Kidney and Liver Function Tests Flashcards
Functions of the urinary system
- excretion and elimination (removal of organic waste products from body fluids such as urea, creatinine and uric acid: terminal prods of metabolism)
- homeostatic regulation (water, electrolyte, acid-base balance)
- endocrine function (kidney hormone production)
What are some hormones produced by kidneys
- renin
- erythropoietin
- 1,25-dihydroxy vitamin D3
- Prostaglandins
Main function of kidney (multifunctional)
storage of liquids by concentration of urine
Urine excreted daily in adults is
about 1.5 L (kidney is only 1% of total body weight)
Renal blood flow accounts for what % of cardiac output
20%
plasma renal flow: 600 ml/min/1.73 meter squared
Two processes involved in renal blood flow
ultrafiltration (GFR): 180 L/day
Reabsorption (>99% of amount filtered gets reabsorbed)
functional units of kidney
nephrons
(600,000-1.5 million)
*decrease in functioning nephrons =impaired kidney function
number of nephrons an individual is born with which may determine that individual’s susceptibility to renal injury
nephron dose
Parts of the nephron
- Glomerulus
- Distal tubule
- Proximal tubule
- Collecting duct
- Loop of Henle
What is formed when collecting ducts ultimately combine? This is where urine collects before passing along the ureter and into the bladder
renal calyces
Where does transport of solutes and water occur?
across and between the epithelial cells that line the renal tubules
Kinds of transport observed in nephrons
active and passive
*many passive transport are dependent upon active ie sodium transport
mediator of filtration which is formed from a specialized capillary network (capillary endothelial cells are ~40 nm thick)
glomerulus
Purpose of circular fenestrations/pores with diameters of ~60 nmn in glomerulus endothelium
Permits virtually free access of plasma solutes to the basement membrane
What is the renal threshold for glucose?
180 mg/dL
What is renal threshold?
Blood concentration of a substance that when surpassed, is excreted in urine
[Renal threshold]
What is tubular maximum?
maximum capacity of the kidneys to absorb a particular substance
*Tm for Glucose = 350 mg/min
What is the pre-renal cause of kidney functional disorder?
pre-renal: decreased intravascular volume
What is the renal cause of kidney functional disorder?
acute tubular necrosis
What is the post-renal cause of kidney functional disorder?
ureteral obstruction
What are the terminal products of hemoglobin catabolism?
bilirubin
urobilin
Hormone metabolites excreted from bloodstream
cortisol
testosterone
*other substances: organic acid, drugs, food additives
Other mechanisms of excretory function of kidneys
- Regulation of blood pressure, circulating volume, and water balance by urine concentration
- Regulation of electrolytes by excretion and resorption
- Maintenance of blood pH in a physiological range by eliminating radical acids, reabsorbing and forming bases
[Homeostatic regulation]
What hormone regulates maintenance of water balance
antidiuretic hormone
[Homeostatic regulation] ADH in maintenance of water balance responds primarily to changes in?
osmolality and intravascular volume
secreted from posterior pituitary
[Homeostatic regulation] What happens when ADH increases permeability of DCT and collecting ducts of water?
Results in increased water reabsorption and excretion of more concentrated urine
[Homeostatic regulation] What do the renal tubules do in states of dehydration?
reabsorb water at their maximal rate resulting in production of a small amount of maximally concentrated urine
[Homeostatic regulation]
When do renal tubules reabsorb water at only a minimal rate?
in states of water excess resulting in excretion of large volume of extremely dilute urine
hormonal factors affecting regulation of electrolyte concentration
*together with neurogenic stimuli
ADH (through detection of osmotic and mechanical stimuli) Aldosterone Natriuretic peptides (sodium urinary removal requires h2o removal)
How does aldosterone affect electrolyte concentration?
*triggered by decreased blood flow or blood pressure in renal arteriole and decreased plasma sodium
sodium reabsorption and excretion of potassium and hydrogen
[homeostatic regulation: electrolyte concentration]
Thirst sensation causes
osmolality variation by 2%
- increase in thirst = HYPERtonic ECF = lower ICF
- decrease in thirst = HYPOtonic ECF = higher ICF
[homeostatic regulation]
two mechanisms performed by kidney in maintaining blood pH
tubular reabsorption of filter HCO3
removal of H+ ions produced daily
Urinary pH
4.5-5.0 (0.04 mol/L)
[homeostatic regulation: maintenance of blood pH] 99% of H+ ions are discarded by
urinary buffer
[H2PO4 > H+ + HPO42-]
Other homeostatic roles of kidneys
- Government of calcium phosphorus metabolism by secretion and reabsorbing.
- Regulation of the production of red blood cells.
The secretory function of kidneys involve hormones such as
- erythropoietin (regulates RBC prod in BM);
- renin (regulates BP; key part of renin-angiotensin-aldosterone system);
- calcitriol (for calcium reabsorption and bone mineralization; active form of vit. D);
- prostaglandins (PGE1, PGE2, thromboxane)
Major renal functions which together, regulate and maintain constant optimal composition of the blood and intracellular fluids
® Glomerular filtration
® Tubular reabsorption (peritubular capillaries)
® Tubular secretion
UE= filtration - reabsorption + secretion
[Secretory function]
Each nephron produces this amount of ultrafiltrate per day
100 μL
*170-200L of ultrafiltrate passes through glomeruli daily
[Secretory function] What determines the initial mass on which the nephron must operate to produce and excrete urine?
Bulk transfer of substances from blood to glomerular filtrate
Laboratory tests and renal functionality studies
• urinary index • Serum creatinine and creatinine clearance Estimated GFR (eGFR) • Proteinuria and diagnosis • Cistatin C detection • Electrolytes • Laboratory and AKI evaluation
In urine tests*, small, randomly collected urine samples is examined through its:
- Physical: color, odor, appearance, and concentration specific gravity
- Chemical: protein, glucose, and pH
- Microscopic: Cellular elements (RBCs, WBCs, and epithelial cells), Bacteria, Crystals, Casts (structures formed by the deposit of protein, cells, and other substances in the kidneys’ tubules)
[Urine tests] Additional test for water balance in ECF and plasma
Volume
[Urine tests] Additional test for solute regulation (sodium, glucose, urea)
specific gravity and osmolality
[Urine tests] Additional test for blood acidity/ alkalinity balance
pH
[Urine tests] Creatinine is used to asses what?
glomerular filtration capacity
[Urine tests] Solute clearance is used to assess what?
glomerular filtration RATE
[Urine tests] These tests are used to assess filtration and/or reabsorption
urine proteins
urine albumin
[Urine tests] test for presence of RBC
hematuria
presence of cystatin C in plasma indicates
presence of bence-jones in urine ????
[Urine tests]
Urine 24 hours volume is useful in evaluating
glomerular filtration and tubular functionality
*normal adult range = 800-2000ml/day (normal fluid intake = 2L/day)
Adequate homeostasis is maintained with a urine output of
400-2000ml/day
Reduced urine volume is caused by
dehydration
not enough fluid intake
some types of chronic kidney disease
increased urine volume is caused by
diabetes
high fluid intake
some forms of kidney disease
use of diuretic medications
[Abnormal results in urine tests] Anuria or no passage of urine or production of <100 ml per day is often caused by
• Total obstruction of urinary tract
- E.g. prostatic hyperplasia and tumors
• Heart failure or severe hypotension
- E.g. renal ischemia (acute tubular necrosis)
• Glomerular nephritis (acute, subacute, chronic)
• Hemolytic reaction caused by blood transfusion
[Abnormal results in urine tests] Oliguria or low output of urine may be due to
no water intake, Prolonged vomit, diarrhea, sweating, ascites, aedema, hypoperfusion, AKI (acute kidney injury), uremic terminal phase of CKD (chronic kidney disease), glomerulonephritis (Diabetic Ketoacidosis, Kidney tubular necrosis- CRI)
[Abnormal results in urine tests] Polyuria with increased azotemia (BUN) and creatinine is due to:
- Diabetic ketoacidosis
* Kidney tubular necrosis (chronic renal insufficiency)
[Abnormal results in urine tests] Polyuria with normal azotemia (BUN) and creatinine is due to:
- Polydipsia
- Extreme protein uptake
- Caffeine and alcohol
- Diuretic medication
- Diabetes mellitus e insipidus
- Deficit Anti-Diuretic Hormone (ADH; vasopressin)
T or f: Urea is freely filtered from glomerulus and reabsorbed in a variable manner by proximal tubules
true
*not useful GFR marker; good for detection of tissue lesions and cellular damaging (burns) and monitoring renal functionality
T or F: urea increases earlier than creatinine and decreases quickly
true
*high values in acute renal insufficiency and terminal stage of chronic renal insufficiency
Why is there an increase in serum BUn in azotemia (20-40 mg/dL of BUN)
Kidney is not able to discard nitrogen metabolism’s degradation products
Pre-renal uremia is usually caused by
outside kidney (upstream of glomerular filtration) such as reduced renal perfusion (shock, dehydration, hemorrhage) and increased protein catabolism (alimentary canal bleeding, burns and fever)