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Kidney Flashcards

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1
Q

role of kidney

A

-Maintenance & regulation of fluid balance
-Acid / Base & electrolyte balance:
-Sodium
-Potassium
-Bicarbonate
-Calcium
-Phosphate
-magnesium

-conservation:
-glucose- we dont want to filter this -> if people have too high glucose -> leaks through basement membrane and we pee glucose
-amino acids
-proteins

-excretion of wastes*: essential -> dialysis if not
-Urea
-Creatinine
-Nitrogenous waste
-Hydrogen ions

-Production of erythropoietin- know this
-Production of 1,25 dihydroxyvitamin D- know this

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2
Q

renal panel

A

-BUN
-creatinine

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3
Q

BMP

A

-BUN- N2 in blood in form of urea
-CO2 (HCO3-) - buffer
-Creatinine- breakdown of product in muscle
-Glucose- energy
-Chloride- O2/CO2 exchange in RBC
-Potassium- acid-base balance, neuromuscular function, cardiac muscle contraction + conduction
-Sodium- fluid volume, nerve conduction, neuromuscular function

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4
Q

creatinine

A

-kidneys are not getting proper flow or filtration issue if creatinine is high
-too little creatinine - malnutrition and low muscle mass
-too much- kidney disease, dehydration, muscle breakdown

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5
Q

BUN

A

-too much- kidney disease, dehydration, heart failure
-too little- liver failure, malnutrition

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6
Q

electrolytes

A

-Sodium
-Potassium
-Bicarbonate
-Calcium
-Phosphate
-magnesium

-abnormal:
-dehydration
-kidney disease
-heart failure
-liver disease
-high BP

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7
Q

calcium

A

-abnormal:
-kidney/liver problems
-bone disease
-thyroid disease
-cancer
-malnutrition

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8
Q

glucose

A

-abnormal results:
-too much- diabetes, prediabetes
-too little- hypoglycemia
-chronic damage to basement membrane -> damaging nephron

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9
Q

renal failure

A

-symptoms:
-Malaise
-Headache
-Visual disturbances
-Nausea
-Vomiting
-dysuria
-wasting

-signs:
-Flank tenderness
-rash- nitrogen waste may deposit into skin -> irritation
-Volume of urine reduction <500 cc
-Anuria <100 cc
-Hematuria, Casts, Proteinuria (signs of basement membrane leaking), Pyuria (pus)
-Hypertension- if BP is not affected by meds or lifestyle -> consider renal artery stenosis -> activates ACE to increase pressure
-Change in color or odor
-Lab changes
-AV knicking- redness shows longstanding HTN and diabetes
-abdominal brewey- renal artery stenosis, AAA
-peripheral neuropathy

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10
Q

causes of renal failure

A

-basement membrane
-vascular disturbances
-low flow state- acute
-renal artery stenosis- obstruction
-kidney stones- obstruction
-obstruction alters fluid backup and disturbs osmotic gradients -> alters GFR
-MC -> diabetes, HTN

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11
Q

azotemia

A

-nitrogen byproducts in the blood

-Prerenal (MC cause): any issue before kidneys:
-Reduced flow to kidney- low BP
-CHF, hemorrhage, renal artery stenosis, dehydration

-Renal:
-Kidney is dysfunctional
-Disease of vessels, glomerulus, tubules, mesangium
-Autoimmune (lupus), infectious (glomerular nephritis), medication damage

-postrenal:
-Anatomic obstruction (narrow ureters, AAA, tumor)
-Ureter, bladder, or urethra stone
-Congenital anomaly
-Inflammatory lesion
-neoplasm

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12
Q

BMP, SMA 7, chem 7

A

-Sodium
-Potassium
-Chloride
-Bicarbonate
-Bun
-Creatinine
-glucose

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13
Q

eryhtropoietin

A

-effect on CBC
-kidney stops telling you to make EPO -> less RBC formation in marrow
-less O2 delivery

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14
Q

other lab tests

A

-Acid base with ABG
-Plasma calcium, albumin, phosphate, parathyroid hormone, Vitamin D panel
-Urinalysis

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15
Q

creatinine

A

-chemical waste molecule that is generated from muscle metabolism
-transported through bloodstream to kidneys
-kidneys filter out most of creatinine and dispose of it in urine
-Breakdown of creatine phosphate
-Produced in skeletal muscle, kidney, pancreas
-Clearance from the kidneys = GFR

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16
Q

GFR and CRCL

A

-Milliliters of body fluid cleared by the kidneys per minute, mL/min
-Reduction represents waste retention
-Usually based on creatinine clearance
-Estimated from Creatinine, age, sex and ethnicity.
-24 hr urine collection for accuracy- Uses urine creatinine, serum creatinine, urine volume and collection time in minutes
-For drug calculation use Cockcroft-Gault Creatinine clearance formula

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17
Q

Crockcroft-Gault formula for estimating creatinine clearance

A

-used for drug calculation
-adjust dose based on this
-impaired function, 1 kidney
-lower creatinine clearance-> increase risk for rhabdo

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18
Q

stage of chronic kidney disease

A

-stage 1- kidney damage with normal kidney function - GFR >= 90
-stage 2- kidney damage with mild loss of kidney function- GFR 89-60
-stage 3a- mild to moderate loss of kidney function- GFR 59-45
-stage 3b- moderate to severe loss of kidney function- GFR 44-30
-stage 4- severe loss of kidney function- GFR 29-15
-stage 5- kidney failure- GFR <15

-aggressively treat underlying issue once you see any signs
-potassium rise and no urine -> consider dialysis

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19
Q

BUN

A

-Blood urea nitrogen
-Amino acids -> Ammonia -> Urea produced by the liver
-Can be affected by hydration, protein intake, blood in GI tract*, liver failure, malnutrition
-absorbing the blood -> causes rise in BUN

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20
Q

dehydration

A

-Volume depletion results from loss of Na and water from the following anatomic sites:
-dehydration causes pre-renal azotemia
●Gastrointestinal losses- vomiting, diarrhea, bleeding, and external drainage
●Renal losses- diuretics, osmotic diuresis, salt-wasting nephropathies (nephrotic syndrome), and hypoaldosteronism
●Skin losses- sweat, burns, and other dermatological conditions
●Third-space sequestration- intestinal obstruction, crush injury, fracture, and acute pancreatitis -> a lot of edema -> lose fluid into extravascular space

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21
Q

symptoms of dehydration in pt

A

-General?
-Skin?
-Cardiac?
-Labs?:
-Low urine output- ADH holds onto water
-elevations in the BUN and the BUN/serum creatinine ratio-> greater than 20:1
-Low Sodium Excretion in urine

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22
Q

BUN: creatinine ratio

A

-blood urea nitrogen : creatinine (20:1) = normal = 12-20 (optimum 15)
-WNL- 10-20 to 1
-creatinine is another NPN
-BUN:creatinine ratio- LOW (< 20:1) -> acute tubular necrosis, low protein intake, starvation, severe liver disease
-HIGH (> 20:1) -> pre-renal uremia, high protein intake, after GI bleeding**
-HIGH with raised creatinine -> post renal obstruction, pre-renal uremia with renal disease

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23
Q

increased BUN/normal creat

A

-pre-renal increased BUN/creat ratio
-BUN is more susceptible to non-renal factors
-pre-renal uremia, high protein intake, after GI bleeding**

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24
Q

increased BUN/increased creat

Study These Flashcards
A

-post-renal increased ratio BUN/creat ratio
-both BUN and creat are elevated
-post renal obstruction, pre-renal uremia with renal disease

25
decreased BUN/normal creat
-renal decreased BUN/creat ratio -low dietary protein or severe liver disease -acute tubular necrosis, low protein intake, starvation, severe liver disease
26
special circumstances with BUN
-Although an elevated BUN/serum creatinine may indicate hypovolemia -> subject to misinterpretation for 2 major reasons: -1) the BUN is affected by the rate of urea production; a high ratio may be due solely to increased urea production (as with steroid therapy) rather than hypovolemia, whereas a normal ratio may occur in patients with hypovolemia if urea production is reduced (eg, due to decreased protein intake); -2) the serum creatinine is affected by muscle mass as well as GFR; a high ratio may be due to a low muscle mass (which lowers the serum creatinine concentration), increasing the BUN/serum creatinine ratio in the absence of hypovolemia. -A special case is the increased BUN/serum creatinine ratio in pts with upper GI bleeding. In such patients, the ratio increases markedly for 2 reasons: -ECF volume is decreased due to the blood loss, which increases proximal tubule urea reabsorption -rate of urea production is increased due to the catabolism and absorption of blood proteins from the GI tract
27
urine protein
-Urine dipstick -24 hr urine- spun down, more accurate -> creatinine filtration, sodium losses, protein spillage -Normal 150mg per day in 24 hrs ->1 gram per day abnormal
28
nephrotic syndrome
- ->3.5 gram per day -Hypoalbuminemia- peed it out -Edema- third space edema -hyperlipidemia
29
nephritis
-inflammation of renal tissue -Htn -can be due to infectious issues -Mild edema -Mild proteinemia -Hematuria / red blood cell casts
30
microalbuminuria
-Dm nephropathy -HTN renal damage
31
proteinuria
-Assess for cause of proteinuria -Molecular weight of spilled protein -Urine electrophoresis: -Glomerular issue (basemembrane): high albuminuria & Beta globulins -Tubular: alpha-2 doublet (dont need to know), increased albumin -Overflow (spilling of protein): monoclonal immunoglobulin “ M spike” (multiple myeloma)** board question -Nonselective: matches serum Protein
32
sodium excretion
-Test the resorptive function of the tubules -Uses serum sodium (BMP) and Creatinine level with a random urine sample -Normal is less than 1% -> we reabsorb almost all Na -hyponatremia- BBB, brain swelling -> death ->1% in acute tubular injury or disease -Not reliable on diuretic therapy or chronic kidney disease -the FENa is usually under 1 percent in hypovolemic patients and above 1 percent when the oliguria is due to acute tubule necrosis
33
fractional excretion of sodium (FENa)
34
equations to know
-sodium excreton -urea excretion -creatinine clearance
35
fractional urea excretion
-A fractional excretion of urea (FEUrea) of < 35% is suggestive of pre-renal azotemia. Unlike when measuring of the fractional excretion of sodium, (FENa), it can be used even when patients are taking diuretics -Fractional Excretion of Urea = Uur X Pcreat / Ucreat X Pur · 100% -Where: -Uur = Urine urea -Pcreat = Plasma creatinine -Ucreat = Urine creatinine -Pur = Plasma urea
36
urinalysis: physical
-Color -Clarity -Specific gravity (density)
37
urinalysis: chemical
-pH -Glucose -Protein -Blood -Ketones -Bilirubin -Urobilirubin -Nitrite- byproduct of bacteria -Leukocyte esterase- WBC*
38
urinalysis: microscopic
-sent to lab -Cells- epithelial cells (not proper collection) -Bacteria -Crystals -Casts -Lipids -contaminants
39
quantity of urine
-1000-1500mL a day -polyuria- diabetes mellitus, diabetes insipidus, nervous diseases, chronic nephritis, diuretics -oliguria- acute nephritis, heart disease, fever, eclampsia, diarrhea, vomiting, inadequate fluid intake -aruria- uremia (nitrogenous waste in blood), acute nephritis, metal poisoning, complete obstruction of urinary tract
40
color of urine
-pale- diabetes insipidus, dilute -milky- fat globules, pus in GU infections -reddish- blood pigments, drugs, food pigments -greenish- bile pigments, jaundice -brown-black- poisoning, hemorrhage
41
transparency: urine
-clear- normal -cloud on standing- precipitation of mucin from urinary tract (Not pathologic) -turbid- precipitation of calcium phosphate (not pathologic) abnormal: -milky- presence of fat globules -turbid- presence of pus due to inflammation of urinary tract
42
odor
-pleasant (sweet)- acetone- diabetes mellitus -unpleasant- decomposition or ingestion of certain drugs or foods -peppermint- menthol ingestion -acrid- asparagus diet -spicy- ingestion of sandalwood oil or saffron
43
proteinuria
-albumin- altered renal function (renal pathology or systemic disease like diabetes) -globulin- Bence-Jones proteins* (M spike) assoc with multiple myeloma and disease of globulin metabolism -> other types of globulins may be present in acute and chronic pyelonephritis
44
specific gravity
-specific gravity is proportional to volume -low (chronic)- dilution if volume is large -> otherwise nephritis -high (Chronic)- acute nephritis concentrated if volume is small -> otherwise light colored and volume large -> diabetes mellitus
45
acidity
-high- acidosis, diabetes mellitus, fevers, starvation -alkaline- vegetarian diet changes urea into ammonium carbonate, infection or ingestion of alkaline compounds
46
approach to pt with red brown urine flow chart
47
urinaylsis results
-ketones can be high with keto diet -blood also consider tumor
48
urinary casts
-broad or waxy cast- chronic renal failure -WBC cast- interstitial nephritis / pyelonephritis -renal tubular epithelial cell cast- acute tubular necrosis (ATN) -RBC cast- glomerulonephritis -hyaline cast- exercise, diuretics, concentrated urine -granular cast- chronic renal failure, muddy brown = ATN -fatty cast- (oval fat bodies) nephrotic syndrome
49
where you feel pain with stone
-connect to bladder -psoas muscle -exiting the kidney
50
calcium stones
-composed of calcium compounds -calcium oxalate- MC -calcium phosphate -can be caused by high calcium -> hyperparathyroidism -high oxalate can also cause increased risk for calcium stones
51
uric acid stones
-formed due to low urine output -excessive intake of proteins especially red meat, alcohol, inflammatory bowel disease, gout -not visible in plain x-ray** -> US of kidney -dont r/o if you dont see on x-ray!
52
struvite
-associated with urinary infection -can grow very rapidly forming cast in urinary tract (staghorn calculus) -left untreated -> chronic infection and permanent kidney damage
53
cystine stone
-occur due to inherited defect in amino acid transport -manifests as recurrent stones in young pts
54
stone tx
-lithotripsy -hydration -drink alkaline (change environment)- cranberry juice -antibiotics for infection -cystine stone- specialist -try to collect stone for identification
55
crystals
-precursor to stone formation -can be found in urinalysis
56
-41 male -longstanding hx of HTN and diabetes -pruritus, lethargy, lower extremity edema -nausea and emesis- acute process -AV nicking and copper wire changes -180/110 bp -tachypnea but no tachycardic -no fever -2+ lower extremity edema and superficial excoriation of his skin from scratching -moderate distress- acute -S1,S2,S4
-potassium- high (vomiting, fluid in legs) -CO2- low -BUN- very high -creatinine- very high -creatinine, BUN, and K are high -> nausea and itching -10:1 ratio -alkaline phosphatase- high -parathyroid hormone- very high -Hmg- low -Hct- low -mean cell volume- normocytic anemia -specific gravity- 1.010- dilute -waxy casts- chronic renal failure -pH 6 -urine- proteinuria -creatinine clearance- 6.5 -stage 5 renal failure -dialysis asap
57
diabetes
-microvascular damage -anywhere -nephropathy -peripheral neuropathy -eyes
58
A 14-year-old boy is brought to the pediatrician by his mother because he has had a fever with shaking chills for the past day. On physical examination, he has a temperature of 39.6 C and has mild right costovertebral angle tenderness.
do this case
59
know what causes pH changes in urine

Clin Lab (14 decks)

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