> For the complete documentation index, see [llms.txt](https://kam-1.gitbook.io/kam-docs/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://kam-1.gitbook.io/kam-docs/medical-jap/pharmacy/01_kidneys.md).

# Kidney Function

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Checking Kidney function is done through the **Examine Patient** tab using the **"Check Breathing"** action on the patient's head.

Kidney function is modeled using an **acidosis index** (internally tracked as `externalPh`) that goes from `0` (ideal/healthy) to `3000` (critical failure/arrest). The system checks these values every 20 seconds.

## 🩺 Kidney States

* **Normal (Healthy)**
  * **Acidosis Index:** `0` to `999`
  * **Behavior:** The body naturally filters out the acidosis, restoring the index back to `0` by **decreasing it by 60 points every 20 seconds**.
* **Pressure**
  * **Acidosis Index:** `1000` to `1999`
  * **Behavior:** The body struggles to filter the acidity. The index **decreases by only 30 points every 20 seconds** until it drops below `1000` (returning to the Normal state).
  * **Physiological Effect:** Triggers a systemic reaction (simulated as a medication) that:
    * Takes 15 seconds to reach maximum effect.
    * Lasts for **20 minutes** in the body.
    * **Increases Heart Rate by 30 BPM** and raises Blood Pressure.
* **Fail**
  * **Acidosis Index:** `2000` to `3000`
  * **Behavior:** The kidneys fail completely. Natural recovery stops, and the acidosis index **does not decrease on its own**.
  * **Physiological Effect:**
    * At `2000 - 2999`: Has a **25% chance every 20 seconds** to trigger Kidney Function Arrest, which immediately causes Cardiac Arrest.
    * At `3000`: Causes a **100% chance** of Kidney Function Arrest (immediate Cardiac Arrest).

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## 🧪 Treatment & Restoration

To lower the acidosis index and restore kidney function:

* **Dialysis:** Done inside a medical vehicle/facility. This completely resets the acidosis index to `0` (ideal).
* **Transfusions:** Administering **Blood** or **Plasma** reduces the acidosis index (adds negative values).
* **Avoid Saline Excess:** Administering **Saline** *increases* the acidosis index. Excessive saline use is the primary cause of kidney pressure and failure.

For specific volume adjustments, see the [Fluids](/kam-docs/medical-jap/pharmacy/03_fluids.md) documentation.

***

## 👃 Diagnostic Breath Profiles

The **Check Breathing** action checks the patient's actual blood pH (which starts at `7.4` under normal conditions). Note that actual blood pH is distinct from the 0-3000 acidosis index.

|       Check Breath Result      |  Blood pH Value |          Clinical State          |
| :----------------------------: | :-------------: | :------------------------------: |
|          **Good (ok)**         |      >= 7.2     |              Normal              |
|   **Mild (slightly fruity)**   | 6.9 <= pH < 7.2 |    Acidosis / Kidney Pressure    |
| **Stink (harsh and metallic)** |      < 6.9      | Severe Acidosis / Kidney Failure |