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IMS- Strand 12 > The U&E > Flashcards

The U&E Flashcards

(60 cards)

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1
Q

5 roles of the kidney

A

-Erythropoiesis
- Bone health
- Excretion of wastes/ drug metabolism
- Fluid and electrolytes balance
- Acid base balance

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2
Q

What does the U&Es measure

A

Sodium (Na)
Potassium (K)
Urea
Creatinine

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3
Q

Importance of sodium in the body

A
  • most abundant extracellular ion
  • Maintains body fluid component
  • Important for nerve conduction and muscle contraction
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4
Q

How is sodium balanced?

A

Intake through diet
Excretion (kidneys 95%, 5% sweat and faeces)

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5
Q

What is hypernatremia?

A
  • High sodium (>145mmol/L)
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6
Q

Causes & effects of hypernatremia

A
  • dehydration, excessive sodium intake, loss of free water
    Effects= cellular dehydration, neurological symptoms
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7
Q

What is hyponatremia?

A

Low sodium (<135mmol/L)

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8
Q

Causes & effects of hyponatremia

A

Excess water retention, renal sodium loss, SIADH
effects= cellular swelling, neurological symptoms

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9
Q

Sodium handling by the kidney

A

-sodium freely filtered in glomerulus
-65% absorbed in the proximal tubule
- None is reabsorbed in the thin descending limb
- Some minimal amount is reabsorbed in the thin ascending limb
- 25% reabsorbed in thick ascending limb
-5-10% reabsorbed in the distal convoluted tubule
- 2% reabsorbed in the collecting duct

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10
Q

Sodium handling- volume balance

A

Happens when you exercise
End result= increase thirst & blood volume

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11
Q

What is Angiotension II?

A

Responsible for thirst, stimulated the production of hormone aldosterone

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12
Q

What is Aldosterone?

A

Works on distal part and absorbs Na+

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13
Q

What is the importance of potassium in the body?

A
  • major intracellular cation, 98% of total potassium inside cells, critical for cellular function
  • maintains resting membrane potential
  • involved in protein synthesis and cellular metabolism
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14
Q

Potassium balance

A

Intake through diet
Excretion: kidneys 90%, 10% via the gastrointestinal tract and sweat

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15
Q

What is hyperkalmia?

A

High potassium (>5 mol/L)

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16
Q

What are the causes and effects of hyperkalmia?

A

Acute/ chronic kidney disease, hypoaldosteronism, acidosis, cell lysis
Effects= cardiac arrhythmias, muscle weakness, paralysis

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17
Q

What is hypokalaemia?

A

Low potassium (<3.5mmol/L)

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18
Q

What are the causes and effects of hypokalaemia?

A

Diuretics, vomiting/ diarrhoea, hyperaldosteronism, alkalosis
Effects= muscle weakness, arrhythmias

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19
Q

Filtration of potassium

A

Potassium is filtered from the body of the kidneys into the glomeruli

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20
Q

Potassium reabsorption

A

Most potassium is reabsorbed in the proximal tubule and loop of henle to avoid excessive loss of

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21
Q

Potassium secretion

A

Fine- tuning occurs in the distal tubule and collecting duct, where potassium is secreted or reabsorbed based on the body’s needs

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22
Q

Aldosterone regulation potassium

A

The hormone aldosterone increases potassium secretion in the distal tubule and collecting ducts when blood potassium levels are high

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23
Q

Acid- base balance potassium

A

Potassium balance is influenced by pH:
- Acidosis= potassium moves out of cells, increasing blood levels
- Alkalosis= potassium shifts into cells, lowering blood levels

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24
Q

Excretion potassium

A

Excess potassium is excreted in urine maintaining overall balance

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25
Potassium handling in the kidney
Glomerulus= potassium freely filtered from blood Proximal tubule= 65-70% passive absorption with sodium and water Loop of henle= 20-25% reabsorption via Na/K/2Cl cotransporters Distal tubule= minimal reabsorption site for initial regulation of potassium based on body needs Collecting duct= Aldosterone regulated secretion, minimal absorption when serum levels are low
26
What is urea?
Urea is a waste product formed in the liver from ammonia during protein metabolism
27
What is the role of urea?
Major nitrogenous waste excreted by the body
28
How is urea produced?
Synthesised in the liver through the urea cycle
29
How is urea excreted?
Eliminated by the kidneys in urine some reabsorbed for maintaining medullary osmotic gradient
30
Clinical relevance of urea?
- Elevated levels indicate kidney dysfunction, dehydration, reabsorption from bowel and certain medications - low level may occur in severe liver disease and malnutrition Normal levels= 2.5-7.1mmol/L
31
What is Creatinine?
Waste product from muscle metabolism Excreted by kidneys Marker of renal function
32
Production and excretion of creatinine
- produced at a constant rate, proportional to muscle mass - Freely filtered by glomeruli with minimal reabsorption
33
Normal range of Creatinine
Male: 62-115 Female: 53-97 Children: typically lower, depending on age and growth Variations depend on muscle mass, diet and hydration
34
Clinical importance of creatinine
Elevated creatinine= potential kidney dysfunction Used to estimate glomerular filtration rate
35
Limitations of creatinine
- affected by diet, muscle mass and medications - less sensitive in early kidney disease
36
What is Glomerular filtration rate (GFR)
The rate at which the kidneys filter blood to form filtrate in the glomeruli
37
What is the normal GFR?
90-120 mL/min in healthy adults
38
Importance of GFR
Indicator of kidney function Reduced GFR signifies kidney disease
39
What is estimate GFR?
A calculated estimate of GFR based on serum biomarkers like creatinine
40
Why eGFR?
Direct GFR measurement is complex and time consuming
41
What are the key differences between GFR & eGFR?
GFR - measured directly - accurate but impractical for routine use eGFR - estimate using equations - convenient and widely used but less precise
42
Insulin clearance method
1. Gold standard: insulin is filtered but not reabsorbed, secreted or metabolised 2. Procedure: infusion of insulin, measurement of urine and plasma levels 3. Limitation: expensive and impractical for routine clinical use
43
Key features of eGFR calculation
- developed for patients with chronic kidney disease - Variables: serum creatinine, age, sex, race Strengths: easy to use and widely applied Limitation: less accurate for GFR values
44
What is AKI?
Sudden decline in kidney function over hours to days Leads to accumulation of waste products and disruption of fluid/ electrolyte balance
45
Key features of AKI
Diagnostic marker: serum creatinine rise is used to detect AKI Urine output: reduced urine production may indicate AKI Stage 1-3 Complications: often reversible with treatment but need for renal replacement therapy can be required
46
What is CKD?
Long term progressive loss of kidney function Irreversible damage but progression can be slowed
47
Key features of CKD
- diagnostic markers: eGFR and protein leak level - stage 1-5 - Implications: anaemia, bone health, acid base imbalance etc - Need for renal replacement therapies at advanced stages
48
8 other roles of kidney
- calcium reabsorption - Activation of Vitamin D - Phosphate regulation - Bone health - excretion of H+ ions - reabsorption of bicarbonate - Ammonia production - overall function
49
Calcium reabsorption
Kidneys transport calcium from the filtrate, maintaining blood calcium levels
50
Activation of vitamin D
Kidneys convert inactive vitamin D into active form, essential for calcium absorption in the gut
51
Phosphate regulation
Kidneys excrete phosphate to maintain a balance with calcium preventing bone mineralisation disorders
52
Bone health
Regulating calcium, phosphate and vitamin D levels the kidney ensure proper bone strength
53
Excretion of H+ ions
The kidneys excrete into urine to remove excess acid from the body
54
Reabsorption of bicarbonate
Kidneys reabsorb filtered bicarbonate, key buffer that maintains blood pH
55
Ammonia production
Kidneys produce ammonia to bind H+, forming ammonium, excreted in urine
56
Overall function of kidneys
Maintain blood pH with narrow range
57
Why U&Es
-Assess kidney function - monitor fluid balance - diagnose and monitor diseases - guide treatment decisions - detect acute conditions - screening before procedures - routine monitoring in chronic diseases
58
Assess kidney function
Creatinine: marker of kidney filtration Urea: indicates protein metabolism and kidney excretion efficiency
59
Monitor fluid balance
- sodium= reflects hydration status and water- electrolyte balance - potassium= critical for maintaining cellular function and electrical activity
60
Diagnose and monitor diseases
Kidney diseases Dehydration Electrolyte imbalances

IMS- Strand 12 (4 decks)

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