Day 3 5/14/15 Flashcards
(40 cards)
1
Q
Normal Na Level
A
140 mEq/L
-low suggests avid tubular sodium reabsorption ( 40 mEq/L)
2
Q
Normal K Level
A
4.5 mEq/L
3
Q
Normal Cl Level
A
104 mEq/L
4
Q
Normal Total CO2
A
27 mEq/L
5
Q
Normal Glucose Level (Fasting)
A
90 +/- 30 mg/dL
6
Q
Normal Creatinine Level
A
1.0 mg/dL
-usually viewed in concert with plasma creatinine; a UCr/PCr value greater than 20 suggests avid tubular water reabsorption, a value less than 10
suggests less avid water reabsorption
7
Q
Normal BUN Level
A
12 +/- 4 mg/dL
8
Q
Normal Phosphorous Level
A
4 mg/dL
9
Q
Normal Ca Level
A
9.5 mg/dL
10
Q
Normal Cholesterol Level
A
140-200 mg/dL
11
Q
Normal Osmolality Level
A
285 mosm/kg
12
Q
Acute Kidney Injury
A
- rapid reduction in glomerular filtration rate manifested by a rise in plasma creatinine (Pcr) concentration and urea
- results in reduced clearance of waste products
- produces state called azotemia
13
Q
3 Types of Acute Kidney Injury
A
- pre-renal azotemia- dec. in GFR due to dec. in renal plasma flow and/or renal perfusion pressure
- post-renal azotemia or obstructive neuropathy- dec. in GFR due to obstruction of urine flow
- intrinsic renal disease- dec. in GFR due to direct injury to kidneys
14
Q
Uremia and Sx
A
- signs and sx of multiple organ dysfunction caused by retention of uremic toxins and lack of renal hormones due to acute or chronic kidney injury
- sx: nausea, vomiting, abdominal pain, diarrhea, weakness and fatigue
15
Q
Azotemia
A
-buildup of nitrogenous wastes in blood, ex. BUN and creatinine
16
Q
Oliguria
A
-urine volume
17
Q
Anuria
A
-urine volume
18
Q
___________ is the most common cause of an abrupt call in GFR in a hospitalized pt.
A
-prerenal azotemia
19
Q
Causes of Pre Renal Azotemia
A
Dec. ECF Volume
- renal losses
- third space losses
- GI losses
- hemorrhage
Inc. ECF Volume
- dec. cardiac output: CHF, MI, valvular disease, pericardial tamponade
- systemic arterial vasodilation: cirrhosis, sepsis, medication, autonomic neuropathy
20
Q
Causes of Post Renal Azotemia
A
- obstruction of ureters
- bladder outlet obstruction
- urethral obstruction
21
Q
Intrinsic Renal Diseases That Cause AKI
A
- vascular diseases: cholesterol emboli, renal vein thrombosis
- glomerular diseases: acute glomerulonephritis, hemolytic uremic syndrome
- interstitial diseases: acute interstitial nephritis, infection, myeloma kidney
- tubular diseases: ischemic or nephrotoxic acute tubular necrosis (ATN)
22
Q
Pre Renal Signs and Symptoms
A
- intravascular volume depletion
- dec. weight
- flat neck veins
- postural changes in BP/pulse
- cardiac dysfunction
- edema
- pulmonary rales
- S3 gallop
23
Q
Signs and Sx of Intrinsic Renal Disease
A
- hx of exposure to renal insults associated with ATN
- hypotension
- surgery w/ large blood loss
- transfusion rxns
- exposure to radiocontrast dye
24
Q
Signs and Sx of Post Renal Disease
A
-anuria, intermittent anuria, large swings in urine flow rate
25
In general, a ____ FEN suggests prerenal azotemia.
low
26
Common Causes of Death in Acute Tubular Nephritis
- infections
| - gastrointestinal bleeding
27
Nephrotic Syndrome Management
- low salt diet
- diuretics
- BP control
- cholesterol lowering drugs
- ACE inhibitors to dec. proteinuria
- Vit D replacement
- normal or slightly low protein diet
28
Nephrotic Syndrome Classification
- proteinuria (>3.5 g/d)
- hypoalbuminemia
- edema (even around eyes)
- hyperlipidemia
- lipiduria
29
Causes of Idiopathic Nephrotic Syndrome
- minimal change disease (most common in children)
- focal glomerular sclerosis
- membranous nephropathy
- membranoproliferative GN
- other proliferative GN
- also diabetes, amyloid and light chain disease, SLE
30
Minimal Change Disease
- presentation
- lab
- associations
- phathophys
• Presentation:
- Peak Incidence 2-6 years old
- Male-female 2-1
- Edema, ascites
- Hypertension (20%)
• Lab:
- Renal function normal or slightly depressed
- Urinalysis: 4 + protein, hyaline casts, microscopic hematuria rare
- Normal Light Microscopy
- Negative Immunofluorescence
- EM with foot process fusion
• Associations:
- History of allergy/atopy
- Hodgkin’s lymphoma
- Nonsteroidal drugs (idiosyncratic reaction)
• Pathophys:
- ? T cell disorder
- Loss of charge barrier

31
Focal and Segmental Glomerulosclerosis
• Presentation:
- most common cause of nephrotic syndrome in young adults and AAs
- proteinuria
- hypertension
- urinary sediment often with RBCs
- may be idiopathic or related to previous minimal change disease
- IV heroin, HIV, etc.
* Lab:
* Associations:
- usually idiopathic
- may occur in subjects w/ HIV
• Pathophys:
- not mediated by immune complexes
- may be due to circulating factor (suPAR)
- pathology factor APO lipoprotein L1
• Tx: steroids (for 6 months); relapse is high.
32
Membranous Nephropathy
• Presentation:
-presents w/ nephrotic syndrome
• Lab:
-histology looks like "burning bush"
• Associations:
- idiopathic 2/3 cases (due to antibodies to phopholipase A2 on podocyte)
- hep B
- drugs (gold, mercury)
- SLE
- cancer
• Pathophys:
-up to 50% progress to chronic kidney disease if not tx
33
Membranoproliferative GN
• Presentation:
-two types
• Lab:
- light microscopy: mesangial proliferation and GBM thickening
- IF type 1: granular deposits IgG, C3, +/- C4
- IF type 2: granular deposits C3
- EM type 1: subendothelial deposits
- EM type 2: dense intramembranous depsits
• Associations:
- type 1: hep C infection
- type 2: complement disorder
• Pathophys:
-Hep C type 1: 70% response to interferon
34
Clinical Classification of Nephritic Syndrome
- dec. renal function
- hypertension
- RBC casts
- edema
- proteinuria (
35
Complications of Nephrotic Syndrome
- inc. coagulation factors leads to hypercoagulable state
| - inc. risk bacterial infections
36
Clinical Features of Glomerulonephritis
- inflammatory injury of glomeruli
- infiltration leukocytes
- deposition of immune proteins
- disturbed function of affected tissue
- rapidly progressive
- nephritic
- pulmonary-renal syndrome
- crescentic GN
37
Mechanisms of Injury in Glomerulonephritis
1. deposited immune complexes
2. antibodies specific for renal antigens
3. other causes of inflammation within glomeruli
- GN is usually caused by immune-mediated glomerular injury
38
Algorithm for Dx Glomerulonephritis
- definitive dx require kidney biopsy
- blood tests
- urinalysis
39
Tx for Glomerulonephritis
- immunosuppressive drugs: prednisone, cyclophosphamide, rituxumab, etc
- plasma exchange
40
4 Causes of Glomerulonephritis
- IgA nephropathy
- lupus nephritis
- anti-GBM disease
- ANCA associated vasculitis
