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NME Emma copy and edit > Measurement of Renal Function > Flashcards

Measurement of Renal Function Flashcards

1
Q

According to the British National Formulary (BNF) what are the 3 reasons why we need to measure renal function?

A

1 - identify renal impairment in your patient

2 - modification of dosages of drugs which are cleared by the kidneys

3 - plan appropriate management of renal dysfunction

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2
Q

When assessing a patient with suspected renal impairment, why would be measure fluid balance and what symptoms may be associated with fluid balance?

A
  • oedema may be present
  • can cause breathlessness
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3
Q

When assessing a patient with suspected renal impairment, what could an imbalance in the patients electrolytes cause, specifically in the heart?

A
  • abnormal ECG:
  • absent P waves
  • broad QRS complex
  • peaked T waves
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4
Q

When assessing a patient with suspected renal impairment, if we detect low erythropoietin levels which is produced by the kidney, what can this cause patients to present with?

A
  • pallor
  • fatigue
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5
Q

When assessing a patient with suspected renal impairment, if we detect low vitamine D3 (active vitamine D) levels which is produced by the kidney, what can this cause patients to present with?

A
  • osteomalacia (softening of bones)
  • bone pain
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6
Q

When assessing a patient with suspected renal impairment, what are some haemodynamic measurements that would provide information about the patients condition?

A
  • pulse
  • BP
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7
Q

When assessing a patient with suspected renal impairment, why are fluid charts useful that would provide information about the patients condition?

A
  • determines if patient is dehydrated
  • urine passed helps with this as well
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8
Q

When assessing a patient with suspected renal impairment, why would serial blood tests be useful?

A
  • creatinine is filtered out in urine normally
  • if this is high in urine then GFR is not functioning effectively
  • FBC
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9
Q

When assessing a patient with suspected renal impairment, why would an arterial blood gas be useful?

A
  • measures acid base shift
  • pH
  • metabolic acidosis
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10
Q

When assessing a patient with suspected renal impairment, why would urinalysis be useful?

A
  • identify if glucose and proteins are present in the urine
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11
Q

What are the main imaging modalities used to investigate renal impairment?

A
  • renal ultrasound scan (mostly first scan)
  • CT/MRI Kidney Ureter Bladder
  • Nuclear Medicine
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12
Q

What is the main manifestation of renal impairment?

A
  • oedema
  • can be felt on patients
  • patients weight monitored (if in hospital)
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13
Q

If blood is found in the urine, what does this indicate?

A
  • blood loss is occuring in either the kidney, ureter or bladder
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14
Q

What is the most common cause of kidney disease?

A
  • diabetes
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15
Q

In addition to doing a FBC, what other measures would you look at in the blood if you suspect the patient has impaired kidney function?

A
  • serum creatinine
  • serum urea
  • serum HCO3-
  • serum K+
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16
Q

In addition to doing a FBC, creatinine is a useful measures that would be completed in a patient with impaired renal function, why is this?

A
  • creatinine is breakdown product of creatine phosphate from muscles
  • creatinine is filtered at glomerulus and secreted into urine
  • if plasma creatinine is high then GFR is reduced
17
Q

In addition to doing a FBC, creatinine is a useful measures that would be completed in a patient with impaired renal function. Creatinine is breakdown product of creatine phosphate from muscles and is filtered at glomerulus and secreted into urine. High levels of serum creatinine would suggest what?

A
  • low GFR
  • normal range = 40-120 mmol/L
18
Q

In addition to doing a FBC, creatinine is a useful measures that would be completed in a patient with impaired renal function. Creatinine is breakdown product of creatine phosphate from muscles and is filtered at glomerulus and secreted into urine. High levels of serum creatinine can suggest a low GFR, where a normal serum creatinine is 40-120 mmol/L. What instances can serum creatinine be raised in a young or old individual?

A
  • young may exercise more so increased creatinine
  • old may have atropy or creatinine so decreased creatinine
19
Q

In addition to doing a FBC, creatinine is a useful measures that would be completed in a patient with impaired renal function. Creatinine is breakdown product of creatine phosphate from muscles and is filtered at glomerulus and secreted into urine. High levels of serum creatinine can suggest a low GFR, where a normal serum creatinine is 40-120 mmol/L. Drugs can affect creatinine levels, what can the antibiotic trimethoprim do to creatinine levels?

A
  • used to treat UTI
  • blocks secretion of creatinine into proximal tubules
  • blood creatinine levels go up
  • ALWAYS CHECK FOR THIS DRUG
20
Q

Urea is produced in the liver as a waste product of protein digestion, before being excreted by the urinary system. If urea is raised or decreased in patients with renal impairment, why is this?

A
  • it is secreted from tubules in collecting ducts
  • if high, suggests the secretion/reabsorbtion is impaired
  • can be raised on high protein diet or GIT bleeds
  • can be decreased in liver disease andmalnourished
21
Q

When we talk about renal clearance, what do we mean by clearance?

A
  • volume of plasma completely cleared of a given substance in unit time
  • compares rate at which glomeruli filter a substance with the rate at which the kidneys excrete it via the urine
  • clearance = (Glomerular filtration + Tubular secretion) – Tubular reabsorbtion
22
Q

When designing an ideal molecule to meausure renal clearance, what would the molecule have to do?

A
  • be a naturally occurring molecule
  • not metabolised or synthesized in kidney
  • only excreted by the kidney
  • filtered but not secreted or reabsorbed by the kidney
23
Q

Inulin is filtered by the glomerulus and NOT reabsorbed, which makes this an excellent measure of renal functin. But what is the problem with inulin?

A
  • has to be administered
  • not natural compound
24
Q

Paraaminohippurate is an exogenous substance that can be used to assess renal function, why is this a good compound to use?

A
  • it is freely filtered at the glomerula
  • not reabsorbed in tubules but fully secreted
  • % in urine is a measure of renal function
25
Q

How can clinicians measure creatinine clearance?

A
  • 24 hour urine collection
26
Q

Clinicians can measure creatinine clearance by doing a 24 hour urne collection. What is the formula to calculate creatinine clearance?

A
  • creatinine in urine x volume of urine / serum creatinine concentration
27
Q

Clinicians can measure creatinine clearance by doing a 24 hour urne collection. Creatinine clearance can be calculated by meausuring creatinine in urine x volume of urine and dividing by serum creatinine concentration measured in ml/min. What is the downside of measuring creatinine clearance using this approach?

A
  • cumulative clearance of all the nephrons is measured
  • 15-20% of creatinine is secreted in proximal convoluted tubules
  • creatinine filtered vs. creatinine secreted is not provided
28
Q

Ther severity of kidney disease can be classified by what 2 things?

A

1 - GFR rate

2 - leakage of protein (creatinine)

29
Q

On a scale of 1 to 5, which is normal and which is severe kidney disease?

A
  • 1 = normal
  • 5 = severe kidney disease
30
Q

In a patient who has acute decline in renal function, is GFR or serum creatinine levels a better measure of renal function?

A
  • serum creatinine
31
Q

Why is serum creatinine currently the best biochemical measurement of kidney function, why is this?

A
  • it is freely filtered at the glomerulus and not reabsorbed
  • BUT some is screted though

NME Emma copy and edit (61 decks)

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