Renal Phys: blood concentrations and kidney diseases

increased ADH secretion leads to ____ with water and sodium causing ____

impaired water excretion so

water retention > sodium retention leading to hyponatremia

With hyponatremia, explain hypovolemic hyponatremia versus euvolemic hyponatremia versus hypervolemic hyponatremia

hypovolemic: sodium and water loss

euvolemic: pure water retention without significant sodium loss

hypervolemic: water retention exceeds sodium retention in edematous states

With hypernatremia, explain hypovolemic hypernatremia versus euvolemic hypernatremia versus hypervolemic hypernatremia

hypovolemic: water loss exceeds sodium loss (diarrhea)

euvolemic: pure water loss (diabetes or excessive sweating)

hypervolemic: sodium gain exceeds water gain

With hypernatremia, what does a high versus low urine osmolarity indicate?

high urine osmolarity: extrarenal; kidney not the cause

low urine osmolarity: indicates renal losses/ kidney is the cause

Would this cause hyper or hyponatremia?

excessive water loss like fever and burns, insufficient water intake due to impaired thirst or lack of access

hypernatremia

the water loss exceeds the sodium loss

Hypernatremia is generally the result of water loss exceeding sodium loss, however in rare cases it can be caused by sodium gain exceeding water gain

explain the causes

• hypertonic sodium admin

• mineralcorticoid excess

SIADH goes with what type of natremia?

hyponatremia

explain urine sodium levels and kidney involvment

high sodium in urine = renal issue

low sodium in urone = extrarenal losses or hypovolemia

What condition do we see ECG changes of peaked t waves?

hyperkalemia

What condition do we see ECG changes of flattened or inverted t waves and the presence of U waves?

hypokalemia

shift of K + from intracellular to extracellular:

shift of K + from extracellular to intracellular:

in to ex: hyperkalemia (more K + reabsorption)

ex to in hypokalemia (more K secretion/excretion)

explain membrane potential and calcemia levels

hypercalcemia: reduces membrane excitability

hypocalcemia: increases membrane excitability

Shortened QT interval goes with ___calcemia

prolonged QT interval goes with ____calcemia

shortened: hypercalcemia

prolonged: hypocalcemia

With what condition do we see muddy brown casts?

acute tubular necrosis (epithelial cell casts)

With acute tubular necrosis we see:

____kalemia, metabolic _____, and uremia

hyperkalemia and metabolic acidosis

What is the most common and second most ommon cause of CKD in developed countries?

1: diabetes mellitus

2: HTN

glomerular disease is another cause

is this acute kidney injury or chronic kidney disease?

elevates serum creatinine, decreased urine output (oliguria/anuria), fluid overload, hyperkalemia, metabolic acidosis, azotemia

AKI

is this acute kidney injury or chronic kidney disease?

hypertension (sodium retention, proteinuria), hypocalcemia, hyperphosphatemia, uremia, bone disease

CKD