KIDNEY/NPN Flashcards by Sab Manlapaz

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

KIDNEY

back
under
side

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_______`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

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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

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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

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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

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3 MAJOR GROUPS OF KIDNEY FUNCTION TESTS

Test Measuring GFR
Test Measuring Renal Blood Flow
Test Measuring Tubular Functions

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3 TYPES OF CLEARANCES under GFR RATE Tests

Creatinine Clearance Test
Inulin Clearance Test
Urea Clearance Test

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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

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

Inulin Clearance test

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➢MOST ACCURATE of GFR measurement.

Inulin Clearance Test

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➢ 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

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

less

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Normal Values of the ff:

Creatinine Clearance Test
Inulin Clearance Test

107-139 ml/min

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

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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

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➢ Measures renal plasma flow
➢ Requires clearance of a dye

[PAH]
Para-Aminohippurate Test/Diodrast Test

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

PAH

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

[PSP] Henolsufophthalein Dye Excretion Test

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PSP
[#] mg- thru IV

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PSP Ref range

1,200 ml blood flow/min

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testing the CONCENTRATING ABILITY OF THE KIDNEY.

CONCENTRATION Test

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

Collecting tubules
Loop of Henle

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Specific gravity in kidney concentration test

1.005 – 1.030

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

X-ray
Mannitol

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Osmolality expression of concentration in terms:
[2]

solute particles per kg of solvent

moles per kg of solvent

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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

1. Creatinase method 2. Creatinine Aminohydrolase method 3. 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]

1. Direct Redox Methods 2. Blaunch & Kock / Uricase Method 3. Caraway Method 4. 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