Systemic Lupus Erythematosus (SLE #6)

Fluid/Electrolytes and Renal Exercise

Lupus nephritis is a common complication of SLE.  Antibodies attack many different tissue types and cause vasculitic lesions which can affect the glomerulus of the nephron.

1. The glomerulus filters water and dissolved substances via
2. Passive diffusion.
3. Filtration

1. Colloid osmotic pressure

1. Energy-driven processes across a “gate” in the endothelium

     Lupus nephritis can lead to a significant loss of serum protein due to renal damage   Damage to the glomerulus can lead to loss of plasma albumin into the glomerular filtrate.

2. The distribution of water in the intracellular fluid compartment is regulated by
3. Albumin
5. Sodium
6. Potassium

3. Colloid (oncotic) osmotic pressure is the movement of water toward a (an)
4. Protein-rich compartment
5. Salt-poor compartment
6. Protein-poor compartment
7. Compartment with equal amounts of protein, salt, and water

4. The distribution of water in the intravascular fluid compartment is regulated by
5. Hydrostatic pressure and colloid osmotic pressure
6. Aldosterone
7. Sodium and chloride ion concentrations
8. Potassium and bicarbonate ion concentrations

     Dependent edema is a common finding in patients with glomerular disease

5. Excess loss of plasma albumin (hypoalbuminemia) could result in a shift of body water from
6. The intracellular fluid compartment (ICF) into the intravascular fluid (IVF) compartment
7. The interstitial fluid (ISF) compartment into the intravascular fluid (IVF) compartment
8. The intravascular fluid (IVF) compartment to the interstitial fluid (ISF) compartment
9. The intracellular fluid compartment (ICF) to the extracellular fluid compartment (ECF)

     Tests for renal function include hematocrit and hemoglobin; serum chemistries including BUN, Cr, and eGFR; urinalysis including micro-albuminuria; and a 24-hour urine for protein and creatinine clearance.

6. The most sensitive marker of glomerular function is
7. Urinary calcium oxalate
8. Serum sodium levels
9. Pyuria and WBC casts
10. Glomerular filtration rate

7. The pathophysiologic characteristic of glomerulonephritis (e.g., post streptococcal) that distinguishes it from glomerulonephrosis is

1. Proteinuria.

b.      Hematuria

c.       Hypertension

1. Azotemia

8. Kidneys stimulate active hematopoiesis by releasing
9. Vitamin D₃ (calcitriol)
10. Renin
11. Erythropoietin
12. Ferrous iron

In the absence of immunosuppressive therapy, stage IV lupus nephritis will progress to end-stage renal disease in 70% of patients within 5 years.

9. The category of renal disease associated with both nephrosis and nephritis is

1. Pre-renal
2. Intra-renal
3. Post renal
4. Neurogenic

Chronic, end-stage renal failure causes fluid, electrolyte, and acid-base imbalances.

10. Complications of chronic kidney disease include
11. Hypophosphatemia
12. Hypercalcemia

1. Polycythemia
2. Metabolic acidosis