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liver and kidney Flashcards

1
Q

The chief metabolic organ

A

liver

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2
Q

functional unit of the liver

A

lobules

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3
Q

2 major types of cells

A

Hepatocytes- majority of lobules
Kupffer cells (hepatic macrophage)

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4
Q

2 blood supply

A

Hepatic artery-25%
- Portal vein- 75%

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5
Q

blood supply in the liver

A

1,500 mL/min

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6
Q

secretes plasma proteins,
carbohydrates, lipids, lipoproteins as well as ketone
bodies and enzymes; 12g of albumin is secreted by
the liver/ day

A

Synthetic Function-

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7
Q

protects the
body from potentially toxic substances which are
absorbed by the intestine and toxic metabolic by
products such as ammonia

A

Detoxification and Drug Metabolism-

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8
Q

Test for liver function includes albumin, as well as vit
K
Assessment of nutritional status and presence of
severe disease involving the liver, kidney and bone
marrow

A

Total Protein

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9
Q

Transudates value

A

<3.0 g/dL

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10
Q

Interference in TP

A

hemolysis & ictericia

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11
Q

Methods for Total protein

A

Kjeldahl Method
2. Biuret Method
3. Folin-Ciocalteu (Lowry) Method
4. UV Absorption Method
5. Refractometry
6. Turbidimetry and Nephelometry
7. Salt Fractionation
8. Coomasie Brilliant Blue Dye
9. Ninhydrin
10. Serum Protein Electrophoresis

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12
Q

principle of Serum Protein Electrophoresis

A

Migration of charged particles in an electric field

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13
Q

pH of Serum Protein Electrophoresis

A

8.6 (majority of the serum protein are
negatively charged)

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14
Q

fastest band to migrate in anode

A

albumin band (53-65%)

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15
Q

2nd fastest band to migrate to anode

A

α1Globulin-α1-antitrypsin as the major contributor
(90%)

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16
Q

Cancer of plasma cells
Increase of y globulin or gamma spike
Plasma cells produces too many immunoglobulins

A

MULTIPLE MYELOMA

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17
Q

Decreased albumin due to decreased hepatic
synthesis.
Increased γ-globulin is also present
Abnormality in 3 bands (albumin, b globulin, and y
globulin)

A

HEPATIC CIRRHOSIS

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18
Q

Decrease in albumin and other low-molecular weight
proteins due to increased renal excretion in the urine.
Significant increased of a2 globulin fraction of particularly a2 macroglobin and haptoglobin; and increased in beta globulin fraction particulary beta lipoprotein and complement protein
Decrease albumin and a significant increase of
α2-globulin and β-globulin fractions

A

NEPHROTIC SYNDROME

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19
Q

Seen in juvenile cirrhosis
α1-Antitrypsin comprises 90% of the proteins found in
the α1-globulin band
We can observe a flat curve in electrophoretic pattern

A

a1-ANTITRYPSIN DEFICIENCY

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20
Q

INCREASED TOTAL
PROTEIN

A

Malignancy, Multiple myeloma, Waldenstroms, & macroglobulinemia

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21
Q

DECREASED TOTAL
PROTEIN

A

Hepatic cirrhosis, Glomerulonephritis, Nephrotic syndrome, Starvation

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22
Q

Concentration is inversely proportional to the severity of hepatic disease.

A

ALBUMIN

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23
Q

Salt Precipitation reagent

A

sodium sulfate salts

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24
Q

Globulins are precipitated
Albumin in supernatant is
quantitated by biuret reaction

A

Salt Precipitation reagent

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25
Q

Nonspecific for Albumin

A

Methyl orange

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26
Q

Many Interferences
(salicylates, bilirubin)
Presence of drugs such as
aspirin, penicillin, and
sulfonamides’ may interfere
in dye binding activity

A

2,4’-hydroxyazobenzenebenzoic acid (HABA)

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27
Q

Sensitive
Overestimates low albumin
levels
Most commonly used dye

A

BCG (Bromcresol green)

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28
Q

Specific, Sensitive and Precise

A

BCP (Bromcresol purple)

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29
Q

Increased albumin in the
blood

A

HYPERALBUMINEMIA

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30
Q

Decreased albumin in the
blood

A

HYPOALBUMINEMIA

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31
Q

Prolonged tourniquet application causes?

A

pseudohyperalbuminemia

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32
Q

hereditary absence of albumin or inability to synthesized albumin

A

Analbuminuria

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33
Q

Presence of two albumin bands instead of a single
band in electrophoresis.
Associated with excess amount of therapeutic drug in
serum

A

BISALBUMINEMIA

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34
Q

Determine if globulin is higher than albumin

A

ALBUMIN OR GLOBULIN RATIO

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35
Q

originates from the liver; prolonged Prothrombin time

A

intrahepatic disorder

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36
Q

AG ratio formula

A

𝐴𝑙𝑏𝑢𝑚𝑖𝑛/𝐺𝑙𝑜𝑏𝑢𝑙𝑖n

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37
Q

not correlated to liver; normal prothrombin time

A

extrahepatic disorder

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38
Q

prolonged prothrombin
time signifies massive cellular damage

A

Acute/Chronic Hepatitis

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39
Q

Conjugated bilirubin bounded to albumin
Has longer half-life than other forms of bilirubin
Formed due to prolonged elevation of conjugated
bilirubin in biliary obstruction

A

DELTA BILIRUBIN

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40
Q

Delta bilirubin formula

A

Total bilirubin - direct bilirubin +
indirect bilirubin

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41
Q

yellow discoloration of the skin, sclera of the eye

A

Icterus

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42
Q

Indirect Bilirubin: increased
Direct Bilirubin: normal
Urobilinogen: normal
Urine bilirubin: Negative

A

PRE-HEPATIC JAUNDICE

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43
Q

Unconjugated hyperbilirubinemia

A

PRE-HEPATIC JAUNDICE

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44
Q

Failure of bile to flow in intestine or there is an impaired bilirubin excretion

A

POST-HEPATIC JAUNDICE

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45
Q

Indirect bilirubin: normal
Direct bilirubin: increased
Urobilinogen: decreased
Urine bilirubin: positive

A

POST-HEPATIC JAUNDICE

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46
Q

can cross blood brain barrier result
to cause Kernicterus; there will be bilirubin deposition in brain which cause mental retardation

A

Indirect Bilirubin

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47
Q

Caused by disorder of bilirubin metabolism as well as
transport defects; theres a hepatic injury caused by viruses, parasites, and also ?

A

HEPATIC JAUNDICE

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48
Q

Indirect bilirubin:increased
Direct bilirubin:increased
Urobilinogen:decreased
Urine bilirubin:positive

A

HEPATIC JAUNDICE

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49
Q

INHERITED DISORDERS of BILIRUBIN METABOLISM

A

Gilbert’s Syndrome
Crigler-Najjar Syndrome (Type I & II)
Dubin-Johnson Syndrome
Rotor Syndrome
Lucey-Driscoll Syndrome

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50
Q

Characterized by impaired cellular uptake of bilirubin due to genetic mutation in UGT1A1 gene (seen in chromosome 2)

A

Gilbert’s Syndrome

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51
Q

Bilirubin Transport Deficit

A

Gilbert’s Syndrome

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52
Q

Affected individuals may have no symptoms but may
have mild icterus and predisposed acetaminophen toxicity

A

Gilbert’s Syndrome

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53
Q

Conjugation deficit

A

Crigler-Najjar Syndrome

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54
Q

Chronic non-hemolytic unconjugated
hyperbilirubinemia

A

Crigler-Najjar Syndrome

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55
Q

Complete deficiency of the enzyme UDPGT

A

Crigler-Najjar Syndrome Type I

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56
Q

Partial deficiency of the enzyme UDPGT

A

Crigler-Najjar Syndrome Type II

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57
Q

Bilirubin Excretion Deficit

A

Dubin-Johnson Syndrome and Rotor Syndrome

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58
Q

Characterized by intense dark pigmentation of the
liver (Black liver); accumulation of the pigment called
lipofuscin

A

Dubin-Johnson Syndrome and Rotor Syndrome

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59
Q

similar with Dubin-Johnson
Syndrome without the “black liver

A

Rotor Syndrome

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60
Q

Familial form of unconjugated hyperbilirubinemia
caused by a circulating inhibitor of bilirubin conjugation

A

Lucey-Driscoll Syndrome

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61
Q

Principle: Van den Berg Reaction–diazotization of bilirubin to form azobilirubin

A

BILIRUBIN ASSAY

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62
Q

methanol (pink to purple azobilirubin)

A

Evelyn and Malloy Method

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63
Q

caffeine, sodium benzoate? (most commonly used
method, popular technique for discrete
analyte) more sensitive technique than
evelyn and malloy method (pink to blue
azobilirubin)

A

Jendrassik and Grof Method-

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64
Q

Colorless end product of bilirubin metabolism that is
oxidized by intestinal flora to urobilin or stercobilin

A

UROBILINOGEN

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65
Q

responsible for the pigmentation of feces

A

urobilin or stercobilin

66
Q

Reagent for urobilinogen

A

p-dimethyl aminobenzaldehyde

67
Q

Test for hepatocellular function and potency of bile duct

A

BROMSULPHTHALEIN (BSP) DYE EXCRETION TEST

68
Q

Also known as Double
Collection Method

A

Rosenthal White Method

69
Q

BSP Dose of Rosenthal white method

A

2mg/Kg body weight

70
Q

After 5 minutes in Rosenthal white method

A

50% dye retention

71
Q

After 30 minutes in Rosenthal white method

A

0% dye retention

72
Q

Also known as Single
collection method

A

Mac Donald Method

73
Q

After 45 minutes in Mac Donald Method

A

+/-5% dye retention

74
Q

Used to assess the extent of liver damage and to differentiate hepatocellular functional of the ?, which of the mechanical disease

A

Enzyme Test

75
Q

Hepatic enzymes

A
  • Alanine aminotransferase (ALT)]
  • Aspartate aminotransferase (AST)
  • 5’ Nucleotidase
  • Gamma glutamyl transferase
  • Lactate dehydrogenase
  • Ornithine Carbamoyl Transferase
76
Q

Diagnostic marker of hepatic failure
Produced by the catabolism of amino acids and by bacterial metabolism in the intestine.
Also released from metabolic reactions in the skeletal muscle
Not useful for renal studies

A

ammonia

77
Q

increased plasma levels and associated
in encephalopathy

A

Neurotoxic(ammonia)

78
Q

Preferred specimen in ammonia

A

Arterial blood w/ heparin or EDTA as
anticoagulant
Serum sample-fist clenching avoided and the
use of tourniquet should be minimal

79
Q

Specimen precautions in ammonia

A
  • Smoking- increased by 100-200ug/L/cigar
  • Exercise
  • Probing of vein
  • Under filing of tube
  • Hemolysis
80
Q

common method of ammonia

A

Berthelot & Glutamate
Dehydrogenase

81
Q

TEST FOR DETOXIFICATION FUNCTION
(ammonia)

A

Digestion Method
Nesslerization Reaction
Berthelot Reaction
Glutamate dehydrogenase

82
Q

Nitrogen ion in a protein-free filtrate of the specimen
is converted to ammonia using hot concentrated
sulfuric acid in the presence of catalyst

A

Kjeldahl Method

83
Q

catalyst of Kjeldahl Method

A

copper sulfate, mercury, and selenium

84
Q

gum ghatti

A

nesslerization rxn

85
Q

sodium nitroprusside

A

berthelot rxn

86
Q

yellow end color of nesslerization rxn

A

low to moderate n2

87
Q

orange to brown end color of nesslerization rxn

A

high N2

88
Q

produced by berthelot rxn

A

indephenol blue

89
Q

Main function of kidneys

A

urine formation; excretion of urine
waste products

90
Q

regulates water and salt in the body,
promotes reabsorption of sodium and excretion of potassium by the kidney

A

Aldosterone

91
Q

prevents water loss also known as ADH

A

vasopressin

92
Q

produce by endocrine gland

A

erythropoietin

93
Q

hormone that stimulates
bone marrow to produce RBCs

A

erythropoietin

94
Q

Each kidney contains how many nephrons?

A

1-1.5 million nephrons

95
Q

Functional unit of the kidney

A

nephrons

96
Q

5 basic parts of nephrons

A
  1. Glomerulus
  2. Proximal Convoluted Tubule
  3. Loop of henle
  4. Convoluted Tubule
  5. Collecting duct
97
Q

final site or either
concentrating of urine.

A

collectingduct

98
Q

major exchange of water and salt
takes place.

A

LOOP OF HENLE

99
Q

reabsorbs sodium,
chloride, bicarbonate, glucose, amino acid, proteins,urea, and uric acid.

A

Proximal Convoluted Tubule

100
Q

NPN PERCENT OF PLASMA

A

contains 20-35 mg/dL of NPN compound

101
Q

MOST ABUNDANT NPN

A

UREA-45%

102
Q

two second most abundant NPN

A

Uric acid & Amino acid-20%

103
Q

3RD NPN

A

CREATININE-5%

104
Q

4TH NPN

A

CREATINE-1-2%

105
Q

LAST NPN

A

AMMONIA-0.2%

106
Q

Produced by the catabolism of amino acids and by
bacterial metabolism in the intestine
Excreted by the kidney or consumed by the liver to
produce urea

A

AMMONIA

107
Q

At normal blood pH, most ammonia exist as?

A

AMMONIUM IONS

108
Q

liver is unable to detoxify ammonia to
become urea

A

HEPATIC FAILURE

109
Q

AMMONIA IS USED FOR DIAGNOSIS OF?

A

hepatic failure
Inherited deficiencies of urea cycle enzymes
Reye’s syndrome

110
Q

acute metabolic disorder of the
liver; most common on children

A

Reye’s syndrome

111
Q

Major end product of protein and amino acid catabolism

A

BUN ( Blood Urea Nitrogen)

112
Q

easily removed by dialysis

A

BUN

113
Q

Formed through the Krebs-Henseleit (Urea) cycle in the liver

A

BUN

114
Q

First metabolite to increase in kidney disease

A

BUN

115
Q

Bun:Creatinine Ratio

A

10:1-20:1

116
Q

End product of muscle metabolism derived from
creatine and creatine phosphate
It is produced as waste product of creatine and
creatine phosphate

A

CREATININE

117
Q

Creatine is converted to become creatinine in the process called?

A

dehydration or simply removal of water

118
Q

Creatine phosphate is converted to become creatinine in the process called?

A

dephosphorylation or simply
removal of phosphate group

119
Q

Synthesized primarily by the liver from
arginine,glycine and methionine

A

creatinine

120
Q

Measure the completeness of 24 hour urine collection

A

creatinine

121
Q

Elevated creatinine is found in?

A

abnormal renal function

122
Q

functional or structural
abnormalities or markers of kidney damage (seen in blood, urine, tissue test, imaging studies) present for less than three months.

A

Acute Kidney Injury

123
Q

Heating converts creatine to creatinine and the
difference between the two samples is the creatine
concentration.
It is a specialized testing, it is not a part of routine
laboratory procedure

A

creatine

124
Q

Elevated creatine is seen in?

A

Muscular dystrophy,
hyperthyroidism, trauma.

125
Q

anything that causes a decrease

A

Pre-renal azotemia

126
Q

characterized by damage within the kidney

A

renal azotemia

127
Q

elevated plasma urea
concentration accompanied by renal failure

A

Uremia/Uremic syndrome

128
Q

It is the major product of purine (adenine and
guanine) catabolism.
It is the final breakdown of nucleic acids catabolism in humans.

A

URIC ACID

129
Q

It is formed from xanthine by the action of xanthine oxidase in the liver and intestine

A

URIC ACID

130
Q

Increased BUA and over production of uric
acid

A

HYPERURICEMIA

131
Q

PERCENT OF INCREASE OF BUA & URIC ACID IN HYPERURICEMIA

A

25-30% increase

132
Q
  • Pain & inflammation of joints by precipitation of
    sodium urates in tissues
  • Definitive diagnosis: presence of “birefringent crystal
    in synovial fluid”
  • Increased risk of renal calculi/nephrolithiasis
A

Gout

133
Q

occurs in patients on chemotherapy for diseases such as leukemia & multiple myeloma

A

Increased nuclear metabolism

134
Q

an enzyme in the uric acid synthesis pathway, is used to treat these patients.

A

Allopurinol inhibits xanthine oxidase

135
Q

causes elevated levels of uric acid because filtration and secretion are hindered.

A

Chronic Renal Disease

136
Q
  • Inborn error of purine catabolism
  • It is deficiency of hypoxanthine-guanine
    phosphoribosyl transferase (HGPRT)
A

Lesch-Nyhan Syndrome

137
Q

Other Causes of hyperuricemia

A
  1. Secondary to glycogen storage disease
  2. Toxemia of pregnancy and lactic acidosis
  3. Increased dietary intake
  4. Ethanol consumption
138
Q

Decreased BUA

A

HYPORURICEMIA

139
Q

HYPORURICEMIA includes?

A

Fanconi’s syndrome
Wilson’s disease
Hodgkin’s disease
Chemotheraphy
Alzheimer’s disease
Parkinson’s disease

140
Q

Disorder of reabsorption in the PCT of the
kidney

A

Fanconi’s syndrome

141
Q

Overtreatment with allopurinol

A

Hodgkin’s disease

142
Q

6-mercaptopurine, azathioprine

A

Chemotheraphy

143
Q

BEST OVERALL INDICATOR OF THE LEVEL OF
KIDNEY FUNCTION
Measures of the clearance of substances not bound to protein

A

GLOMERULAR FILTRATION RATE

144
Q

how many liters of glomerular filtrate is produced daily?

A

150 liters of glomerular filtrate is produced daily

145
Q

Removal of the substance from plasma into urine over a fixed time (24 HRS)

A

CLEARANCE

146
Q

Plasma concentration is inversely proportional to?

A

CLEARANCE

147
Q

time required to collect urine IN CLEARANCE

A

1440 minutes

148
Q

ave. body surface of adult individual

A

1.73

149
Q

ave. body surface of CHILDREN

A

0.717

150
Q

Reference method FOR TESTING GFR

A

INULIN CLEARANCE

151
Q

exogenous substance (never produced by the body) produced via IV (500 mL of 1.5%
after administration, urine is collect)

A

INULIN

152
Q

Alternatives to Inulin

A
  • Radioactive marker: 125I-iothalamate &
    99mTc-DTPA
  • Iohexoland Chromium 51-labelled EDTA
  • Nonradiolabeled iothalamate
153
Q

Best alternative method for inulin

A

CREATININE CLEARANCE

154
Q

endogenous substance freely filtered by
the glomeruli but not reabsorbed.

A

CREATININE

155
Q

GRAMS OF creatinine are excreted/day

A

1.2 -1.5 g

156
Q

Demonstrate progression of renal disease or
response to therapy
Not reliable GFR–urea is freely filtered but variably reabsorbed by the tubules

A

UREA CLEARANCE

157
Q

Low molecular weight protease inhibitor and produced
at
a constant rate by all nucleated cells.
Indirect estimate of GFR

A

CYSTATIN C

158
Q

NOT SEEN IN HEALTHY URINE

A

CYSTATIN C

159
Q

SPECIMEN OF CYSTATIN C

A

SERUM OR PLASMA

160
Q

GFR is computed using?

A

Modified Cystatin C Equation

161
Q

Prostaglandin D synthase
A low molecular weight glycoprotein; primarily a 168 amino acids
Belongs to the lipocalin protein family Isolated primarily from CSF
Accurate marker of CSF
Freely filtered by the glomerulus but completely reabsorbed and catabolized by the proximal tubule

A

B TRACE PROTEIN

162
Q

Not a diagnostic efficient test for glomerular filtration rate, this is increased in condition such as renal disease

A

B TRACE PROTEIN

cc lec (1 decks)

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