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1
Q

produced as the result of normal muscle metabolism? what is the breakdown from?

A

creatinine– production & excretion are constant/regular
breakdown of phosphocreatine

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2
Q

used to approximate the GFR? what is the normal level

A

creatinine– normal is 0.5-1.5 mg/dL

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3
Q

relationship between GFR & serum creatinine

A

inverse! 2x increase in Cr= 50% decrease in GFR so mild elevation= significant dysfunction even if its in the normal range

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4
Q

what is CrCl

A
  • measure of the GFR
  • normal is 100ml/min; dependent on age and gender (m>f)
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5
Q

how is CrCl measured directly?

A

24 hour urine collection– time consuming & hard for patients; both serum & urine needed; dispose of the first urine
- does NOT give a more accurate estimate than the prediction equations

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6
Q

how is CrCl measured indirectly

A

cockcroft-gault equation– age, kg, sex & serum cr are used in it
- used as the standard for drug dosing

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7
Q

sum filtraion of all functioning nephrons; gold standard for measuring kidney function? what is normal value?

A

GFR– varies by age, gender & body size
normal is above 90

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8
Q

5 uses of GFR

A
  • identify kidney dz
  • select doses
  • avoid certain meds
  • monitor CKD
  • criteria for referral & dialysis
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9
Q

produced in liver, found in blood & secreted and reabsorbed by the kidneys; directly related to metabolic liver function; assuming normal liver, it is estimate of renal function

A

BUN– also affected by protein breakdown, hydration status, liver failure; rises faster than Cr with dehydration

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10
Q

how does serum Cr, eGFR, CrCl, BUN change when kidney is going bad?

A

Decreases– eGFR & CrCl
increase– serum Cr, BUN

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11
Q

symptomatic azotemia– N/V, lethargy

A

uremia

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12
Q

what is the diff. btwn acute and chronic kidney failure

A

time— 3 months

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13
Q

good screening test for obstruction & differentiation btwn acute & chronic renal dz

A

renal US

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14
Q

size difference btwn small & large kidneys

A

small < 10 cm; chronic dz
large > 12 cm; acute (potentially reversible; associated w/ DM, amyloid, infiltrative CA)

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15
Q

5 tests that can help in finding the cause of kidney failure

A

BUN:Cr
Urine NA
fractional excretion Na
urine Sp Gr
urine osmolality

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16
Q

in presence of kidney disease, what does BUN/Cr of over 20 mean?

A

pre-renal: GI bleed, less volume
Urine obstruction

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17
Q

in presence of kidney disease, what does BUN/Cr of under 20 mean?

A

intrarenal
often Chronic (CKD)

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18
Q

random urine Na of what value suggests dehydration? what value sugguests kidney/adrenal disease?

A
  • Na under 10 suggests dehydration– CHF, liver dz
  • Na over 20 suggests kidney/adrenal dsease
  • electrolytes can be used to calculate FENa
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19
Q

helpful to distinguish btwn pre-renal and intrarenal azotemia; over 1% means intra-renal azotemia while under 1% means pre-renal azotemia

A

FENa (fractional excretion of Na)

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20
Q

prerenal vs intrarenal vs postrenal

  • urine Na under 10
  • serum BUN:Cr over 20
  • FENa under 1%
  • Sp Gr over 1.020
  • U osmolality over 500
A

prerenal

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21
Q

prerenal vs intrarenal vs postrenal

  • urine Na over 20
  • serum BUN:Cr under 10
  • FENa over 1%
  • Sp Gr under 1.012
  • U osmolality under 250
A

intra-renal

22
Q

what GFR is considered moderate CKD3 & signals need to refer?

23
Q

what GFR signals dialysis?

24
Q

this measurement is determined by # and size of particles in the urine & varies with osmolality. what is the normal range for this lab value?

A

Specific gravity
normal is 1.005 to 1.025

osmolality is more accurate & is determined by # of particles only

25
what is the normal pH range for urine?
4.5 to 8.0; usually 6.0
26
uncontrolled DM, starvation, dehydration, protein changes your urine pH in what way?
makes it acidic
27
chronic renal failure, salicylate intox., proteus infection changes your urine pH how?
makes it alkaline
28
persistent proteinuria is classified into what 3 ways?
glomerular tubular overflow
29
# what class of persistent proteinuria is this - may cause massive proteinuria & has many causes - albumin is primary protein
glomerular
30
# what type of persistent proteinuria - malfunctioning tubule cells don't metabolize or reabsorb normally filtered protein - LMW proteins predominate - rarely exceed 2g/day
tubular
31
# what type of persistent proteinuria - LMW proteins overwhelm ability of tubules to reabsorb filtered proteins - can be seen in multiple myeloma?
overflow
32
what do you do if there is mild proteinuria on dip in an asymptomatic patient
recheck the dipstick it can be transietnt d/t many things
33
4 things to do if there is proteinuria in a non-asymptomatic patient
- get 24hr urine - microscopic exam of urinary sediment - urinary protein electrophoresis - assess renal function
34
you get a 24 h urine test and the value is **under 3g/24hrs** what type of disease is this? **over 3g/24hrs**?
- under 3g: glomerular or tubular disease (nephritic)-- could be either but tends to be tubular - **over 3g**: nephrotic range, typically **glomerular**
35
# what is this called? excretion of **30-150mg of protein/day** found via other test (not dipstick); affected by hydration status and **indicates renal tubular disease**
microalbuminuria - if patient has this + DM, should start ACEi
36
if patient has glucosuria but not DM after checking for it, what is likely happening?
its renal **tubular** disease
37
other than diabetes & diets, what are 3 other times you may expect to see ketones in urine
- strenuous exercise - frequent vomiting - pregnancy
38
bilirubin vs urobilinogen-- which is normally found in urine in small amounts?
urobilinogen
39
if someone has microscopic hematuria w/o e/o renal dz, what do we do? why?
recheck it in weeks & if still present, refer to urology because it can be serious urologic disease or malignancy
40
transitional epithelial cells means what?
can be normal but if in large amounts may suggest a UTI
41
which type of cells seen in microscopic UA is the desquamation of tubular epithelium that suggests significant renal pathology
tubular epithelial cells
42
over ____ is significant bacteriuia in asymp. pt while over ____ suggests UTI in pt w/ sx. what should you do after diagnosing bacteriuria?
- over 100K mL in asymptomatic = significant bacteriuria - over 100 mL in sx suggests UTI - after dx, need C & S (culture and sensitivity)
43
# what type of cast? * small # w/ exercise, dehydration, stress, pyelonephritis but may be normal * from distal tubules * protein w/o cellular inclusion
hyaline cast
44
# what type of cast - # of casts increses w/ severity of disease - indicates glomerulonephritis
RBC cast
45
# what type of cast - seen w/ renal tubule dz - seen in ATN, interstitial nephritis, eclampsia, nephritic syndrome
epithelial casts
46
# what type of cast - made up of various cell types in final phase of cellular degeneration - very slow tubular transit time - severe chronic renal disease (HTN nephropathy)
waxy/granular casts
47
# what type of cast -indicates **nephrotic** syndrome, renal disease, hypothyroidism
fatty cast
48
# what type of cast made of various cell types and indicates ESRD
broad cast
49
colorless crystal w/ coffin lid appearance associated w/ alkaline urine & UTI (proteus species)
triple phosphate
50
colorless hexagonal shaped crystals found in acidic urine; diagnostic of cystinuria
cystine crystals

nephrology (13 decks)

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