Renal Labs 2 Schoenwald

Question 1

If free water is increased, what happens to the sodium?

Answer 1

It is diluted and levels decrease (less concentrated)

Question 2

If free water is decreased, what happens to the sodium?

Answer 2

It is concentrated and levels increase (more concentrated)

Question 3

What is osmolality?

Answer 3

Measures the amt of dissolved particles in the blood to determine hydration status

Question 4

Osmolality _______ with overhydration and ________ with dehydration

Answer 4

decreases, increases

Question 5

What is the purpose of ADH?

Answer 5

It regulates body water and osmolality so when there is an increased osmolality = dehydration = ADH stimulated so we hold onto water

Question 6

What is SIADH?

Answer 6

Syndrome of inappropriate ADH

-This causes the body to retain too much water and leads to decreased serum sodium

Question 7

What is diabetes insipidus?

Answer 7

Opposite of SIADH
-Inadequate amt of ADH present so symptoms are increased passage of large volumes of dilute urine leading to hypernatremia

Question 8

SIADH causes sodium levels to ______ whereas diabetes insipidus causes sodium levels to ________

Answer 8

decrease, increase

Question 9

This evaluates the ability of the kidney to concentrate urine and is more accurate than specific gravity

Answer 9

urine osmolality

Question 10

What is urine osmolality?

Answer 10

Basically the amount of particles concentrated in the urine

Question 11

Urine osmolality is increased in what two conditions?

Answer 11

• SIADH

- CHF

Question 12

Urine osmolality is decreased in what two conditions?

Answer 12

• Diabetes insipidus

- Excess fluid intake

Question 13

What are two types of hyponatremia?

Answer 13

• Sodium depletion (free water loss)

- Water intake > water output- renal failure

Question 14

Hyponatremia causes what three symptoms?

Answer 14

Muscle cramps, nausea, lethargy

-Cerebral edema b/c not enough sodium to keep water in its space

Question 15

Symptoms of hypernatremia are…

Answer 15

dehydration

Question 16

To test sodium levels, what test do we use?

Answer 16

24 hour urine or spot testing

Question 17

Once you determine hyponatremia from a urine test, what is the next step?

Answer 17

Order a serum osmolality to tell tonicity status of hyponatremia

Question 18

What are some causes of hypovolemic hyponatremia <10?

Answer 18

• Dehydration
• Diarrhea
• Vomiting

Question 19

What are some causes of hypovolemic hyponatremia <20?

Answer 19

Renal salt loss

Question 20

What are some causes of euvolemic hyponatremia?

Answer 20

SIADH and postop hyponatremia

Question 21

What are some causes of hypervolemic hyponatremia?

Answer 21

= edema

• CHF
• Advanced renal failure
• Liver disease

Question 22

Sodium is primairly a _______ cation

Answer 22

circulating (extracellular space)

Question 23

Potassium is primarily an _______ cation

Answer 23

intracellular

Question 24

As sodium is reabsorbed, _____ is lost

Answer 24

potassium

Question 25

When you are on furosemide and lasix, what else should you supplement with?

Answer 25

K+ because you pee out K+ when taking these meds

Question 26

EKG findings of this include flattened or inverted T waves

Answer 26

Hypokalemia

Question 27

EKG findings of this include peaked T waves

Answer 27

Hyperkalemia

Question 28

Hyperkalemia is associated with what two things?

Answer 28

Renal failure and acidosis

Question 29

Symptoms of this cause malaise, skeletal mm weakness and arythmias

Answer 29

Hypokalemia

Question 30

Symptoms of this cause arrythmias and cardiac arrest, numbness, tingling and weakness

Answer 30

Hyperkalemia

Question 31

This is the most abundant extracellular anion

Answer 31

Chloride

Question 32

Chloride is regulated by the renal proximal tubules and exchanged for ______ ions

Answer 32

bicarb

Question 33

If Na increases, what happens to the Cl?

Answer 33

It also increases

Question 34

This is a condition in which there is a rapid deterioration of kidney function and accumulation of nitrogenous wastes?

Answer 34

Acute renal failure

Question 35

Is Acute renal failure reversible?

Answer 35

Yes

Question 36

Symptoms of this disease include nausea, vomiting, AMS and edema

Answer 36

Acute renal failure

Question 37

Causes of prerenal ARF?

Answer 37

- **CHF - Hypovolemia - Hypotension - Renal artery stenosis

Question 38

Causes of renal ARF?

Answer 38

- nephrotoxins | - autoimmune diseases

Question 39

Causes of postrenal ARF?

Answer 39

-Obstruction

Question 40

ARF is an increase in serum Cr by ____5 over baseline levels

Answer 40

50%

Question 41

The RIFLE classification is used to stratify the severity of acute kidney injury. What does it stand for?

Answer 41

``` Risk Injury Failure Loss End stage ```

Question 42

What is the RIF in the RIFLE criteria and what happens to the Creat or GFR?

Answer 42

- Risk = inc Cr 1.5x or GFR > 25% decrease from baseline - Injury = inc Cr 2.0x or GFR > 50% decrease from baseline - Failure = inc Cr 3.0x or Cr >4 with acute increase >0.5 or GFR > 75% decrease from baseline

Question 43

What stage CKD is this? | Kidney damage with normal GFR >90 mls/min

Answer 43

Stage 1

Question 44

What stage CKD is this? | Kidney damage with mild decrease in GFR 60-89 mls/min

Answer 44

Stage 2

Question 45

What stage CKD is this? | Moderate decrease GFR 30-59 mls/min

Answer 45

Stage 3

Question 46

A BUN/Cr ratio of <15:1 = renal or prerenal cause?

Answer 46

renal

Question 47

A BUN/Cr ratio of >20:1 = renal or prerenal cause?

Answer 47

prerenal cause

Question 48

What are the two mc causes of chronic renal failure?

Answer 48

DM and HTN

Question 49

CO2 = acid- regulated by the ____

Answer 49

lungs

Question 50

Bicarb= base- regulated by the ______

Answer 50

kidneys