Test 2 lab med lectures 5 and 6

waste product of creatine and phosphocreatine metabolism (in muscle tissue); proportional to muscle ass and excreted daily by the kidneys

what is serum ceatine

- endocrine

- kidney function

- electrolytes

- blood gas/PH

what does a BMP test for

electrolyes

what is the important factor in a BMP that is essential for being healthy

BMP and liver function panel

what is a CMP lab

- <50

- >450

what are the critical glucose levels for a male

- <40

- >450

what are the critical glucose levels for a female

true

T/F: eGFR is not directly calculated from BUN. BUN levels often change in parallel with creatine

skeletal muscles

where is creatine produced

serum creatine

Increase in ______ by less than or equal to 0.3 mg/dl with 48 hours or grater than or equal to 50% in 7 days is considered a kidney injury

urine output

decrease in ________ less than 0.5 mL/kg/hour for greater than 6 hours is considered a kidney issue

acute tubular necrosis

what is the most common cause of acute kidney injury

ischemic ATN

what is the most common cause of acute tubular necrosis

- due to poor blood flow

- kidneys dont get enough oxygen so tubules get damages

what is Ischemic ATN

nephrotoxic ATN

what is the 2nd most common cause of acute tubular necrosis

toxic substances like: drugs, myoglobin, hemoglobin

what causes nephrotoxic ATN

- tubular cells die and slough off-> block the tubules

- filtration is impaired -> waste builds up in the blood

what happens with acute kidney injury

- low urine output (oliguria) or sometimes normal

- rising serum Cr and BUN

- electrolyte imbalance

what are symptoms of acute kidney injury

- prerenal

- intrarenal

- postrenal

where are the three location acute renal failure can occur

decrease blood flow

what will cause pre renal issues

-CHF

- shock

- dehydration

- vomiting, diarrhea with dehydration

- ACE/ARB, NSAIDS

what will lead to pre- renal injury

- high bun:CR. 20:1

- low Urine Na+, <20 mmol/L

what does bun and unrine levels look like with pre- renal

intrinsic kidney damage

what can lead to renal damage

- glomerulonephritis

- pyelonephritis

- interstitial nephritis

- rhabdomyolysis

- DM

- nephrotoxic drugs

- anabolic steriods

- ATN

what are some causes of renal damage

- Normal Bun:Cr 10-15:1

- High Urine Na+, >40 mmol/L

what does bun and unrine levels look like with intrarenal

obstruction preventing micturition

what leads to post renal issues

- prostate

- nephrolithiasis

- bladder outlet obstruction

- neurogenic bladder

- tumor

what causes post renal issues

variable Bun:Cr

what does the bun and unrine levels look like with post renal

increase, more cr produced from muscle metabolism

what is increased muscle mass going to do to Serum C and why

increase (transient) muscle break down temporarily raises Cr

what is intense exercise going to do to Serum C and why

increase (slightly) creatine like substances absorbed from diet

what is high protein or cooked meat intake going to do to Serum C and why

decrease, increased GFR (more blood filtered) clears cr more rapidly

what is pregnancy going to do to Serum C and why

decrease or normal, lower muscle mass= less Cr production

what is aging going to do to Serum C and why

- acute kidney injury

- chronic kidney disease

- rhabdomyolysis

- urinary tract infection

- heart failure or hypovolemia

- Nephrotoxic drugs

- glomerulonephritis

what are some diseases that increase Serum Cr

eGFR <60mL/min for 3 + months

why does chronic kidney disease increase Serum Cr

- muscle wasting

- liver disease

- overhydration

what diseases can decrease serum Cr

- increase or decrease frequency of micturition, urgency, nocturia, incontinence

- weak stream, strain void

- clank pain with gross hematuria

- microscopic hematuria and/or proteinuria on urinalysis

what are some urinary symptoms that you should measure your creatine levels

- Chronic kidney disease

- DM

- hypertension

- autoimmune that affects kidneys

- any chronic condition that requires the use of chronic medication

what are some chronic reasons to measure your creatine levels

assess volume state

in hyponatremia what do you first want to do

- diuretics

- GI loss

- 3rd spacing burns

- adrenal insufficiency

what are some things that can cause hypovolemic

- SIADH

- hypothyroidism

- adrenal insufficiency

- psychogenic polydipsia

- drugs

what are some things that can cause euvolemic

- heart failure

- cirrhosis

- Nephrotic syndrome

- advanced CKD

what are some things that can cause hypervolemic

freely filters across the glomerulus

where does creatine go in the blood

low creatine

will creatine be low or high with someone with low muscle mass

- age

- gender

what are the biggest factors in estimating GFR

liver

where is BUN formed

an increase in BUN levels

what is azotemia

kidney and liver fxn

what is BUN:Cr used to assess

increases: decreases

BUN ---- with age and ---- with muscle mass

- dry mucous membrane

- thirsty

- agitation

- restlessness

- hyperflexia

- mania

- seizures

- come

what are symptoms of hypernatremia

arterial blood gas

what is the most accurate way to get a carbon dioxide level

- dietary inatke

- renal excretion

what is NA measured by in the body

- <120

- >160

what is the critical value of sodium

inverse of each other

what is the relationship btwn Cl and Co2

its just dissolved gas and is mostly HCO3-

why is a Co2 on a BMP inaccurate

- dehydration

- GI bleed

- CHF

- kidney disease

- hyperthyroidism

causes for a high BUN:Cr

- maintain electrical neutrality w sodium

- water balance

- buffer in acid base balance

what are the functions of Cl

excessive saline infusions

what can cause in increase in Cl levels

extra-cellular anion

which of the following describes Cl

prolonged tourniquet time

what can squew the results of a corrected ca level

- hypoparathyroidism

- low Vit D

- renal failure

- Mg def

- transfusion

- chemo

- drugs

what can be reasons for hypocalcemia

- hyperparathyroidism

- malignancy

- excessive Vit D

- thiazide diuretics

what can be reasons for hypercalcemia

- neuromuscular disease

- cardiac function

- bone metabolism

- Parathyroid fxn

- renal disease

what is calcium important for

- low protein

- advanced liver disease

- rhabdomyolysis

- kidney damage

- hypothyroidism

causes for a low BUN:Cr

kidneys

what is BUN excreted by

- dietary protein intake

- muscle mass

- pregnancy

what can affect BUN results

a product of protein metabolism and digestion that assess kidney function

what is BUN

high

will creatine be low or high with someone with high muscle mass

increases serum creatine by 0.3 mg/dl OR 50% in 48 hours

how much does acute kidney injury increase creatine by

low

would the GFR be low or high with a high muscle mass person

high meat diet

what can elevate serum creatine levels

kideny function

what does creatine assess

high

would the GFR be low or high with a low muscle mass person

- retention of urea

- dysregulation of extracellular volume and electrolytes

- mutliple etiologies can cause it

what can cause an abrupt decrease in renal function

- stress

- myocardial infarction

- caffeine

what can cause increase glucose levels

simple test that estimates how well your kidneys are filtering waste from the blood. it is mainly used to check kidney function

what is eGFR

decreases

bun levels rise when kidney function _____

low

if creatine is high usually mean GFR is _______

eGFR

what is calculated using serum creatine

product of digestion and protein metabolism, which takes place in the liver excreted by the kidney

what is bun

less

in chronic hypernatremia patients are --- likely to induce neurological symptoms

- dietary

- IV

what are causes are hypernatremia

- cushing syndrome

- hyperaldosteronism

what are causes are sodium loss

- weakness

- confusion

- lethargy

- stupor

- coma

what are some symptoms of hyponatremia

- dietary

- IV

what can cause hypothyroidism

syndrome of inappropriate or ectopic secretion

what is the most common cause of increase free body water in hyponatremia

- CHF

- Pleural effusion

what are some causes of increased free body water in hyponatremia

- <3

- >6.1

what is a critical value for K

- cardiac function

- maintenance of electrical potential

- heart rate

- contractility

what is potassium an important measure for

Potassium

what is a major cation in the intracellular space

Potassium

what cation DOES NOT get get reabsorbed by the kidneys

- aldosterone

- Na reabsorbtion

- Acid base balance

common factors affecting Potassium

alkolotic

what state lowers serum K levels (acidic or alkalotic?)

acidotic

what state increases serum K levels (acidic or alkalotic?)

- ascending muscle weakness

- paralysis

- cardiac arrhythmia

- peaked T waves on EKG

what are some symptoms of hyperkalemia

- renal failure

- addisons disease

- hypoaldosteroism

- acidosis

what are some causes for hyperkalemia

- beta blockers

- ACE inhibitors

what can be some medications that cause hyperkalemia

insulin administration pushed K and glucose into the cell

Diuretics

burns

GI

Hypoaldosteronism

what can be some causes of hypokalemia

amphotericin B

Barium intoxication

Chloroquine intoxication

antipysychotics

what medications cause hypokalemia