Interpreting U+Es

Question 1

the creatinine baseline is highest physiologically in which people?

Answer 1

people with high muscle mass eg a bodybuilder

Question 2

where is creatinine made?

Answer 2

liver

Question 3

what is creatinine’s actual function?

Answer 3

is an energy store for fast twitch muscle fibres

Question 4

what does creatinine phosphate break down into?

Answer 4

ATP and creatinine (waste product)

Question 5

creatinine blood conc is used to determine….

Answer 5

the severity of kidney injury

Question 6

where does the conversion of ammonia to urea take place?

Answer 6

liver

Question 7

urea blood conc is used to determine kidney injury T or F

Answer 7

F

Question 8

high urea would suggest..

Answer 8

dehydration
GI bleed
protein breakdown eg infection/drugs/trauma

Question 9

low urea would suggest..

Answer 9

malnutrition
liver disease
pregnancy

Question 10

how much higher than the baseline should creatinine be to confirm AKI?

Answer 10

> 50%

Question 11

how low should urine output be and for how long for it to be a sign of AKI?

Answer 11

less than 0.5ml per kg per hr for 6hrs straight

Question 12

what blood tests do all patients need if they are suspected to have an AKI?

Answer 12

FBC
U+Es
CRP
PTH
VENOUS blood gas

Question 13

immediate management of an AKI?

Answer 13

prompt urinalysis
take blood and do a VBG
renal USS
start fluids 
insert catheter and monitor UO on a fluid balance chart
STOP any nephrotoxic drugs
manage the cause

Question 14

patient has +++ urea and ++ creatinine, what type of renal failure do you suspect?

Answer 14

pre-renal

Question 15

which form of renal failure is most likely to show blood and protein on urinalysis?

Answer 15

intrinsic renal

Question 16

a urine protein-creatinine ratio under what value is considered normal?

Answer 16

15mg/mmol

Question 17

a urine protein-creatinine ratio over what value indicates nephrotic syndrome?

Answer 17

> 300mg/mmol

Question 18

if glomerulonephritis is suspected, what additional tests should be done?

Answer 18

immunological screen:
ANA
ANCA
anti-GBM
complement
RF and other rheumatological Ab's
hepatitis serology

PLUS a renal biopsy

Question 19

what test should be done if you suspect rhabdomyolysis?

Answer 19

CK

Question 20

if your patient is old, has an AKI and reports deteriorating symptoms over the past few months what additional test would you do?

Answer 20

myeloma screen

Question 21

uraemia is classed as a urea value over…

Answer 21

60

Question 22

potassium >__ indicates hyperkalaemia?

Answer 22

6.5

Question 23

if a patient is hypovolaemic, their Na levels will be __

Answer 23

low

Question 24

if Na is low in the body, will urinary osmolarity be high or low?

Answer 24

high because it will all be excreted in the urine

Question 25

urine sodium over _mmol/l indicates a renal cause for hypovolaemia

Answer 25

20

Question 26

what tests should be done to check Na levels and why?

Answer 26

plasma osmolality to confirm hyponatraemia | urine sodium to confirm/negate a renal cause

Question 27

aldosterone causes ___ of K+

Answer 27

excretion

Question 28

what 2 substances cause cellular K+ uptake?

Answer 28

insulin and catecholamines

Question 29

renal excretory causes of hypokalaemia?

Answer 29

``` diuretics conn's cushing's renal tubular acidosis hypomagnesaemia ```

Question 30

what endocrine conditions cause hypokalaemia and why

Answer 30

cushings due to excess steroid | conn's due to excess aldosterone

Question 31

Tx of hypokalaemia?

Answer 31

potassium chloride (tablets or IV depending on severity)

Question 32

renal retention causes of hyperkalaemia?

Answer 32

AKI CKD drugs eg K sparing diuretics, NSAIDs, ACEi addison's

Question 33

appearance of hyperkalaemia on ECG?

Answer 33

flat p waves wide QRS tall tented T waves

Question 34

why is insulin used in hyperkalaemia?

Answer 34

pushes K back into cells

Question 35

high ALP, high PTH and low Ca indicates __calcaemia. what could cause this result?

Answer 35

``` hypocalcaemia; loop diuretics CKD rhabdomyolysis (basically any renal cause) ```

Question 36

PTH should ___ in response to hypocalcaemia

Answer 36

increase

Question 37

high ALP, low PTH and low Ca indicates __calcaemia. what could cause this result?

Answer 37

hypoparathyroidism hypomagnesaemia PTH resistance

Question 38

low ALP, high PTH and low Ca indicates __calcaemia. what could cause this result?

Answer 38

bisphosphonate use | vitamin d deficiency

Question 39

tests for hypocalcaemia?

Answer 39

renal function PTH ALP magaesium

Question 40

what calcium level is the marker between a mild or severe hypocalcaemia

Answer 40

1,9mmol/l | eg if it was 2mmol/l it would be mild, if it was 1.8mmol/l it would be severe

Question 41

what drugs can act on the kidneys to cause hypercalcaemia?

Answer 41

thiazides

Question 42

dehydration would present with what 2 markers being raised?

Answer 42

urea | albumin

Question 43

if ALP and Ca are high, what should be suspected?

Answer 43

malignancy

Question 44

severe hypercalcaemia is a Ca level of...

Answer 44

3.5mmol/l or more

Question 45

low albumin indicates...

Answer 45

capillary leak from liver damage

Question 46

what causes high urea?

Answer 46

renal failure | excessive protein overload