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Renal System, A/B
Clinical Medicine
| Question | Answer |
|---|---|
| If intake is 3g last 2-3 days, what will output be next 2-3 days | 3g intake must equal output in water and electrolytes |
| What is TBW, ICF, ECF | 60%, I: 66% E: 33% (8% IVF or plasma and 25% in ISF) |
| What % is the blood of TBW | 12% |
| What is free water | comes as no expense to energy |
| Fxs of the kidneys | filtration, secretion, reabsorbtion, endocrine, metabolic |
| What are the metabolic fxns of the kidneys | activation of Vit D3, gluconeogenesis, metabolisms of insulin and steroids |
| What is crucial to remember as kidney fxn fails about kidney metabolism | for diabetics as renal fxn ↓ insulin ↑so ↓ need for insulin replacement |
| If a pt is on the same insulin dose, but their kidney fxn fails, why can they get hypoglycemic | ↓ insulin metabolism (stays in the body) |
| What secretes renin, fxn? | juxtaglomerular apparatus, powerful regulator of BP |
| What secretes erythropoietin, fxn | interstitial cells, RBC production |
| What happens with a clamp on the renal artery | ↑ BP d/t ↑ renin |
| Fxns of prostaglandins on the kidneys | vasodilation effect on the renal vasculature |
| What happens if we give NSAIDS in periods of vasoconstriction | kidney failure (prostaglandin inhibitors on the kidney) |
| What happens to blood w/ kidney failure | ↓ d/t ↓ EPO |
| What is nephrotic syndrome | d/t kidney damage, it leaks large amounts of protein from blood to urine, often see ↑ cholesterol, TGs, swelling (edema) |
| What is nephrictic syndrome | d/t kidney damage RBCs leak into urine: hematuria |
| Are proteins and protein bound compounds normally filtered? | no. |
| What normally passes through bowman’s capsule | water and small molecular wt. ions/molecules |
| What proteins are most commonly found with the nephrotic syndrome | albumin |
| Where does most of the secretion occur | proximal tubule (active transport) goes from plasma to tubular lumen |
| What blocks penicillin secretion | probenecid |
| What plays a high role in elimination of drugs | p-glycoprotein in proximal tubule |
| What blocks p-glycoprotein | verapamil and cyclosporine |
| How can we tx aspirin overdose (in part) | ↑ urine pH, minimizes reabsorption which ↑ elimination |
| Where does most of the reabsorption occur | DT and CDs |
| What is a sign of acute renal failure | ↑ creatining |
| What classifies subacute renal failure | weeks to months |
| Levels of CrCl for renal failure, irreversible? | R: <30, sometimes irreversible: <20 |
| How do we measure CrCl | 24 hr urine collection |
| Formulas to estimate CrCl | Crochroft-Gaul, MDRD Cystatin-C CKD-EPI |
| What is Iodothalmate | non-radioactive marker given 1st thing in the morning, measure blood and urine in afternoon, CrCl measurement |
| 5 ways to measure/estimate CrCl | CrCl 24 hr measure, Formulas, Iodothalmate, Inulin, Neutrophil gelatinase associated lipocalin |
| What is creatining based on | muscle mass |
| Nl creatning levels | .5-1.2 BUT depends on GFR, need to use Cockgroft-golt equation |
| Why doesn’t our creatning ↑ with age if our renal fxn ↓ | muscle mass usually decreases |
| Nl pH and PCO2 | 7.40-7.44, 40-44mmHg |
| Rule #1 for A/B | determine pH Alkalosis vs. acidosis (>7.44, <7.40) |
| What two A/B d/o can’t you have at the same time | can’t have a respiratory acidosis and alkalosis at the same time |
| PCO2 is substantially (+/-2) less than 40mmHg | respiratory alkalemia |
| If bicarb is greater than 25mEq/L | metabolic alkalemia |
| How can we compensate for a metabolic alkalemia | hypoventilate (stop breathing) |
| If PCO2 is >44mmHg | respiratory academia |
| If bicarb is less than 25 mEq/ L | metabolic academia |
| Look up some compensation stuff | |
| What is the anion gap | Na+-(bicarb+cl) |
| If an anion gap is >10mEq what does this mean | possible metabolic acidosis, for sure if >20mEq |
| What is nl range of anion gap | 7-20, <7 concerned about excess protein? But relate it to hx (given saline? Will ↓ gap) |
| What A/B do/o can’t happen together | Respiratory acidosis and alkalosis |
Created by:
becker15
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