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BIOL 031 Lecture Notes - Lecture 22: Proximal Tubule, Uremia, Kidney Stone Disease

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pearjellyfish736
22 Dec 2020
School
College of The Sequoias
Department
Biology (BIOL)
Course
BIOL 031
Professor
carey

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Document Summary

Arterial ph normally kept from 7. 36-7. 44 (give or take) Because of in pco2 and/or in hco3. Respiratory: primary change is in the blood pco2. Respiratory acidosis: disorder causing ph & pco2. Defend: increase net acid secretion blood hco3. Respiratory alkalosis: disorder causing ph & pco2. Defend: decrease renal acid secretion blood hco3. Metabolic: primary change is in the serum hco3. Metabolic acidosis: disorder causing ph & hco3. Increase net acid secretion blood hco3. Metabolic alkalosis: disorder causing ph & hco3. Decrease renal acid secretion blood hco3. Simple acid-base disorder: either just metabolic or just respiratory. Mixed acid-base disorder: 2 acid-base disturbances stemming from 2 different disease processes. Metabolic acidosis: primary disturbance where blood bicarbonate falls ph. Kidneys don"t excrete acid (advanced kidney disease) 2 types: increased anion gap and normal anion gap (hyperchloremic) Ag = [na+ + k+] - [cl- + hco3. 8-16 meq/l is fine, according to this guy. Type a: la production tissue hypoxia (hypotension, cardiac arrest, sepsis)

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Related Questions

Case-2: Patient History

L.S. is brought to the emergency department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is nonresponsive. She is admitted to the critical care unit to be closely monitored for the development of respiratory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased to about 20 ml/hr. Her laboratory values are serum K+ = 5.7 mEq/L; arterial blood gases (ABGs): pH = 7.13, PaCO2 = 56 mm Hg, PaO2 = 89 mm Hg, HCO3- = 18 mEq/L.

Analyze this case study and answer the next four questions that follow.

Case-2 Question-1

What is the most likely cause of L.S.’s potassium imbalance? (select all that apply)

The most likely cause of L.S.’s potassium imbalance is impaired kidney function.
The most likely cause of L.S.’s potassium imbalance is respiratory failure.
The most likely cause of L.S.’s potassium imbalance is her shallow breathing.
The most likely cause of L.S.’s potassium imbalance is renal failure.

Case-2: Question-2

What is the relationship between acid-base balance and serum potassium level? (select all that apply)

Acidosis contributes to hyperkalemia.
Alkalosis contributes to hypokalemia.
Acidosis contributes to hypokalemia.
Alkalosis contributes to hyperkalemia.

Case-2: Question-3

Categorize and explain the probable cause of L.S.’s acid-base disorder. (select all that apply)

L.S. has respiratory alkalosis.
L.S. has respiratory acidosis.
L.S. has metabolic alkalosis.
L.S. has metabolic acidosis.

Case-2: Question-4

Can L.S. compensate for her acid-base disorder? (select all that apply)

She can compensate by excreting more bicarbonate ions.
She can compensate by hypoventilation.
She will not be able to compensate on her own because the lungs and the kidneys are malfunctioning.
She can compensate by hyperventilation.



1. Martha’s first patient on the pediatric floor is a 12-year oldboy named Sam who is undergoing kidney dialysis treatment. Sam hasbeen on dialysis for the last week, and the treatments willprobably be discontinued because his kidneys are becoming fullyfunctional again. Martha questions Sam’s mother concerning hisillness. Three weeks ago, Sam had a sore throat, which kept himhome from school for two days but was not medically treated. Oneweek ago, Sam told his mother his urine looked red-brown and foamy.He was admitted to the hospital. Physical exam revealedcostovertebral tenderness and blood pressure of 135/90. Theurinalysis and other studies revealed the following:

Color: red-brown tinged
Specific gravity: 1.030
RBC’s: numerous RBC’s per high powered field
Protein: > 1g/24 hr
Casts: epithelial cells and RBC’s
BUN: 90 mg/dl
Creatinine: 4mg/dl
Creatine Clearance Test: 50 ml/min


a. What is your diagnosis?
i. Glomerulonephritis
ii. Cystitis
iii. Urinary obstruction
iv. Pyelitis

b. The etiology would be a(n):
i. Virus
ii. Bacteria
iii. Genetic or developmental anomaly
iv. Anatomic malfunction after birth


2. Fred suffers from chronic emphysema. His arterial blood gasresults are as follows: pH 7.30; bicarbonate 32 mEq/l; PCO2 50 mmHg. Which of the following best describe Fred’s condition?
a. Metabolic acidosis with respiratory compensation
b. Respiratory acidosis with metabolic compensation
c. Metabolic alkalosis with respiratory compensation
d. Respiratory alkalosis with metabolic compensation

3. Hypocalcaemia may develop in a patient with which of thefollowing conditions?
a. Chronic renal failure
b. Hyperparathyroidism
c. Thiazide therapy
d. Vitamin D overdose

4. Which of the following conditions would cause prerenalfailure?
a. Nephrotoxicity
b. Glomerulonephritis
c. Acute tubular necrosis
d. Hypovolemia

5. Abnormal serum laboratory findings common to patients with acuterenal failure are:
a. Increased potassium and BUN; decreased creatinine
b. Increased potassium and creatinine; decreased BUN
c. Decreased potassium; increased BUN and creatinine
d. Increased potassium, BUN and creatinine

6. In the diuretic phase of acute tubular necrosis (ATN), theclinician must be alert for which of the followingcomplications?
a. Fluid overload
b. Hypokalemia
c. Hypertension
d. Hypernatremia

7. The primary acid-base disorder associated with renal failureis:
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

8. Patients with acute renal failure may have all of the followingcomplications EXCEPT:
a. Peaked T wave EKG and pericarditis
b. Sinus tachycardia and ST elevation
c. Heart failure and Friction rub
d. Mitral insufficiency and Mobitz type II heart block

9. A patient’s glomerular filtration rate can be measure byevaluating:
a. Serum creatinine
b. Blood urea nitrogen
c. Serum osmolarity
d. Creatinine clearance

10. A patient taking medication that acts to block or inhibit theaction of aldosterone would:
a. Have high blood potassium levels
b. Have high blood sodium levels
c. Have high levels of circulating aldosterone
d. A, B, and C
e. A and C only

11. A patient exhibits the following signs and symptoms: Elevatedblood pressure, elevated blood glucose, muscle weakness, poor woundhealing, red cheeks, thin arms and legs with fat deposits in thetrunk, neck and face. The patient findings are consistentwith:
a. Addison’s Disease
b. Myxedema
c. Cushing’s disease or long-term high dose steroid use
d. Grave’s disease
e. Pheochoromocytoma

12. The MOST dramatic functional change that occurs in theendocrine system due to aging is
a. A decrease in blood and tissue concentrations of ADH andTSH
b. And overall decrease in circulating levels of mosthormones.
c. A decline in the concentration of reproductive hormones
d. And increase in the secretion of glucocortioids

1. Martha’s first patienton the pediatric floor is a 12-year old boy named Sam who isundergoing kidney dialysis treatment. Sam has been on dialysis forthe last week, and the treatments will probably be discontinuedbecause his kidneys are becoming fully functional again. Marthaquestions Sam’s mother concerning his illness. Three weeks ago,Sam had a sore throat, which kept him home from school for two daysbut was not medically treated. One week ago, Sam told his motherhis urine looked red-brown and foamy. He was admitted to thehospital. Physical exam revealed costovertebral tenderness andblood pressure of 135/90. The urinalysis and other studies revealedthe following:

Color: red-brown tinged
Specific gravity: 1.030
RBC’s: numerous RBC’s per high poweredfield
Protein: > 1g/24 hr
Casts: epithelial cells and RBC’s
BUN: 90 mg/dl
Creatinine: 4mg/dl
Creatine Clearance Test: 50 ml/min


a. What is yourdiagnosis?
i. Glomerulonephritis
ii. Cystitis
iii. Urinary obstruction
iv. Pyelitis

b. The etiology would bea(n):
i. Virus
ii. Bacteria
iii. Genetic or developmental anomaly
iv. Anatomic malfunction after birth


2. Fred suffers from chronic emphysema.His arterial blood gas results are as follows: pH 7.30; bicarbonate32 mEq/l; PCO2 50 mm Hg. Which of the following best describeFred’s condition?
a. Metabolic acidosis with respiratorycompensation
b. Respiratory acidosis with metaboliccompensation
c. Metabolic alkalosis with respiratorycompensation
d. Respiratory alkalosis with metaboliccompensation

3. Hypocalcaemia may develop in a patientwith which of the following conditions?
a. Chronic renal failure
b. Hyperparathyroidism
c. Thiazide therapy
d. Vitamin D overdose

4. Which of the following conditions wouldcause prerenal failure?
a. Nephrotoxicity
b. Glomerulonephritis
c. Acute tubular necrosis
d. Hypovolemia

5. Abnormal serum laboratory findingscommon to patients with acute renal failureare:
a. Increased potassium and BUN; decreasedcreatinine
b. Increased potassium and creatinine; decreasedBUN
c. Decreased potassium; increased BUN andcreatinine
d. Increased potassium, BUN andcreatinine

6. In the diuretic phase of acute tubularnecrosis (ATN), the clinician must be alert for which ofthe following complications?
a. Fluid overload
b. Hypokalemia
c. Hypertension
d. Hypernatremia

7. The primary acid-base disorderassociated with renal failure is:
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

8. Patients with acute renal failure mayhave all of the following complicationsEXCEPT:
a. Peaked T wave EKG and pericarditis
b. Sinus tachycardia and ST elevation
c. Heart failure and Friction rub
d. Mitral insufficiency and Mobitz type II heartblock

9. A patient’s glomerular filtrationrate can be measure by evaluating:
a. Serum creatinine
b. Blood urea nitrogen
c. Serum osmolarity
d. Creatinine clearance

10. A patient taking medication that actsto block or inhibit the action of aldosteronewould:
a. Have high blood potassium levels
b. Have high blood sodium levels
c. Have high levels of circulatingaldosterone
d. A, B, and C
e. A and C only

11. A patient exhibits the following signsand symptoms: Elevated blood pressure, elevated blood glucose,muscle weakness, poor wound healing, red cheeks, thin arms and legswith fat deposits in the trunk, neck and face. The patient findingsare consistent with:
a. Addison’s Disease
b. Myxedema
c. Cushing’s disease or long-term high dosesteroid use
d. Grave’s disease
e. Pheochoromocytoma

12. The MOST dramatic functional changethat occurs in the endocrine system due to agingis
a. A decrease in blood and tissue concentrationsof ADH and TSH
b. And overall decrease in circulating levels ofmost hormones.
c. A decline in the concentration of reproductivehormones
d. And increase in the secretion ofglucocortioids