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37 Cards in this Set
- Front
- Back
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ADH causes water retention in response to what 2 stimuli?
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1. hypovolemia
2. hyperosmolarity |
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ADH regulates the concentration of what ion?
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Na
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Aldosterone causes retention of what?
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Na (water retention is secondary to Na retention)
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What 2 things will stimulate aldosterone?
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1. hypovolemia
2. hyperkalemia |
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By what mechanism does aldosterone act?
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JG cells --> renin --> Angiotensinogen II --> aldosterone -->opening of Na Ch (bringing Na in) and K Ch (pushing K out) in the principal cell and pulling HCO3 in and pushing H out of the intercalated cell
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Hyponatremia is associated with what 3 general brain-related causes?
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1. Unhappy PVN (carotid body --> pvn: CHF, cirrhosis, nephrotic sxme
2. Polydipsia 3. SIADH (antidep, antipsych) |
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Hyponatremia + hyperosmolarity
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Glucose, contrast, or mannitol in blood
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Hyponatremia + normal plasma osmolarity
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"pseudohyponatremia"
presence of lipids or multiple myeloma |
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Hyponatremia + hypoOsmolarity:
Check what next? |
Volume status
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Hyponatremia, low plamsa osmolarity, euvolemia
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1. Polydipsia
2. SIADH -antipsych, antidep, thiazides -pulm dz 3. hypothyroid 4. adrenal insuf 5. osmol reset (pregnancy) |
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Why is it dangerous to correct hyponatremia too quickly?
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Central pontine myelinosis
1. dysarthria 2. dysphagia 3. flaccid paralysis |
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The AEIOU absolute indications for dialysis
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Acidosis_Electrolyte imbalance (severe hyperkalemia)_Intox (menthol, ethylene glycol, lithium, aspirin)_ Overload (hypervolemia)_Uremia (uremic pericarditis, lethargy)
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Urine osm, Na, FeNa, and sediment in PRERENAL failure
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high osm (>500), low Na (<20), low FeNa (<1%), hyaline casts
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Urine osm, Na, FeNa, sediment in ATN
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low osm (<350), high Na (>40), high FeNa (>2%), brownish, granular casts
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Hepatorenal sxme
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End-stage liver dz: renal failure in liver sz 2/2 hypoperfusion; azotemia, oliguria, hyponatremia, hypotension, low urine Na (fatal w/o liver txplnt)
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Glomerular dz has what kind of casts?
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RBC casts
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Fatty casts indicate what?
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Nephrotic sxme, look like maltese cross
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In ARF, tx metab acidosis with...
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Sodium bicarb
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Explain hypocalcemia in ARF
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can't activate Vit D, PTH resistance --> hyperphosphatemia
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GFR severity
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GFR < 30 = severe, ESRD = gfr<10
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What is azotemia?
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elevation of BUN
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Explain hypocalcemia in CRF
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dec clearance of phos --> hyperphosphatemia --> dec Vit D --> hypoCa--> 2ndary hyperPTH --> renal osteodystrophy (bone pain, fx)
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ACEi can cause hyper or hypo kalemia?
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HyperK
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3 features of nephrotic sxme
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1. hyperlipidemia
2. hypoalbuminemia 3. proteinuria |
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Why use ACEi in nephrotic sxme?
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They decrease urinary albumin loss.
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Recurrent asx hematuria, esp in young men?
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IgA nephropathy (Berger's dz) - gross hemature after URI or exercise is common
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Renal tubular acidosis
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1. non-anion gap acidosis (hyperCl)
2. urine alkalosis |
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distal renal tubular acidosis
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can't secrete H into urine, so H goes into 1. blood (metab acidosis), increased excretion of ions --> hypokalemia, renal stones (inc ca exretion into alkaline urine)
2. ass'd with congenital, mult myeloma, Sjogrens, analgesic 3. Tx --> bicarb |
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proximal renal tubular acidosis
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can't reabsorb bicarb--> metab acidosis - caused by Fanconi's, Wilson's, amyloidosis
TX = Na restriction |
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renal tubular acidosis ass'd with hypoaldosteronism
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results in hyperkalemia, acid urine, non-gap acidosis
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3 signs of Nephritic Sxme
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1. hematuria
2. azotemia 3. HTN |
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renal artery stenosis in a young person
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fibromuscular dysplasia
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Ca kidney stones
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bipyramidal, visible, limit Ca intake
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Uric acid stones
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flat, hyperuricemia, gout, can't be seen, limit protein intake
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struvite stones (staghorn)
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visible, ass'd with urease bugs (klebsieslla, proteus, enterobacter, serratia)
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cystine stones
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genetic, hexagon shaped, poorly visualized
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Why are thiazides good for kidney stones?
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these drugs decrease urinary Ca and lower Ca kidney stone recurrence
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