certain drugs
Low sodium due to:
Addison’s disease
Diarrhoea and vomiting
Bowel obstruction (as increase water in certain area)

Question 3

What tests are found in a U&E blood test and levels?

Answer 3

Na+ -> 135-140
K+ -> 3.5-5.0
HCO3 -> 25-27
Urea -> 7
Creatinine -> 90-100
eGFR
Ca2+
Cl- -> 100-105

Question 4

What are the causes of HIGH Na+?

Answer 4

Little drink and polyuria (e.g. diuretics)

Important in geriatrics as they DO NOT drink a lot

Question 5

What can inappropriate levels of K+ cause and what are they caused by?

Answer 5

HIGH K+
causes: CKD, if blood sample haemolysed as K+
What it causes: asystole/heart block/changes in ECG

LOW K+
Causes: Diarrhoea and vomiting
What can happen: ventricular fibrillation/changes with ECG
Wiat to do: K+ replacement

Question 6

Where are concentrations of Na+ and K+ high?

Answer 6

HIGH Na+ -> ECF

HIGH K+ -> ICF

Question 7

What foods contain K+?

Answer 7

Coffee (instant)
Bananas
Chips
Vegetables

Question 8

What is creatinine clearance?

Answer 8

How much creatinine removed from blood in a given time

U(time) x V / Pcr

Question 9

Why would you check HCO3?

Answer 9

To check for acidosis (by an ABG)
Anion gap: if big gap that’s bad
Cations: Na+ and K+
Anions: Cl- and HCO3-

Question 10

What happens to cholesterol when producing albumin?

Answer 10

Cholesterol is a by-product of albumin formation

Question 11

What idiopathic oedema?

Answer 11

Oedema that has NO known cause
More common in women
Due to increase leaky capillaries

Question 12

What are the causes of lymphoedema?

Answer 12

Surgery
Lymph obstruction
Radiotherapy

Question 13

What are the causes of oedema?

Answer 13

INCREASED capillary hydrostatic pressure due to:
Obstruction - increase pressure
Chronic venous insufficiency (increases with age)
Compartment syndrome (usually due to haematoma)
Systematic hypertension e.g. HF
Increase plasma volume (fluid retention -> RAAS e.g. in pregnancy, drugs NSAIDs)
- DECREASED plasma oncotic pressure due to:
Decreased albumin
Malnourished (e.g. Yemen)
Malabsorption
Proteinuria (less albumin -> <20]
- INCREASE capillary permeability due to:
Infection
Insect bites
Allergies
Burns
Increase temperature
Drugs e.g. calcium channel blockers

Question 14

When do people get sacral and pitting oedema?

Answer 14

Sacral oedema - when lying down due to gravity

Pitting oedema - when stand up

Question 15

When would you see oedema in someone?

Answer 15

When 2.5-3L excess fluid in body (in extra cellular space

Due to INCREASE retention of water due to RAAS system

Question 16

What questions and examination would you do on a person with oedema?

Answer 16

Questions:
How long for?
Meds
Alcohol
Location
Permanent or intermittent
PMH
FH

Examinations:
JVP
Ultrasound
BP
Bilateral or symmetrical 
DVT e.g. leg squeeze at calf and will get pain