Small Group Shit you JUST GOTTA KNOW!

Question 1

What are the normal serum concentrations for the following:

[Na]

[K]

[HCO3]

Answer 1

Na = 140-145

K = 3.5-5

HCO3 = 22-28

Question 2

What is Winter’s Equation? What do you use it for?

Answer 2

Winter’s equation is used to check to see if the changes in PCO2 that occur in response to metabolic changes in HCO3 are Secondary or Primary - meaning are they within confidence bands or not

PCO2 = 1.5[HCO3] + 8 +/- 2

Question 3

How do you calculate POSM?

Answer 3

Posm = 2Na + BUN/2.8 + Gluc/18

Question 4

What is the Equation for FENA?

Answer 4

FENA = Una x Pcreat / Ucreat x PNa

(2 big numbers in the denominator)

Question 5

How do you calculate the estimated GFR?

Answer 5

GFR = [(140-Age) x Mass(kg) x 0.85 (for females)]/ 72 x serum creatinine

Question 6

What are the Normal compensation values for PCO2 in response to metabolic changes in HCO3?

Answer 6

Metab Acidosis

1 mEq/L decrease HCO3 = 1.2 mmHg decrease PCO2

Metab Alkalosis

1 mEq/L increase HCO3 = 0.6 mmHg increase PCO2

Question 7

Appropriate Acute and Chronic Compensation in HCO3 for Respiratory Acidosis?

Answer 7

Acute:

10 mm Hg increase PCO2 = 1 mEq/L increase HCO3

Chronic:

10 mm Hg increase PCO2 = 3.5 mEq/l increase HCO3

Question 8

Appropriate Acute and Chronic Compensation in HCO3 for Respiratory Alkalosis?

Answer 8

Acute:

10 mmHg decrease in PCO2 = 2 mEq/L decrease in HCO3

Chronic

10 mmhg decrease in PCO2 = 5 mEq/L decrease in HCO3

Question 9

What causes maintained metab alkalosis?

Answer 9

Low Urine Chloride

Or Low POtassium!

Question 10

What do Salicylates cause?

Answer 10

Metabolic Acidosis (AG) + Respiratory Alkalosis

Question 11

How can you get Respiratory Acidosis from Diarrhea?

Answer 11

Diarrhea –> Hypokalemia –> Low Resp Muscle Function –> Increased PCO2 –> Resp Acidosis

Question 12

What is the range of Urinalysis Specific Gravity? What is Isosthenuric?

Answer 12

Range 1 to 1.030

Isosthenuric = 1.010

Question 13

If Renal failure is a problem w/ the tubules, what are possible causes and what can you see in urinalysis?

Answer 13

ATN from ischemia, toxic, Pigments (myoglobin or hemoglobin), cyrstals like Uric acid or Oxalic acid etc

Urinalysis:

Tubular cells in urine

tubular cell cast

Pigments

crystals

UNa will be high bc tubules damages and will be Iso-osmolar

(except w/ Radiocontrast which is a renal vasoconstrictor so in neprhotoxic ATN may have urine Na lower and Uosm higher)

Question 14

What is the presetnation of Alport Syndrome?

Answer 14

Glomerulonephroitis and hearing loss

Question 15

What features of labs/urinalysis can ID that a renal pathology is glomerularly located?

Answer 15

Hematuria/Proteinuria

Dysmorpphic RBCs

RBC casts

Question 16

What tests do you order if pt has AKI and lung problems?

Answer 16

Complement studies - C3/C4

pANCA and cANCA

Anti-GBM

Antinuclear antibody

dsDNA

serum protein electrophoresisis

Urine protein electrophoresis

RENAL BIOPSY!

Question 17

What if you see crescentic GN and linear IgG staining of BM?

Answer 17

Goodpasteur’s!!!

Question 18

If you see granular casts in urine w/ renal tubular epithelial cells - what do you have?

Answer 18

ATN!!!!

Question 19

Acanthocytes in urinalysis mean what?

Answer 19

Acanthocytes = Dysmorphic RBCs and blebs on the cells

= GLOMERULAR NEPHRITIS!!!!

Question 20

How can Hep C cause glomerulonephritis?

Answer 20

Can cuse Cryo-globulins!!! that leads to immune complex mediated disease

Question 21

Compare and Contrast Acute vs Chronic Kidney disease features?

Answer 21

AKI: creatinine is INCREASING, oliguric, normal/large kidney, Phosphates ~normal, Anemia Mild, Granular casts- brown and tubular epithelium in casts

vs

CKD: Creatinine is stable, not really oliguric, SMALL KIDNEY!!!!!, Increased Phosphates (GFR<30), Anemia!!, Large Casts Hyaline (bc when you lose nephrons tubules existing get bigger), No tubular epithelial cell casts

Question 22

Compare and contrast the features of glomerular vs medullary/interstitial causes of CKD?

Answer 22

_Glomerular - Vascular _

• Heavy proteinuria, Na retention, low urine output, HTN early and severe stages, Acodisosis (high aniong gap gfr <30), Bone disease - late CKD

MEdullary-Interstitial:

• mild proteinuria, Na wasting, normal urine output, HTN late and mild stages, Acidoisis AG normal, Bone Disease - early CKD, Anemia - Late ckd

Question 23

why do you get hypercholesterolemia in CKD?

Answer 23

Liver thinks low protein bc low albumin and so starts making a bunch of lipids to beef up blood volume

Question 24

What are classic findings for Hyper PTH?

Answer 24

Sub-Periosteal REabsorption of bone gives MOth Eaten appearance in Distal Phalanges

renal osteodystrophy from high PTH

secondary hyperparathyroidis in bone - Ostreofibrosis Cystica

Question 25

What is the warning for Diabetics w/ CKD?

Answer 25

CAREFUL W INSULIN!!!!

Normally Insulin is filtered by the kidney 50% but as GFR drops then more insulin retained and pts get hypoglycemia