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AUBF > 2. RENAL FUNCTION TEST - LAB > Flashcards

2. RENAL FUNCTION TEST - LAB Flashcards

1
Q

What are the standard tests used to measure the filtering capacity of the glomeruli called?

A

Clearance tests.

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2
Q

What does a clearance test measure?

A

The rate in milliliters per minute at which the kidneys remove (clear) a filterable substance from the blood.

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3
Q

What is an important requirement for the substance used in a clearance test?

A

The substance must not be reabsorbed or secreted by the tubules.

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4
Q

What OTHER factors should be considered when selecting a substance for a clearance test?

A

Stability of the substance in urine
consistency of plasma levels
availability to the body
availability of tests to analyze the substance.

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5
Q

Why is it important that the substance used in a clearance test is not reabsorbed or secreted by the tubules?

A

To ensure accurate measurement of glomerular filtration.

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6
Q

How should the substance in a clearance test behave during a 24-hour collection period?

A

It should remain stable in the urine.

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7
Q

What must be consistent for an accurate clearance test?

A

The plasma level of the substance being tested.

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8
Q

What must be available for the substance used in a clearance test?

A

Tests to analyze the substance.

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9
Q

What is used to measure the glomerular filtration rate (GFR)?

A

A variety of substances, including creatinine, beta2-microglobulin (B2M), cystatin C, and possibly radioisotopes.

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10
Q

What are the primary substances currently used in clearance tests?

A

Creatinine, beta2-microglobulin (B2M), cystatin C, and possibly radioisotopes.

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11
Q

What is a common substance used in clearance tests that measures GFR?

A

Creatinine.

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12
Q

What is another substance used for measuring GFR, aside from creatinine?

A

Beta2-microglobulin (B2M).

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13
Q

Which substance used in GFR measurement is known for being a protein in blood plasma?

A

Cystatin C

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14
Q

What method might be used for GFR measurement that involves radioactive substances?

A

Radioisotopes.

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15
Q

What was the earliest substance measured to assess glomerular filtration?

A

Urea.

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16
Q

Why was urea used in early glomerular filtration tests?

A

Urea is present in all urine specimens and there were established methods for its chemical analysis.

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17
Q

What percentage of filtered urea is reabsorbed in the body?

A

Approximately 40%.

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18
Q

How were normal values for urea clearance adjusted to account for reabsorption?

A

Normal values were adjusted to reflect the 40% reabsorption of filtered urea.

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19
Q

What practice was used to ensure that no more than 40% of the urea was reabsorbed during measurement?

A

Patients were hydrated to produce a urine flow rate of 2 mL/min

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20
Q

What was the purpose of producing a urine flow rate of 2 mL/min in urea clearance tests?

A

To ensure that reabsorption of urea did not exceed 40%, providing accurate measurement.

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21
Q

What substance was originally used as the reference method for clearance tests?

A

Inulin.

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22
Q

What is inulin and why is it used in clearance tests?

A

Inulin is a polymer of fructose that is extremely stable, not reabsorbed or secreted by the tubules, making it ideal for measuring GFR.

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23
Q

How is inulin administered for clearance tests?

A

Inulin must be infused intravenously at a constant rate throughout the testing period.

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24
Q

Why is inulin not used as commonly today for clearance tests?

A

There are newer methods available that use endogenous substances and can provide accurate GFR results.

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25
Q

What are the advantages of using inulin in clearance tests?

A

Its stability and the fact that it is neither reabsorbed nor secreted by the tubules make it an accurate measure of GFR.

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26
Q

What is a key disadvantage of using inulin for clearance tests?

A

Inulin is not a normal body constituent and requires intravenous infusion, making it less convenient compared to endogenous substances.

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27
Q

What is a test that requires an infused substance called?

A

An exogenous procedure.

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28
Q

Why are exogenous procedures seldom the method of choice for clearance tests?

A

Because suitable test substances that are already present in the body (endogenous procedures) are preferred if available.

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29
Q

What is the main advantage of using endogenous substances in clearance tests?

A

They are already present in the body, eliminating the need for infusion and making the procedure simpler.

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30
Q

What differentiates an endogenous procedure from an exogenous procedure in clearance tests?

A

Endogenous procedures use substances naturally present in the body, while exogenous procedures require the infusion of external substances.

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31
Q

a waste product of muscle metabolism produced by creatine phosphokinase from creatine, which interacts with ATP to produce ADP and energy

A

Creatinine

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32
Q

What is creatinine and how is it produced?

A

Creatinine is a waste product of muscle metabolism produced by creatine phosphokinase from creatine, which interacts with ATP to produce ADP and energy.

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33
Q

Why is creatinine used in evaluating glomerular function?

A

Because it is normally found at a relatively constant level in the blood, making it an endogenous procedure for assessing kidney function.

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34
Q

What is one disadvantage of using creatinine for clearance tests?

A

Some creatinine is secreted by the tubules, and this secretion increases as blood levels rise.

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35
Q

How can chromogens in plasma affect creatinine clearance results?

A

Chromogens can react in chemical analysis, potentially counteracting falsely elevated rates caused by tubular secretion.

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36
Q

How can certain medications affect creatinine clearance measurements?

A

Medications inhibit tubular secretion of creatinine, resulting in falsely low serum levels.

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37
Q

Name examples of medications that inhibit tubular secretion of creatinine.

A

Gentamicin, cephalosporins, and cimetidine (Tagamet).

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38
Q

What issue can arise if urinary creatinine specimens are kept at room temperature for extended periods?

A

Bacteria can break down urinary creatinine, affecting the results.

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39
Q

How can a diet high in meat affect creatinine clearance results?

A

A high meat intake can increase creatinine levels in urine and plasma, affecting results if plasma specimens are drawn before the 24-hour collection period.

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40
Q

Why might creatinine clearance measurements be unreliable in certain patients?

A

In patients with muscle-wasting diseases, those engaged in heavy exercise, or athletes supplementing with creatine, creatinine clearance may not be reliable.

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41
Q

What factor must be corrected for when measuring creatinine clearance?

A

Creatinine clearance values must be corrected for body surface area and adjusted for children.

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42
Q

What newer methods are available for assessing glomerular filtration rate (GFR)?

A

Newer methods use serum creatinine, cystatin C, or beta2-microglobulin (B2M) values to estimate GFR (eGFR) without needing timed urine collections.

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43
Q

Why is the traditional procedure for creatinine clearance still important despite newer methods?

A

The traditional procedure is still performed and its principles apply to other clearance procedures using urine.

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44
Q

What is the main purpose of eGFR formulas?

A

To estimate glomerular filtration rates for screening patients, monitoring renal disease, and aiding in medication prescriptions requiring renal clearance.

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45
Q

What is the most frequently used eGFR formula?

A

The Modification of Diet in Renal Disease (MDRD) study formula.

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46
Q

What is the recommended eGFR formula by the National Kidney Disease Education Program (NKDEP)?

A

The MDRD-IDMS-traceable formula.

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47
Q

Why were previous eGFR formulas revised?

A

Discrepancies arose from the methods used to measure serum creatinine.

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48
Q

What makes eGFR superior to serum creatinine alone?

A

eGFR includes variables for race, age, and gender, making it more accurate.

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49
Q

What creatinine assay methods are primarily used in laboratories now?

A

Enzyme assays that align more closely with the isotope dilution mass spectrophotometry (IDMS) reference method.

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50
Q

For what GFR values is the MDRD-IDMS formula most accurate?

A

For GFR values lower than 60 mL/min.

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51
Q

How are eGFR results higher than 60 mL/min typically reported?

A

As “≥60 mL/min.”

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52
Q

What is the GFR range for Stage 1 chronic kidney disease (CKD) according to KDIGO?

A

Greater than 90 mL/min/1.73 m².

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53
Q

What is the GFR range for Stage 2 CKD according to KDIGO?

A

Between 60 and 89 mL/min/1.73 m².

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54
Q

What is the GFR range for Stage 3 CKD according to KDIGO?

A

Between 45 and 59 mL/min/1.73 m².

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55
Q

What is the GFR range for Stage 4 CKD according to KDIGO?

A

Between 15 and 29 mL/min/1.73 m².

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56
Q

What GFR value defines Stage 5 CKD (end-stage renal disease) according to KDIGO?

A

Less than 15 mL/min/1.73 m².

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57
Q

a small protein produced by all nucleated cells at a constant rate, used to screen and monitor GFR.

A

Cystatin C

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58
Q

Why is cystatin C a reliable marker for GFR?

A

It is filtered by the glomerulus, reabsorbed, and broken down by the renal tubular cells, with no secretion by the tubules.

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59
Q

What is the advantage of cystatin C measurement over creatinine clearance?

A

Cystatin C is independent of muscle mass, making it more accurate for patients with varying muscle conditions.

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60
Q

For which patients is monitoring cystatin C levels recommended?

A

Pediatric patients, people with diabetes, the elderly, and critically ill patients.

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61
Q

What is the advantage of measuring both cystatin C and creatinine levels?

A

Combining both measurements provides more accurate information on a patient’s GFR

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62
Q

How is cystatin C measured?

A

immunoassay procedures.

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63
Q

What is the molecular weight of cystatin C?

A

13,359

64
Q

meaning of B2M

A

Beta2-Microglobulin (B2M)

64
Q

What is the molecular weight of B2M?

A

11,800

65
Q

From where does B2M dissociate?

A

Human leukocyte antigens

66
Q

How is B2M removed from plasma?

A

Glomerular filtration

67
Q

What does increased B2M in urine indicate?

A

Tubular damage

68
Q

What does increased B2M in blood and low urine levels indicate?

A

Glomerular disorders

69
Q

What disease and condition is B2M used to identify?

A

End-stage renal disease and early kidney transplant rejection

70
Q

Which test is more sensitive than creatinine clearance for decreased GFR?

A

Plasma B2M

71
Q

What patients may not have reliable B2M results?

A

Patients with immunologic disorders or malignancy

72
Q

What method is used to measure B2M?

A

Enzyme immunoassay

73
Q

What radionucleotide is used for glomerular filtration testing?

A

125I-iothalamate

Iodine-125 with iothalamate

74
Q

What does the use of I-iothalamate allow?

A

Visualization of filtration in one or both kidneys

75
Q

Which exogenous marker is used to assess a transplanted kidney’s viability?

A

125I-iothalamate

Iodine-125 with iothalamate

76
Q

What are other exogenous markers used in renal filtration tests?

A

51 Cr-EDTA and 99-Tc-DTPA

Chromium-51 Ethylenediaminetetraacetic acid

Technetium-99m Diethylenetriaminepentaacetate

77
Q

What nonradioactive contrast agent is used for children in filtration testing?

A

Iohexol

78
Q

What determines the GFR besides the number of functioning nephrons?

A

The functional capacity of the remaining nephrons

79
Q

Why does GFR not change if half of the nephrons are nonfunctional?

A

The remaining nephrons double their filtering capacity

80
Q

What is the primary clinical significance of GFR testing?

A

To monitor nephron damage in known renal disease

81
Q

Why is GFR testing not effective for detecting early renal disease?

A

Functional nephrons can compensate for nonfunctional ones

82
Q

Why is GFR important for medication administration?

A

To prevent dangerous blood levels of medications when GFR is reduced

83
Q

What are tests that determine the kidney’s ability to reabsorb essential salts and water called?

A

Concentration tests

84
Q

What is the specific gravity of ultrafiltrate as it enters the tubules?

A

1.010

85
Q

Why might a urine specimen have a specific gravity of 1.010 without indicating renal disease?

A

Because urine concentration is largely determined by the body’s state of hydration.

86
Q

A concentration test where patients were deprived of fluids for 24 hours before measuring specific gravity.

A

Fishberg test

87
Q

A test comparing the volume and specific gravity of urine collected during the day and at night to evaluate concentrating ability.

A

Mosenthal test

88
Q

What is the current method for testing renal concentrating ability?

A

Osmometry after periods of fluid deprivation.

89
Q

What urine osmolality reading indicates normal tubular reabsorption?

A

800 mOsm or higher

90
Q

What does a urine-to-serum osmolality ratio of 3:1 or greater indicate?

A

Normal tubular reabsorption.

91
Q

What condition is indicated by the kidney’s failure to produce ADH?

A

Neurogenic diabetes insipidus

92
Q

What condition is indicated if the renal tubules do not respond to ADH?

A

Nephrogenic diabetes insipidus

93
Q

What does osmolality measure?

A

Number of particles in a solution

94
Q

How does osmolality differ from specific gravity?

A

Osmolality measures the number of particles, while specific gravity is influenced by both the number and density of particles.

95
Q

What type of particles does renal concentration primarily concern?

A

Small particles, primarily sodium and chloride molecules

96
Q

Do large-molecular-weight molecules like glucose and urea contribute to the evaluation of renal concentration?

A

No

97
Q

Why is osmolality preferred over specific gravity for evaluating renal concentrating ability?

A

Because osmolality provides a more accurate evaluation of renal concentration by focusing on small particles.

98
Q

What principle do freezing-point osmometers use to measure osmolality?

A

Freezing-point depression

99
Q

How is the freezing point of a solution determined in freezing-point osmometers?

A

By supercooling the sample and measuring the temperature increase caused by crystallization.

100
Q

What does the heat of fusion from crystallizing water temporarily raise?

A

The temperature of the solution to its freezing point

101
Q

What is used to measure the temperature increase in freezing-point osmometers?

A

A thermistor

102
Q

How is osmolarity calculated using freezing-point depression?

A

By comparing the freezing-point depression of an unknown solution with a known molal solution.

103
Q

What is the known freezing-point depression value for 1 mol (1000 mOsm) of a nonionizing substance dissolved in 1 kg of water?

A

1.86°C

104
Q

What type of solutions are used as reference standards in clinical osmometers?

A

Solutions of known NaCl concentration

105
Q

Why are NaCl solutions used as reference standards in clinical osmometers?

A

Because they are more representative of urine and plasma composition.

106
Q

At what temperature is the sample supercooled in freezing-point osmometers?

A

Approximately 27°C

107
Q

What does a vapor pressure osmometer measure?

A

Dew point temperature

108
Q

How does the depression of the dew point temperature relate to the measurement?

A

It parallels the decrease in vapor pressure, providing a measure of the colligative property.

109
Q

What type of paper is used to absorb the sample in a vapor pressure osmometer?

A

Small-filter paper disks

110
Q

What happens to the sample after absorption into the filter paper disks?

A

The sample evaporates in a sealed chamber, forming a vapor.

111
Q

What role does the temperature-sensitive thermocoupler play in a vapor pressure osmometer?

A

It measures the temperature increase caused by the heat of condensation when the dew point temperature is reached.

112
Q

How is the dew point temperature related to vapor pressure in a vapor pressure osmometer?

A

The dew point temperature is proportional to the vapor pressure from the evaporating sample.

113
Q

How are the temperatures measured by the vapor pressure osmometer converted?

A

They are compared with NaCl standards and converted into milliosmoles.

114
Q

Why must care be taken to prevent evaporation before testing in a vapor pressure osmometer?

A

Because the instrument uses microsamples, and evaporation can affect the accuracy of the measurement.

114
Q

What is the typical volume of samples used in vapor pressure osmometers?

A

Less than 0.01 mL

114
Q

What has correlation studies revealed about the accuracy of vapor pressure osmometers?

A

There is more variation compared to other methods, highlighting the need for careful technique.

115
Q

What factor can cause erroneous results in both vapor pressure and freezing-point osmometers?

A

lipemic serum,
lactic acid,
and volatile substances, such as ethanol, in the specimen.

116
Q

What are the major clinical uses of osmolarity?

A

Evaluating renal concentrating ability, monitoring renal disease, fluid and electrolyte therapy, diagnosing hypernatremia and hyponatremia, evaluating ADH secretion and response

117
Q

What is the reference range for serum osmolality?

A

275 to 300 mOsm

118
Q

Why are reference values for urine osmolality difficult to establish?

A

Factors like fluid intake and exercise greatly influence urine concentration.

119
Q

What is the normal range for urine osmolality?

A

50 to 1400 mOsm

120
Q

What ratio of urine to serum osmolality is considered normal under random conditions?

A

At least 1:1

121
Q

What should the urine-to-serum osmolality ratio reach after controlled fluid intake?

A

3:1

122
Q

What type of samples are vapor pressure osmometers primarily used to analyze?

A

Serum and sweat microsamples

123
Q

What disorders are vapor pressure osmometers primarily used to analyze for?

A

Disorders not related to renal function, such as cystic fibrosis

124
Q

In which department are vapor pressure osmometers primarily used?

A

Chemistry department

125
Q

What is used in conjunction with the urine-to-serum osmolality ratio to differentiate the type of diabetes insipidus?

A

Controlled fluid intake and injection of ADH

126
Q

What does a failure to achieve a urine-to-serum osmolality ratio of 3:1 after injecting ADH indicate?

A

The collecting duct does not have functional ADH receptors

127
Q

What does it indicate if concentration occurs after ADH injection?

A

An inability to produce adequate ADH

128
Q

What tests are available for difficult diagnostic cases of diabetes insipidus?

A

Tests to measure ADH concentration in plasma and urine

129
Q

What is calculated first when determining free water clearance?

A

Osmolar clearance (Cosm)

130
Q

What does a negative free water clearance value indicate?

A

Less than the necessary amount of water is being excreted (possible state of dehydration)

131
Q

What does a free water clearance value of 0 indicate?

A

No renal concentration or dilution is taking place

132
Q

What does a positive free water clearance value indicate?

A

Excess water is being excreted

133
Q

How is osmolar clearance related to urine volume?

A

t indicates how much water must be cleared each minute to produce urine with the same osmolality as the plasma

134
Q

What must be measured to evaluate tubular secretion and renal blood flow?

A

A substance that is secreted rather than filtered through the glomerulus

135
Q

What test is most commonly associated with measuring tubular secretion and renal blood flow?

A

p-aminohippuric acid (PAH) test

136
Q

What could cause an abnormal result in tubular secretion and renal blood flow tests?

A

Impaired tubular secretory ability or decreased renal blood flow

137
Q

Why is it important to understand the principles and limitations of tests for tubular secretion and renal blood flow?

A

To correctly interpret the test results in correlation with other clinical data

138
Q

What principle does the PAH test use to measure blood flow through the kidney?

A

measuring the amount of PAH completely removed from the blood by renal tissue.

139
Q

Why must the PAH test substance be removed primarily in the peritubular capillaries?

A

To ensure measurement of blood flow through the entire nephron, not just when the blood reaches the glomerulus.

140
Q

What is the range for reference values of effective renal plasma flow?

A

600 to 700 mL/min

141
Q

Why is the term “effective” used in “effective renal plasma flow”?

A

Because approximately 8% of the renal blood flow does not come into contact with functional renal tissue.

142
Q

What is the average renal blood flow based on normal hematocrit readings?

A

About 1200 mL/min

143
Q

What additional method can nuclear medicine procedures use to determine renal blood flow?

A

Measuring the plasma disappearance of a radioactive hippurate injection and visualizing blood flow through the kidneys.

144
Q

What determines the kidney’s ability to produce an acid urine?

A

Tubular secretion of hydrogen ions and production

Secretion of ammonia by the distal convoluted tubule.

145
Q

Approximately how much acid is excreted daily by a typical person?

A

70 mEq/day

146
Q

When does diurnal variation in urine acidity occur in typical people?

A

Shortly after arising, postprandially at about 2 p.m. and 8 p.m., with the lowest pH found at night.

147
Q

What condition results from the inability to produce an acid urine in the presence of metabolic acidosis?

A

Renal tubular acidosis

148
Q

What may cause renal tubular acidosis?

A

Impaired tubular secretion of hydrogen ions (proximal convoluted tubule) or defects in ammonia secretion (distal convoluted tubule).

149
Q

How can urine pH, titratable acidity, and urinary ammonia be used in diagnosing renal function issues?

A

They help determine defective function by measuring and comparing the acidity and ammonia levels.

150
Q

What method is used to collect specimens for titratable acidity and urinary ammonia tests?

A

Fresh urine specimens or those preserved with toluene, collected at 2-hour intervals after priming with an acid load (oral ammonium chloride).

151
Q

How is ammonium concentration calculated in these tests?

A

By subtracting the titratable acidity from the total acidity of the urine specimen.

152
Q

What dye was historically used to evaluate renal functions in the Phenolsulfonphthalein (PSP) test?

A

Phenolsulfonphthalein (PSP)

153
Q

Why is standardization and interpretation of the PSP test challenging?

A

Due to interference by medications, elevated waste products, need for accurately timed specimens, and risk of anaphylactic shock.

154
Q

What risk is associated with the PSP test that can affect its safety?

A

The risk of producing anaphylactic shock.

AUBF (9 decks)

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