Renal - Theory

Action of aldosterone?

Action: Na retention, K excretion, water retention

Use of urinary anion gap?

It is a proxy for NH4 excretion, because NH4 is excreted with Cl

What does poitive UAG suggest?

Indicates LOW NH4 excretion → Metabolic acidosis/RTA

Acronym for drugs to stop in AKI?

DAMN: Diuretics, ACE/ARB, Metformin/Lithium (because levels ^) , NSAIDs

What receptor and where does aldosterone bind?

Binds mineralocorticoid receptor in principal cells

What does a high UCR suggest?

Suggests PRE-RENAL cause of AKI e.g. dehydration

Indication for the use of Cinacalcet in CKD?

Severe refractory secondary hyperparathyroidism. This drug increases receptor sensitivity to extracellular calcium.

Indication for the use of Alfacalcidol in CKD?

Indication: stage 4 & 5 CKD, with secondary hyperparathyroidism. When kidneys are unable to convert native D to it’s active form, Alfacalcidol is already converted.

What condition would these biopsy results indicate? Fibrosis, Kimmelstiel-Wilson nodules, Mesangial EXPANSION

Diabetic nephropathy

What is the use of calcium acetate?

It is a calcium-based binder used to treat hyperphosphataemia