GenNeph

Question 1

GFR

Answer 1

amount of plasma filtered thru the nephron per unit of time

Question 2

How to measure?

Answer 2

**1.inulin (exogenous)- gold standard **
**2.creatinine (endogeneous) **
3.EDTA
4.DTPA
5.iohexol
6.iothalamate
7.Cystatin C

Question 3

eGFR calculation evolution

Answer 3

1. Cockcroft-Gault equation 1973
2. MDRD 1999
3. reexpressed MDRD 2005
4. CKD epi 2009

Question 4

Cockcroft-Gault equation

Answer 4

• overestimate in obese /edematous pt
  *~ as the equation 140-age X **BW ** x 1.2 (male) / se creat

Question 5

MDRD

Answer 5

1. poorly validated in children / elderly / pregnant / ethnic group / those without CKD
2. underestimate

Question 6

characteristic of ideal clearance marker

Answer 6

1. freely filtered
2. not reabsorb / secreted
3. not protein bounded
4. no extra-renal elimination
5. safe to administer & economical

Question 7

Drawback of Creatinine

Answer 7

influences by
a. body mass
b. dietary intake (pt intake)
c. exercise
d. meds: bactrim / cimetidine

Question 8

Conversion

Answer 8

mg/dL - umol/L : x 88.4

mg/dL - mmol/L : x 0.357

Question 9

CKD-epi

Answer 9

1. more accurate
2. same variable as MDRD
3. pooled of data fron CKD+ non CKD

Question 10

Cystatin C

Answer 10

1. non glycosylated pt (low molecular mass)
2. produced by all nucleated cells
3. filtered, reabsorbed, excreted (small amount)
4. independent of age, muscle mass, sex, dietary
5. expensive
6. short half life, smaller volume distribution (useful in AKI)
7. if eGFRcr 45-69 (3a) no marker for kidney damage — to proceed with cystatin C equation
   - if eGFRcys <60 = CKD
   - if eGFRcys >60 = CKD not confirmed
8. accurate in obese: as adipocytes no nucleus

Question 11

definition of CKD

Answer 11

eGFR < 60ml/min/1.73m2 > 3/12 with or without kidney damage

**kidney damage > 3/12 **
(based on biopsy /imaging / urine) regardless eGFR

Question 12

type of nuclear imaging

Answer 12

1. GFR estimation: EDTA
2. dynamic: DTPA, MAG 3
3. static: DMSA

DTPA,MAG 3: renal blood flow,tubular secretion, urinary excretion, GFR

**DMSA **: anatomical abN, renal scarring (non-fx renal tissue)

Question 13

what is pathological proteinuria?

type of proteinuria

Answer 13

1. glomerular: : failure of glomerular failure of high + intermediate MW pt (alb)
2. tubular: LMW pt (Ig light chain,b2 microglobulin) filtered but failure of reabsorb by prox tubules, neg on dipstick
3. overflow: overproduction of LMW pt exceed the capacity of reabsorption (sequalae of #2)
4. secretory: not albuminuric pt added to urine (UTI, bladder ca)

Question 14

definition of
anuria
oliguric
polyuric

Answer 14

anuric: <100ml/ day
oliguric: < 400ml/day
polyuria: 3L/day

Question 15

How SGLT2 works?