biochemical measurement in renal disease

Question 1

glomerular funciton is assessed using

Answer 1

glomerular filtration rate

Question 2

ideal marker of GFR

Answer 2

would appear at ac instant rate be freely filtered at the glomerulus, not re-asborbed or secreted by the renal tubules and not undergo extra-renal eliminations

Question 3

ideally what would be used as a GFR marker

Answer 3

inulin however, it has to be given as a constant infusion therefore, creatinine is used instead

Question 4

whats the issue with creatinine being used as GFR

Answer 4

small amount is secreted in the distal convoluted tubule therefore, it might slightly overestimate GFR

Question 5

creatinine is a product of what

Answer 5

muscle breakdown so people with large muscle masses have greater glomerular filtration rates as they are producing more creatinine

Question 6

clearance is

Answer 6

the volume of plasma cleared of a substance per minute

Question 7

urinary clearance calcualtion

Answer 7

(creatinine) urine x urine volume/ (creatinine) serum x duration of collection (minutes)

Question 8

i.e. if the concentration of creatinine of 6800 micro mol in the urine of a volume of 2500ml and there is 100 micro mol of creatinine in the serum over 24 horus work out plasma clearance of creatinein

Answer 8

6800x 2500/ 100x 1440= 118ml/min

Question 9

estimated glomerular filtration rate takes into account

Answer 9

creatinine, sex, age and albumin

Question 10

if it is absolutely essential to get exact measurement of GFR then

Answer 10

chromate clearance is carried out

Question 11

normal levels of protein

Answer 11

DIPSTICK= NEGATIVE
PROTEIN CREATININE RATIO= LESS THAN 15MG/MMOL
TOTAL PROTEIN= LESS THAN 0.15G/24 HOURS
ALBUMIN CREATININE RATIO= LESS THAN 2.5 IN MALES AND LESS THAN 3.5 IN FEMALES

Question 12

MICROALBUMINURIA LEVELS OF PROTEIN

Answer 12

DIPSTICK NEGATIVE
PROTEIN CREATINEIN RTATION= LESS THAN 25MG/MMOL
TOTAL PROTEIN= LESS THAN 0.15G/ 24 HOURS
ALBUMIN CREATINIEN RATIO= 2.5-30 IN MALES 3.5-30 IN FEMALES

Question 13

CLINCIAL PROTEINURIA

Answer 13

DIPSTICK 1+ OR 2+
PROTEIN TO CREATININE RATIO= 45- 449
TOTAL PROTEIN= 1.5-4.49 IN 24 HOUS
ALBUMIN CREATINIEN RATIO GREATER THAN 30

Question 14

NEPHROTIC SYDNROME

Answer 14

DIPSTICK 3+
PCR GREATER THAN 450
TOTAL PROTEIN GREATER THAN 4.5G/ 24 HOURS
ALBUMIN CREATINING RATIO GREATER THAN 30

Question 15

microalbuinuria is the

Answer 15

excretion of albumin in abnormal quantities but not enough to be detected by a dipstick

Question 16

microalbuminuria is the earliest sign of

Answer 16

diabetic nephropathy

Question 17

in pre-renal AKI the tubules are still working

Answer 17

so urinary sodium is less than 20

urine: serum urea greater than 10:1
urine: serum osmolarity= greater than 1.5:1

Question 18

in intra-renal AKI

Answer 18

the tubules are not working
- urinary sodium is greater than 40
urine: serum urea less than 3: 1
urine to serum osmolarity less than 1.1: 1
THE TUBULES ARE DAMAGES SO THE KIDNEYS CANNOT CONCENTRATE THE URINE