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Biochimie > Rein (Biochimie) > Flashcards

Rein (Biochimie) Flashcards

1
Q

A physician calls in the laboratory and asks what lab tests should be requested to assess the regulatory function of a patient’s renal system. Your response is serum

  1. creatinine, serum urea, serum uric acid, and creatinine clearance
  2. bilirubin and urine urobilinogen
  3. renin and erythropoietin
  4. and urine sodium and potassium, arterial blood pH, and sodium bicarbonate
A

4 - serum and urine sodiam and potassium, arterial blood pH, and sodium bicarbonate

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2
Q

Which of the following laboratory results would point to a diagnosis of acute nephritic syndrome:

  1. increased serum protein, increased GFR, and hematuria
  2. increased WBCs in the urine, bacteria in the urine, decrease GFR, and proteinuria
  3. hematuria, sodium retention, decreased GFR, and proteinuria
  4. normal serum urea and creatinine, increased GFR, and massive proteinuria
A

3 - hematuria, sodium retention, decreased GFR, and proteinuria

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3
Q

A 4 year old girl has edema that is most obvious around her ankles and face, and a rash. Her laboratory findings reveal: serum protein 4.8 g/dL (low), serum cholesterol 450 mg/dL (high), serum urea 20 mg/dL (high), heavy urine protein (high), and negative urine blood (normal). All other values were normal. These findings are most consistent with a diagnosis of:

  1. nephrotic syndrome
  2. acute pyelonephritis
  3. IgA nephropathy
  4. acute poststreptococcal glomerulonephritis
A

1 - nephrotic syndrome

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4
Q

A toxic condition involving a very high serum level of urea and creatinine accompanied by failure of the three main functions of the renal system is referred to as:

  1. uremic syndrome
  2. acute renal failure
  3. azotemia
  4. acute glomerulonephritis
A

1 - uremic syndrome

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5
Q

The functional unit of the kidney is the:

  1. lobule
  2. bladder
  3. glomerulus
  4. nephron
A

4 - nephron

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6
Q

If a physician orders a creatinine clearance of an individual, what is he or she attempting to determine:

  1. glomerular filtration rate (GFR)
  2. 24 hour urine output volume
  3. serum creatinine level
  4. urine creatinine level
A

1 - glomerular filtration rate

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7
Q

The major function of the loops of Henle in the kidney is to

  1. secrete ions under hormonal control
  2. eliminate urea
  3. adjust urine osmolality
  4. conserve protein
A

3 - adjust urine osmolality

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8
Q

Which one of the following statements regarding creatinine is correct:

  1. serum creatinine levels are elevated early in all renal disease
  2. normal plasma creatinine does not always indicate normal kidney function
  3. creatinine levels fluctuate in a diurnal manner
  4. creatinine is completely reabsorbed by the renal tubules
A

2 - normal plasma creatinine does not always indicated normal kidney function

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9
Q

Secretion of renin and antidiuretic hormone (ADH) is induced by low blood pressure and volume. Renin is synthesized in the ______ and ADH is made in the ________.

  1. brain; adrenal gland
  2. kidney; brain
  3. adrenal gland; brain
  4. adrenal gland; kidney
A

2 - kidney; brain

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10
Q

Secretion of renin and antidiuretic hormone (ADH) is induced by low blood pressure and volume. What other hormone would be released in the event of low blood pressure and volume:

  1. 1,25 (OH2) vitamin D3
  2. growth hormone
  3. erythropoietin
  4. aldosterone
A

4 - aldosterone

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11
Q

Where is aldosterone synthesized:

  1. kidney juxtaglomerular cells
  2. brain
  3. adrenal gland
  4. kidney proximal tubular epithelial cells
A

3 - adrenal gland

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12
Q

Upon microscopic examination, a patient’s urine exhibits many bacteria, white blood cells, and cellular casts composed of polymorphonuclear leukocytes. It is likely that this individual has:

  1. pyelonephritis
  2. rapidly progressing glomerulonephritis
  3. urinary tract infection
  4. end-stage renal disease
A

1 - pyelonephritis

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13
Q

If a freshly voided morning urine specimen has a pH of 6.0 in the absence of any other systemic disease, what is the likely cause:

  1. it is increased above the reference interval due to the conversion of urea to ammonia
  2. this pH is within the healthy reference interval for this speciman
  3. it has decreased below the reference interval due to the urea content
  4. there is likely the onset of distal renal tubular acidosis
A

2 - this pH is within the healthy reference interval for this specimen

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14
Q

Damage to the glomerulus would be suspected when the urine sediment contains:

  1. proteinaceous casts
  2. red blood cell casts
  3. visible proteins
  4. crystals
A

2 - red blood cell casts

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15
Q

An individual is admitted to the emergency department of the hospital with possible carbon monoxide intoxication. What kidney hormone might be relased in this case:

  1. ADH
  2. aldosterone
  3. erythropoietin
  4. renin
A

3 - erythropoietin

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16
Q

The portion of a nephron that is most important in maintaning plasma electrolyte balance is the:

  1. glomerulus
  2. proximal tubule
  3. loop of Henle
  4. distal tubule
A

4 - distal tubule

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17
Q

Renal colic is:

  1. a consequence of urinary obstruction usually above the bladder with dilation of the renal pelvis
  2. associated with chronic pyelonephritis
  3. caused by elevated blood renin due to a tumor of the kidney
  4. severe flank pain observed in an individual with renal calculi
A

4 - severe flank pain observed in an individual with renal calculi

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18
Q

The most common glomerular disease woldwide is

  1. acute proliferative glomerulonephritis
  2. acute pyelonephritis
  3. IgA nephropathy
  4. minimal change disease
A

3 - IgA nephropathy

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19
Q

A female patient visits her physician with a complaint of blood in her urine and oliguria. She states that these symptoms have gotten worse over the past 2 to 3 months. Urine and blood samples are collected. Urine GFR is calculated to be 40 ml/min/1.73m2 and hemoglobin is 8 g/dL. Urine protein was elevated. Upon review of her health history, it was noted that she was a cigarette smoker with hypertension. The most likely diagnosis in this case would be:

  1. nephrotic syndrome
  2. chronic kidney disease
  3. end stage renal disease
  4. chronic pyelophritis
A

2 - chronic kidney disease

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20
Q

What might be the predominant cause of the low hemoglobin value noted in the preceding question and based on the correctly identified disease:

  1. decreased EPO synthesis
  2. decreased iron absorption
  3. bone loss from decreased 1, 25 (OH2) vitamin D3 synthesis
  4. folate deficiency
A

1 - decreased EPO synthesis

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21
Q

A man comes to his physician with generalized weakness and fatigue. Blood is collected and an elevated WBC count with lymphocytosis is noted. Serum protein is moderately decreased, but the urine reagent dipstick does not indicate proteinuria. Upon confirmatory testing with a precipitation test, the urine protien is 4+. Based on other symptoms, the physician suspects multiple myeloma. What might be the cause of the discrepency in urine protein values:

  1. increased WBC will interfere with urine protein dipstick values
  2. the urine reagent dipsticks are outdated and must be discarded
  3. the precipitation tests was performed without controls
  4. reagent dipstick respond mostly to urine albumin and not other proteins
A

4 - reagent dipstick respond mostly to urine albumin and not other proteins

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22
Q

In regard to the preceding question, what protein is likely causing the elevated value in the urine protein confirmatory test:

  1. tamm-Horsfall protein
  2. bence jones protein
  3. haptoglobin
  4. mucoprotein
A

2 - Bence Jones protein

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23
Q

A patient visits his physician with complaints of insatiable thirst, sudden onset of fatigue, polydipsia, and polyuria. Laboratory results indicate a normal fasting blood sugar. Serum sodium was slightly elevated. Urine was hypotonic. The most likely cause of these symptoms and lab results would be:

  1. diabetes mellitus due to hormonal deficiency
  2. secondary hypothyroidism
  3. pituitary adenoma
  4. diabetes insipidus
A

4 - diabetes insipidus

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24
Q

In homeostatic regulation of plasma acid-base concentrations, sodium is both actively and passively exchanged in the tubules for which one of the following ions:

  1. bicarbonate
  2. carbon dioxide
  3. hydrogen
  4. potassium
A

3 - hydrogen

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25
Q

Destruction of a kidney stone and removal of the fragments is referred to as nephrolithiasis:

  1. true
  2. false
A

2 - false

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26
Q

High doses of amoxicillin can lead to interstitial nephritis:

  1. true
  2. false
A

1 - true

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27
Q

Which one of the following statements regarding creatinine is correct:

  1. most intraindividual variation in serum creatinine is due to muscle mass
  2. serum creatinine levels are not affected by renal disease
  3. creatinine production increases when serum creatinine is elevated
  4. creatinine is completely reabsorbed by the renal tubules
A

1 - most intraindividual variation in serum creatinine is due to muscle mass

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28
Q

Urea

  1. biosynthesis is carried out exclusively in the renal system
  2. is 100% reabsorbed by the kidney
  3. is decreased in plasma by a variety of renal diseases
  4. concentration in plasma is increased by a high protein diet
A

4 - concentration in plasma is increased by a high protein diet

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29
Q

A pateint’s urea value is 32 mg/dL (high) and serum creatinine level is 1.1 mg/dL (limit high). These results suggest:

  1. laboratory error measuring the urea
  2. renal dysfunction
  3. possible heart failure
  4. a healthy reference ratio value
A

3 - possible heart failure

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30
Q

Creatinine clearance is a measure of the _____ of a patient:

  1. glomerular filtration rate
  2. creatine concentration
  3. renal threshhold
  4. renin function
A

1 - glomerular filtration rate

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31
Q

Which of the following is the primary reagent used in the Jaffe reaction for creatinine:

  1. alkaline copper sulfate
  2. phosphotungstic acid
  3. alkaline picric acid
  4. diacetyl monoxime
A

3 - alkaline picric acid

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32
Q

Plasma urea concentration:

  1. is a more reliable indicator of renal function than creatinine
  2. can increase because of decreased renal blood flow
  3. is decreased in intrinsic renal failure
  4. is not affected by diet
A

2 - can increase because of decreased renal blood flow

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33
Q

In the measurement of urea, urea is initially hydrolyzed by urease to form ammonium ion. The spectrophotometric measurement of the resulting ammonia is referred to as the:

  1. ammonia selective electrode method
  2. Berthelot reaction
  3. Jaffe reaction
  4. urea method
A

2 - Berthelot reaction

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34
Q

Urea is produced from:

  1. catabolism of purine nucleosides
  2. phosphorylation of creatine in muscle
  3. reduction of bilirubin
  4. catabolism of proteins and amino acids
A

4 - catabolism of proteins and amino acids

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35
Q

The major nonprotein nitrogen degradation product of endogenous purines is:

  1. urea
  2. creatinine
  3. uric acid
  4. ammonia
A

3 - uric acid

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36
Q

A 40 year old man visits his physician complaining of pain associated with his joints and back. His initial lab values are as follows: urea nitrogen 120 mg/dL (high), creatinine 4.0 mg/dL (high), uric acid 9.0 mg/dL (high), creatinine clearance 50 ml/min (low) and urine pH 5.0. Whis is most likely diagnosis in this case:

  1. prerenal azotemia due to congestive heart failure
  2. renal azotemia causeed by intrinsic kidney failure
  3. gout and postrenal azotemia caused by uric acid stones
  4. preeclampsia accompanied by prerenal azotemia
A

3 - gout and postrenal azotemia caused by uric acid stones

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37
Q

A 40 year old man visits his physician complaining of pain associated with his joints and back. His initial lab values are as follows: urea nitrogen 120 mg/dL (high), creatinine 4.0 mg/dL (high), uric acid 9.0 mg/dL (high), creatinine clearance 50 ml/min (low) and urine pH 5.0. What does the calculated urea nitrogen:creatinine indicate, considering the creatinine value:

  1. it is increased as is the creatinine, indicating high protein intake
  2. it is decreased but the creatinine is elevated, indicating kidney tubule necrosis
  3. it is increased as is the creatinine, indicating postrenal obstuction
  4. it is decreased but the creatinine is elevated, indicating heart failure
A

3 - it is increased as is the creatinine, indicatif postrenal obstuction

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38
Q

A 40 year old man visits his physician complaining of pain associated with his joints and back. His initial lab values are as follows: urea nitrogen 120 mg/dL (high), creatinine 4.0 mg/dL (high), uric acid 9.0 mg/dL (high), creatinine clearance 50 ml/min (low) and urine pH 5.0. What does the elevated uric acid indicate, considering the individual

  1. men with plasma uric acid concentrations exceeding 9.0 are much more likely to have gout arthirtis
  2. in men, concentration of plasma uric acid increases gradually with age, rising about 10% between the ages of 20 and 60
  3. in this individual, organic acidemia has interfered with tubular secretion of urate
  4. this individual must be receiving treament for a malignancy, with concomitant tissue breakdown due to chemotherapy
A

1 - men with plasma uric acid concentrations exceeding 9.0 are much more likely to have gouty arthirtis.

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39
Q

A 40 year old man visits his physician complaining of pain associated with his joints and back. His initial lab values are as follows: urea nitrogen 120 mg/dL (high), creatinine 4.0 mg/dL (high), uric acid 9.0 mg/dL (high), creatinine clearance 50 ml/min (low) and urine pH 5.0. What is the significance of the decreased glomerular filtration rate:

  1. increased serum creatinine causes reduced creatinine clearance, renal failure, and GFR reduction
  2. blockage of the urinary tracts caused by kidney stones leads to decreased GFR and urine output
  3. elevated urea nitrogen leads to increased excretion, which blocks renal tubules and leads to decreaed GFR
  4. the creatinine clearance cannot be used in this case to assess GFR
A

2 - blockage of the urinary tracts caused by kidney stones leads to decreased GFR and urine output

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40
Q

A 40 year old man visits his physician complaining of pain associated with his joints and back. His initial lab values are as follows: urea nitrogen 120 mg/dL (high), creatinine 4.0 mg/dL (high), uric acid 9.0 mg/dL (high), creatinine clearance 50 ml/min (low) and urine pH 5.0. If the creatinine were 1.0 instead of 4.0 would the diagnosis change:

  1. yes, because the urea nitrogen/creatinine ratio is now within the reference interval indicating no disease state
  2. yes, the diagnosis may change because the ratio of urea to creatinine now indicates renal failure
  3. no, because this indicates a failure in the methodology used to determine urea and creatinine
  4. no, because the other analytes still indicate the presence of gout; additionnaly, creatiin values of 1.0 with an elevated ratio can indicate tissue breakdown, which could be kidney tissue damaged from the stones
A

4 - no, because the other analytes still indicate the presence of gout; additionnaly, creatiin values of 1.0 with an elevated ratio can indicate tissue breakdown, which could be kidney tissue damaged from the stones

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41
Q

Why do values obtained with the endopoint Jaffe reaction for creatinine measurement overestimate creatinine concentration by 20%

  1. the components of the reaction mixture often continue to react at endpoint and synthesize excess creatinine
  2. the rate of Jaffe complex formation is temperature dependent, and excess heat formed by the reaction leads to increased absorptivity and falsely increased creatinine value
  3. noncreatinine chromogens in the reaction react with the picrate in the end point Jaffe methods and overestimate true plasma creatinine concentration
  4. hydroxide concentrations above 0.5 mmol/L produce a decreased degradation of the Jaffe complex
A

3 - noncreatinine chromogens in the reaction react with the picrate in the end point Jaffe methods and overestimate true plasma creatinine concentration

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42
Q

Why does persistently acidic urine leads to formation of uric acid renal stones:

  1. uric acid has a pKa of 5.57, which makes it insoluble in acidic solutions
  2. at a pH of 10, uric acid is insoluble and aggregates to form stones
  3. elevated urine purines cause uric acid crystals to aggregate and form stones
  4. supersaturation of acidic urine causes calcium to form complexes with uric acid, which is the initial step in stone formation
A
  1. uric acid has a pKa of 5.57, which makes it insoluble in acidic solutions
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43
Q

All of the follwing conditions are associated with hyperuriciemia except:

  1. excessive cell turnover as in malignancy treated with chemotherapy
  2. deficiency of hypoxanthine-guanine phosphoribosyl transferase
  3. preeclampsia toxemia
  4. severe hepatocellular disease
A

4 - severe hepatocellular disease

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44
Q

Creatininase reactions for creatinine assessement:

  1. yield sarcosine and urea
  2. requires the addition potassium ferricyanide to reduce interference
  3. catalyze the conversion of creatinine to creatine
  4. catalyze the conversion of creatinine to N-methylhydantoin and ammonia
A

3 - catalyze the conversion of creatinine to creatine

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45
Q

Uricase is used in the assay of uric acid to:

  1. decarboxylate uric acid to form tungsten blue
  2. oxidize uric acid to form allantoin
  3. reduce uric acid to form allantoin
  4. reduce uric acid to form tungsten blue
A

2 - oxidize uric acid to form allantoin

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46
Q

A new physician that practices at a university student-healthcare facility often recomments to her student patients that they take magadoses of vitamin C to fend off colds. As director of the chemistry laboratory that serves this facility, you notice a trend in that many olf this physician’s sutdent’s serum uric acid levels are unusually high. You are currently using a dry reagent slide format method of uric acid analysis that uses uricase and peroxidase. What might be the cause of the elvated values:

  1. high doses of ascorbic acid cause increased hepatic synthesis of bilirubin, which interferes with the enzymes used in assay
  2. elevated ascorbic acid in serum interferes with the development of the color reaction in the dry reagent slide format
  3. it may be that his physician’s p atients all are exhibiting increased catabolism of purine nuclosides
  4. the phenolic compounds derived from the catabolism of uric acid in the students serum is interfering with the development of the color reaction
A

2 - elevated ascorbic acid in serum interferes with the development of the color reaction in the dry reagent slide format

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47
Q

Quel effet va avoir une diminution de la pression sanguine et du volume sanguin:

A

Une vasoconstriction (via Angiotnesine II)

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48
Q

Quel effet va avoir une diminution de la concentration du sodium dans le sang:

A

Une augmentation de l’aldostérone ⇒ augmentation de l’osmolalité ⇒ sensation de soif ⇒ augmentation de ADH ⇒ augmentation de réabsorption de H2O ⇒ augmentation du volume sanguin et pression sanguine

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49
Q

Quel est le mécanisme de la voie rénine-angiotensine:

A

Angiotensine (pro hormone du sang) ————-> angiotensine I ———–> angiotensine II

Rénine dans sang Enzyme dans poumons

Angiotensine II —————> aldostérone —————>augmentation de la réabsoption Na

stimulation (cortex surrénalien) Rein (TCP et TCD)

Donc aug osm, aug ADH (hypothalamus), aug réabsorption H2O

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50
Q

Qu’est ce qui est donc les roles d’angiotensine II:

A
  1. vasoconstriction
  2. stimulation de la production d’aldostérone
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51
Q

La caféine peut supprimer:

A

ALD

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52
Q

L’alcool peut supprimer:

A

ADH

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53
Q

Si eau augmente, qu’est ce qui arrive à l’hydratation:

A

Hydratation augmente, ADH diminue, volume sanguin diminue, volume urinaire augmente

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54
Q

Si eau diminue, qu’est ce qui arrive à l’hydratation:

A

hydratation diminue, ADH augmente, volume sanguin augmente, volume urinaire diminue

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55
Q

Si sodium augmente, qu’est ce qui arrive à l’osmolalité:

A

Osmolalité augmente, ALD diminue, sodium augmente dans urine

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56
Q

Si sodium diminue, qu’est ce qui arrive à l’osmolalité:

A

Osmolalité diminue, ALD augmente, sodium diminue dans l’urine

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57
Q

Spécimen de choix pour glycosurie:

A

2h pc

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58
Q

Le rein a une double fonction:

A
  1. débarrasser le sang des déchets pour ne pas empoissonner les cellules
  2. retenir les substances essentielles dans le sang
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59
Q

Le rein filtre la totalité du sang dans:

A

5 minutes

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60
Q

On produit combien d’urine par minute:

A

1 ml

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61
Q

Chaque rein contient combien de néphrons:

A

1.2 millions de néphrons dont le tiers seulement est fonctionnel

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62
Q

Quel est le pouvoir d’adaptation du rein:

A

Il faut une destruction de 50% du tissu rénal pour observer un ralentissement de cet organe.

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63
Q

La majortié des substances sont absrbés où dans le rein:

A

Dans le tube contourné proximal

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64
Q

Quelle est la différence entre le sang et le filtrat:

A

Le filtrat n’a pas:

  1. globules rouges
  2. globules blancs
  3. protéines
  4. lipides
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65
Q

Quels sont les trois barrières du néphron:

A
  1. fenestration: laisse passer des petites substances
  2. membrane basale:chargé donc répulse les particules négatives comme protéines
  3. podocytes: barrière physique
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66
Q

Quel est le trajet du sang dans le rein:

A
  1. artère rénal
  2. artère interlobaires
  3. artères sus-pyramidale
  4. artères interlobulaires
  5. artérioles afférentes
  6. glomérule
  7. artérioles efférentes
  8. vasa recta ou capillaires péritubulaires
  9. veines interlobulaires
  10. veines sus-pyramidales
  11. veine interlobaire
  12. veine rénale
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67
Q

Quels sont les 3 pressions associé à la filtrations:

A
  1. pression hydrostatique 6.0 mmHg ⇒ augmente la filtration
  2. pression oncotique 27 mmHg ⇒s’oppose à la filtration
  3. pression capsulaire 15 mm Hg ⇒s’oppose à la filtration
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68
Q

Si le taux de filtration est trop élevé:

A

Les substances nécessaires à l’organisme peuvent traverser trop rapidement les tubules rénaux pour être réabsorbés; elles sont plutot perdues dans l’urine

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69
Q

Si le taux de filtration est trop bas:

A

Presque tout le filtrat peut être réabsorbé et certains déchets ne peuvent pas être excrétés de facon appropriés.

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70
Q

Qu’est ce qui est un ultra-filtrat du plasma:

A

Le filtrat glomérulaire qui pénètre dans la capsule de Bowmann.

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71
Q

Valeur du polyurie:

A

> 2.5 L

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72
Q

Valeur de oligurie

A

< 400 ml

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73
Q

Valeur de anurie:

A

< 50 ml

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74
Q

Quels sont les processus de réabsorption tubulaire:

A
  1. processus actif: glucose, acides aminés, urée, ions
  2. action passive: électrolytes
  3. processus passif d’osmose: eau
75
Q

La réabsorption du sodium est controlée par:

A

L’aldostérone

76
Q

La réabsorption de l’eau est controlée par:

A

ADH

77
Q

Quels substances fait partie de la sécrétion tubulaire:

A
  1. potassium
  2. hydrogène
  3. ammonium
  4. acide urique
  5. pénicilline
78
Q

La sécrétion tubulaire à deux effets principaux:

A
  1. elle débarrasse l’organisme de certaines substances
  2. elle participe à la régulation du pH sanguin
79
Q

On peut classer les maladies du rein selon la partie du néphron qui est atteinte:

A
  1. néphropathies glomérulaires
  2. néphropathies interstitielles: causé par certaines intoxications médicamenteuses ou infections
  3. néphropathies tubulaires: causé par nécrose tubulaire aigue
  4. néphropathies vasculaires: causé par une hypertension artérielle
80
Q

Les néphropathies sont souvent à l’origine de:

A

Insuffisance rénale chronique qui peut conduire à une urémie.

81
Q

Description de la glomérulonéphrite:

A

Lésions causées par une inflammation antigénique des glomérules.

82
Q

Signes et symptomes de la glomérulonéphrite:

A
  1. taux de filtration glomérulaire réduit
  2. rétention de l’eau et des sels
  3. dommage causés aux glomérules, permettant le passage des GR et des protéines sériques dans l’urine
83
Q

Quelle est la cause de la glomérulonéphrite:

A

Souvent suite à une infection du tractus respiratoire supérieur par un streptocoque hémolytique.

84
Q

Quels sont les examens de laboratoire pour une glomérulonéphrite:

A
  1. urée sérique augmenté
  2. créatinine sérique augmenté
  3. protéinurie
  4. hématurie
  5. cylindres érythrocytaires et granuleux
85
Q

Quelle est la description du syndrome néphrotique:

A

Lésion chimique ou immunologique de la membrane basale du glomérule, membrane qui entoure le réseau de capillaires à l’intérieur du glomérule

86
Q

Quels sont les signes et symptomes du syndrome néphrotique:

A
  1. protéinurie massive
  2. hyperlipidémie, lipidurie
  3. oedème généralisé
87
Q

Quelle est la cause du syndrome néphrotique:

A

Souvent causé par des glomérulonéphrites

88
Q

Pourquoi il peut avoir une hyperlipidémie dans un syndrome néphrotique:

A

Les grosses protéines ne peuvent pas traverser les glomérules donc ils restent dans le sang. Leur job est de capter et transporter les lipides.

89
Q

Quels sont les analyses de laboratoire pour le syndrome néphrotique:

A
  1. protéines diminué
  2. cholestérol augmenté
  3. protéinurie abondante
  4. lipidurie
  5. cylindres cireux, graisseux
  6. hématurie
90
Q

Description de l’insuffisace rénale aigue:

A

Destruction ou dégénération rapide des néphrons

91
Q

Quels sont les signes et symptomes de l’insuffisance rénale aigue:

A
  1. déclin important de la fonction rénale sur une période de quelques heures ou de quelques jours
  2. accumulation des déchets azotés dans l’organisme
92
Q

Quels sont les causes d’une insuffisance rénale aigue:

A
  1. ischémie: ralentissement ou arrêt de la circulation sanguine rénale
  2. exposition à des produits chimiques toxiques pour les reins
93
Q

Quels sont les analyses de laboratoire pour une insuffisance rénale aigue:

A
  1. urée sérique augmentée
  2. créatinine sérique augmentée
  3. globules rouges dans urine
  4. cylindres dans urine
94
Q

Tableau 1

A

:D

95
Q

Quelle est la description d’une pyélonéphrite:

A

Inflammation du rein et du calice rénal causée par une infection.

96
Q

Quelle maladie rénale est fréquente chez la femme:

A

Pyélonéphrite

97
Q

Quels sont les causes d’une pyélonéphrite:

A

Infection par E. coli

98
Q

Quels sont les examens de laboratoire pour une pyélonéphrite:

A
  1. culture d’urine
  2. bactéries dans urine
  3. cylindres
  4. leucocytes, pus
  5. cellules rénales
  6. hématurie
99
Q

Quelle est la description de l’insuffisance rénale chronique (urémie):

A
  1. Détérioration graduelle et progressive de la fonction rénale
  2. destruction progressive des 2 millions de néphrons
  3. accumulation des déchets azotés dans le sang pouvant atteindre des niveaux toxiques
100
Q

Quels sont les causes de l’insuffisance rénale chronique:

A
  1. le plus souvent amorcée par la glomérulonéphrite chronique
  2. diabète melltius, néphrosclérose, pyélonéphrite chronique
101
Q

Quels sont les analyses de laboratoire pour une insuffisance rénale chronique:

A
  1. urée sérique augmente
  2. créatinine sérique augmente
  3. potassium sérique augmente
  4. protéinurie
  5. acidose métabolique
  6. corps gras dans urine
  7. cylindres hématiques dans l’urine
  8. globules rouges dans l’urine
102
Q

Les calculs sont formés par:

A

L’accumulation de cristaux urinaires d’oxalates de calcium, phosphate de calcium ou d’acide urique.

103
Q

Les reins contribuent à la régulation de la pression sanguine en sécrétant:

A

L’enzyme rénine

104
Q

Role de l’érythropoiétine:

A

Protéine synthétisé par le rein qui stimule la production des globules rouges par la moelle osseuse.

105
Q

Quel est le rôle alpha-hydroxylase:

A

Enzyme qui catalyse l’hydroxylation de la vitamine D en calcitrol, la forme la plus active.

106
Q

Quel est le rôle du calcitrol:

A

Augmente la réabsorption intestinale du calclium et du phsohpate.

107
Q

Quels sont les diurétiques:

A

Les médicaments qui augmentent l’élimination de l’eau et sel hors de l’organisme en accroissant le débit urinaire.

108
Q

Qu’est ce que les diurétiques empêchent:

A

La réabsorption des solutés filtrés, particulièrement le sodium ou agissent directement sur la réabsorption de l’eau.

109
Q

Quel substance possède un effet diurétique osmotique important:

A

Le glucose

110
Q

Les diurétiques sont souvent prescrits contre:

A

L’insuffisance cardiaque congestive, l’hypertension et l’oedème

111
Q

Les tests biochimiques reliés à la fonction rénale peuvent être divisés en trois catégories:

A
  1. Filtration, réabsorption et sécrétion rénale
  2. constituants azotés non protéiques (ANP)
  3. examen physique, chimique et microscopique de l’urine
112
Q

Quels sont les ANP:

A
  • urée
  • créatinine
  • eGFR
  • acide urique
  • ammoniaque
113
Q

Triangle cm/pouces:

A

FC

114
Q

Triangle lbs/kg

A

FC

115
Q

Formule de la clairance rénale:

A

FC

116
Q

Formule de la surface corporelle:

A

FC

117
Q

Valeur normale pour la clairance de la créatinine:

A

1.20-2.20 ml/s

118
Q

Quel est l’ordre décroissant des ANP plasmatiques:

A
  • urée
  • acides aminés
  • acide urique
  • créatinine
  • créatine
  • ammoniaque
119
Q

Quels sont les ANP qui ne sont pas des déchets:

A

Acides aminés et créatine

120
Q

Quel est le produit final du catabolisme des protéines:

A

L’urée

121
Q

Un ion d’ammoniac est produit par:

A
  1. La désamination de glutamate
  2. Aspartate dans le cycle Ornithine
122
Q

L’urée constituent combient des ANP excrétés normalement:

A

85%

123
Q

Quel pourcentage de l’urée est filtré par les reins:

A

90%

124
Q

Absorption de l’urée dans le sang:

A

Absorption passive à environ 40-70%

125
Q

Les causes pré-rénales vont causer:

A

Une augmentation d’urée

Créatinine normal

126
Q

Quels sont les causes pré-rénales:

A
  1. déshydratation
  2. insuffisance cardiaque congestive
  3. métabolisme protéique accru
  4. hémorragies intestinales
127
Q

Les causes rénales vont causer:

A

augmentation de l’urée

augmentation de la créatinine

128
Q

Quels sont les causes rénales:

A

Toute pathologie rénale entrainant une diminution de l’excrétion de l’urée.

129
Q

Les causes posst-rénales vont causer:

A

augmentation de l’urée

augmentation de la créatinine

130
Q

Quels sont les causes post-rénales:

A

toute obstruction du débit urinaire (calculs, tumeurs…)

131
Q

Quel est le rapport normal urée/créatinine:

A

12-20

132
Q

S’il y a une diminution du rapport urée/créatinine:

A

Il y a une diminution de la synthèse de l’urée

133
Q

S’il y a une augmentation du rapport urée/créatinine

A

Facteurs rénaux ou post rénal

134
Q

Quels sont les valeurs normals d’urée sérique:

A

2-8 mmol/L

135
Q

Il y a deux types de dosage de l’urée:

A
  1. direct: mesure le chromogène formé par la condensation de l’urée avec le diacétyl
  2. indirect: mesure la formation de l’ion d’ammonium, NH4, sous l’action de l’enzyme uréase
136
Q

Quel est la méthode direct du dosage de l’urée:

A

Méthode Fearon

diacétyl + urée ——–> diazine (jaune)

137
Q

Quel est le problème avec la méthode Fearon:

A

Il n’obéit pas la loi de Beer Lambert

138
Q

Quel est la méthode indirect du dosage de l’urée:

A

Méthode enzymatique avec l’uréase

urée ————-> ammoniac—————> ions d’ammonium

                                <sup>uréase</sup>
139
Q

La méthode enzymatique de l’urée peut être lit par trois facons:

A
  1. Berthelot
  2. glutamate déhydrogénase
  3. conductimétrie
140
Q

Méthode Berthelot

A

Phénol —————> indophénol bleu

nitroprussite

141
Q

Quel est la méthode de référence pour l’urée

A

Glutamate déshydrogénase

142
Q

Méthode glutamate déshydrogénase:

A

NH4 + alpha-cétoglutarate + NADH ——————-> glutamate + NAD + H2O

143
Q

Quel longueur d’onde on mesure le NADH:

A

340 nm UV

144
Q

Méthode conductimétrie:

A

Urée ————–> NH4

uréase

145
Q

Chimie sèche:

A

urée + indicateur pH ou chromogène ————-> chromophore

146
Q

Qu’est ce qu’il faut éviter pour la mesure de l’urée:

A

Fluorure et ammonium

147
Q

Quel est la différence entre la créatine et la créatinine:

A

La créatine a une molécul d’eau de plus

148
Q

Quel est le meilleur indicateur du taux de filtration glomérulaire:

A

La créatinine car elle est formée à une vitesse constante qui est proportionnelle à la masse musculaire.

149
Q

Le pool de créatinine est relié à quoi:

A

A la masse musculaire, qui est affecté principalement par le sexe, age et un peu par l’ingestion de la créatine.

150
Q

Signification clinique de la créatinine sérique:

A

Maladie rénale qui a endommagé 50% ou plus des néphrons. La créatinine sérique double à chaque fois que la filtration glomérulaire est réduite de moitié.

151
Q

Valeur normal pour la créatinine sérique:

A

40-120 umol/L

152
Q

Valeur normal pour la créatinine urinaire:

A

7-25 mmol/d

97-230 umol/d/kg

153
Q

Quels sont les méthodes de dosages de la créatinine:

A
  1. réaction de Jaffé (cinétique)
  2. méthode enzymatique
154
Q

Comment on appelle le picrate de créatinine:

A

Complexe de Janowski

155
Q

Réaction de Jaffé:

A

Picrate + OH ———> picrate-OH + créatinine

156
Q

Temps de lecture par la réaction de Jaffé:

A

Les lectures sont prises entre 20 et 80 secondes

157
Q

Quel est le rôle de la créatinine hydrolase:

A

Il catalyse l’hydrolase de la créatinine en créatine.

158
Q

Quels sont les méthodes enzymatiques du dosage de la créatinine:

A

Créatinine ————–> créatine

créatinine amidohydrolase

Sacrosine + H2O + O2 ————–> H2O2

                     <sup>oxydase</sup>

H2O2 + dérivé phénolique ————–> quinone imine

                 <sup>peroxydase</sup>

créatinine ———————-> créatine

créatinine hydrolase

NADH ————-> NAD

lactate déshydrogénase

3.

créatinine —————-> NH4

    <sup>iminohydrolase</sup>
159
Q

Spécimen urine pour mesurer la créatinine:

A

L’urine doit être dilué 1:100

160
Q

L’acide urique provient du:

A

catabolisme des bases purines qui composent les acides nucléiques

161
Q

L’acide urique se trouvent chez qui:

A

l’homme, primates et dalmatiens. Les autres mammifères possèdent l’uricase.

162
Q

Uricase:

A

Enzyme qui transforme l’acide urique en allantoine plus soluble que l’acide urique.

163
Q

ADN

A

ATCG = purines

164
Q

ARN

A

AUCG = urée

165
Q

pK de l’acide urique:

A

5.7

166
Q

Proportion d’acide urique et urate de sodium dans un pH de 5.7:

A

50/50

167
Q

Proportion d’acide urique et urate de sodium dans un pH de 4.7:

A

Acide urique emporte

168
Q

Proportion d’acide urique et urate de sodium dans un pH de 7.4:

A

Urate de sodium emporte

169
Q

Solubilité de l’acide urique:

A

Le plasma devient saturé aussitot que la concentration de l’urate dépasse la limite supérieure des valeurs de référence (500 umol/L).

170
Q

Hyperuricémie:

A

Cristaux d’urate peuvent se former et précipiter dans les tissus

171
Q

Il y a 3 états pathologiques où l’acide urique augmente:

A
  1. goute
  2. catabolisme nucléaire augmente
  3. maladie rénale
172
Q

Il y a deux facteurs responsables de l’élévation de l’acide urique plasmatique:

A
  1. surproduction d’urate causé par
    • diète riche en viande
    • synthèse de novo accrue
    • dégradation des acides nucléiques endogène suite à une destruction massive des tissus
  2. mauvaise élimination rénale causé par une insuffisance rénale
173
Q

L’hyperuricémie est souvent associé avec:

A

La goutte

174
Q

Valeur normale de l’acide urique:

A

150-500 umol/L

175
Q

Quels sont les méthodes de dosage de l’acide urique:

A
  1. dosage chimique: acide phosphotungstique
  2. dosage enzymatique: uricase
176
Q

Inconvénients de la méthode chimique à l’acide phosphotungstique:

A
  • précipitation des protéines est obligatoire
  • méthode n’est pas spécifique à l’acide urique
177
Q

Méthode à dosage chimique à l’acide phosphotungstique:

A

acide urique + acide phosphotungstique ————> allantoine + bleu de tungstène

178
Q

Méthode à dosage enzymatique à l’uricase:

A

1­.

acide urique ————–> allantoine + H2O2

                                                     <sup>uricase</sup>

H2O2 ——————-> H2O

<span>peroxydase</span>

179
Q

L’acide urique absorbe:

A

En UV

180
Q

Formation de l’ammoniaque:

A

acides aminés ——————-> acides cétoniques + ammoniac

désaminases

181
Q

Quels sont les méthodes d’ammoniac:

A
  1. enzymatique

alpha-cétoglutarate + NH4 + NADH —————> glutamate et NAD (340 nm)

  1. conductimétrie
  2. Berthelot (urée)
  3. Nessler’s
182
Q

Particularité du spécimen pour l’ammoniaque:

A

Trasporté sur glace et centrifugé à 4oC

183
Q
A

Biochimie (21 decks)

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