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Flashcards covering laboratory terminology, chemistry panels, CKD and AKI pathophysiology, clinical presentations, treatment goals, dialysis, and key drug considerations for exam preparation.
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What is a "critical value" in laboratory testing?
A result significantly above or below the reference range that is associated with impending morbidity or mortality.
Define "reference range".
The range of normally accepted values for a given laboratory test.
What is a false-negative laboratory result?
A test result that incorrectly indicates a condition is absent.
What is a false-positive laboratory result?
A test result that incorrectly indicates the presence of a condition.
What does test "sensitivity" measure?
The ability of a test to correctly identify individuals who have a disease (true positives).
What does test "specificity" measure?
The ability of a test to correctly identify individuals who do not have the disease (true negatives).
Define positive predictive value (PPV).
The percentage of positive test results that truly indicate the presence of the condition.
Define negative predictive value (NPV).
The percentage of negative test results that truly indicate absence of the condition.
List the seven components of a Basic Metabolic Panel (BMP or "Chem-7").
Sodium, Potassium, Chloride, Bicarbonate (CO2), Blood Urea Nitrogen (BUN), Serum Creatinine (SCr), Blood Glucose.
What additional analyte is included in a Chem-8 panel that is not in a Chem-7?
Calcium.
Which three extra tests distinguish a Complete Metabolic Panel (CMP) from a Chem-8?
Albumin, additional Calcium report, and a hepatic (liver) panel.
Normal reference range for sodium (Na⁺).
135–145 mEq/L.
Normal reference range for potassium (K⁺).
3.5–5.0 mEq/L.
Normal reference range for chloride (Cl⁻).
97–110 mEq/L.
Normal reference range for bicarbonate/CO₂.
22–26 mEq/L.
Normal reference range for BUN.
8–20 mg/dL.
Normal reference range for serum creatinine (adult).
0.7–1.3 mg/dL.
Normal fasting blood glucose range.
65–109 mg/dL.
Normal magnesium range.
1.3–2.2 mEq/L.
Normal total calcium range.
8.6–10.3 mg/dL.
Normal ionized calcium range.
1.1–1.35 mmol/L.
Normal serum phosphate range.
2.5–4.5 mg/dL.
Three key pathophysiologic processes in chronic kidney disease (CKD).
Loss of nephrons, glomerular capillary hypertension (proteinuria), and progressive protein-mediated nephron injury.
Which hormone mediates intraglomerular hypertension in CKD?
Angiotensin II.
Give two susceptibility (correlative) risk factors for CKD per K/DOQI.
Any two of: advanced age, low birth weight/reduced kidney mass, family history, low income/education, dyslipidemia, systemic inflammation.
Name two initiation factors that directly cause kidney damage leading to CKD.
Any two: Diabetes mellitus, hypertension, glomerulonephritis, drug toxicity, urinary tract infection, urinary stones.
Name two progression factors that worsen existing CKD.
Any two: Hyperglycemia, uncontrolled hypertension, smoking, proteinuria, obesity.
What form of metabolic disturbance is common in advanced CKD?
Metabolic acidosis due to reduced ability to produce ammonia and excrete H⁺.
Why can CKD lead to hyperkalemia?
Loss of the kidney's ability to effectively excrete potassium; risk rises in advanced CKD and with K-raising drugs.
List four medications that can increase serum potassium.
ACE inhibitors, angiotensin-receptor blockers (ARBs), aldosterone antagonists, potassium-sparing diuretics (or K⁺ supplements).
Give two medications that can cause fluid retention and worsen edema in CKD.
Any two: Corticosteroids, NSAIDs, androgens/estrogens, thiazolidinediones, dihydropyridine calcium-channel blockers.
Primary goals of CKD therapy.
Delay progression of CKD and minimize complications.
Recommended dietary protein intake for CKD patients with GFR <30 mL/min (KDIGO).
≈0.8 g/kg/day.
KDIGO blood pressure goal for CKD patients if tolerated.
First-line antihypertensive classes to reduce proteinuria in CKD.
ACE inhibitors or ARBs.
When titrating ACEi/ARB in CKD, what makes you increase the dose even if BP is controlled?
Failure to reduce proteinuria by 30–50% from baseline.
Which calcium-channel blocker class can supplement ACEi/ARB to further reduce proteinuria?
Non-DHP CCBs (e.g., verapamil, diltiazem).
Two common complications of hemodialysis.
Any two: Hypotension, muscle cramps, nausea/vomiting, pruritus, headache, chest/back pain, thrombosis, infection.
Most common form of peritoneal dialysis.
Continuous ambulatory peritoneal dialysis (CAPD).
Define azotemia.
Elevation of nitrogenous waste products (e.g., BUN, SCr) in the blood.
Define uremia.
Clinical syndrome from azotemia marked by anorexia, nausea/vomiting, and altered mental status.
Urine output threshold for oliguria.
Urine output threshold for anuria.
Give the three broad etiologic categories of acute kidney injury (AKI).
Prerenal, intrinsic (intrinsic renal), and postrenal.
Key feature distinguishing prerenal AKI pathophysiology.
Decreased renal perfusion with otherwise undamaged renal tissue.
Most common structure damaged in intrinsic AKI.
Renal tubules (acute tubular necrosis).
Classic BUN:SCr ratio suggestive of prerenal AKI.
20:1.
Typical fractional excretion of sodium (FeNa) in prerenal AKI.
Name one drug class that can cause prerenal AKI by efferent arteriolar dilation.
ACE inhibitors or ARBs.
Why can NSAIDs precipitate prerenal AKI?
They block prostaglandin-mediated afferent arteriolar dilation, reducing renal blood flow.
Define the RIFLE acronym for AKI staging.
Risk, Injury, Failure, Loss, End-stage renal disease.
Two supportive (non-pharmacologic) measures to prevent AKI in high-risk patients receiving IV contrast.
IV isotonic saline hydration and use of antioxidants such as N-acetylcysteine or vitamin C.
List two interventions NOT recommended for AKI prevention.
Any two: Prophylactic renal replacement therapy, routine diuretics, dopamine, theophylline, erythropoiesis-stimulating agents, natriuretic peptides.
Four classic urgent indications for initiating renal replacement therapy in AKI.
Uremia (BUN >100 mg/dL), volume overload unresponsive to diuretics, life-threatening electrolyte imbalance (e.g., hyperkalemia), refractory metabolic acidosis, or encephalopathy (any four).
Standard bolus (intermittent) IV furosemide dosing for AKI patients needing diuresis.
40–80 mg IV every 6–12 hours or equivalent loop dose.
Continuous IV furosemide infusion starting rate.
10–20 mg/hour IV.
Formula most commonly used in adults to estimate creatinine clearance.
Cockcroft–Gault equation.
What physical exam finding often suggests postrenal AKI?
Distended bladder or enlarged prostate indicating urinary obstruction.