KIDNEY/NPN Flashcards
paired, bean-shaped organs located in the _____ of the abdomen and just ____ the rib cage on each _____ of the spine
KIDNEY
back
under
side
_______`inside the kidney is considered as its functional unit which have 5 basic parts [5
NEPHRONS
glomerulus/Bowman’s capsule
PCT
DCT
Collecting ducts
Loop of Henle
GENERAL FUNCTIONS OF KIDNEY
➢ Elimination of _________dissolved in the plasma through the formation of urine
➢ Regulation of the ______ and ______ volume. ______ is the major urine constituent
Make adjustments in the concentration of normal constituents in the plasma thru _______
➢ _________ of ionic equilibrium electrolytes
➢ Maintenance of ________ balance
➢ _______ function hormones such as EPO and renin
foreign/metabolic subs. waste products
plasma
water
water
urination
regulation
acid base
acid-base
Endocrine
TEST MEASURING GLOMERULAR FILTRATION RATE
– generally called ________.
Removal of the [X] substances from the _______ → into the urine over a fixed time
➢ FORMULA __________
✓ ____ = analyte conc. in the urine
✓ ____ = analyte conc. in plasma
✓ ____ = urine vol in mL for ____hrs.
✓ Mins = time required to collect urine (_____ mins.)
✓ ____= body surface of the patient
✓ ____ = constant value, average body surface of an adult individual
CLEARANCES
plasma
[U/P] X [VOL/MINS] X [1.73/A]
U
P
VOL
1440
A
1.73
Substance should neither be excreted nor reabsorbed by _______, it is readily filtered by or passes through the ________ and normal molecules not bound to ______.
tubules
glomerulus
proteins
3 MAJOR GROUPS OF KIDNEY FUNCTION TESTS
- Test Measuring GFR
- Test Measuring Renal Blood Flow
- Test Measuring Tubular Functions
3 TYPES OF CLEARANCES under GFR RATE Tests
Creatinine Clearance Test
Inulin Clearance Test
Urea Clearance Test
Clearance occuring through metabolic production: eliminated from the [X] plasma by [glomerular filtration] → therefore a measurement of its rate of clearance = affords a measure of the process.
Creatinine Clearance Test
➢ freely passes the glomeruli but is not secreted + reabsorbed by the nephric tubules.
Inulin Clearance test
➢MOST ACCURATE of GFR measurement.
Inulin Clearance Test
➢ is freely filtered by the glomeruli but VARIABLY reabsorbed in the tubules depending upon the transit time of _______ [rate of urine flow along the course of nephric tubules]
Urea Clearance Test
urea filtrate
— faster urine flow rate = [more/less] reabsorbed urea
less
Normal Values of the ff:
Creatinine Clearance Test
Inulin Clearance Test
107-139 ml/min
Men: 250 ml/min
Women: 110 ml/min
TEST Measuring TUBULAR FUNCTIONS
[Categories/Subcategories] [3]
I. EXCRETORY TEST
1. Para-Aminohippurate Test [PAH]/Diodrast Test
2. Henolsufophthalein [PSP] Dye Excretion Test
II. CONCENTRATION TEST
1. Fishberg Concentration Test
➢ Measures renal plasma flow
➢ Requires clearance of a dye
[PAH]
Para-Aminohippurate Test/Diodrast Test
A test with a ref. range: 600-700 mL/min
PAH
➢ It measures excretion of a dye = to renal tubular mass
[PSP] Henolsufophthalein Dye Excretion Test
PSP
[#] mg- thru IV
6
PSP Ref range
1,200 ml blood flow/min
testing the CONCENTRATING ABILITY OF THE KIDNEY.
CONCENTRATION Test
Concentration Test reflect the functions of [2 major parts of Kidney]
Collecting tubules
Loop of Henle
Specific gravity in kidney concentration test
1.005 – 1.030
[2] will yield high SG [more than 1.050]
X-ray
Mannitol
Osmolality expression of concentration in terms:
[2]
solute particles per kg of solvent
moles per kg of solvent
Reference values in Concentration Test:
for serum: between _____ mOsm/kg
for urine: ______ mOsm/kg 24 hr urine
275 – 295
300-900
________substances containing nitrogen but not generally considered as proteins
[6]
Non-Protein Nitrogen
Amino Acids
Ammonia
Creatine
Creatinine
Uric Acid
Urea
major NPN of both plasma and urine
Urea
major excretory product of protein metabolism
Urea
Urea is formed in the liver from ____ groups (-NH2) & ______generated during _______ catabolism product of ____ detoxification coming from the ammonia which is water [soluble/insoluble] & _______.
amino
free ammonia
protein
liver
insoluble
neurotoxic
Urea conc. in the plasma is determined by [3]
Renal function/perfusion
Protein content of the diet
Protein catabolism
➢ Major organic solid in the urine
➢ 90% Urea is _____; 10% remain in the _____
Blood Urea Nitrogen [BUN]
excreted
blood
INC BUN is indicative of
kidney disease
DEC BUN is indicative of
severe liver damage
Urea is readily removed by ______.
Dialysis
→ BUN CLINICAL APPLICATION
➢ evaluate renal function
➢ to assess ______ status
➢ to determine _____ balance
➢ to aid in the diagnosis of _____ disease
➢ to verify adequacy of ____.
hydration
nitrogen
kidney
dialysis
Other enzymatic methods for Urea
[4]
GLDH coupled enzymatic
Indicator dye
Conductimetric
Isotope dilution MS
used on many automated instruments; best as kinetic measurement for Urea
GLDH coupled enzymatic
used in automated systems
multilayer film rgt +
dry rgt strips
Indicator dye
Specific and rapid measurement for urea
Conductmetric
Detection of urea /BUA characteristic fragments ionization; quantification using isotopically labeled compound.
THE REFERENCE METHOD
Isotope dilution Mass Spectrometry
Urea METHODS
[2 Categories/ 3 Subcategories] [5]
ENZYMATIC METHODS
1. ENZYMATIC & ACID TITRATION
2. ENZYMATIC & NESSLERIZATION
– 3. Urease-Nessler Method
– 4. Urease Berthelot Method
CHEMICAL METHODS
5. DIACETYL MONOXIME METHOD
ENZYMATIC & NESSLERIZATION
➢ Urea in the protein free filtrate [PFF] → made to react with __________ in the ← presence of [2] → then reacted with ______ reagent to = _______.
urease glycerol extract
buffer
heat-forming ammonium carbonate
Nessler’s
yellow dimercuric ammonium iodide/ NH2HgI3
Urea→ CO2 + NH3
NH3 + Nessler’s reagent→ NH2HgI3
what method is this?
UREASE BERTHELOT METHOD:
➢ Urea is hydrolyzed to ammonium carbonate by _____; ammonia reacts with [2] in an alkaline medium forming a= _________
urease
phenol
sodium hypochlorite
blue indophenol
what method is this?
Urea→CO2 + NH3
NH3 + phenol hypochlorite→indophenol blue
Urease-Berthelot Method
In Enzymatic & Acid Titration, Urea is hydrolyzed by urease forming ____ which is then titrated with a [weak/strong] acid.
ammonia
weak
2 Examples of Enzymatic & Acid Titration
Van Slyke Cullen
Urograph
In Diacetyl Monoxime Method, Urea is made to react with diacetyl monoxime to produce a _________ [Rxn]
➢ ___________ is added to enhance color formation and to exclude protein interference.
yellow diaxine derivative [Fearon’s rxn]
Arsenic thiosemicarbazide
what method is this?
Urea + DAM→ yellow diaxine derivatives [Fearon’s reaction] + Arsenic thiosemicarbazide
Diacetyl Monoxime Method
CONSIDERATION IN BUN DETERMINATION
➢ The determination is affected by [2] + other physiologic functions.
➢ Whole blood→ _______= [-] hgb interferences
➢ _______-containing AC are CONTRAINDICATED in enzymatic methods.
➢_______→ [x] urease action
➢ Prolonged standing→
[INC 2-3x] _______ conc. [due to enzymatic deamination of labile ____ like glutamine]
high protein diet
hydration
DEPROTEINIZED
Ammonium
Sodium fluoride
Ammonia
labile amide
BUN normal value
7-18 mg/dL [2.5-6.4 mg/dL]
___________.conditions in
which kidney CIRCULATION is less efficient than usual.
[5]
Pre-renal causes
Heatstroke [dehydration]
Burns [fluid loss]
Hemorrhage [blood loss]
INC. protein catabolism
Cardiac decompression
_________ characterized by the [+] lesions on the parenchyma itself [Tubular injury].
[5]
Renal causes
Acute glomerulonephritis
Chronic nephritis
Nephrosclerosis
Polycystic kidney
Tubular necrosis
___________urinary tract obstruction due to: [3]
Post-renal causes
Prostatic enlargement
stones
tumors
nitrogen containing a biochemical abnormality that refers to an [INC] BUN + creatinine levels which is largely related to [DEC] glomerular filtration.
Azotemia
Azotemia
[INC]
[DEC]
Bun, Crea
GFR
___________defined as the with accompanying clinical signs & symptoms of renal failure like:
–__________ due to failure of the kidneys to [X] eliminate acidic products of metabolism
– __________ due to failure of [X]potassium excretion
– __________ due to water retention.
Uremia
Metabolic acidosis
Hyperkalemia
Generalized edema
is the principal waste product of muscular metabolism derived mainly from creatine
creatinine
creatinine is also called as?
α- methyl guanidoacetic acid
Amount generated is proportional to the = muscle mass; It is not [X] affected by protein diet and it is not reused by the body so it is solely a waste product
creatinine
Aside from renal diseases, Creatinine is also [INC] myopathies like: Involves particularly the muscles
[4]
Dermatomyositis
Familial period paralysis
Muscular dystrophies
Myasthenia gravis
Creatinine is synthesized form [3]
lysine
arginine
methionine
Creatinine methods
- Creatinase method
- Creatinine Aminohydrolase method
- Direct Jaffe Rxn Method
– Available on Ektachem analyzer wherein creatinine is hydrolyzed to [2] by creatinase → ammonia react with [2] in the [+] glutamate dehydrogenase = forming [2]
CREATINASE METHOD
N-methyldantolin
ammonia
a-ketoglutarate
NADH
glutamate
NAD
In creatinase method, the decrease in NADH is followed _________.
fluorometrically
what method is this?
Creatinine→creatinase→N-methyldantolin + NH4 → α- ketoglutarate + NADH→GDH→= glutamate + NAD
Creatinase Method
Creatinine is hydrolyzed to creatine by ___________ followed by a +series of coupled enzyme reactions in which creatine reacts with [3]
→ culminating in the NADH oxidation.
creatinine aminohydrolase
creatinine kinase
pyruvate kinase
lactate dehydrogenase
rxn chain in Creatinine Aminohydrolase Method
Creatinine + H2O – CAH–> Creatine
Creatine + ATP –CK–> Creatine PO4 + ADP
ADP + Phosphoenol pyruvate –PK–> ATP + Pyruvate
Pyruvate + NADH –LD –> Lactate + NAD
________red tautomer formation of creatinine picrate when creatinine in serum is made to react with a freshly prepared alkaline [3 composition].
Direct Jaffe Rxn
Jaffe rgt
Saturated picrate acid
10% sodium hydroxide
what method is this?
Creatinine + Alk. Na Picrate→ = Creatinine picrate
Direct Jaffe Method
Creatine is synthesized from
glycine
amino acid arginine
methionineC
Creatine is increased in?
Muscular dystrophies
major end product of purine metabolism formed in the @liver & intestinal mucosa from _______ by the action of _________ ________.
— Final breakdown of nucleic acid catabolism
Blood Uric Acid
xanthine
xanthine oxidase
BUA is the major end product of [2]
purine metabolism
nucleic acid catabolism
[#]% of the filtered UA is reabsorbed.
89%
UA
➢ It is relatively [soluble/ insoluble]
➢ When it accumulates # → deposited in the ____ [____], in the genitourinary tracts as __________.
insoluble
joints [tophi]
uric acid stones
BUA METHODS [gen] [4]
- Direct Redox Methods
- Blaunch & Kock / Uricase Method
- Caraway Method
- Henry’s Method
Uric acid is oxidized → [2] by ___________reagent [protein precipitant and color reagent in alkaline solution]. In the process, phosphotungstic acid is reduced to = _______.
allantoin
CO2
phosphotungstic acid
tungsten blue
what method is this
Uric Acid + PTA [reduced to tungsten blue] →Allantoin + CO2
Direc redox method
➢ Differential or Absorption Spectrophotometry
➢ Uric acid is destroyed [oxidation] ← action of uricase → = form CO2, H2O, allantoin.
Blaunch/Kock or Uricase Method
Uric acid is destroyed [oxidation] ← action of _____ → = form [3]
CO2, H2O, allantoin
uric acid max. absorption peak
290-293 nm
➢ OLDEST method for the determination of Uric Acid
Caraway method
What methods are these?
➢ UA + PTA→tungsten blue
➢ Uses NaCN/Sodium Cyanide as color stabilizer
➢ UA + PTA→tungsten blue
➢ Uses Na2CO3/Sodium carbonate as color stabilizer
Caraway Method
Henry’s Method
other analytical methods for BUA
Phosphotungstic acid
Spectrophotometric
Coupled enzymatic I/II
Isotope dilution MS
nonspecific for uric acid; requires protein removal
phosphotungstic acid
In spectrophotometric method for BUA, what are the interferences
Hgb
xanthine
commonly automated BUA method; negative bias with reducing agents
Coupled enzymatic [I]
readily automated; reducing agents interfere
Coupled enzymatic [II]
CONSIDERATION IN BUA
DETERMINATION
➢Stable: several days @ ____ & longer if _______.
➢[+] ______ → [INC] stability to bacterial destruction.
➢ Any common AC; except for __________ → forms potassium phosphotungstate promoting TURBIDITY.
➢ ______-like foods: legumes, visceral organs, others may affect uric acid assay
RT
refrigerated
Thymol
potassium oxalate
purine
UA CLIN. SIG.
➢ a defect in uric acid metabolism which causes an excess of the acid + salts → accumulate in the # bloodstream and joints.
➢ [INC] uric acid in the bloodstream because alcohol inhibits its excretion.
➢ _______ and other malignant conditions due to [INC] ________ turnover.
➢ Elevated levels in decreased renal functions either due to [INC]_____ or [DEC] rate of ______.
➢ Fatal poisoning with [2], excessive exposure to [2], due to [INC] cell breakdown + nucleic acid catabolism
➢ Genetic diseases: [2]
Gout
Chronic Alcoholism
Leukemia
nucleoproteins
production
excretion
chloroform
methanol
Xrays
radioactive radiators
Lesch Nyhan syndrom
Von Gierke’s
➢ formed in the deamination of amino acids during protein metabolism
Ammonia
—determinations contribute very little or none at all in renal impairment.
Ammonia
It has its significance in impending hepatic coma & terminal stages of hepatic cirrhosis.
ammonia
[3] disorders in ammonia
Hepatic failure
Reye’s syndrome
[Inherited deficiencies] Urea Cycle enzymes
Digestion procedure of Ammonia:
[Method name] [RXN]
Kjeldahl Digestion Process
Nitrogen [PFF] + H2SO4 + Catalyst –> Ammonia
Catalyst composition [3]
copper sulfate
mercuric sulfate
selenium oxide
The nitrogen ion in the PFF of the specimen is converted to ammonia using hot concentrated sulfuric acid in the presence of a catalyst.
Kjeldahl Digestion Process
Berthelot’s rxn
The ammonia formed reacts with phenol and _______ using ________ as catalyst to form indophenol blue.
Alkaline hypochlorite
Sodium nitroprusside
The ammonia formed when it reacts with the Nessler’s reagent [double iodide of K + Hg/mercury; named as: _____] in the presence of a colloidal stabilizer [________] forms a colloidal suspension of =___________
- [color]= nitrogen [+] in low to moderate conc.
- [color]= nitrogen [+/-] in high concentration
K2Hg2I2
gum ghatti
dimercuric ammonium iodide/ NH2Hg2I2
yellow
orange brown
What methods are these:
Ammonia + Phenol + Alk. Hypochlorite + Catalyst [Na Nitroprusside] → Indophenol Blue
Ammonia + K2Hg2I2+ Gum ghatti → NH2Hg2I
Berthelot’s Rxn
Nesslerization
