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KIDNEY/NPN Flashcards

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1
Q

paired, bean-shaped organs located in the _____ of the abdomen and just ____ the rib cage on each _____ of the spine

A

KIDNEY

back
under
side

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2
Q

_______`inside the kidney is considered as its functional unit which have 5 basic parts [5

A

NEPHRONS

glomerulus/Bowman’s capsule
PCT
DCT
Collecting ducts
Loop of Henle

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3
Q

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

A

foreign/metabolic subs. waste products

plasma
water
water
urination

regulation

acid base

acid-base

Endocrine

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4
Q

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

A

CLEARANCES

plasma

[U/P] X [VOL/MINS] X [1.73/A]

U
P
VOL
1440
A
1.73

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5
Q

Substance should neither be excreted nor reabsorbed by _______, it is readily filtered by or passes through the ________ and normal molecules not bound to ______.

A

tubules

glomerulus

proteins

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6
Q

3 MAJOR GROUPS OF KIDNEY FUNCTION TESTS

A
  1. Test Measuring GFR
  2. Test Measuring Renal Blood Flow
  3. Test Measuring Tubular Functions
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7
Q

3 TYPES OF CLEARANCES under GFR RATE Tests

A

Creatinine Clearance Test
Inulin Clearance Test
Urea Clearance Test

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8
Q

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.

A

Creatinine Clearance Test

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9
Q

➢ freely passes the glomeruli but is not secreted + reabsorbed by the nephric tubules.

A

Inulin Clearance test

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10
Q

➢MOST ACCURATE of GFR measurement.

A

Inulin Clearance Test

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11
Q

➢ 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]

A

Urea Clearance Test

urea filtrate

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12
Q

— faster urine flow rate = [more/less] reabsorbed urea

A

less

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13
Q

Normal Values of the ff:

Creatinine Clearance Test
Inulin Clearance Test

A

107-139 ml/min

Men: 250 ml/min
Women: 110 ml/min

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14
Q

TEST Measuring TUBULAR FUNCTIONS
[Categories/Subcategories] [3]

A

I. EXCRETORY TEST
1. Para-Aminohippurate Test [PAH]/Diodrast Test
2. Henolsufophthalein [PSP] Dye Excretion Test

II. CONCENTRATION TEST
1. Fishberg Concentration Test

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15
Q

➢ Measures renal plasma flow
➢ Requires clearance of a dye

A

[PAH]
Para-Aminohippurate Test/Diodrast Test

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16
Q

A test with a ref. range: 600-700 mL/min

A

PAH

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17
Q

➢ It measures excretion of a dye = to renal tubular mass

A

[PSP] Henolsufophthalein Dye Excretion Test

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18
Q

PSP
[#] mg- thru IV

A

6

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19
Q

PSP Ref range

A

1,200 ml blood flow/min

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20
Q

testing the CONCENTRATING ABILITY OF THE KIDNEY.

A

CONCENTRATION Test

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21
Q

Concentration Test reflect the functions of [2 major parts of Kidney]

A

Collecting tubules
Loop of Henle

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22
Q

Specific gravity in kidney concentration test

A

1.005 – 1.030

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23
Q

[2] will yield high SG [more than 1.050]

A

X-ray
Mannitol

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24
Q

Osmolality expression of concentration in terms:
[2]

A

solute particles per kg of solvent

moles per kg of solvent

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25
Q

Reference values in Concentration Test:

for serum: between _____ mOsm/kg
for urine: ______ mOsm/kg 24 hr urine

A

275 – 295

300-900

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26
Q

________substances containing nitrogen but not generally considered as proteins

[6]

A

Non-Protein Nitrogen

Amino Acids
Ammonia
Creatine
Creatinine
Uric Acid
Urea

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27
Q

major NPN of both plasma and urine

A

Urea

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28
Q

major excretory product of protein metabolism

A

Urea

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29
Q

Urea is formed in the liver from ____ groups (-NH2) & ______generated during _______ catabolism product of ____ detoxification coming from the ammonia which is water [soluble/insoluble] & _______.

A

amino
free ammonia

protein
liver

insoluble
neurotoxic

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30
Q

Urea conc. in the plasma is determined by [3]

A

Renal function/perfusion
Protein content of the diet
Protein catabolism

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31
Q

➢ Major organic solid in the urine
➢ 90% Urea is _____; 10% remain in the _____

A

Blood Urea Nitrogen [BUN]

excreted
blood

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32
Q

INC BUN is indicative of

A

kidney disease

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33
Q

DEC BUN is indicative of

A

severe liver damage

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34
Q

Urea is readily removed by ______.

A

Dialysis

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35
Q

→ BUN CLINICAL APPLICATION
➢ evaluate renal function
➢ to assess ______ status
➢ to determine _____ balance
➢ to aid in the diagnosis of _____ disease
➢ to verify adequacy of ____.

A

hydration
nitrogen
kidney
dialysis

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36
Q

Other enzymatic methods for Urea
[4]

A

GLDH coupled enzymatic
Indicator dye
Conductimetric

Isotope dilution MS

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37
Q

used on many automated instruments; best as kinetic measurement for Urea

A

GLDH coupled enzymatic

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38
Q

used in automated systems
multilayer film rgt +
dry rgt strips

A

Indicator dye

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39
Q

Specific and rapid measurement for urea

A

Conductmetric

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40
Q

Detection of urea /BUA characteristic fragments ionization; quantification using isotopically labeled compound.

THE REFERENCE METHOD

A

Isotope dilution Mass Spectrometry

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41
Q

Urea METHODS
[2 Categories/ 3 Subcategories] [5]

A

ENZYMATIC METHODS
1. ENZYMATIC & ACID TITRATION
2. ENZYMATIC & NESSLERIZATION
– 3. Urease-Nessler Method
– 4. Urease Berthelot Method

CHEMICAL METHODS
5. DIACETYL MONOXIME METHOD

42
Q

ENZYMATIC & NESSLERIZATION
➢ Urea in the protein free filtrate [PFF] → made to react with __________ in the ← presence of [2] → then reacted with ______ reagent to = _______.

A

urease glycerol extract

buffer
heat-forming ammonium carbonate

Nessler’s

yellow dimercuric ammonium iodide/ NH2HgI3

43
Q

Urea→ CO2 + NH3
NH3 + Nessler’s reagent→ NH2HgI3

A

what method is this?

44
Q

UREASE BERTHELOT METHOD:
➢ Urea is hydrolyzed to ammonium carbonate by _____; ammonia reacts with [2] in an alkaline medium forming a= _________

A

urease

phenol
sodium hypochlorite

blue indophenol

45
Q

what method is this?
Urea→CO2 + NH3
NH3 + phenol hypochlorite→indophenol blue

A

Urease-Berthelot Method

46
Q

In Enzymatic & Acid Titration, Urea is hydrolyzed by urease forming ____ which is then titrated with a [weak/strong] acid.

A

ammonia

weak

47
Q

2 Examples of Enzymatic & Acid Titration

A

Van Slyke Cullen
Urograph

48
Q

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.

A

yellow diaxine derivative [Fearon’s rxn]

Arsenic thiosemicarbazide

49
Q

what method is this?
Urea + DAM→ yellow diaxine derivatives [Fearon’s reaction] + Arsenic thiosemicarbazide

A

Diacetyl Monoxime Method

50
Q

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]

A

high protein diet
hydration

DEPROTEINIZED

Ammonium

Sodium fluoride

Ammonia
labile amide

51
Q

BUN normal value

A

7-18 mg/dL [2.5-6.4 mg/dL]

52
Q

___________.conditions in
which kidney CIRCULATION is less efficient than usual.
[5]

A

Pre-renal causes

Heatstroke [dehydration]
Burns [fluid loss]
Hemorrhage [blood loss]
INC. protein catabolism
Cardiac decompression

53
Q

_________ characterized by the [+] lesions on the parenchyma itself [Tubular injury].
[5]

A

Renal causes

Acute glomerulonephritis
Chronic nephritis
Nephrosclerosis
Polycystic kidney
Tubular necrosis

54
Q

___________urinary tract obstruction due to: [3]

A

Post-renal causes

Prostatic enlargement
stones
tumors

55
Q

nitrogen containing a biochemical abnormality that refers to an [INC] BUN + creatinine levels which is largely related to [DEC] glomerular filtration.

A

Azotemia

56
Q

Azotemia
[INC]
[DEC]

A

Bun, Crea

GFR

57
Q

___________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.

A

Uremia

Metabolic acidosis

Hyperkalemia

Generalized edema

58
Q

is the principal waste product of muscular metabolism derived mainly from creatine

A

creatinine

59
Q

creatinine is also called as?

A

α- methyl guanidoacetic acid

60
Q

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

A

creatinine

61
Q

Aside from renal diseases, Creatinine is also [INC] myopathies like: Involves particularly the muscles
[4]

A

Dermatomyositis
Familial period paralysis
Muscular dystrophies
Myasthenia gravis

62
Q

Creatinine is synthesized form [3]

A

lysine
arginine
methionine

63
Q

Creatinine methods

A
  1. Creatinase method
  2. Creatinine Aminohydrolase method
  3. Direct Jaffe Rxn Method
64
Q

– Available on Ektachem analyzer wherein creatinine is hydrolyzed to [2] by creatinase → ammonia react with [2] in the [+] glutamate dehydrogenase = forming [2]

A

CREATINASE METHOD
N-methyldantolin
ammonia

a-ketoglutarate
NADH

glutamate
NAD

65
Q

In creatinase method, the decrease in NADH is followed _________.

A

fluorometrically

66
Q

what method is this?
Creatinine→creatinase→N-methyldantolin + NH4 → α- ketoglutarate + NADH→GDH→= glutamate + NAD

A

Creatinase Method

67
Q

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.

A

creatinine aminohydrolase

creatinine kinase
pyruvate kinase
lactate dehydrogenase

68
Q

rxn chain in Creatinine Aminohydrolase Method

A

Creatinine + H2O – CAH–> Creatine

Creatine + ATP –CK–> Creatine PO4 + ADP

ADP + Phosphoenol pyruvate –PK–> ATP + Pyruvate

Pyruvate + NADH –LD –> Lactate + NAD

69
Q

________red tautomer formation of creatinine picrate when creatinine in serum is made to react with a freshly prepared alkaline [3 composition].

A

Direct Jaffe Rxn

Jaffe rgt
Saturated picrate acid
10% sodium hydroxide

70
Q

what method is this?
Creatinine + Alk. Na Picrate→ = Creatinine picrate

A

Direct Jaffe Method

71
Q

Creatine is synthesized from

A

glycine
amino acid arginine
methionineC

72
Q

Creatine is increased in?

A

Muscular dystrophies

73
Q

major end product of purine metabolism formed in the @liver & intestinal mucosa from _______ by the action of _________ ________.
— Final breakdown of nucleic acid catabolism

A

Blood Uric Acid

xanthine
xanthine oxidase

74
Q

BUA is the major end product of [2]

A

purine metabolism
nucleic acid catabolism

75
Q

[#]% of the filtered UA is reabsorbed.

A

89%

76
Q

UA
➢ It is relatively [soluble/ insoluble]
➢ When it accumulates # → deposited in the ____ [____], in the genitourinary tracts as __________.

A

insoluble

joints [tophi]
uric acid stones

77
Q

BUA METHODS [gen] [4]

A
  1. Direct Redox Methods
  2. Blaunch & Kock / Uricase Method
  3. Caraway Method
  4. Henry’s Method
78
Q

Uric acid is oxidized → [2] by ___________reagent [protein precipitant and color reagent in alkaline solution]. In the process, phosphotungstic acid is reduced to = _______.

A

allantoin
CO2

phosphotungstic acid

tungsten blue

79
Q

what method is this
Uric Acid + PTA [reduced to tungsten blue] →Allantoin + CO2

A

Direc redox method

80
Q

➢ Differential or Absorption Spectrophotometry
➢ Uric acid is destroyed [oxidation] ← action of uricase → = form CO2, H2O, allantoin.

A

Blaunch/Kock or Uricase Method

81
Q

Uric acid is destroyed [oxidation] ← action of _____ → = form [3]

A

CO2, H2O, allantoin

82
Q

uric acid max. absorption peak

A

290-293 nm

83
Q

➢ OLDEST method for the determination of Uric Acid

A

Caraway method

84
Q

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

A

Caraway Method

Henry’s Method

85
Q

other analytical methods for BUA

A

Phosphotungstic acid
Spectrophotometric
Coupled enzymatic I/II

Isotope dilution MS

86
Q

nonspecific for uric acid; requires protein removal

A

phosphotungstic acid

87
Q

In spectrophotometric method for BUA, what are the interferences

A

Hgb
xanthine

88
Q

commonly automated BUA method; negative bias with reducing agents

A

Coupled enzymatic [I]

89
Q

readily automated; reducing agents interfere

A

Coupled enzymatic [II]

90
Q

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

A

RT
refrigerated

Thymol

potassium oxalate

purine

91
Q

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]

A

Gout

Chronic Alcoholism

Leukemia
nucleoproteins

production
excretion

chloroform
methanol
Xrays
radioactive radiators

Lesch Nyhan syndrom
Von Gierke’s

92
Q

➢ formed in the deamination of amino acids during protein metabolism

A

Ammonia

93
Q

—determinations contribute very little or none at all in renal impairment.

A

Ammonia

94
Q

It has its significance in impending hepatic coma & terminal stages of hepatic cirrhosis.

A

ammonia

95
Q

[3] disorders in ammonia

A

Hepatic failure
Reye’s syndrome
[Inherited deficiencies] Urea Cycle enzymes

96
Q

Digestion procedure of Ammonia:
[Method name] [RXN]

A

Kjeldahl Digestion Process

Nitrogen [PFF] + H2SO4 + Catalyst –> Ammonia

97
Q

Catalyst composition [3]

A

copper sulfate
mercuric sulfate
selenium oxide

98
Q

The nitrogen ion in the PFF of the specimen is converted to ammonia using hot concentrated sulfuric acid in the presence of a catalyst.

A

Kjeldahl Digestion Process

99
Q

Berthelot’s rxn

The ammonia formed reacts with phenol and _______ using ________ as catalyst to form indophenol blue.

A

Alkaline hypochlorite

Sodium nitroprusside

100
Q

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
A

K2Hg2I2

gum ghatti

dimercuric ammonium iodide/ NH2Hg2I2

yellow
orange brown

101
Q

What methods are these:

Ammonia + Phenol + Alk. Hypochlorite + Catalyst [Na Nitroprusside] → Indophenol Blue

Ammonia + K2Hg2I2+ Gum ghatti → NH2Hg2I

A

Berthelot’s Rxn

Nesslerization

CLIN CHEM (12 decks)

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