Kidney and Urinary Tract Disease - Test of Renal Function Flashcards
Kidney function
Excretion (uric acid), regulation (homeostasis, water, acid base), endocrine (renin, erythropoietin)
Kidney function
Excretion (uric acid), regulation (homeostasis, water, acid base), endocrine (renin, erythropoietin)
Urine volume
750-2000ml/24hr
Oliguria
Anuria
Polyuria
> 3000
Plasma urea
Quick, simple measurement, 3-8mmol/L (sensitive)
Urea excretion
Filtered at glomerulus, 40% reabsorbed, if slow tubular flow more reabsorbed (renal hypo perfusion)
Causes of increased plasma urea
GI bleed, trauma, renal hypo perfusion (decreased RBF, ECFV), acute renal impairment, chronic renal disease, post-renal obstruction calculus tumour
Urea
Useful, must be interpreted with great care, always consider input, out and patient’s fluid volume
Plasma creatinine
50-140umol/L, increases in conc as GFR decreases (NOT proportional to renal damage)
Creatine clearance
Ucreat X V/Pcreat
[RR 100-130 mL/min]
incomplete collection/unreliable
Tubular secretion of creatine
Increased in chronic renal disease and decreased by drugs (salicylate, cimetidine)
Pre-renal oliguria
GFR reduced, ADH increased, renal hypo perfusion causes renin secretion (increase Na reabsorption)
Low renal perfusion caused by
Dehydration, haemorrhage, renal artery damage, hypotension
Renal oliguria
GFR reduced/normal, weak urine/low volume, renal renin secretion may be raised (hypertension, unable reabsorb Na)
Intrinsic damage causing renal oliguria
Tubular necorsis, chronic infection, immunological damage (SLE), toxic damage (drugs, heavy metals Hg, Ur, poisons)
Lab tests of renal function
plasma creatinine plasma urea plasma sodium urine volume urine sodium urine urea creatinine clearance urine dispsticks
Problem with GFR
Impractical
Problem with CC
Unreliable
Problem with plasma creatine
Specific, but insensitive
Problem with plasma urea
Subject to problems
Problem with urine vol
Often forgotten
Urine volume
750-2000ml/24hr
Oliguria
Anuria
Polyuria
> 3000
Plasma urea
Quick, simple measurement, 3-8mmol/L (sensitive)
Urea excretion
Filtered at glomerulus, 40% reabsorbed, if slow tubular flow more reabsorbed (renal hypo perfusion)
Causes of increased plasma urea
GI bleed, trauma, renal hypo perfusion (decreased RBF, ECFV), acute renal impairment, chronic renal disease, post-renal obstruction calculus tumour
Urea
Useful, must be interpreted with great care, always consider input, out and patient’s fluid volume
Plasma creatinine
50-140umol/L, increases in conc as GFR decreases (NOT proportional to renal damage)
Creatine clearance
Ucreat X V/Pcreat
[RR 100-130 mL/min]
incomplete collection/unreliable
Tubular secretion of creatine
Increased in chronic renal disease and decreased by drugs (salicylate, cimetidine)
Pre-renal oliguria
GFR reduced, ADH increased, renal hypo perfusion causes renin secretion (increase Na reabsorption)
Low renal perfusion caused by
Dehydration, haemorrhage, renal artery damage, hypotension
Renal oliguria
GFR reduced/normal, weak urine/low volume, renal renin secretion may be raised (hypertension, unable reabsorb Na)
Intrinsic damage causing renal oliguria
Tubular necorsis, chronic infection, immunological damage (SLE), toxic damage (drugs, heavy metals Hg, Ur, poisons)
Lab tests of renal function
plasma creatinine plasma urea plasma sodium urine volume urine sodium urine urea creatinine clearance urine dispsticks
Problem with GFR
Impractical
Problem with CC
Unreliable
Problem with plasma creatine
Specific, but insensitive
Problem with plasma urea
Subject to problems
Problem with urine vol
Often forgotten