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Clinical Chemistry > KIDNEY FUNCTION TEST > Flashcards

KIDNEY FUNCTION TEST Flashcards

1
Q

This is responsible for the reabsorption of:
Sodium
Chloride
Bicarbonate and other ions
Glucose
Amino acids
Proteins
Urea and
Uric Acid

A

Proximal Convoluted Tubule

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2
Q

Renal Function Panel:

A

Glucose
BUN
Creatinine
Sodium
Potassium
Chloride
Phosphorus
Calcoum
Albumin
CO2

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3
Q

Elimination of Waste products
Maintenance of blood volume
Maintenance of electrolyte balance
Maintenance of acid-base balance
Endocrine function (EPO secretion)

A

Functions of the Kidneys

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4
Q

Measure of clearance of normal molecules that are not bound to protein and are freely filtered by the glomeruli neither reabsorbed nor secreted by the tubules

A

Glomerular Filtration Rate

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5
Q

GFR is considered the best ___

A

Overall indicator of level of Kidney function

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6
Q

Removal of substance from plasma into urine over a fixed time
Expressed in mL/minute

A

Clearance

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7
Q

Plasma concentration is _____ to clearance

A

Inversely proportional

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8
Q

Formula for Clearance:

A

(Urine/Plasma) x (Volume/1440) x (1.73/A)

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9
Q

Reference Method

A

Inulin Clearance

Not routinely done

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10
Q

Reference Method

A

Inulin Clearance

Not routinely done

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11
Q

Reference Value of Inulin Clearance

A

Male = 127 mL/min
Female = 118 mL/min

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12
Q

Provides an estimate of the amount of plasma that must flowed through the kidney glomeruli per minute
Excellent measure of renal function

A

Creatinine Clearance

Creatinine is freely filtered by the glomeruli but not reabsorbed

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13
Q

Provides an estimate of the amount of plasma that must flowed through the kidney glomeruli per minute
Excellent measure of renal function

A

Creatinine Clearance

Creatinine is freely filtered by the glomeruli but not reabsorbed

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14
Q

Reference Value of Creatinine Clearance

A

Male: 85-125 mL/min
Female: 75-112 mL/min

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15
Q
  1. High Cardiac Output
  2. Pregnancy
  3. Burns
  4. CO poisoning
A

Increased Creatinine Clearance

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16
Q
  1. Impaired Kidney Function
  2. Shock, Dehydration
  3. Hemorrhage
  4. Congestive Heart Failure
A

Decreased Creatinine Clearance

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17
Q

Can demonstrate progression of renal disease or response to therapy
Not give reliable estimates of the GFR since it is freely filtered by the glomeruli but variably reabsorbed by the tubules

A

Urea Clearance

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18
Q

Volume depletion decreases Urea Clearance by both:

A

Reduced Filtration
Increased Reabsorption

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19
Q

Produced at a constant rate by all nucleated cells
Freely filtered at glomerulus, not secreted by the renal tubules but reabsorbed

A

Cystatin C

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20
Q

Increases more rapidly than creatinine in the early stages of GFR impairment

A

Cystatin C

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21
Q

Reference Value of Cystatin C

A

Adult: 0.5-1.9 mg/L
(>65 yo): 0.9-3.4 mg/L

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22
Q

Low molecular weight glycoprotein
Functions as Prostaglandin D Synthase
Isolated primarily from CSF; Freely filtered at Glomerulus, then reabsorbed completely and catabolized by the proximal tubule

A

Beta Trace Protein

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23
Q

Major end product of Protein and Amino Acid Catabolism
Synthesized in Liver from CO2 and Ammonia from deamination of AA
Glomerulus: Freely filtered
PCT: Substantially reabsorbed
**First Metabolite to Elevate in Kidney Disease

Easily removed by Dialysis

A

Blood Urea Nitrogen

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24
Q

Reference Value of BUN

A

8-23 mg/dL

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25
Q

BUN:Creatinine Ratio

A

10:1
20:1

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26
Q

End Product: Yellow Diazine Derivative

A

Diacetyl Monoxime Method

Chemical Method

BUN

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27
Q

End Product: NH3 + CO2

A

Hydrolysis of Urea by Urease

Enzymatic Method (Indirect)

BUN

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28
Q

End: Glutamate + NAD + H2O

A

Coupled Urease or
Glutamate Dehydrogenase Method

UV Enzymatic Method

BUN

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29
Q

End: Glutamate + NAD + H2O

A

Coupled Urease or
Glutamate Dehydrogenase Method

UV Enzymatic Method

BUN

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30
Q

Reference Method for BUN

A

Isotope Dilution Mass Spectrometry (IDMS)

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31
Q
  1. Chronic Renal Disease
  2. Stress
  3. Burns
  4. High Protein Diet
  5. Dehydration
A

Increased BUN

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32
Q
  1. Poor Nutrition
  2. Hepatic Disease
  3. Impaired Absorption (Celiac Dse)
  4. Pregnancy
A

Decreased BUN

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33
Q

End Product of Muscle Metabolism derived from creatine
Partially secreted by PCT via organic cation transport pathway
Not reused in body’s metabolism, solely as a waste product
Commonly used to monitor renal function; index of overall renal function

A

Creatinine

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34
Q

Measure of the completeness of 24-hour urine collection
Used to evaluate fetal kidney maturity

A

Creatinine

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35
Q

Reference Value of Creatinine

A

Male: 0.9-1.3 mg/dL
Female: 0.6-1.1 mg/dL

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36
Q

Patients taking this antibiotics may have falsely increased result in Jaffe reaction:

A

Cephalosporin

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37
Q

A Red-Orange tautomer of creatinine picrate is formed when creatinine is mixed with alkaline picrate reagent

A

Direct Jaffe Method

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38
Q

False Increased Direct Jaffe

A

Ascorbate
Glucose
Uric Acid
A-Keto acids

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39
Q

False decreased Direct Jaffe

A

Bilirubin
Hemoglobin

40
Q

A Sensitive but nonspecific method
Phosphomolybdenum blue

A

Folin-Wu Method

Creatinine

41
Q

A Sensitive but nonspecific method
Phosphomolybdenum blue

A

Folin-Wu Method

Creatinine

42
Q

Sensitive and Specific Method
Uses Adsorbents to remove interferences

A

Lloyd or Fuller’s Earth Method

43
Q

Adsorbent of Lloyd’s reagent

A

Sodium Aluminum Silicate

44
Q

Adsorbent of Fuller’s Earth Reagent

A

Aluminum Mg Silicate

45
Q

Jaffe Reagent (Alkaline Picrate)

A

Saturated Picric Acid
10% NaOH

46
Q

Requires Automated Equipment for precision
Popular, inexpensive, rapid and easy to perform
Serum is mixed with alkaline picrate and the rate of change in absorbance is measured between 2 points

A

Kinetic Jaffe Method

47
Q

Used to eliminate nonspecificity of the Jaffe Reaction
Specific than Jaffe test

A

Enzymatic Method
Creatinine

48
Q

Requires large volume of pre-incubated sample; not widely used
End: Lactate + NAD

A

Creatinine Aminohydrolase-CK Method

49
Q

Has the potential to replace Jaffe method
Without interference from acetoacetate or cephalosportins
End: Benzoquinonemine dye (Red)

A

Creatinase-Hydrogen Peroxide Method

50
Q

Enzymes:
1. Creatinine Aminohydrolase/Creatininase
2. Creatine Kinase
3. Pyruvate Kinase
4. Lactate Dehydrogenase

A

Creatinine Aminohydrolase - CK Method

51
Q

Enzymes:
1. Creatininase/ Creatinine aminohydrolase
2. Creatinase
3. Sarcosine Oxidase
4. Peroxidase

A

Creatinase- Hydrogen Peroxide Method

52
Q

Reference Method for Creatinine

A

Isotope Dilution Mass Spectroscopy

Like in BUN

53
Q
  1. Impaired Renal Function
  2. Chronic Nephritis
  3. Congestive Heart Failure
A

Increased Serum Creatinine

54
Q
  1. Decreased Muscle Mass
  2. Advanced and Severe Liver Disease
  3. Pregnancy
  4. Inadequate Dietary Protein
A

Decreased Serum Creatinine

55
Q

Major product of Purine Catabolism
Freely filtered, partially reabsorbed and secreted in renal tubules

A

Blood Uric Acid

56
Q

Reference Value of BUA

A

Male: 3.5-7.2 mg/dL
Femal: 2.6-6.0 mg/dL

57
Q

Disease found primarily in males and first diagnosed between 3rd and 5th decade of lide
Pain and inflammation of the joints
Presence of birefrinent crystals in synovial fluid
Persons with this disease are highly susceptible to Nephrolithiasis

A

Gout

Hyperuricemia

58
Q

Disease found primarily in males and first diagnosed between 3rd and 5th decade of lide
Pain and inflammation of the joints
Presence of birefrinent crystals in synovial fluid
Persons with this disease are highly susceptible to Nephrolithiasis

A

Gout

Hyperuricemia

59
Q

Seen in leukemia, lymphoma, multiple myeloma or polycythemia, hemolytic and megaloblastic anemia

A

Increased nuclear metabolism

60
Q

Due to decreased GFR and tubular secretion

A

Chronic Renal Disease

61
Q

Deficiency of Hypoxanthine-Guanine Phosphoribosyl Transferase (HGPRT)

A

Lesch-Nyhan Syndrome

62
Q
  1. Fanconi Syndrome
  2. Wilson’s disease
  3. Hodgkin’s Disease
A

Hypouricemia

63
Q

Principle: Redox reaction
End: Tungsten blue + Allantoin + CO2

A

Chemical Method

BUA

64
Q

Principle: Redox reaction
End: Tungsten blue + Allantoin + CO2

A

Chemical Method

BUA

65
Q

Enzymes for Chemical Method

BUA

A
  1. Sodium Cyanide
  2. Sodium Carbonate
66
Q

Tests that uses Sodium Cyanide

A

Folin
Newton
Brown
Benedict

67
Q

Tests that uses Sodium Carbonate

Na2CO3, BUA

A

Archibald
Henry
Caraway

68
Q

Incubation period after the addition of an alkali to inactivate non-uric acid reactants

69
Q

Specific Method
Uric Acid has UV absorbance peak at 293 nm
The decrease in absorbance is proportional to the concentration of uric acid present in the sample

A

Uricase Method
End: Allantoin (No absorption at 293 nm) + CO2 + H2O

70
Q

Reference method for Uric Acid

A

Isotope Dilution Mass Spectrometry

Crea & BUN

71
Q

Reference method for Uric Acid

A

Isotope Dilution Mass Spectrometry

Crea & BUN

72
Q

Diminished glomerular filtration with normal renal function
Decreased renal blood flow
Cause:
1. Dehydration
2. Shock
3. CHF

A

Pre-Renal Azotemia

73
Q

Damage within Kidneys so decreased GFR
BUN; >100 mg/dL
Crea: 20 mg/dL
BUA: 12 mg/dL
Cause:
1. Acute/Chronic Renal Disease
2. Glomerulonephritis

A

Renal Azotemia

74
Q

Result of Urinary tract obstruction so decreased GFR
Urea level is higher than creatinine due to back-diffusion of urea into the circulation
Cause:
1. Renal Calculi (Nephrolithiasis)
2. Cancer or Tumors of Genitourinary Tract

A

Post-Renal Azotemia

75
Q

Marked elevation in plasma urea and other nitrogen waste products, accompanied by acidemia & electrolyte imbalance (Inc K)
Characterized by:
1. anemia (normocytic normochromic)
2. Uremic frost (dirty skin)
3. Generalized edema
4. Foul breath
5. Sweat is urine-like

76
Q

Uremia is responsible for changes in red cell shape such as:

A

Burr Cells/ Echinocytes
Ellipsoidal cells

77
Q

Reflects the function of the collecting tubules and the loops of Henle
Assess the quantiy of solutes present in urine, which reflects ability of kidneys to produce a concentrated urine

A

Concentration Test

78
Q

Three most prevalent solutes excreted:

A
  1. Urea
  2. Chloride
  3. Sodium
79
Q

Simplest test of renal concentrating ability
Compares weight of fluid with that of distilled water

A

Specific Gravity

80
Q

Reference Value of SG

A

1.005-1.030

81
Q

Concentration in terms of total number of solute particles present/kg of solvent
Affected only by the number of solutes present (More accurate than SG)
Useful in assessing water deficit or excess

A

Osmolality

82
Q

Urine osmolality is primarily due to:

83
Q

Serum osmolality is primarily due to:

A

Sodium
Chloride

84
Q

Osmolality is determined by measuring a colligative property of sample such as:

A
  1. Freezing point
  2. Vapor Pressure
  3. Osmotic Pressure and
  4. Boiling Point
85
Q

Increased Osmolality, Increased:

A

Osmotic Pressure
Boiling Point

86
Q

Increase Osmolality, Decreased:

A

Freezing Point
Vapor Pressure

87
Q

Reference Value of Osmolality

A

Serum: 275-295 mOsm/kg
24-hour: 300-900 mOsm/kg

88
Q

Popular method in determining Osmolality
Direct Method

A

Freezing Point Osmometry

89
Q

Formula for Computing Serum Osmolality:

A

Serum Osm = 1.86Na + Gluc/18 + BUN/2.8

90
Q

Normal ratio of Urine osmolality to Serum osmolality:

91
Q

Loss of renal concentrating ability:

92
Q

Diabetes Insipidus

93
Q

Glomerular Disease & Presence of Increase solute in urinary filtrate

94
Q

Hyperglycemia
Uremia
Anion Gap Acidosis

A

Serum Osmolality (>2.1-2.3)

95
Q

Difference between measured and calculated plasma osmolality

A

Osmolal Gap

96
Q

Sensitive indicator of Alcohol or Drug overdose, causing a large gap in Ethanol Intoxication

A

Osmolal Gap

97
Q

Serum anion gap is increased in patients with:

A

Lactic Acidosis

Clinical Chemistry (16 decks)

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