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HEHI Fall 2020 > Week 4 - Kidneys > Flashcards

Week 4 - Kidneys Flashcards

1
Q

What is the most useful marker for kidney function?

A

Creatinine

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2
Q

What is creatinine a good proxy for?

A

GFR (glomerular filtration rate)

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3
Q

What does it mean if creatinine is low?

A

Kidneys are doing a good job filtering blood

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4
Q

What is GFR?

A

The amount of blood filtered by the kidney each minute.

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5
Q

How can you measure creatinine?

A

By injecting someone with inulin and seeing how long it takes for them to pee it out - but this is invasive and too much work.

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6
Q

What is creatinine a byproduct of? What does this mean for who might have higher baseline creatinine levels?

A

Muscle breakdown. Muscles release creatinine.

Someone with a large muscle mass would have higher creatinine levels that an emaciated person

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7
Q

What are the three reasons a kidney isn’t working well?

A
  1. pre-renal issues
  2. intra-renal issues
  3. post-renal issues
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8
Q

What leads to a pre-renal issue?

A

not enough blood getting to the kidneys (hypovolemia)

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9
Q

What leads to a intra-renal issue?

A

something causing direct harm to kidney tissue (NSAIDs, nephrotoxic drugs)

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10
Q

What leads to a post renal issue?

A

some blockage distal to kidneys that is blocking ability of kidneys to filtrate (obstruction - commonly kidney stones, cancer, and prostate issues)

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11
Q

What are two common comorbidities to chronic kidney disease?

A

HTN and DM2

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12
Q

What should we always ask first if we see high creatinine levels?

A

Is this acute or chronic?

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13
Q

If a patient does have chronic kidney disease, what is important for treatment?

A

Knowing comorbidities

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14
Q

What risk factors do I need to keep an eye out for with chronic kidney disease?

A

Fluid overload

Electrolyte abnormalities

Acid base balance

anemia

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15
Q

What are the commonalities between CHF and CKD?

A

Fluid overload
Edema
Bounding pulses
Fine crackles 2/2 to pulmonary edema

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16
Q

What can we do to figure out if something is CHF or CKD?

A

Labs! Creatinine is the main differentiating factor between CHF and CKD.

Physical exam is not likely going to give us enough info to distinguish between CHF and CKD

elevated BNP is not enough to distinguish

17
Q

A patient with CKD has missed 3 dialysis appointments. Which of the following is most concerning?

  1. potassium of 6.2
  2. palpable thrill in the fistula
  3. HR of 89
  4. Pre-tibial edema
A

Potassium of 6.2

18
Q

You are reviewing labs on a patient with polycythemia 2/2 COPD. Which of the following labs would be most consistent with polycythemia 2/2 COPD?

  1. Hematocrit of 52
  2. Potassium of 4.2
  3. WBC of 8.4
  4. Sodium of 130
A

Hematocrit of 52

19
Q

What does furosemide do?

A

It inhibits the reabsorption of Na, Cl-, and K in the loop of Henle

Hence - they are called “loop” diuretics - they put you at risk of K+ loss

20
Q

What do we assess in a renal assessment?

A
  1. fluid-volume status
  2. acid-base balance
  3. electrolytes
  4. excretion of wastes
  5. hematology
21
Q

What should HR and BP reflect?

A

fluid volume status

22
Q

when can you auscultate a bruit in the kidneys?

A

when there is some form of renal artery stenosis

23
Q

How is BP related to kidney function?

A

It tells us how well kidneys are able to filter b/c it influences the GFR.

24
Q

How do we assess the kidneys?

A
  1. Is and Os
  2. Daily weights
  3. lab values
    - electrolytes
    - BUN & Creatinine
    - GFR
25
Q

Why are the kidneys important?

A

They are the best way to look into perfusion status.

If kidneys aren’t producing urine –> not perfused –> unlikely brain/heart getting perfused either

26
Q

What is the bladder scanner used for?

A

Imagine a patient has 0 urine output for the past two hours.

  • -Does that mean that the kidneys haven’t produced any urine?
  • -Or is there urine in the bladder that can’t get out!

The bladder scanner lets us figure that out – otherwise we would have to place a catheter.

27
Q

Why are daily weights important?

A

They help us keep up with daily shifts in a patient’s fluid volume - important for renal failure and CHF patients

1 L = l kg

Better than Is and Os in patients with insensible losses (e.g. diaphoretic, diarrhea, tachypneic)

28
Q

Lab tests for kidney function

A

BMP

Arterial blood gas

Urinalysis

29
Q

BMP

A

Focusing on BUN and creatinine

30
Q

What is creatinine?

A

Byproduct of normal muscle breakdown. Produced at a steady rate, which makes it a reliable indicator.

It does vary based on how much muscle mass an individual has (more muscle = higher baseline creatinine)

31
Q

Why is creatinine important?

A

Since it is filtered by the kidney but not reabsorbed (and only about 5% is secreted), it is the best approximation of what our Glomerular Filtration Rate is.

Basically, it’s the best biomarker for tracking kidney function!

32
Q

Creatinine normal range

A

0.5 - 1.2

33
Q

Is creatinine a toxin?

A

If it builds to high levels in the blood stream, it can cause some mental status changes, but it isn’t tremendously harmful on its own

34
Q

What is BUN?

A

a waste product resulting from the breakdown of protein.

35
Q

BUN normal range

A

7-20 - should be in a roughly 20:1 BUN:Creatinine ratio

36
Q

Why is BUN clinically important?

A

Can be used as a proxy for creatinine

BUN is not as clinically useful as creatinine because many different factors influence urea production, whereas creatinine production is pretty steady.

(So alterations in BUN can reflect changes in Urea production rather than kidney clearance)

Also less useful b/c 50% of it reabsorbed in the PCT - key to its (relatively small) clinical usefulness

(If dehydrated, body will reabsorb more BUN; so when see high BUN:Creatinine level, think dehydration first)

37
Q

How do we estimate GFR?

A 
Creatinine Clearance (CrCl) 
--Uses the Cockroft-Gault formula, which adjusts for age, weight, and sex

eGFR (CrCl)
–Uses the MDRD equation, which adjusts for age, weight, sex, and if pt is African American

38
Q

What is the normal range for GFR/CrCL?

A

90-120 ml/min/1.73m2

39
Q

When should we be renally dosing our medications?

A

When eGFR drops lover than 60 ml/min/1.73m2

HEHI Fall 2020 (6 decks)

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