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37 Cards in this Set

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