Kidney

Question 1

Complete metabolic panel

Answer 1

secondary to the CBC in importance
The CMP measures a variety of different proteins and electrolytes, gives the status of renal and liver function, and is useful in monitoring numerous diseases, such as diabetes and hypertension

Question 2

Sodium CMP

Answer 2

normal range is 136-142 mEq/L

Question 3

Potassium CMP

Answer 3

Normal range is 3.5-5.0 mEq/L

Question 4

Glucose CMP

Answer 4

Normal Range is 70-110 mg/dL

Question 5

Creatinine CMP male

Answer 5

0.2-0.7 mg/dL

Question 6

Creatinine CMP female

Answer 6

0.3-0.9 mg/dL

Question 7

total Bilirubin CMP

Answer 7

0.3-1.2 mg/dL

Question 8

Where is sodium?

Answer 8

In the ECF

Question 9

Glucose is increased in

Answer 9

Diabetes
acute stress response
pancreatitis
certain diuretics
corticosteroid therapy

Question 10

Glucose is decreased in

Answer 10

insulinoma
insulin overdose
starvation
hypothyroidism

Question 11

GFR

Answer 11

= number of mL of body fluid cleared by the kidneys per unit of time
=mL/minute

Question 12

BUN

Answer 12

Blood urea nitrogen
Urea formation occurs primarily in the liver as a result of the catabolism of protein into amino acids → free ammonia is formed in process
BUN therefore reflects the metabolic functioning of the liver and excretory function of the kidneys

Question 13

BUN increased in

Answer 13

high protein diets
GI bleeding
Dehydration
Certain meds
Sepsis

Question 14

BUN decreased in

Answer 14

Primary liver disease/failure
Low protein diets
Overhydration

Question 15

Creatinine

Answer 15

byproduct of catabolism of creatine phosphate, which is involved in the contraction of skeletal muscles
Secreted by the kidneys at a constant rate (not metabolized or reabsorbed)
A Marker for Kidney function!

Question 16

Creatinine increased in

Answer 16

disorder of renal function
UT obstruction
Diabetic nephropathy
Rhabdomyolysis
Giagantism/acromegaly

Question 17

Creatine decreased in

Answer 17

Debilitation

Decreased muscle mass

Question 18

Where is Ca?`

Answer 18

more abundant in ECF than ICF and is involved in:
Muscle contraction
Cardiac function
Neural transmission
Clotting cascade

Question 19

Calcium forms

Answer 19

Protein- bound - mostly albumin, but also to alpha, beta 1&2, gamma globin

Complexed – w/ phosphate, citrate, bicarbonate, sulfate

Ionized- “Free” Calcium in its active form

Question 20

what regulates ca?

Answer 20

by parathyroid hormone (PTH), which is secreted by the parathyroid glands, which are located on the thyroid gland
As calcium levels decrease, PTH is released and calcium is reabsorbed by the kidneys, released from bone and absorption from GI tract is increased

Question 21

Elevated Ca warning

Answer 21

think Malignancy!
Bone mets
cancer can produce pth-like substances

Question 22

CA increased in

Answer 22

hyperparathyroidism
Vitamin D intoxication
TUMORS
acromegaly

Question 23

Ca decreased in

Answer 23

Hypoparathyroidism
Vitamin D deficiency
Hypoalbuminemia
Malabsorbtion

Question 24

Na regulation, plasma water Increases

Answer 24

Na and osmolality decreases –> ADH decreases –> water is not reabsorbed–> urination

Question 25

Na regulation, Plasma water decreases

Answer 25

Na and osmolality increases --> ADH increases --> collecting renal tubule absorbs more water

Question 26

Hypernaturemia

Answer 26

Usually, hypernatremia occurs in unreplaced water loss: elderly patients who have impaired mental faculties and may have diminished thirst stimulation Patients not given free access to water, given hypertonic saline solutions

Question 27

Hyponaturemia

Answer 27

can be due to diet, but it is rare Thiazide diuretics Renal insufficiency – impaired free water excretion, retention of ingested water

Question 28

Where is potassium

Answer 28

intracellular cation minor changes in serum potassium can have dramatic effects on that potential across cell membrane, especially in muscle cells Potassium is secreted, but not reabsorbed, by the kidneys

Question 29

Increased potassium

Answer 29

From increased intake (IV) From crush injuries, or infection acidotic states

Question 30

Decreased potassium

Answer 30

insufficient intake (IV) from fluid and electrolyte loss Alkylotic states- Diuretics

Question 31

Bilirubin

Answer 31

the spleen breaks down RBCs --> heme + globin molecules Heme--> biliverdin --> bilirubin Measures liver function

Question 32

conjugated bilirubin

Answer 32

Once in the liver, the bilirubin becomes conjugated with glycuronide to become conjugated bilirubin

Question 33

Total bilirubin

Answer 33

direct + indirect In order to determine the cause of the elevated bilirubin, we need to measure direct and indirect bilirubin as part of the total bilirubin Depending on where the defect occurs in the bilirubin pathway, either indirect (unconjugated) or direct (conjugated) hyperbilirubinemia can result

Question 34

indirect (unconjugated) hyperbilirubinemia

Answer 34

Can cause Jaundice Unconjugated bilirubin can pass BBB, and if levels on unconjugated bilirubin are too high, mental retardation and encephalopathy can result (>15 mg/dL is critical!) Caused by Hepatic dysfunction, any disease that increases RBC destruction, and medications Normal % unconjugated is 70-85%, if it is >85% then it is due to one of the ^ pathologies

Question 35

direct (conjugated) hyperbilirubinemia

Answer 35

``` Gallstones Obstruction of extrahepatic ducts by tumor or other cause Liver metastases (obstruction) Normal Conjugated is 15-30% it is obstructive if direct is >50% ```

Question 36

Hyperproteinemia

Answer 36

``` Dehydration → less water → increased concentration of proteins Malignancy (overproduction of immunoglobulins) Infection (overproduction of immunoglobulins) ```

Question 37

Hypoproteinemia

Answer 37

Hepatic failure or disease Malnutrition states Malabsorption states Renal failure or disease

Question 38

Alkaline Phosphatase

Answer 38

ALP functions in growth and development of bones, teeth and many other tissues → essential for bone mineralization Highest in liver, biliary tract and bone Functions better at higher pH important in detection of bone and liver cancers

Question 39

Alkaline phosphatase increase

Answer 39

in liver disorders: cirrhosis, biliary tract obstruction, liver tumors in bone disorders: cancers that have bone mets and primary bone cancers Also increased in growing children

Question 40

Aspartate Aminotransferase

Answer 40

AST an enzyme that is found in highly metabolic tissue within the body, such as heart, liver, skeletal muscle If damage occurs to any of these tissues, AST is released into the circulation and its level increases.

Question 41

AST elevation

Answer 41

``` Any disease that causes cellular injury to the liver will usually result in an elevation in the AST. AST elevated in: Liver disease, such as hepatitis Tumors involving the liver Infectious mononucleosis ```

Question 42

Alanine Aminotransferase

Answer 42

ALT In the jaundiced patient, elevation of the ALT points to the liver as the source instead of RBC hemolysis. ALT is found primarily in the liver If ALT increased think LIVER ABNORMALITY! – more specific for liver

Question 43

AST: ALT >1

Answer 43

alcoholic cirrhosis- frequently > 2 metastatic tumor of the liver. *Dont make an AST out of yourself (alcohol)

Question 44

AST:ALT

Answer 44

Acute/viral hepatitis | Mononucleosis

Question 45

Basic Metabolic panel

Answer 45

Chem7 Includes: 4 to 5 electrolytes: Sodium, Potassium, Calcium, Carbon Dioxide, Chloride 2 tests of kidney function: BUN and Creatinine 1 test of Glucose Does not include liver function tests

Question 46

BUN: Creatinine ratio

Answer 46

manually calculate this, but would not bother if neither BUN nor creatinine are elevated Tells you where the issue is that is resulting in an increase of nitrogen compounds in the blood- pre-renal, intrarenal or post-renal

Question 47

BUN: Creatinine > 20:1

Answer 47

It is a pre-renal issue volume depletion, sepsis, hypotension, CHF Could also be early disease state of a post-renal issue, like an obstruction, Nephrolithiasis, Prostatic Hyperplasia, Metastatic Disease

Question 48

BUN: Creatinine

Answer 48

It is an intra-renal issue Nephrosclerosis or Glomerulonephritis Could also be a late disease sate of a post-renal issue, like an obstruction, Nephrolithiasis, Prostatic Hyperplasia, Metastatic Disease

Question 49

Creatinine clearance calculation based off of 24 hour urine collection and serum creatine

Answer 49

urine creatine/plasma creatine x urine volume/time x 1.73/BSA

Question 50

Creatinine clearance based off of age

Answer 50

(140-age) x IBW or actual Weight / 72 x SCr