Renal

Question 1

Mention the renal function tests

Answer 1

Serum urea, creatinine
BUN, Urine examination, microalbumin
clearance tests: urea, creatinine, inulin.
S albumin, S protein, S phosphorus, S calcium, serum electrolyte levels

Question 2

١_normal creatinine value
٢_what is creatinine
٣_dose normal creatinine clearance exclude the renal disease?

Answer 2

1_0.6-1.2 mg/dl
2_non enzymtic breakdown product of creatine and phosphocreatine
3_No

Question 3

when dose creatinin concentration increase or decrease?

Answer 3

1_ increase;
male, body bulider or athlete, muscle trauma
2_decrease;
age, female, malnutrition, muscle wasting, setting desk worker.

Question 4

Why dose creatine clearance test is not ideal for estimating GFR?

Answer 4

1_small amount is secreted from renal tubules that increase in renal f
2_collection of urine is often incomplete
3_it is affected by intake of meat and m mass
4_affected by certain drugs: cimetidin e, probenacid, trimethoprim

Question 5

How to calculate creatinine clearance?

Answer 5

by Cockcroft and gult formula:
male:( 140-age in years) ×body weight /(72×serum creatinine in mg/dl)

female: the result is multipled by 0.85

Question 6

1_How much is the normal value of urea.
2_its reabsorption affected by what
3_Increase in?
4_decrease in?

Answer 6

1_20-45 mg/dl
2_influenced by ECV status
3_high pn intake, catabolic state, GI bleeding, tetracycline, Intravascular volume depletion, diuertics, CCF, RF
4_CLD, alcohol abuse, severe malnutrition.

Question 7

deffrentiate between the term azotemia and uremia

Answer 7

Azotemia is increase in blood level of urea.

Uremia is the clinical syndrome resulting from this increase.

Question 8

How much is normal BUN, and how to calculate it

Answer 8

7-20 mg/dl

calculated from the serum urea level by multiplying it by 0.47

Question 9

1_What is benefit of calculating BUN/craetine ratio.
2_The ideal ratio
3_when it’s elevated, normal, decrease?

Answer 9

1_to defferintiate the causes of azotemia
2_between 10:1_20:1
3_A_whenever urea production is increased; diet, glucocorticoid therapy, with neoplasms and antibiotics, excessive pn catabolism as seen in infections, uncontrolled DM, Dehydration.
B_normal: in renal azotemia
C_low in: pregnancy, overhydration, severe liver ds, malnutrition.

Question 10

1_What’s the best test for assessment of excretory renal function?
2_varies with what?
3_Normal GFR in young adults?

Answer 10

1_BUN/creatinine ratio
2_age, sex, body weight, normal renal blood flow and pressure.
3_120_130 ml/min per 1.73 m2.

Question 11

What is the gold standard for measuring GFR?
why?
why it’s not common to use?

Answer 11

inulin clearance.
freely filtered, not pn bound, not absorbed or secreted.
the measurment is difficult.

Question 12

Mention the test to evaluate glomerular function

Answer 12

1_clearance test: inulin clearance, I-iothalamate clearance, Cr-EDTA clearance, cystatin C clearance, creatinine clearance, urea clearance.
2_blood biochemistry: S creatinine, BUN, and BUN/serum creatinine ratio.

Question 13

Describe the clinical guidlines for CKD

Answer 13

Stage. Description. GFR
1_kideny damage+normal or inc> 90
2_k damage with mild dec 60_89
3_moderate dec. 30-59
4_severe dec. 15_29
5_kideny failure <15 or dialysis

Question 14

Mention the tests avaulable to evaluate tubular function

Answer 14

1_tests for proximal tubular function 
Glycosuria, phosphaturia, uricouria
generalized aminoaciduria
tubular proteinuria
fractional sodium excretion prediction equation. 

2_test for distal tubular function
specific gravity and osmolality of urine
water deprivation test and water loading test
Ammonium chloride loading test

Question 15

What are the indications for quantitation of proteinuria?

Answer 15

1_diagnosis of Nephrotic syndrome «odema, hypoalbuminemia, proteinuria> 3g/24 hour
2_prognosis of progressive renal disease; Diabeteic nephropathy, chronic glomerulonephritis, reflux nephropathy
3_Diagnosis of early diabetic nephropathy «increase GFR, increase albumin excretion, HT»