Clin med 2: test 2
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Questions and Answers

What percentage of cardiac output is received by the kidneys?

  • 25-30%
  • 15-20%
  • 20-25% (correct)
  • 30-35%

    • What is the primary function of the distal tubule and collecting ducts in the nephron?

  • Reabsorption of essential nutrients
  • Secretion of hormones
  • Filtration of blood
  • Fine tuning of water and acid/base for homeostasis (correct)

    • What is the term for the sudden onset of kidney injury?

  • End-stage renal disease
  • Renal insufficiency
  • Acute kidney injury (correct)
  • Chronic kidney disease

    • Which of the following is a measure of the volume of blood filtered through the kidney per minute?

    <p>Glomerular filtration rate (GFR)</p> Signup and view all the answers

    What is the normal range of glomerular filtration rate (GFR) per day?

    <p>150-250 L/24hr</p> Signup and view all the answers

    What is the benefit of using cystatin C to estimate GFR?

    <p>It is less influenced by age, race, sex, body mass, diet, or drugs than creatinine</p> Signup and view all the answers

    What is the primary difference between a 24-hour urine and a spot urine test?

    <p>The 24-hour urine test measures creatinine clearance, while the spot urine test measures albumin excretion</p> Signup and view all the answers

    What is the term for the presence of protein in the urine?

    <p>Proteinuria</p> Signup and view all the answers

    What is the term for the abnormally high levels of waste products in the blood?

    <p>Uremic syndrome</p> Signup and view all the answers

    What is the location of the adrenal glands in relation to the kidneys?

    <p>On top of the kidneys</p> Signup and view all the answers

    What is the most likely cause of proteinuria exceeding 1-2 g/day?

    <p>Glomerular kidney disease</p> Signup and view all the answers

    What is the term for proteinuria caused by stressors such as acute illness, exercise, and orthostatic proteinuria?

    <p>Functional proteinuria</p> Signup and view all the answers

    What is the term for proteinuria resulting from faulty reabsorption of normally filtered proteins in the proximal tubule?

    <p>Tubular proteinuria</p> Signup and view all the answers

    What is the minimum number of RBCs per HPF required to consider hematuria clinically significant?

    <p>3</p> Signup and view all the answers

    What is the likely cause of hematuria in a patient with a history of anthracycline use?

    <p>Anthrocycline-induced hematuria</p> Signup and view all the answers

    What is the term for kidney injury caused by impaired perfusion?

    <p>Prerenal AKI</p> Signup and view all the answers

    What is the characteristic BUN:creatinine ratio in prerenal azotemia?

    <p>&gt;20:1</p> Signup and view all the answers

    What is the most common cause of AKI?

    <p>Prerenal causes</p> Signup and view all the answers

    What is the term for the sudden onset of kidney injury?

    <p>Acute kidney injury</p> Signup and view all the answers

    What percentage of AKI cases are due to renal causes?

    <p>10%</p> Signup and view all the answers

    What is the primary goal of treatment for prerenal AKI?

    <p>Return to euvolemia</p> Signup and view all the answers

    What is the most common cause of postrenal AKI?

    <p>Stone</p> Signup and view all the answers

    What is the primary difference between nephritic and nephrotic syndrome?

    <p>Level of proteinuria</p> Signup and view all the answers

    When should a patient with AKI be referred to a urologist?

    <p>If there are signs of urinary tract obstruction</p> Signup and view all the answers

    What is the most common cause of AKI in patients with COVID-19?

    <p>Acute tubular necrosis (ATN)</p> Signup and view all the answers

    What is the primary goal of treatment for COVID-19-related AKI?

    <p>Supportive care</p> Signup and view all the answers

    What is the term for the sudden increase in urinary output after relief of obstruction?

    <p>Postobstructive diuresis</p> Signup and view all the answers

    What is the benefit of bladder catheterization and ultrasonography in patients with suspected postrenal AKI?

    <p>To assess for urinary tract obstruction</p> Signup and view all the answers

    What is the term for the damage to the kidney tissue itself, including the tubules, interstitium, vasculature, and glomeruli?

    <p>Intrinsic renal AKI</p> Signup and view all the answers

    What is the primary reason for hospitalization in patients with AKI?

    <p>Sudden loss of kidney function</p> Signup and view all the answers

    What is the primary goal of the initial approach to kidney disease?

    <p>To assess the cause and severity of any abnormal renal function</p> Signup and view all the answers

    What is the characteristic of Acute Kidney Injury (AKI) that distinguishes it from Chronic Kidney Disease (CKD)?

    <p>Worsening of kidney function over hours to days</p> Signup and view all the answers

    What is the significance of oliguria in distinguishing between AKI and CKD?

    <p>Oliguria is only observed in AKI</p> Signup and view all the answers

    What is the primary purpose of examining urine within one hour of collection?

    <p>To prevent bacterial growth and contamination</p> Signup and view all the answers

    What is the significance of protein on dipstick examination?

    <p>It suggests underlying glomerular disease</p> Signup and view all the answers

    What is the characteristic of granular casts in urinary sediment?

    <p>They are a hallmark of acute tubular necrosis</p> Signup and view all the answers

    What is the definition of proteinuria?

    <p>Excessive protein excretion in the urine, generally greater than 150 mg/24 hours</p> Signup and view all the answers

    What is the significance of WBCs in urinary sediment?

    <p>It is a sign of pyelonephritis or interstitial nephritis</p> Signup and view all the answers

    What is a characteristic of chronic kidney disease (CKD) that makes it difficult to diagnose in its early stages?

    <p>Asymptomatic until near end-stage disease</p> Signup and view all the answers

    What is a major risk factor for the development of chronic kidney disease (CKD)?

    <p>All of the above</p> Signup and view all the answers

    What is a common manifestation of uremic syndrome?

    <p>Fatigue and anorexia</p> Signup and view all the answers

    Which of the following is a consequence of chronic kidney disease (CKD) leading to end-stage disease?

    <p>Destruction of nephrons</p> Signup and view all the answers

    What is a complication of chronic kidney disease (CKD) that may occur in patients taking insulin for diabetes?

    <p>Medication accumulation and toxicity</p> Signup and view all the answers

    What is a characteristic of chronic kidney disease (CKD) that distinguishes it from acute kidney injury (AKI)?

    <p>Progressive decline in kidney function</p> Signup and view all the answers

    What is a risk factor for cardiovascular disease (CVD) in patients with chronic kidney disease (CKD)?

    <p>Proteinuric CKD</p> Signup and view all the answers

    What is a consequence of the destruction of nephrons in chronic kidney disease (CKD)?

    <p>Compensatory hypertrophy and supranormal GFR</p> Signup and view all the answers

    What is the primary complication of CKD that tends to be progressive and salt-sensitive?

    <p>Hypertension</p> Signup and view all the answers

    What is the primary indicator of chronic scarring of advanced CKD on renal imaging?

    <p>Small, echogenic kidneys bilaterally</p> Signup and view all the answers

    What is the primary cause of death in patients with CKD?

    <p>Cardiovascular disease</p> Signup and view all the answers

    What is the primary treatment for anemia of chronic disease in pre-ESKD CKD?

    <p>Oral therapy with ferrous sulfate</p> Signup and view all the answers

    What is the primary mechanism of metabolic acidosis in CKD?

    <p>Decreased GFR</p> Signup and view all the answers

    What is the primary complication of CKD that contributes to vessel stiffness?

    <p>Hypertension</p> Signup and view all the answers

    What is the primary indication for hospitalization and nephrology consultation in patients with uremia?

    <p>Symptoms and signs of uremia</p> Signup and view all the answers

    What is the primary treatment for hyperkalemia in CKD?

    <p>Dietary potassium restriction</p> Signup and view all the answers

    What is the primary complication of CKD that contributes to fractures?

    <p>Metabolic bone disease</p> Signup and view all the answers

    What is the primary goal of treatment for CKD?

    <p>Monitor and correct reversible insults</p> Signup and view all the answers

    What is the primary goal of managing traditional CVD risk factors in patients with CKD?

    <p>To minimize the risk of cardiovascular disease</p> Signup and view all the answers

    In patients with advanced CKD, why may glycemic targets need to be relaxed?

    <p>Due to increased risk of hypoglycemia</p> Signup and view all the answers

    What is the reasonable daily sodium intake goal in patients with advanced CKD?

    <p>2 g/day</p> Signup and view all the answers

    At what level of GFR should potassium restriction be considered?

    <p>Below 10–20 mL/minute/1.73 m2</p> Signup and view all the answers

    What is the recommended daily fluid restriction in patients with CKD and volume overload?

    <p>2 L/day</p> Signup and view all the answers

    What is the recommended daily phosphorus intake in patients with CKD?

    <p>800-1000 mg/day</p> Signup and view all the answers

    When should a patient with CKD be referred to a nephrologist?

    <p>At stage 3-5 CKD</p> Signup and view all the answers

    What is the primary reason for hospital admission in patients with CKD?

    <p>Decompensation related to CKD</p> Signup and view all the answers

    What is the recommendation for metformin use in patients with CKD receiving iodinated contrast media?

    <p>Withhold metformin temporarily and restart after creatinine has been checked 48 hours after contrast</p> Signup and view all the answers

    What is the primary predictor of mortality in patients with CKD?

    <p>All of the above</p> Signup and view all the answers

    What percentage of patients with SLE develop lupus nephritis?

    <p>90%</p> Signup and view all the answers

    What is the recommended treatment for all patients with lupus nephritis?

    <p>Hydroxychloroquine</p> Signup and view all the answers

    What is the prognosis for patients with SLE who undergo dialysis?

    <p>Favorable</p> Signup and view all the answers

    What is the term for the pattern of injury seen in lupus nephritis?

    <p>Class I-VI</p> Signup and view all the answers

    What is the recommended therapy for patients with class III or IV lesions?

    <p>Immunosuppressive therapy</p> Signup and view all the answers

    What is the prognosis for patients with class VI lesions?

    <p>Poor</p> Signup and view all the answers

    What is the term for the pattern of injury seen in Goodpasture Syndrome?

    <p>RPGN</p> Signup and view all the answers

    What is the significance of serum complement levels in Goodpasture Syndrome?

    <p>Normal</p> Signup and view all the answers

    What percentage of patients with Goodpasture syndrome have circulating anti-GBM antibodies?

    <p>90%</p> Signup and view all the answers

    What is the primary goal of treatment in patients with Goodpasture syndrome?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a poor prognostic factor in patients with Goodpasture syndrome?

    <p>Requires dialysis at presentation</p> Signup and view all the answers

    What is the pathogenesis of ANCA-associated vasculitis?

    <p>Cytokine-primed neutrophils presenting cytoplasmic antigens on their surfaces</p> Signup and view all the answers

    What is a common symptom of ANCA-associated vasculitis?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of granulomatosis with polyangiitis?

    <p>All of the above</p> Signup and view all the answers

    What is a concerning sign in patients with ANCA-associated vasculitis?

    <p>Hemoptysis</p> Signup and view all the answers

    What is the term for a kidney disease characterized by inflammation and damage to the glomeruli?

    <p>Nephritic syndrome</p> Signup and view all the answers

    Which of the following is a characteristic of nephritic syndrome?

    <p>Red blood cells and red blood cell casts in the urine</p> Signup and view all the answers

    Which of the following is a primary cause of Focal Segmental Glomerulosclerosis (FSGS)?

    <p>Heritable abnormalities in podocyte proteins</p> Signup and view all the answers

    What is the characteristic pattern of injury seen on biopsy in IgA nephropathy?

    <p>Focal glomerulonephritis with mesangial proliferation</p> Signup and view all the answers

    What is the primary goal of treatment for post-infectious glomerulonephritis?

    <p>Supportive care</p> Signup and view all the answers

    Which of the following is a characteristic of Diabetic Nephropathy?

    <p>Diffuse glomerulosclerosis</p> Signup and view all the answers

    What is the primary treatment for HIV-associated nephropathy?

    <p>Antiretroviral therapy</p> Signup and view all the answers

    Which of the following is a characteristic of Minimal Change Disease?

    <p>Glomeruli appear normal on light microscopy</p> Signup and view all the answers

    What is the primary complication of Membranous Nephropathy?

    <p>Hypercoagulability</p> Signup and view all the answers

    Which of the following is a characteristic of Renal Amyloidosis?

    <p>Tissue deposition of abnormally folded protein</p> Signup and view all the answers

    What is the primary goal of treatment for IgA nephropathy?

    <p>ACE inhibitors or ARBs</p> Signup and view all the answers

    What is the primary mechanism of acute tubular necrosis?

    <p>Direct cellular toxicity from ischemia and toxins</p> Signup and view all the answers

    What is the characteristic urinary finding in acute tubular necrosis?

    <p>Muddy brown casts and granular casts</p> Signup and view all the answers

    What is the primary goal of treatment in acute tubular necrosis?

    <p>Removing the underlying cause and supporting kidney function</p> Signup and view all the answers

    What is the characteristic metabolic abnormality in acute tubular necrosis?

    <p>Metabolic acidosis</p> Signup and view all the answers

    What is the name of the phase characterized by a sharp increase in creatinine levels?

    <p>Initial phase</p> Signup and view all the answers

    What is the primary indication for dialysis in acute tubular necrosis?

    <p>Oliguria or anuria</p> Signup and view all the answers

    What is the term for the excessive urine output that occurs during the recovery phase of acute tubular necrosis?

    <p>Post-ATN diuresis</p> Signup and view all the answers

    What is the primary difference between the initial and maintenance phases of acute tubular necrosis?

    <p>GFR decrease and oliguria versus GFR stabilization and anuria</p> Signup and view all the answers

    What is the primary mechanism of injury in interstitial nephritis due to drug hypersensitivity reaction?

    <p>Release of cytokines and inflammatory mediators</p> Signup and view all the answers

    In analgesic nephropathy, which of the following is a common finding on CT scan?

    <p>Renal papillary necrosis</p> Signup and view all the answers

    What is the primary mechanism of injury in heavy metal toxicity?

    <p>Oxidative stress causing direct damage to proximal renal tubular cells</p> Signup and view all the answers

    What is the primary goal of treatment for interstitial nephritis?

    <p>Removal of the causative agent</p> Signup and view all the answers

    What is the primary complication of chronic kidney disease that may occur in patients taking insulin for diabetes?

    <p>Lactic acidosis</p> Signup and view all the answers

    What is the primary indicator of chronic scarring of advanced CKD on renal imaging?

    <p>Cortical thinning</p> Signup and view all the answers

    What is the primary cause of death in patients with CKD?

    <p>Cardiovascular disease</p> Signup and view all the answers

    What is the primary goal of treatment for PTRA?

    <p>Angioplasty to relieve stenosis</p> Signup and view all the answers

    What is the primary complication of sickle cell disease on the kidneys?

    <p>Papillary necrosis</p> Signup and view all the answers

    What is the primary reason for hospitalization in patients with AKI?

    <p>Electrolyte imbalance</p> Signup and view all the answers

    What is the likely cause of hypercalciuria and nephrolithiasis in patients with occupational exposures?

    <p>Cadmium toxicity</p> Signup and view all the answers

    What is the characteristic of urine culture in patients with renal tuberculosis?

    <p>Microscopic pyuria without bacterial growth</p> Signup and view all the answers

    What is the pathophysiological mechanism of lithium toxicity in the kidneys?

    <p>Lithium accumulates in the collecting tubular cells, causing injury</p> Signup and view all the answers

    What is the laboratory finding in patients with lead poisoning?

    <p>Glucosuria, aminoaciduria, and phosphaturia with decreased GFR</p> Signup and view all the answers

    What is the treatment goal for patients with chronic interstitial nephritis due to lead exposure and lithium use?

    <p>Remove the causative agents and manage symptoms</p> Signup and view all the answers

    What is the characteristic imaging finding in patients with lithium-related nephrotoxicity?

    <p>Normal-sized kidneys with multiple small cortical and medullary cysts</p> Signup and view all the answers

    What is the diagnostic criterion for lead poisoning?

    <p>Blood lead levels persistently &gt;60 mcg/dL</p> Signup and view all the answers

    What is the complication of untreated renal tuberculosis?

    <p>End-stage renal disease (ESRD)</p> Signup and view all the answers

    What is the primary mechanism of lead toxicity in the proximal tubules?

    <p>Injury to the proximal tubular cells through intranuclear inclusion bodies</p> Signup and view all the answers

    What is the primary goal of supportive care in patients with chronic interstitial nephritis?

    <p>Manage blood pressure and electrolyte imbalances</p> Signup and view all the answers

    What is the primary mechanism of kidney injury in cast nephropathy?

    <p>Toxic effects of monoclonal immunoglobulins</p> Signup and view all the answers

    What is the characteristic appearance of medullary sponge kidney on imaging?

    <p>Striated appearance of the distal collecting tubules</p> Signup and view all the answers

    What is the primary complication of medullary sponge kidney?

    <p>Nephrolithiasis</p> Signup and view all the answers

    What is the primary predictor of kidney function decline in patients with autosomal dominant polycystic kidney disease?

    <p>Total kidney volume</p> Signup and view all the answers

    Which of the following medications may be prescribed to help lower blood pressure and reduce proteinuria in patients with kidney disease?

    <p>Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)</p> Signup and view all the answers

    What is the typical presentation of a simple renal cyst?

    <p>Asymptomatic, incidentally found on imaging</p> Signup and view all the answers

    What is the percentage of patients with autosomal dominant polycystic kidney disease who will have kidney failure by age 70?

    <p>60%</p> Signup and view all the answers

    What is the characteristic of a simple renal cyst on ultrasound?

    <p>Echo-free, sharply demarcated, and an enhanced back wall</p> Signup and view all the answers

    What is the primary concern in a patient with a complex renal cyst?

    <p>Renal cell carcinoma</p> Signup and view all the answers

    What is the probable diagnosis for a patient presenting with abdominal or flank pain, hematuria, and a history of UTI and nephrolithiasis?

    <p>Autosomal dominant polycystic kidney disease</p> Signup and view all the answers

    What is the primary goal of treatment for medullary sponge kidney?

    <p>Supportive care and management of urinary tract infections and kidney stones</p> Signup and view all the answers

    What is the likely cause of impaired ability to concentrate or dilute urine in older patients?

    <p>Renal tubular changes</p> Signup and view all the answers

    What is the prognosis for patients with medullary sponge kidney?

    <p>Good, with preservation of most kidney function</p> Signup and view all the answers

    What is the benefit of using ACE inhibitors or ARBs in patients with autosomal dominant polycystic kidney disease?

    <p>To delay cyst growth and prevent hypertension</p> Signup and view all the answers

    What is the primary difference between cast nephropathy and medullary sponge kidney?

    <p>Mechanism of kidney injury</p> Signup and view all the answers

    What is the percentage of patients with autosomal dominant polycystic kidney disease who have associated cysts in the liver?

    <p>More than 50%</p> Signup and view all the answers

    What is the primary complication of cast nephropathy?

    <p>Fanconi syndrome</p> Signup and view all the answers

    What is the consequence of impaired renal clearance of medications in older patients?

    <p>Adverse drug interactions</p> Signup and view all the answers

    What is the diagnostic criterion for autosomal dominant polycystic kidney disease in patients under 30 years old?

    <p>2 or more cysts in patients under 30 years old</p> Signup and view all the answers

    What is the goal of treatment for patients with autosomal dominant polycystic kidney disease?

    <p>To delay cyst growth</p> Signup and view all the answers

    What is the primary cause of direct renal toxicity in Rhabdomyolysis?

    <p>Myoglobin</p> Signup and view all the answers

    What is the goal of treatment in Rhabdomyolysis?

    <p>To avoid AKI</p> Signup and view all the answers

    What is the most common cause of Renal Artery Stenosis?

    <p>Atherosclerosis</p> Signup and view all the answers

    What is the mechanism by which Renal Artery Stenosis leads to Chronic Kidney Disease?

    <p>All of the above</p> Signup and view all the answers

    What is the primary complication of Rhabdomyolysis?

    <p>Acute Kidney Injury</p> Signup and view all the answers

    What is the term for the syndrome of acute necrosis of skeletal muscle resulting in markedly elevated plasma creatine kinase levels and myoglobinuria?

    <p>Rhabdomyolysis</p> Signup and view all the answers

    What is the primary goal of medical management in Renal Artery Stenosis?

    <p>All of the above</p> Signup and view all the answers

    What is the term for the narrowing of the renal arteries, leading to reduced blood flow to the kidneys?

    <p>Renal Artery Stenosis</p> Signup and view all the answers

    What is the primary cause of Chronic Kidney Disease in Renal Artery Stenosis?

    <p>Ischemic nephropathy</p> Signup and view all the answers

    What is the term for the sudden reduction in kidney function, which can occur with ACE inhibitors or ARBs?

    <p>Acute Kidney Injury</p> Signup and view all the answers

    What is the preferred method of reversing hypokalemia in patients who are unable to tolerate oral supplementation?

    <p>IV potassium chloride</p> Signup and view all the answers

    What is the primary mechanism by which insulin and glucose treats hyperkalemia?

    <p>Shifts potassium from the extracellular to intracellular space</p> Signup and view all the answers

    What is the recommended dose of calcium gluconate for the treatment of hyperkalemia?

    <p>10 mL of 10% calcium gluconate over 2-10 minutes</p> Signup and view all the answers

    What is the most likely cause of hypomagnesemia in a patient with lithium therapy?

    <p>Lithium-induced nephrotoxicity</p> Signup and view all the answers

    What is the primary treatment for asymptomatic hypermagnesemia in patients with normal kidney function?

    <p>0.9% NaCl and loop diuretics</p> Signup and view all the answers

    What is the characteristic clinical presentation of severe hypophosphatemia?

    <p>Tissue hypoxia, coma, and respiratory failure</p> Signup and view all the answers

    What is the primary cause of hyperphosphatemia in patients with tumor lysis syndrome?

    <p>Increased phosphate release from tumor cells</p> Signup and view all the answers

    Why do we correct calcium levels for albumin?

    <p>Low serum albumin causes falsely low Ca++ levels</p> Signup and view all the answers

    What is the primary cause of hypocalcemia in patients with chronic kidney disease?

    <p>Hyperphosphatemia</p> Signup and view all the answers

    What is the primary complication of rapid calcium infusion?

    <p>Cardiac arrhythmias and asystole</p> Signup and view all the answers

    What is the primary reason for avoiding D5W in cases of increased intracranial pressure?

    <p>It can cross into cerebral cells, causing further ICP elevation</p> Signup and view all the answers

    What percentage of Total Body Fluids is distributed to the intracellular space?

    <p>60%</p> Signup and view all the answers

    What is the primary difference between Lactated Ringers and 0.9% NaCl?

    <p>LR has more potassium and calcium</p> Signup and view all the answers

    What is the primary goal of fluid resuscitation in cases of hemorrhagic or septic shock?

    <p>To restore organ perfusion and cardiac function</p> Signup and view all the answers

    What is the characteristic of colloid IV fluids that differentiates them from crystalloids?

    <p>They remain in the plasma and do not cross into the interstitial space</p> Signup and view all the answers

    What is the significance of 25% albumin in colloid IV fluids?

    <p>It causes 5x increased oncotic pressure</p> Signup and view all the answers

    What is the associated complication of dextran and Hetastarch in colloid IV fluids?

    <p>Coagulopathy and kidney impairment</p> Signup and view all the answers

    What is the characteristic of 0.9% NaCl or Lactated Ringers in crystalloid IV fluids?

    <p>25% remains in the intravascular space, 75% distributes into the interstitial space</p> Signup and view all the answers

    What is the primary electrolyte determinant of plasma osmolality?

    <p>Sodium</p> Signup and view all the answers

    What is the term for the effect of hypotonic fluids on blood cells?

    <p>Hemolysis</p> Signup and view all the answers

    What is the primary mechanism that maintains normal plasma concentrations of potassium?

    <p>Na+/K+ pump</p> Signup and view all the answers

    What is the preferred treatment for euvolemic hyponatremia?

    <p>Fluid restriction</p> Signup and view all the answers

    What is the term for the sudden onset of organ hypoperfusion due to intravascular volume depletion?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is the primary cause of hypernatremia?

    <p>Diabetes insipidus</p> Signup and view all the answers

    What is the term for the rapid correction of hyponatremia, which can lead to cerebral edema?

    <p>Osmotic demyelination</p> Signup and view all the answers

    What is the primary goal of treatment for hypovolemic hyponatremia?

    <p>Fluid resuscitation</p> Signup and view all the answers

    What is the term for the regulation of nerve and muscle function, as well as acid-base and water balance?

    <p>Electrolyte regulation</p> Signup and view all the answers

    What is the primary complication of correcting hypernatremia too rapidly?

    <p>Cerebral edema</p> Signup and view all the answers

    Study Notes

    Kidney Anatomy

    • Kidneys are retroperitoneal, cushioned by fat, and have adrenals resting on top of them
    • The right kidney is slightly lower than the left due to the liver's position

    Kidney Function

    • Kidneys receive 20-25% of cardiac output, approximately 1 liter per minute
    • Of this, 125ml/min filters into the Glomerular Filtration Rate (GFR)
    • Only 1.5 liters/day of the 173 liters/day of filtrate is excreted as urine, with 99% being reabsorbed
    • Distal tubule and collecting ducts handle fine-tuning of water and acid-base for homeostasis

    Renal Patients

    • Patients may be inpatient or outpatient, with symptoms ranging from none to highly symptomatic
    • Symptoms include dysuria, urgency, frequency, incontinence, nocturia, polyuria, oliguria, anuria, flank pain, hematuria, uremia, and azotemia
    • Findings include weight gain, hypertension, edema, mental status changes, ascites, muffled heart tones, and crackles

    Kidney Disease Classification

    • Acute kidney injury: sudden onset
    • Chronic kidney disease: long-lasting, caused by another condition (e.g., diabetes, hypertension)
    • Renal insufficiency: some lessening of kidney function (GFR impacted)
    • Renal failure: kidneys not working, requiring dialysis
    • End-stage renal disease

    Laboratory Studies

    • Glomerular filtration rate (GFR): the volume of blood filtered through the kidney per minute
    • Normal GFR: 150-250 L/24hr or 90-120 ml/min
    • GFR starts a slow annual decline after 30-35 years old
    • Decreased in patients with renal disease, with monitoring recommended in patients with chronic kidney disease (CKD)
    • Estimated via calculations using the CKD-EPI Equation

    Additional Laboratory Studies

    • Cystatin C: a protein produced by all nucleated cells, completely reabsorbed by the kidney at the proximal renal tubule
    • Elevated cystatin C levels indicate poor kidney function
    • Serum creatinine: a byproduct of the breakdown of creatine phosphate in muscle, removed in the kidneys via glomerular filtration
    • 24-hour urine: carefully collected urine over an exact 24-hour cycle, quantifying total protein excretion
    • Spot urine: a marker of urinary excretion of albumin, with normal levels being < 30mg/24hr urine sample

    Kidney Disease

    • Much kidney disease is asymptomatic and often discovered incidentally through tests for other conditions
    • Symptoms of kidney disease may include hypertension, edema, nausea, or hematuria, which can lead to a diagnosis of kidney disease
    • Initial approach to kidney disease involves assessing the cause and severity of any abnormal renal function

    Acute vs Chronic Kidney Disease

    • Kidney disease can be acute (Acute Kidney Injury, AKI) or chronic (Chronic Kidney Disease, CKD)
    • Acute Kidney Injury (AKI) is characterized by a rapid worsening of kidney function over hours to days, resulting in retention of waste products in the blood
    • Chronic Kidney Disease (CKD) is characterized by a gradual loss of kidney function over months to years
    • Determining AKI from CKD is important for diagnosis and treatment

    Evaluation of Urine

    • Urine collection involves clean catch or catheterization, and examination within one hour
    • Dipstick urinalysis involves testing for urinary pH, specific gravity, protein, hemoglobin, glucose, ketones, bilirubin, nitrites, and leukocyte esterase
    • Microscopy of centrifuged urinary sediment involves examining formed elements, such as crystals, cells, casts, and infectious organisms

    Proteinuria

    • Defined as excessive protein excretion in the urine, generally greater than 150 mg/24 hours in adults
    • Proteinuria can be due to glomerular disease, functional proteinuria, overload proteinuria, or tubular proteinuria
    • Glomerular proteinuria results from effacement of epithelial cell foot processes, leading to increased glomerular permeability and increased filtration of albumin

    Hematuria

    • Blood in the urine is considered clinically significant if >3 RBCs per HPF on at least 2 occasions
    • Hematuria can be due to renal or extrarenal causes, including glomerulonephritis, hereditary disorders, cysts, calculi, interstitial nephritis, and genitourinary neoplasms

    Causes of AKI

    • Categorized by anatomy: prerenal, renal, and postrenal causes
    • Prerenal causes include impaired perfusion, cardiac failure, sepsis, blood loss, dehydration, and vascular occlusion
    • Renal causes include glomerulonephritis, small-vessel vasculitis, acute tubular necrosis, drugs, toxins, and interstitial nephritis
    • Postrenal causes include urinary calculi, retroperitoneal fibrosis, benign prostatic enlargement, prostate cancer, cervical cancer, urethral stricture, and meatal stenosis/phimosis

    Prerenal AKI

    • Most common etiology of AKI, occurring in 40-80% of cases
    • Defined as a physiologic response to renal hypoperfusion
    • Reversible with restoration of renal blood flow, but can develop into intrinsic kidney injury if persists

    Postrenal AKI

    • Least common cause of AKI, occurring in 5-10% of cases
    • Defined as obstruction to urinary outflow from both kidneys or a single functioning kidney
    • Can occur due to obstruction at the level of the urethra, bladder, ureters, or renal pelvises

    Intrinsic Renal Causes of AKI

    • Corresponds to damage to the kidney tissue itself
    • Includes glomerular disorders, renal disorders, and nephritic vs nephrotic syndrome

    When to Refer and Admit

    • Refer to a nephrologist if AKI persists for 1-2 weeks or has a concerning degree of severity
    • Admit to the hospital if AKI is severe, requires acute intervention, or has abnormalities that cannot be handled expeditiously in an outpatient setting

    COVID-19 and AKI

    • 30% of patients hospitalized with COVID-19 and 50% of critically ill patients are affected by AKI
    • Associated with poorer prognosis
    • Most common cause of AKI in COVID-19 patients is acute tubular necrosis (ATN)

    Essentials of Diagnosis

    • Decline in GFR over months to years, with persistent proteinuria or abnormal renal morphology, and hypertension in most cases.
    • Bilateral small or echogenic kidneys on ultrasound in advanced disease.
    • Symptoms and signs of uremia when nearing end-stage disease.

    Chronic Kidney Disease (CKD)

    • Affects at least 10% of Americans.
    • CKD may be asymptomatic until it nears end-stage, with over 70% of late-stage cases due to diabetes mellitus or hypertension/cardiovascular disease.
    • Glomerulonephritis, cystic diseases, chronic tubulointerstitial diseases, and other renal diseases account for the remainder.
    • Progressive decline in kidney function occurs even if the cause of damage can be found and treated.
    • Destruction of nephrons leads to compensatory hypertrophy and supranormal GFR of the remaining nephrons.
    • Serum creatinine may remain relatively normal even in the face of significant loss of renal mass.
    • CKD is an independent risk factor for CVD, with proteinuric CKD conferring the highest risk.

    Signs and Symptoms

    • Stages 1-4 CKD are typically asymptomatic (>15% GFR).
    • Symptoms develop slowly and do not manifest until disease is far advanced (GFR < 5-10 mL/minute/1.73 m2).
    • Uremic syndrome results from the accumulation of metabolic waste products.
    • Symptoms of uremia may include fatigue, anorexia, nausea, and a metallic taste in the mouth.
    • Neurologic symptoms may include memory impairment, insomnia, restless legs, and twitching.
    • Generalized pruritus (without rash) may occur, as may decreased libido and menstrual irregularities.
    • Medications that are cleared by the kidneys will accumulate as kidney function worsens and may result in toxicity.

    Laboratory Findings

    • eGFR must be measured over time to monitor progression.
    • Anemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and metabolic acidosis are common complications of advanced CKD.
    • Urinary sediment may show broad waxy casts as a result of dilated, hypertrophic nephrons.
    • Any proteinuria must be monitored over time.
    • Higher urinary protein excretion is associated with more rapid progression of CKD and increased risk of cardiovascular mortality.

    Imaging Findings

    • Abnormalities on renal imaging (e.g., polycystic kidneys or a single kidney) are diagnostic of CKD, even when eGFR is normal.
    • Small, echogenic kidneys bilaterally (less than 9-10 cm) by ultrasonography indicate chronic scarring of advanced CKD.
    • Large kidneys can be seen with adult polycystic kidney disease, diabetic nephropathy, HIV-associated nephropathy, plasma cell myeloma, amyloidosis, and obstructive uropathy.

    Complications

    • Patients with CKD experience greater morbidity/mortality compared with the general population.
    • ~80% of patients with CKD die before reaching ESKD, primarily of CVD.
    • Hypertension is the most common complication of CKD, tending to be progressive and salt-sensitive.
    • A low-salt diet (2 g/day) is essential to control BP and avoid volume overload.
    • Diuretics are nearly always needed to help control HTN.
    • Thiazides work well in earlier CKD, while loop diuretics may be more effective when GFR < 30 mL/minute/1.73 m2.
    • Initial drug therapy for proteinuric patients should include ACE inhibitors or ARBs.
    • Complications result in increased cardiac workload due to hypertension, volume overload, and anemia.
    • May also have accelerated rates of atherosclerosis and vascular calcification, contributing to LVH and heart failure with preserved EF.

    CKD: Treatment

    • Aggressive control of diabetes is crucial in early CKD, but glycemic targets may need to be relaxed in advanced CKD due to increased risk of hypoglycemia.
    • Blood pressure control is vital to slow the progression of all forms of CKD.
    • In proteinuric patients, agents that block the renin-angiotensin-aldosterone system are important.
    • SGLT2 inhibitors can slow CKD progression, even in patients without diabetes.
    • Management of traditional CVD risk factors is vital, and risks for AKI should be minimized or avoided.

    CKD: Complications

    • Patients with CKD should be evaluated by a renal nutritionist.
    • Protein restriction is necessary, with a recommended intake of 0.6-0.8 g/kg/day to slow CKD progression.
    • Salt and water restriction are important, with a goal of 2 g/day of sodium and daily fluid restriction to 2 L if volume overload is present.
    • Potassium restriction is necessary once the GFR has fallen below 10-20 mL/minute/1.73 m2, and patients should limit their intake to less than 50-60 mEq/day.
    • Phosphorus restriction is necessary, with a goal of lowering elevated serum phosphorus levels toward normal in all stages of CKD; dietary phosphate restriction to 800-1000 mg/day is the first step.

    CKD: Complications (Drugs and Mortality)

    • Many drugs excreted by the kidney require dosage adjustments based on GFR.
    • The risk of lactic acidosis with metformin is due to both dose and eGFR, and it should be discontinued when eGFR < 50%.
    • Diabetes, advanced age, low serum albumin, lower SES, and inadequate dialysis are all significant predictors of mortality.

    CKD: Referral and Admission

    • Patients with stage 3-5 CKD should be referred to a nephrologist for management in conjunction with the PCP.
    • Patients with other forms of CKD, such as proteinuria greater than 1 g/day or polycystic kidney disease, should be referred to a nephrologist at earlier stages.
    • Admission should be considered for decompensation related to CKD, such as worsening of acid-base status, electrolyte abnormalities, and volume overload, that cannot be appropriately treated in the outpatient setting.

    IV Contrast in Patients on Metformin

    • The US FDA recommends withholding metformin temporarily in patients receiving iodinated contrast media if their GFR is between 30 and 60 mL/min/1.73 m2 and restarting after creatinine has been checked 48 hours after contrast.
    • The American College of Radiology (ACR) recommends that, for patients with eGFR ≥30 mL/min/1.73 m2, there is no need to discontinue metformin prior to the procedure.
    • For patients with eGFR ≤30 mL/min/1.73 m2, metformin should be withheld at the time of the contrast infusion and for 48 hours after the procedure, and renal function should be reassessed.

    Acute Kidney Injury and Chronic Kidney Disease

    • Acute Kidney Injury (AKI): sudden deterioration of renal function over days to weeks, leading to uremic symptoms and biochemical abnormalities, and can be life-threatening
    • Chronic Kidney Disease (CKD): long-standing and progressive impairment of kidney function over weeks to months, eventually leading to end-stage renal disease

    Nephritic and Nephrotic Syndromes

    • Nephritic syndrome: characterized by red blood cells, red blood cell casts, proteinuria, hypertension, and edema
    • Nephrotic syndrome: characterized by proteinuria > 3.5 g, fatty casts, and no white/red cells

    Primary Glomerular Diseases

    • Minimal Change Disease (MCD):

      • Most common cause of proteinuric kidney disease in children (~80%)
      • Often resolves with corticosteroid treatment
      • Can occur following viral upper respiratory infections, neoplasms, drugs, or hypersensitivity reactions

    • Focal Segmental Glomerulosclerosis (FSGS):

      • Can be primary or secondary to another underlying disease
      • Genetic testing is becoming more common, especially in children
      • Diagnosis requires kidney biopsy

    • Membranous Nephropathy:

      • Most common cause of primary adult nephrotic syndrome
      • "Spike and dome" pattern on kidney biopsy
      • Secondary causes include hepatitis B virus and cancer

    • Diabetic Nephropathy:

      • Most common cause of ESKD in the US
      • Develops about 10 years after onset of DM
      • Family history of kidney disease increases risk

    • HIV-Associated Nephropathy:

      • Presents with nephrotic syndrome and declining GFR in patients with active HIV infection
      • Associated with low CD4 counts and AIDS

    • Renal Amyloidosis:

      • Rare cause of nephrotic syndrome caused by tissue deposition of overproduced, abnormally folded protein
      • Diagnosis requires kidney biopsy

    • Glomerulonephritis:

      • Uncommon cause of AKI (~5% of cases)
      • Glomerular inflammation often incites a proliferative response

    • IgA Nephropathy:

      • Most common primary glomerular disease worldwide
      • Can be primary or secondary to cirrhosis, celiac disease, or infections
      • Classic presentation is an episode of gross hematuria associated with a mucosal viral infection

    • Post-Infectious Glomerulonephritis:

      • Symptoms occur during or after an infection
      • Characterized by glomerular injury during active or recent infection

    • Lupus Nephritis:

      • Occurs in 35-90% of patients with SLE
      • Presents within the nephritic spectrum
      • All patients with SLE should have routine UAs to monitor for hematuria or proteinuria

    • Goodpasture Syndrome:

      • May be preceded by an upper respiratory tract infection
      • Kidney findings are consistent with an RPGN
      • Serum complement levels are normal### Goodpasture Syndrome

    • Circulating anti-GBM antibodies are present in over 90% of patients

    • Kidney biopsy typically shows crescent formation with light microscopy

    • Patients with pulmonary hemorrhage and strong clinical suspicion of Goodpasture syndrome should be treated emergently, often prior to confirming the diagnosis

    • Treatment involves a combination of therapeutic plasma exchange and administration of corticosteroids and cyclophosphamide

    • Patients with oliguric AKI or requiring dialysis upon presentation have a poor prognosis

    ANCA-Associated Vasculitis (AAV)

    • Causes nephritic syndrome
    • Caused by granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss disease)
    • Can present as a kidney-limited disease without systemic vasculitis
    • Pathogenesis involves cytokine-primed neutrophils presenting cytoplasmic antigens on their surfaces
    • Renal involvement classically presents as RPGN, but more indolent presentations can be seen
    • Most cases are idiopathic, but some are linked to infection, environmental exposure, or drug exposure
    • Symptoms may include fever, malaise, weight loss, and upper or lower respiratory tract symptoms
    • Vasculitic involvement of dermal capillaries and nerve arterioles can result in purpura and mononeuritis multiplex
    • 90% of patients with granulomatosis with polyangiitis have upper or lower respiratory tract symptoms
    • Hemoptysis is a concerning sign of possible alveolar hemorrhage and usually warrants hospitalization and aggressive immunosuppression

    Glomerular Diseases

    • A glomerulus is a network of capillaries responsible for retaining plasma proteins in blood when filtrate is excreted in urine
    • Pathology affecting the glomerulus can lead to proteinuria and hematuria
    • Glomerular diseases can be nephrotic or nephritic
    • Most glomerular disorders are treated with corticosteroids and/or immune-suppressing agents
    • Some of these are acute kidney injuries that can lead to chronic kidney disease and even end-stage renal disease

    Here are the study notes:

    Acute Tubular Necrosis (ATN)

    • Most common cause of AKI (80% of cases)
    • Etiologies: ischemia, drugs, toxins, sepsis, and contrast dye
    • Pathophysiology:
      • Hypoperfusion leads to cellular death and muddy brown casts in tubules
      • Lack of oxygen hurts cells, stops vasodilators, and constricts tubules
      • Dead cells clog tubules, reducing GFR and increasing BUN/Creatinine
    • Clinical Presentation:
      • Decreased GFR and increased BUN/Creatinine levels
      • Oliguria or anuria
      • Edema and fatigue
      • Hematuria (dead cells/casts)
    • Diagnostic Evaluation:
      • Serum creatinine > 0.3 mg/dl within 48 hrs or 1.5 times baseline within 7 days
      • Metabolic acidosis
      • Hyperkalemia, hyperphosphatemia
      • Renal tubular casts ("muddy brown")
      • Renal epithelial cells
      • BUN:Creatinine ratio < 20:1 (intrarenal)
      • Increased fractional excretion of sodium (FENa)

    Rhabdomyolysis

    • Defined as a syndrome of acute necrosis of skeletal muscle
    • Etiologies: trauma, prolonged immobility, drug toxicity, hypothermia
    • Pathophysiology:
      • Release of myoglobin leads to direct renal toxicity
      • Causes AKI in 10-15% of cases
    • Clinical Presentation:
      • Myalgias or weakness
      • Dark urine
      • May be asymptomatic
    • Diagnostic Evaluation:
      • CK levels > 20,000 IU/L
      • Elevated LFTs
      • Electrolyte abnormalities (e.g., hyperkalemia)
      • Urine dipstick positive for "blood" without RBCs on microscopy

    Renal Artery Stenosis (RAS)

    • Characterized by narrowing of renal arteries, reducing blood flow to kidneys
    • Causes: atherosclerosis (most common), fibromuscular dysplasia
    • Mechanisms:
      • Renal artery narrowing leads to reduced kidney perfusion
      • RAAS activation causes renovascular hypertension
    • Impact on kidney health:
      • Hypertension
      • Ischemic nephropathy
      • AKI (especially with ACE inhibitors or ARBs)
      • Chronic kidney disease (CKD)

    Interstitial Nephritis

    • Pathophysiology and Etiology:
      • Drug hypersensitivity reaction (70% of cases)
      • Infections (15%)
      • Autoimmune diseases (6%)
    • Clinical Presentation:
      • Fever, rash, arthralgias, peripheral blood eosinophilia
    • Diagnostic Evaluation:
      • Urinalysis: WBCs, RBCs, white cell casts
      • Peripheral blood smear: eosinophilia
      • Ultrasound: may visualize kidneys
      • Kidney biopsy: clinical history and lab data often suggest the diagnosis
    • Treatment and Prognosis:
      • Supportive care and removal of the causative agent
      • Good prognosis for acute interstitial nephritis with weeks to months of recovery

    I hope this helps! Let me know if you'd like me to add anything.### Renal Failure

    • Renal failure is a rare but potential complication of recurrent issues like UTIs, kidney stones, and severe infections.

    Simple Cysts in the Kidney

    • Most simple cysts are discovered incidentally on ultrasound (US) and are typically asymptomatic.
    • Simple cysts can become infected or cause hematuria.
    • Simple cysts must be differentiated from malignancy, abscess, or polycystic kidney disease.
    • A simple cyst is considered benign if it:
      • Is echo-free on US
      • Has sharply demarcated (smooth) walls
      • Has an enhanced back wall on US
    • Benign cysts are not usually treated unless the patient becomes symptomatic (e.g., drainage if blocking urine flow).
    • Rarely, simple cysts can transform into renal cell carcinoma.
    • Complex cysts (with thick walls, calcifications/solid components, or mixed echogenicity) should be investigated further for carcinoma.
    • Renal cell carcinoma is typically vascular.
    • Cysts with questionable characteristics require periodic reevaluation and possible urologic consultation.

    Adverse Events of IV Fluids

    • Arrhythmia, edema, and electrolyte abnormalities can occur if IV fluids are given incorrectly.

    Distribution of Total Body Fluids

    • Total body fluids (TBF) account for 60% of body weight in men and 50% in women.
    • Intracellular fluids account for 60% of TBF, while extracellular fluids account for 40% of TBF.
    • Extracellular fluids are further divided into interstitial space (75%) and plasma (25%).

    Types of IV Fluids

    • Crystalloids: distribute evenly into extracellular space, composed of water, dextrose, Na+, Cl-, and other electrolytes.
      • Examples: Lactated Ringers (LR), 0.9% NaCl.
      • Characteristics: 25% remains in intravascular space, 75% distributes into interstitial space.
    • Free Water (D5W): metabolized to water and carbon dioxide, distributes evenly into TBF; not suitable for resuscitation.
    • Colloids: more expensive than crystalloids, remains in plasma, and can cause coagulopathy and kidney impairment.
      • Examples: packed RBCs, pooled human plasma, semisynthetic glucose polymers, and semisynthetic hydroxyethyl starch.
      • Characteristics: 500 mL of colloid equals 500 mL of intravascular volume expansion.

    Contraindications and Precautions

    • D5W should be avoided in cases of increased intracranial pressure because it can cross into cerebral cells and cause further ICP elevation.
    • D5W can cause hyperglycemia due to its small amount of dextrose.

    Goals of Fluid Resuscitation

    • Restore intravascular volume and prevent organ hypoperfusion.
    • Administer fluids rapidly, with 500-1000 mL boluses, and reassess after each bolus.

    Preferred IV Fluid for Resuscitation

    • Crystalloids, particularly Lactated Ringers, are preferred for fluid resuscitation.

    Signs and Symptoms of Intravascular Dehydration

    • Tachycardia, hypotension, orthostasis, increased BUN/Cr ratio >10:1, dry mucous membranes, decreased skin turgor, reduced urine output, and dizziness.

    Osmolality and Osmolarity

    • Osmolality: osmoles of solute per kg of solvent (mOsm/kg).
    • Osmolarity: osmoles of solute per L of solution (Osm/L).

    Functions of Electrolytes

    • Regulate nerve and muscle function, maintain acid-base and water balance.

    Hyponatremia

    • Defined as sodium levels below 135 mmol/L.
    • Causes: increased ADH, excessive water retention, and low solute intake.
    • Types:
      • Hypervolemic: excess Na+ and fluid, but fluid excess > Na+ excess.
      • Euvolemic: normal Na+ but excess fluid volume, no edema.
      • Hypovolemic: low Na+ and fluid, Na+ lower than fluid.

    Symptoms of Hyponatremia

    • Mild: nausea, headache, lethargy, malaise.
    • Severe: seizures, brain herniation, coma, and death.

    Causes of Hyponatremia

    • Hyperglycemia, replacement of lost solute with water, volume depletion, SIADH, glucocorticoid deficiency, medications, and renal failure.

    Treatment of Hyponatremia

    • Fluid restriction, vasopressin agonists, and stop offending medications.
    • Avoid rapid correction of hyponatremia to prevent osmotic demyelination.

    Osmotic Demyelination

    • Occurs with rapid correction of hyponatremia, leading to lethargy, affective changes, and permanent neurological damage.

    Correcting Hypernatremia

    • Aim for a safe range of 120-125 Na+, avoid rapid increases/decreases of >8-12 Na+ per 24 hours.
    • Correct over 48-96 hours to prevent cerebral edema and brain damage.

    Potassium Homeostasis

    • Maintained by the Na+/K+ pump, which regulates potassium levels in the body.

    Causes of Potassium Depletion

    • Increased K+ into cells, diuretics, hypomagnesemia, and vomiting and diarrhea.

    Monitoring Potassium and Magnesium

    • Magnesium levels should be monitored in relationship to potassium levels.

    Conditions Requiring IV Potassium Supplementation

    • EKG changes, symptoms, or inability to tolerate oral potassium.

    Causes of Hyperkalemia

    • Increased K+ intake, shift of K+ from IC to EC, and reduced urinary excretion.

    Signs and Symptoms of Hyperkalemia

    • Muscle weakness, paralysis, abnormal cardiac conduction, and VFIB.

    Treatment of Hyperkalemia

    • Sodium polystyrene sulfonate, IV calcium, insulin and glucose, sodium bicarbonate, and beta-adrenergic agonists.

    Calcium in Hyperkalemia Treatment

    • Used to antagonize the effect of K+ on cardiac conduction cells, but does not decrease plasma K+ levels.

    Magnesium Distribution

    • Primarily distributed in bone.

    Causes of Hypomagnesemia

    • Renal insufficiency, excessive vitamin or antacid use, lithium therapy, and hypercatabolic states.

    Symptoms of Hypomagnesemia

    • Arrhythmias, muscle weakness, lethargy, confusion, and loss of deep tendon reflexes.

    Hyperphosphatemia

    • Causes: tumor lysis syndrome, kidney dysfunction, and internal redistribution.
    • Symptoms: delirium, lethargy, paresthesia, neuromuscular hyperexcitability, and seizures.

    Hypophosphatemia

    • Causes: decreased GI absorption, reduced tubular reabsorption, and internal redistribution.
    • Symptoms: tissue hypoxia, confusion, delirium, seizures, and respiratory failure.

    Calcium Correction

    • Corrected for albumin levels, as low albumin levels can cause falsely low calcium levels.

    Causes of Hypocalcemia

    • CKD, hypoparathyroidism, vitamin D deficiency, hyperphosphatemia, and hypomagnesemia.

    Symptoms of Hypocalcemia

    • Neuromuscular, neurologic, acute, and chronic symptoms.

    Calcium Infusion Precautions

    • Infusion should be done slowly to avoid hypotension, bradycardia, and asystole.

    Drugs that Cause Hypercalcemia

    • Lithium and thiazide diuretics.

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    Day 1: Renal Diagnostics ppt Day 2: Acute Kidney Disease ppt day 3: Day 3: Chronic Kidney Disease ppt day 4: Glomerulonephritis student presentations and electrolyte imbalances

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