Kidney Kard - 6th Edition

7 .
HCO3
pH = 6.1 + log ____________
.03 pCO2
50
HCO3 mEq/L
7 .4
pCO2
pH = 7.62 - log ____________
HCO3
H+ (nEq/L) =
40
7 .5
24 pCO2
____________
HCO3
7 .3
pH
= 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8
H+ nM = 100 79 63 50 40 32 25 20 16
0.1 pH = 80% H+
H+ ~ (7.8 - pH) x 100
7 .2
30
7 .1
20
10
20
30
40
Metabolic acidosis
Metabolic alkalosis
PaCO2
PaCO2
1.25 mmHg per mEq/L HCO3

.75 mmHg per mEq/L HCO3
( 5 mmHg)
( 5 mmHg)
Acute Resp acidosis

Chronic Resp acidosis
HCO3
HCO3
1 mEq/L per 10 mmHg pCO2

( 3 mEq/L)
( 4 mEq/L)
Acute Resp alkalosis

Chronic Resp alkalosis
HCO3
HCO3

( 3 mEq/L)
( 3 mEq/L)
70
90
50
pCO2 mmHg
60
80
GFR
Normal
FRACTIONAL EXCRETIONS
= 100 - 125 ml/min/1.73 m2 (Male) 85 - 105 (Female)
FENa
Ucreat (mg/dL)
Uvolume (ml/day)
Ucreat (mg/day)
Measured = ____________ x _______________ = ____________ x .07
Pcreat (mg/dL)
1440 min/ 1 day
Pcreat (mg/dl)
(ml/min)
Cockroft - Gault
Cockroft-Gault Estimate =
(ml/min)
140 - age x __________

weight (kg)
__________
(x.85 Female)
Pcreat
72
MDRD Estimate = 170 x P creat
-.999
x Age
-.176
= % filtered Na load excreted.
U
U
= __
Na __ creat
P
P
< 1% in normal urine, and prerenal azotemia
FEurea
< 35% = prerenal, not altered by diuretics
FEuric acid < 10% = prerenal, not altered by diuretics
x (.762 if Female) x (1.18 if Black) x BUN
-.17
+.318
x Albumin
HYPONATREMIA
UNa
< 10 mEq/L = ECF volume (CHF, cirrhosis, nephrotic)

ECF volume
> 10
H2O gain = .6 x [wt,kg] - .6 x [wt,kg] x osm/290

UNa + UK
CH O = Uvolume - __________
(L/day)
2
PNa
= Normal ECF volume

RATS = Renal, Adrenal, or Thyroid insufficiency or SIADH
SIADH = CNS, pulmonary, or psychiatric disorder, drugs,
nausea, ADH-secreting tumors
H2O load: 20 ml/kg; Nml = 80 % excreted in 4 hrs

& Uosm < 100
CORRECTIONS TO PLASMA VALUES
OLIGURIA = <500 ml/day = <20 ml/hour

Prerenal
Azotemia
Uosm, mOsm/Kg
UNa, mEq/L
FENa
Sediment
> 400
< 20
< 1%
normal
ATN
< 400
> 40
> 2%
muddy casts, RTE
and bubble cells
Acute
Acute
Obstruction Glomerulonephritis
variable
variable
variable
normal
> 400
< 30
< 1%
RBC casts,
Dysmorphic RBCs
HYPOKALEMIA
intake
shift into cells: glucose, insulin, agonists, alkalosis or HCO3 Rx
loss - Renal: diuretics; high flow; aldo, RTA
GI: emesis, diarrhea, laxatives
HYPERKALEMIA
Artifact: hemolysis, WBC > 50,000, tourniquet + exercise, platelets
intake: hemolysis, rhabdomyolysis, transfusion, salt substitutes
shift out of cells: acidosis, 0 insulin, dig toxicity, arginine
blockers, hyperalimentation
renal excretion: GFR, aldo, tubular defects, drugs
Na
1.35 - 2.4 mEq/L per 100 mg% glucose

No artifact with lipemia or paraproteins if Na measured
by ion-specific electrode on undiluted plasma
Calcium
.8 mg% per gm%

albumin
.16 mg% per gm% globulins
.12 mg% per .1
pH
.6 mEq/L
.6 mEq/L
.15 mEq/L
per 0.1 pH
} variable, depends
per 10 mOsm }
on cause
per 100 x 109 platelets /L
TTKG
= transtubular K gradient at CCD
= 4-14, varies with diet
U K UOsm
=
U
P
With hypokalemia
<2
= GI loss
>4
= Renal loss; excess aldo
nml
With hyperkalemia
<6
= renal: aldo effect
>10 = non-renal hyperkalemia, normal aldo effect
NORMAL ABGs
Arterial
pH
7.40 .02
pCO2 mmHg 40 2
pO2 mmHg
90 10
O2 sat, %
>95%
HCO3 mEq/L 24 2
REMOVAL OF TOXINS
Mixed venous
7.36 .02
46 .02
38 5
70 10%
24 2
Consider hemodialysis (HD) or hemoperfusion (HP)

at these levels: (Source: Handbook of Dialysis,
Daugirdas and Ing, Little Brown and Co., Boston,1988)
Drug
Phenobarbital
Glutethimide
Methaqualone
Salicylates
Theophylline
Lithium
Methanol
Serum level (mg/dl)

10
4
4
80
30-40
2.5-3.5
100
METABOLIC ACIDOSIS
Treatment choice
HD or HP
HP
HP
HD
HP
HD
HD
mean
1-7
10-20
6-12
3.5-5.5
METABOLIC ALKALOSIS
Plasma anion gap = Na - [Cl + HCO3] Nml = 12 2
Urine Cl < 10 mEq/L = saline responsive = emesis, diuretics, posthypercapnea

> 10
= mineralocorticoids, alkali intake, K depletion
< 12 = diarrhea, RTA, CaCl2 or other acids

> 15 = MUDPALES = Methanol, Uremia, Diabetic
ketoacidosis, Paraldehyde, Alcoholic
ketoacidosis, Lactic acidosis, Ethylene
glycol, Salicylates
RENAL TUBULAR ACIDOSIS

Proximal
Urine anion gap = UNa + UK -UCl

GI HCO3 Loss
HEMODYNAMICS
systolic
diastolic
RA,
mmHg
RV,
mmHg
15-25
0-8
PA,
mmHg
15-25
8-15
PCWP, mmHg
CO,
L/min
MAP = diast. BP + 1/3 [syst. - diast.]
SVR = 80 x [MAP - CVP]/CO (L/min)
= Nml 900- 1200 dyne/sec/cm2
Renal HCO3 Loss
Gap
Gap
NH4+ present
No NH4+ present
UNH + = UCl [UNa + UK] + 80 mEq /L
4
Osmolar gap = measured osm - calculated osm; nml = 10
= measured osm - (1.87 Na + BUN/2.8 + glucose/18 + 9)
> 10 = ethanol (4.4 mg%/mOsm/L), methanol (3), ethylene
glycol (6), isopropanol (5.7), sorbitol, mannitol, X-Ray dye
Prevalence
Plasma K
Urine pH
Urine NH4+
Defect
Rare
Low
<6
Normal
Rx
High capacity
HCO3 transport
Diuretic
Examples
Acetazolamide
Classical
Distal
Rare
Low
>6
Low
H Pump
HCO3
Amphotericin
Type 4
Very common
High
<6
Low
Hyperkalemic
Distal
Common
High
variable
Low
NH3 generation
aldo effect
Distal Na
Transport
Diuretic
HCO3
Obstruction
Diabetes
Kidney Kard
Please see full Prescribing Information, including boxed WARNING for MICARDIS Tablets.
MC-11292
ADEQUACY OF DIALYSIS
THE 5 STAGES OF CHRONIC KIDNEY DISEASE (CKD) NKF GUIDELINES

STAGE
Hemodialysis
KT/V per Rx
% reduction urea
Protein intake
Unacceptable
DOQI Goal
<1
< 60%
> 1.2
> 65%
> 1.2gm/kg/day
2
3
> 2.0
> 60
> 1.2 -1.3 gm/kg/day
4
5
Peritoneal dialysis
KT/V per week
< 1.6
Creatinine clearance < 40 liters/week
Protein intake
PLASMA
Common units
NORMAL VALUES
DESCRIPTION
BUN
Calcium
Ca-ionized
Creatinine
Cystatin C
Glucose
K
Mg
Na
NH3+NH4
Osmolality
8-25
8.5-10.5
mg%
mg%
.6-1.5
.53-.95
70-110
3.5-5
1.8-3
135-145
mg%
mg/L
mg%
mEq/L
mg%
mEq/L
280-296
Phosphate
Urate
2.6-4.5
3.6-8.5
2.3-6.6
Sl units
At risk
Kidney damage with
normal or GFR
Kidney damage with
mild GFR
Mark Graber, M.D. 6th Edition 2006

VA Medical Center, Northport, NY 11768
mark.graber@med.va.gov
> 90
INTERVENTIONS
Screening, reduce cardiovascular and CKD risks
Above, + pursue early diagnosis and treatment. Treat comorbid
conditions. Reduce cardiovascular risk. Slow CKD progression
60-89
Above + estimate and slow progression of CKD.
Moderate GFR
30-59
Treat anemia, improve nutrition, manage bone disease, manage

symptomatic neuropathy, manage biochemical abnormalities
(acidosis, potassium disturbances)
Severe GFR
15-29
Prepare for renal replacement therapy
Kidney failure
15 or
dialysis
Replacement therapy if uremia present. Manage PD or

hemodialysis access, ensure dialysis adequacy
Conversion
Factor
URINE
units = /day
2.9-8.9
2.1-2.6
1.14-1.3
53-133
mM urea
mM
mM
uM
0.357
0.25
160 mg/gm diet protein

<300 mg
88.4
15-20 mg/kg (M); 10-15 (F)
mM
mM
mM
mM
uM
mmol/kg
0.0555
1
0.411
1
mOsm/kg
3.9-6.1
3.5-5
0.8-1.2
135-145
12-55
280-296
mg%
mg% (M)
mg% (F)
.84-1.45
214-506
137-393
mM
uM
uM
0.323
59.5
59.5
Kidney Kard
GFR
Division of Nephrology, HSC 15-020

SUNY at Stony Brook, NY 11794
= intake (.5-1 mEq/kg)

If Mg depleted: < 1 mEq
=intake (.5-2 mEq/kg)
0.5-1 mEq/kg
If Posm low: < 100 mOsm/kg
If Posm high: > 700 mOsm/kg
about 1 gm
< 700 mg
< 700 mg

Kidney Kard - 6th Edition

Uploaded by

Copyright:

Available Formats

Kidney Kard - 6th Edition

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Kidney Kard - 6th Edition

Uploaded by

Copyright:

Available Formats

7 .

1.25 mmHg per mEq/L HCO3

Acute Resp acidosis

1 mEq/L per 10 mmHg pCO2

Acute Resp alkalosis

2 mEq/L per 10 mmHg pCO2

140 - age x __________

MDRD Estimate = 170 x P creat

= % filtered Na load excreted.

x (.762 if Female) x (1.18 if Black) x BUN

< 10 mEq/L = ECF volume (CHF, cirrhosis, nephrotic)

H2O gain = .6 x [wt,kg] - .6 x [wt,kg] x osm/290

= Normal ECF volume

H2O load: 20 ml/kg; Nml = 80 % excreted in 4 hrs

OLIGURIA = <500 ml/day = <20 ml/hour

1.35 - 2.4 mEq/L per 100 mg% glucose

.8 mg% per gm%

Consider hemodialysis (HD) or hemoperfusion (HP)

Serum level (mg/dl)

Plasma anion gap = Na - [Cl + HCO3] Nml = 12 2

Urine Cl < 10 mEq/L = saline responsive = emesis, diuretics, posthypercapnea

< 12 = diarrhea, RTA, CaCl2 or other acids

RENAL TUBULAR ACIDOSIS

Urine anion gap = UNa + UK -UCl

Renal HCO3 Loss

THE 5 STAGES OF CHRONIC KIDNEY DISEASE (CKD) NKF GUIDELINES

Mark Graber, M.D. 6th Edition 2006

Above + estimate and slow progression of CKD.

Treat anemia, improve nutrition, manage bone disease, manage

Prepare for renal replacement therapy

Replacement therapy if uremia present. Manage PD or

160 mg/gm diet protein

15-20 mg/kg (M); 10-15 (F)

Division of Nephrology, HSC 15-020

= intake (.5-1 mEq/kg)

You might also like