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Clinical Chemistry Review > Kidney Function Tests > Flashcards

Kidney Function Tests Flashcards

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1
Q

Tests for GFR
Clearance:

A

-Inulin clearance
-Creatinine clearance
-Urea clearance

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2
Q

Phenolsulfonphthalein dye test

A

GFR

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3
Q

Cystatin C

A

GFR

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4
Q

Tests for Renal Blood Flow

A

BUN
Creatinine
Uric acid

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5
Q

Tests Measuring Tubular Function
Excretion:

Concentration:

A

-Para-amino hippurate test (Diodrast test)
-Phenolsulfonphthalein dye test

-Specific gravity
-Osmolality

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6
Q

Decreases by 1.0 mL/min/year after age 20-30 years

A

GFR

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7
Q

of glomerular filtrate is produced daily

A

150 L

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8
Q

Reference method for GFR

A

Inulin clearance

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9
Q

Best alternative method

A

Creatinine clearance

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10
Q

Measure of the completeness of a 24-hour urine collection

A

Creatinine clearance

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11
Q

Creatinine clearance Excretion:

A

1.2-1.5 g creatinine/day

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12
Q

Demonstrate progression of renal disease or response to therapy

A

Urea clearance

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13
Q

Low MW protease inhibitor

A

Cystatin C

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14
Q

Filtered > Not secreted > Completely reabsorbed (PCT)

A

Cystatin C

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15
Q

Indirect estimates of GFR

A

Cystatin C

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16
Q

Its presence in urine denotes damage to PCT

A

Cystatin C

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17
Q

Synthesized from Ornithine or Kreb’s Henseleit cycle

A

BUN

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18
Q

First metabolite to elevate in kidney diseases

A

BUN

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19
Q

Better indicator of nitrogen intake and state of hydration

A

BUN

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20
Q

BUN > Urea (mg/dL)

A

2.14

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21
Q

Inhibit urease

A

Fluoride or citrate

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22
Q

Enhance color development (BUN mtd)

A

Thiosemicarbazide
Ferric ions

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23
Q

Yellow diazine derivative

A

Diacetyl monoxime method

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24
Q

BUN: Routinely used

A

Urease method

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25
Q

: prepared from jack beans

A

Urease

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26
Q

Urea —(Urease)–>

A

NH4 + Berthelot reagent (Measure ammonia)

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27
Q

Coupled urease

A

Glutamate dehydrogenase method

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28
Q

UV enzymatic method

A

Coupled urease

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29
Q

BUN: Reference method

A

Isotope dilution mass spectrometry

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30
Q

For research purposes

A

Isotope dilution mass spectrometry

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31
Q

NPN

A

45% Urea
20% Amino acid
20% Uric acid
5% Creatinine
1-2% Creatine
0.2% Ammonia

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32
Q

Creatinine: Derived from

A

alpha-methyl guanidoacetic acid

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33
Q

Produced by 3 amino acids (methionine, arginine, lysine)

A

Creatinine

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34
Q

Most commonly used to monitor renal function

A

Creatinine

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35
Q

Enzymatic methods (Creatinine)

A

Creatinine Aminohydrolase – CK method
Creatinase-Hydrogen Peroxide method – benzoquinonemine dye (red)
Creatininase (a.k.a. creatinine aminohydrolase)

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36
Q

Formation of red tautomer of creatinine picrate

A

Direct Jaffe method

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37
Q

Interferences (Direct Jaffe) Falsely increased:

A

Ascorbate
Glucose
Uric acid
Alpha-keto acids

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38
Q

(+) Red orange tautomer

A

Folin Wu Method

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39
Q

True measure of creatinine

A

Lloyd’s or Fuller’s Earth method

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40
Q

Sensitive and specific

A

Lloyd’s or Fuller’s Earth method

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41
Q

Uses adsorbent to remove interferences (UA, Hgb, Bili)

A

Lloyd’s or Fuller’s Earth method

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42
Q

Lloyd’s reagent

A

Sodium aluminum silicate

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43
Q

Fuller’s earth reagent

A

Aluminum magnesium silicate

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44
Q

Jaffe reagent (Alk. picrate)

A

Satd. picric acid + 10% NaOH

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45
Q

Popular, inexpensive, rapid and easy to perform

A

Kinetic Jaffe method

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46
Q

Requires automated equipment

A

Kinetic Jaffe method

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47
Q

Elevated urea and creatinine in blood

A

Azotemia

48
Q

Decreased GFR but normal renal function

A

Pre-renal azotemia

49
Q

Dehydration, shock, CHF

A

Pre-renal azotemia

50
Q

Increased: BUN
Normal: Creatinine

A

Pre-renal azotemia

51
Q

True renal disease

A

Renal azotemia

52
Q

GFR Striking BUN level but slowly rising creatinine value

A

Renal azotemia

53
Q

BUN = >100 mg/dL
Creatinine = >20 mg/dL
Uric acid = >12 mg/dL

A

Renal azotemia

54
Q

Urinary tract obstruction

A

Post renal azotemia

55
Q

Decreased GFR

A

Pre and Post renal azotemia

56
Q

Nephrolithiasis, cancer or tumors of GUT

A

Post renal azotemia

57
Q

Creatinine = normal or slightly increased

A

Post renal azotemia

58
Q

Marked elevation of urea, accompanied by acidemia and electrolyte imbalance

A

Uremia

59
Q

(K+ elevation) of renal failure

A

Uremia

60
Q

Normocytic, normochromic anemia

A

Uremia

61
Q

Uremic frost (dirty skin)

A

Uremia

62
Q

Edema

A

Uremia

63
Q

Foul breath

A

Uremia

64
Q

Urine-like sweat

A

Uremia

65
Q

From purine (adenine and guanine) catabolism

A

Uric acid

66
Q

Uric acid Excretion:

A

1g/day

67
Q

-Gout

A

Hyperuricemia

68
Q

-Increased nuclear metabolism

A

Hyperuricemia

69
Q

-Chronic renal disease

A

Hyperuricemia

70
Q

-Lesch-Nyhan syndrome (HGPRT deficiency)

A

Hyperuricemia

71
Q

Fanconi’s syndrome

A

Hypouricemia

72
Q

Wilson’s disease

A

Hypouricemia

73
Q

Hodgkin’s disease

A

Hypouricemia

74
Q

Stable for 3 days

A

Methods (Uric acid)

75
Q

Potassium oxalate cannot be used

A

Methods (Uric acid)

76
Q

Methods (Uric acid) Major interferences:

A

Ascorbate and bilirubin

77
Q

Phosphotungstic acid mtd:

A

Uric acid + Phosphotungstic acid —(NaCN/NaCO3)–> Tungsten blue + Allantoin

78
Q

NaCN

A

Folin
Newton
Brown
Benedict

79
Q

NaCO3

A

Archibald
Henry
Caraway

80
Q

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

A

Lagphase

81
Q

UREA: Simplest and most specific method

A

Uricase method

82
Q

URIC ACID: Candidate reference method

A

Uricase method

83
Q

Uricase method

A

Uric acid (Absorbance at 293nm) —[Uricase]–> Allantoin (No absorbance)

84
Q

Decrease in absorbance α uric acid concentration

A

Uricase method

85
Q

Measures renal plasma flow

A

Para-amino hippurate test

86
Q

Reference method for tubular function

A

Para-amino hippurate test

87
Q

Measures excretion of dye proportional to renal tubular mass

A

Phenolsulfonphthalein dye test

88
Q

6 mg of PSP is administered IV

A

Phenolsulfonphthalein dye test

89
Q

Collecting tubules and loops of Henle

A

Concentration tests

90
Q

Concentration tests Specimen:

A

1st morning urine

91
Q

Specific gravity
Affected by [?]
SG > [?]: X-ray dye and mannitol
[?]= SG of ultrafiltrate in Bowman’s space

A

solute number and mass

1.050

1.010

92
Q

Total number solute particles present/kg of solvent (moles/kg solvent)

A

Osmolality

93
Q

Affectted only by number of solutes present

A

Osmolality

94
Q

Urine osmolality = due to
Serum osmolality = due to

A

urea

sodium and chloride

95
Q

Det. by Colligative properties:
Freezing point
Vapor pressure
Osmotic pressure
Boiling point

A

Freezing point (incr. osm. = decr. FP)
Vapor pressure (incr. osm. = decr. VP)
Osmotic pressure (incr. osm. = incr. OP)
Boiling point (incr. osm. = incr. BP)

96
Q

Direct methods (Osmolality)
= popular method
(Seebeck effect)

A

Freezing point osmometry
Vapor pressure osmometry

97
Q

Incr. vasopressin (H2O reabsorption) =

A

decr. plasma osmolality

98
Q

Tubular failure
Increased:
Decreased:

A

BUN, creatinine, calcium

Phosphate

99
Q

Difference between measured and calculated osmolality

A

Osmolal gap

100
Q

Sensitive indicator of alcohol or drug overdose

A

Osmolal gap

101
Q

Sensitive indicator of alcohol or drug overdose

A

Osmolal gap

102
Q

Osmolal gap: >12 mOsm/kg

A

DKA
Drug overdose
Renal failure

103
Q

Creatinine Clearance:
Male =
Female =

A

85-125 mL/min

75-112 mL/min

104
Q

BUN =

A

8-23 mg/dL

105
Q

BUN =

A

8-23 mg/dL

106
Q

Uric acid:
Male =
Female =

A

3.5-7.2 mg/dL

2.6-6.0 mg/dL

107
Q

Renal plasma flow (PAH) =

A

600-700 mL/min

108
Q

Renal blood flow (PSP) =

A

1200 mL/min

109
Q

SG =

A

1.005-1.030

110
Q

Osmolality:
Serum =
Urine (24-hr) =

A

275-295 mOsm/kg

300-900 mOsm/kg [<290 mOsm/kg = kidney damage]

111
Q

Urine osmolality: Serum osmolality =

A

1:1 to 3:1

112
Q

[= Glomerular disease]

A

> 1:1

113
Q

[= loss of renal concentrating ability]

A

1.2:1

114
Q

[= Diabetes Insipidus]

A

<1:1

115
Q

-Increased nuclear metabolism Tx:

A

Allopurinol

Clinical Chemistry Review (15 decks)

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