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Urinary > Session 6 > Flashcards

Session 6 Flashcards

1
Q

A change in one pH unit represents a

A

10 fold change in H+ conc

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2
Q

PH of the urine varies between

A

4.5 and 8.4 depending on the bodies need to excrete H+ or HCO3-

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3
Q

What is the consequence of alkalemia on free calcium

A

Lowers free calcium by causing Ca2+ ions to come out of solution

Alkalemia = not enough H+, H+ dissociated from COOH on albumin, therefore COO- negative site for Ca2+ to bind

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4
Q

Consequence of lowering free calcium

A

Increases neuronal excitability
Fire action potentials at slightest signal
Numbness or tingling
Muscle twitches

if severe- sustained contraction (tetany) that paralyse respiratory muscles

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5
Q

Acidemia impact on free calcium

A

Increases free calcium by causing Ca2+ ions to go into solution

Acidemia= increased H+ in blood, binds to COO- on albumin, decreased negative sites for Ca2+ to bind to, more free in blood

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6
Q

What other impacts does Acidemia have apart from increasing free calcium

A

Increases plasma potassium ion concentration due to K+ H+ exchange
-Affects excitability especially in cardiac muscles- arrhythmia

Increasing H+ denatured proteins

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7
Q

Sources of H+

A

Diet, metabolism (breaking down ketones, lactic acid…)

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8
Q

Normal plasma pH

A

7.35-7.45

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9
Q

Buffers in body

A

ECF = HCO3-
Cells = proteins, Haemoglobin, phosphates
Urine = phosphates and ammonia

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10
Q

H+ output

A

Ventilation, renal

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11
Q

3 mechanisms to control pH of blood

A

Buffers, ventilation, renal regulation of H+ and HCO3-

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12
Q

Time frames of pH homeostasis

A

Renal regulation is slower than buffers and ventilation (1-2 days)

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13
Q

2 ways in which kidneys alter pH

A

Directly, by excreting or reabsorbing H+

Indirectly, by changing the rate at which HCO3- is reabsorbed or excreted

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14
Q

pH management at proximal tubule

A

Carbonic anhydrase converts H+ and HCO3- to H20 and C02, which goes into cell and is converted back to H+ and HCO3-

H+ transported into lumen with Na+ exchanger, HCO3- transported into blood with Na+ cotransporter

PH drop stimulated glutamine to break down into 2 alpha KG and then 2HCO3-, which is transported into blood, and 2NH4+ which is broken down into NH3 and diffuses into lumen to bind to H+ and form NH4+

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15
Q

PH control at Late DCT/CD

A

K+ and H+ exchanged

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16
Q

Acidosis can cause

A

Hyperkalaemia, due to XS K+ reabsorption at CD so H+ can be taken out of blood

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17
Q

Hyperkalaemia can cause

A

Acidosis

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18
Q

Alkalosis can cause

A

Hypokalaemia, Decreased K+ reabsorption in CD

More pumped into cells, less absorbed into blood, so H+ can be absorbed into blood

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19
Q

Hypokalaemia can cuase

A

Alkalosis

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20
Q

Respiratory acidosis occurs when

A

Alveolar hypoventilation results in CO2 retention and elevated pCO2

More CO2 is combined with H20 and converted into H+ and HCO3-

Any compensation must come from renal mechanisms that secrete H+ and reabsorb HCO3-

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21
Q

What is more common respiratory alkalosis or acidosis

A

Alkalosis

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22
Q

Respiratory alkalosis is often a result of

A

Hyperventilation, alveolar ventilation increases without a matching increase in metabolic CO2 production

CO2 levels fall causing levels of H+ to fall

Primary cause is excessive artificial ventilation e.g. panic attack

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23
Q

Compensation for respiratory alkalosis

A

Any compensation must come from renal mechanisms

HCO3- not reabsorbed in proximal tubule

Late DCT/CD: HCO3- secreted, H+ reabsorbed with potassium

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24
Q

Metabolic acidosis occurs when

A

Dietary and metabolic input of H+ exceeds H+ excretion (lactic acidosis, ketoacidosis)

Can also occur if body loses HCO3- (diarrhoea)

25
Q

metabolic acidosis compensation

A

Respiratory compensation instant, increased ventilation, pCO2 decreases due to hyperventilation

Renal compensation, Late DCT/CD: secretion of H+ and potassium, reabsorption of HCO3-

26
Q

What is the anion gap

A

Difference between measured cations and anions

Gap is increased if HCO3- is replaced by other anions

27
Q

What happens to anion gap in renal causes of acidosis

A

Unchanged

Not making enough HCO3- but this is already replaced by Cl-

28
Q

Metabolic alkalosis can be caused by

A

XS vomiting of acidic stomach contents and XS ingestion of bicarbonate containing antacid

29
Q

Metabolic alkalosis compensation

A

Respiratory compensation is rapid: hypoventilation means the body retains CO2 (creates more H+ and HCO3-, restores pH but produces more HCO3-)

Renal compensation:
HCO3- not reabsorbed in proximal tubule
Late DCT/CD HCO3- secreted, H+ reabsorbed with potassium

30
Q

Respiratory acidosis and alkalosis test results

A
31
Q

Metabolic acidosis and alkalosis results

A
32
Q

Respiratory and metabolic acidosis results

A
33
Q

Respiratory and metabolic alkalosis results

A
34
Q

What are the preferred terms for acute or chronic renal failure

A

Acute kidney injury AKI
Or chronic kidney disease CKD

35
Q

What is uraemia

A

Term given to the clinical symptoms which arise when nitrogenous metabolic waste products accumulate in the blood (urea and creatinine)

As a result of decreased filtration by kidneys

36
Q

Defining AKI

A

Sudden deterioration of real function over hours to days

urea and creatinine rise rapidly

Usually associated with oliguria or anuria

Usually reversible but not always

37
Q

What are oliguria and anuria

A

Oliguria- low urine output, <500ml

Anuria- no urine output

38
Q

How do you stage AKI with regards to creatinine

A
39
Q

how do you stage AKI with regards to urine output

A
40
Q

AKI is staged according to

A

The most severe classification outcome

41
Q

3 different types of AKI

A

Pre- renal
Intrinsic renal
Post-renal

42
Q

Pre renal AKI can be due to

A
43
Q

Intrinsic renal AKI can be due to

A
44
Q

Post renal AKI can be due to

A
45
Q

Features of post-renal AKI due to stone

A
46
Q

Signs of someone with AKI

A
47
Q

Complications of AKI

A
48
Q

Further investigations for someone with an AKI

A

Bedside
Bloods
Imagine
Procedures

49
Q

What does these scans show

A

left hydroureter

50
Q

What does this show

A

Left hydronephrotis

51
Q

What does this scan show

A

Right hydronephrosis

52
Q

What does this show

A

Right hydroureter

53
Q

Imagine report for previous images

A

Short interval increase in the size of the centrally necrotic mass arising from pelvis

Mass now involved both ureters now causing bilateral hydronephrosis

54
Q

Management of pre renal AKI

A
55
Q

Management of renal/intrinsic AKI

A
56
Q

Management of post-renal AKI

A
57
Q

What happens in a nephrostomy

A

Urine is drained through nephrostomy tube

dye can be used to check

58
Q

Best treatment for AKI is to

A

Prevent it

Urinary (20 decks)

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