Nephrology Cumulative

Active form of vitamin D that helps regulate calcium homeostasis

Calcitriol

Hormone that stimulates production of RBCs

Erythropoietin

Net filtration pressure (NFP) = _____ mmHg

10

Best overall index of kidney function

GFR

Best indicator of GFR

Cystatin C

ADH insufficiency = _____

Diabetes insipidus

ADH excess = ______

SIADH

SIADH results in (hypernatremia/hyponatremia)

Hyponatremia

Diabetes insipidus results in (hypernatremia/hyponatremia)

Hypernatremia

The usual means of estimating GFR

Creatinine clearance

Normal BUN/Creatinine ratio

10:1

Creatinine clearance may (overestimate/underestimate) GFR

Overestimate

BUN may (overestimate/underestimate) GFR

Underestimate

What stage of CKD:

Kidney damage, protein in the urine, normal filtration rate

Stage 1

What stage of CKD:

GFR >90

Stage 1

What stage of CKD:

Kidney damage, a mild decrease in filtration rate

Stage 2

What stage of CKD:

GFR = 60-89

Stage 2

What stage of CKD:

Moderate decrease in filtration rate

Stage 3

What stage of CKD:

GFR = 30-59

Stage 3

What stage of CKD:

Severe decline in filtration rate

Stage 4

What stage of CKD:

GFR = 15-29

Stage 4

What stage of CKD:

Kidney failure

Stage 5

What stage of CKD:

GFR = <15

Stage 5

_____ is often the 1st indication of renal disease

Proteinuria

Ketones in the urine might be a false positive with _____

Fasting, post-exercise, pregnancy

Tamm-Horsfall mucoprotein

Benign excreted protein in urine

Dysmorphic RBCs in urine indicates ____

Glomerulonephritis

Round/normal RBCs in urine indicates _______

Disease along epithelial lining of tract

Presence of squamous epithelial cells in urine is indicative of ____

Contamination

Present of large numbers/clumps of transitional epithelial cells in urine is indicative of ______

Possible neoplasm

White cell casts in urine are indicative of ______

Pyelonephritis (also interstitial nephritis)

Red cell casts in urine are indicative of ______

Glomerulonephritis

Muddy, brown tubular cell casts in urine are indicative of _____

Acute tubular necrosis

Broad, waxy casts in urine are indicative of ______

CKD

Maltese cross = ______

Lipiduria seen with nephrotic syndrome

Major cellular osms

Na+ > glucose > urea

Exogenous osmoles

Mannitol, Ethylene glycol

Normal Osmolal Gap

+10 to -10

An osmolal gap > _____ is considered a critical value or cutoff

15

Major cation of extracellular fluid

Na+

Aldosterone (increases/decreases) Na+ and water

Increases

Aldosterone (increases/decreases) K+

Decreases

What type of hyponatremic state:

Total body water decreases, total body Na+ decreases to a greater extent, the extracellular fluid volume is decreased

Hypovolemic hyponatremia

What type of hyponatremic state:

TBW increases while total Na+ remains normal, the ECF volume is increased minimally to moderately but without the presence of edema

Euvolemic hyponatremia

What type of hyponatremic state:

Total body Na+ increases, and TBW increases to a greater extent, the ECG is increased markedly with the presence of edema

Hypervolemic hyponatremia

What type of hyponatremic state:

Water shifts from the intracellular to the extracellular compartment, with a resultant dilution of Na+, the TBW and total body Na+ are unchanged, this condition occurs with hyperglycemia or the administration of mannitol

Redistributive hyponatremia

What type of hyponatremic state:

The aqueous phase is diluted by excessive sugars, proteins or lipids. The TBW and total body Na+ are unchanged. This condition is seen with hypertriglyceridemia and multiple myeloma

Pseudohyponatremia

What type of hyponatremic state:

Caused by Early SIADH

Euvolemic hyponatremia

What type of hyponatremic state:

Caused by Polydipsia

Euvolemic hyponatremia

What type of hyponatremic state:

Caused by Diuretics

Euvolemic hyponatremia

What type of hyponatremic state:

Caused by hypothyroidism

Euvolemic hyponatremia

What type of hyponatremic state:

Caused by severe hyperglycemia (polyuria)

Euvolemic hyponatremia

When correcting the sodium in the setting of hyperglycemia: add _____ to the sodium for every 100 mg/dL increment the glucose is > 100

1.6

Lithium is associated with what electrolyte disorder?

SIADH

What type of hyponatremic state:

Dehydration with both sodium and water losses

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by loss of fluids (GI, burns)

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by hypotonic fluid replacement

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by thiazide diuretics

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by K+ depletion in cells

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by aldosterone deficiency

Hypovolemic hyponatremia

What type of hyponatremic state:

Caused by congestive heart failure

Hypervolemic hyponatremia

What type of hyponatremic state:

Caused by hepatic cirrhosis

Hypervolemic hyponatremia

What type of hyponatremic state:

Caused by Overhydration

Hypervolemic hyponatremia

What type of hyponatremic state:

Caused by nephrotic syndrome

Hypervolemic hyponatremia

What type of hyponatremic state:

Caused by renal failure

Hypervolemic hyponatremia

______ is the major defense against the development of hypernatremia

Thirst

MCC of hypernatremia

Hypovolemic hypernatremia

What type of hypernatremic state:

Caused by dehydration, vomiting or diarrhea

Hypovolemic hypernatremia

What type of hypernatremic state:

Caused by skin/stool/lung losses: insensible losses, ~500 cc/day is lost

Normovolemic hypernatremia

DM will cause (hypernatremia/hyponatremia)

Hyponatremia

What type of hypernatremic state:

Caused by hypertonic saline or sodium bicarb treatment

Hypervolemic hypernatremia

What type of hypernatremic state:

Caused by hyperaldosteronism & Cushing's syndrome

Hypervolemic hypernatremia

Diagnostic tests for diabetes insipidus

ADH level & Vasopressin challenge test

Tx of central DI

DDAVP

Tx for nephrogenic DI

HCTZ, indomethacin

Major intracellular cation

K+

Where in the kidneys in K+ reabsorbed?

Proximal tubules

Where does the aldosterone-Na/K+ exchange occur?

Cortical collecting duct

MCC of hypokalemia

Diuretics

What types of diuretics increases K+ loss?

Loop & Thiazide diuretics

Hyperkalemia is often associated with _____

Metabolic acidosis

Major extracellular anion

Cl-

Hyperchloremia parallels ______

Hypernatremia

Hypochloremia parallels ______

Hyponatremia

Hyperchloremia or Hypochloremia:

Caused by dehydration & hypertonic NaCl solution

Hyperchloremia

Hyperchloremia or Hypochloremia:

Caused by prolonged vomiting, metabolic alkalosis, and pyelonephritis

Hypochloremia

Avg anion gap

10

HARDUP

Normal anion gap metabolic acidosis

MUDPILES

High anion gap metabolic acidosis

MCC of normal anion gap metabolic acidosis

RTA, Diarrhea

Used to expand the ECFV because it stays mostly in the ECFV namely IVV

a. Isotonic

b. Hypotonic

c. Hypertonic

Isotonic

What IV solution is used to provide free water?

D5W

What IV fluid is given to dehydrated patients with a normal BP?

D5W

Daily requirement for H2O is ~_______ cc/day

2000-2500

It is customary to supply _____ mEq/day of Na+ and sodium chloride

50-100

Under normal circumstances, _____mEq/day of K+ is supplied in maintenance IV solutions

20-60

3 main buffer systems

1. Bicarb-carbonic acid buffer

2. Phosphate buffer

3. Protein buffer

Most important buffer system

Bicarbonate buffer system

The bicarbonate buffer is active in (ECF/ICF/both)

Both

The phosphate buffer is active in (ECF/ICF/both)

ICF