10- Indices of the Kidney

Question 1

What are examples of qualitative tests

Answer 1

Scans and Endoscopic procedures

Question 2

What are examples of quantitive results

Answer 2

Haematology and biochemistry results

Question 3

What are common specimens that are analysed

Answer 3

whole blood
serum
urine
cerebrospinal fluid

Question 4

What are factors affecting biochemistry test results

Answer 4

The way a specimen is collected, transported, stored and processed.
Patients position
Several blood constituents can fluctuate throughout the day.
State of nutrition
The age of the patient
Patients rate of physical activity.

Question 5

What analytes are found in blood

Answer 5

Urea and Electrolytes (U and Es)
Liver function tests (LFTs)

Glucose
Lipids
Endocrinology

Question 6

What is found in purple collection tubes

Answer 6

FBC, blood film, ESR, HbA1c

Question 7

What is found in pink collection tubes

Answer 7

Group and save crossmatch

Question 8

What is found in blue collection tubes

Answer 8

coagulation screen, INR and D-dimer

Question 9

What is found in yellow collection tubes

Answer 9

U+E, CRP, LFTs, amylase, calcium, phosphate, magnesium, TFTs, lipid profile, troponins

Question 10

what is found in green collection tubes

Answer 10

glucose
lactate

Question 11

How is sodium in the body controlled

Answer 11

Renin is produced in the kidneys in response to decreased blood flow(due usually to a decreased intravascular volume) and converts angiotensinogen to angiotensin I

Angiotensin I converted in the lungs by angiotensin converting enzyme (ACE) to angiotensin II

Stimulates adrenal cortex to produce aldosterone  peripheral vasoconstriction

Activates pump in in the distal renal tubule leading to reabsorption of Na+ and water from the urine in exchange for K+ and H+ ions

Question 12

How is water controlled in the body.

Answer 12

Controlled mainly by sodium concentration
An increased plasma concentration causes thirst  release of antidiuretic hormone (ADH) from the posterior pituitary  increases the passive water reabsorption from renal collecting ducts

So, lots of ion transport going on in body – coordinated with exchange/movement at other sites/locations e.g. previous identification of regulation of acid secretion

Question 13

Where does ion transport go on

Answer 13

Acid secretion; stomach
Adsorption in GIT (as per previous examples); small intestine – e.g. monosaccharides

Muscle function; skeletal vs. smooth muscle
Different forms of E-C coupling : Ca2+ movement
Neuronal function
Renal-hepatic systems

Question 14

What is the symptoms of low body sodium

Answer 14

cellular over hydration, confusion, fits

Question 15

What are symptoms of water excess

Answer 15

Hypertension, cardiac failure, oedema, anorexia, nausea, muscle weakness, haemodilution

Question 16

What are symptoms of increased body sodium

Answer 16

cellular dehydration; thirst, confusion, coma

Question 17

What are symptoms of water deficiency

Answer 17

hypotension, low pulse volume, decreased skin turgour, peripheral vasoconstriction, tachycardia, raised plasma protein, uraemia

Question 18

What is needed to measure creatinine clearance

Answer 18

Collect urine over 24h
Empty bladder just before start
Take sample for plasma creati§nine once during 24h

Question 19

What are symptoms of low GFR (classic acute renal failure)

Answer 19

Raised: urea, creatnine, K+, H+, urate, phsophate

Lowered: calcium and bicarbonate

Question 20

What are symptoms of tubular dysfunction

Answer 20

Lowered: K+, phosphate, urate, bicarbonate

Urea and creatinine are normal

Question 21

What are causes of tubular dysfunction

Answer 21

hypercalcaemia, hyperuricaemia, myeloma, hypokalaemia, pyelonephritis (bacterial infection), poisoning

Question 22

Symptoms of Chronic Renal Failure

Answer 22

Raised: creatinine, urea, phosphate, urate, potassium

Decreased: bicarbonate and Hb

Question 23

What GFR indicates the start of decrease in renal function

Answer 23

89 or under