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Clinical Lab Med > Renal > Flashcards

Renal Flashcards

1
Q

How is GFR most easily obtained?

A

By measuring the concentration of creatinine and urea nitrogen in the serum.

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2
Q

What does reduction of GFR indicate?

A

Reduction implies progression of underlying disease or development of superimposed and often reversible problem.

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3
Q

What are the prognostic implications of GFR in patients with CKD?

A

GFR helps with staging

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4
Q

What do the normal values of GFR depend on?

A

Age
Sex
Body Size

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5
Q

Is there a correlation between loss of kidney mass and loss of GFR?

A

No

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6
Q

When is it important to know GFR?

A

In dose adjustments of medications (i.e. chemo), prior to kidney donations, prior to deermining the need for preemptive transplant

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7
Q

What is the gold standard of exogenous filtration markers?

A

Inulin

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8
Q

What is the key parameter to measure renal function?

A

GFR

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9
Q

How do SrCr and BUN vary with GFR?

A

Inversely

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10
Q

How is GFR estimated?

A

Measurement of CrCl, estimation equations based on SrCr

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11
Q

What is creatinine clearance used for?

A

estimated GFR from SrCr when there are variations in creatinine production

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12
Q

What are the 2 major limitations in accuracy of CrCl?

A

Inaccurate urine collection

Increasing creatinine secretion

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13
Q

How is creatinine filtered?

A

Creatinine is freely filtered across the golmerulus and isn’t reabsorbed nor metabolized by the kidney

If effect of secretion is ignored -> CrCl = GFR; all filtered creatinine will be excreted

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14
Q

Is CrCl normally higher or lower than GFR?

A

Normally CrCl should exceed GFR

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15
Q

How is 24-hour creatinine clearance measured?

A

24-hour creatinine clearance is measured on two separate occasions in patient with known kidney disease and a stable weight and diet

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16
Q

What is the test of choice to exclude urinary tract obstruction?

A

Renal Ultrasound

-Helps avoid allergies and complications of radio contrast

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17
Q

Who should renal ultra sound be performed in?

A

All patients with renal failure of unknown etiology

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18
Q

What is renal ultrasound useful in diagnosing?

A

Hydronephrosis

Polycystic Kidney Disease (also useful for screening)

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19
Q

What is renal ultrasound useful in detecting?

A

Renal masses

(Differentiate from simple benign cyst, complex cysts, and solid tumor) - CT is more sensitive

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20
Q

What are the findings on renal ultrasound that are used to assess the presence of irreversible kidney disease?

A

Increased echogenecity is a nonspecific finding seen with many diffuse and renal diseases

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21
Q

In patients with decreased kidney size is their renal process increased or decreased for likeliness of being treatable?

A

Decreased

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22
Q

What can provide complementary information that was obtained in a renal U/S?

A

A CT scan

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23
Q

What is used to distinguish a neoplastic lesion form a simple cyst?

A

A CT Scan

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24
Q

What is the gold standard for renal stone disease?

A

A non-contrast enhanced helical CT scan

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25
Q

What is used to evaluate and stage renal cell carcinoma?

A

A CT scan

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26
Q

What is used to diagnose renal vein thrombosis?

A

CT scan

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27
Q

What is a CT scan useful for diagnosing?

A

Renal cell carcinoma
Renal vein thrombosis
Renal stone disease (GOLD STANDARD)
Polycystic kidney disease (Gold standard is renal U/S but CT scan is more sensitive)

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28
Q

Can a CT scan be done to diagnose PCKD?

A

Yes and is more sensitive, but renal U/S is gold standard

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29
Q

What is the gold standard for renal vein thrombosis?

A

MRI along with CT and renal venography

-Book states that renal venography is gold standard but has an increased risk for clot dislodgment, bleeding, and iodinated contrast, so less invasive methods are now commonly used.

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30
Q

When is an MRI used?

A

In evaluation of a patient with a susepected or confirmed renal cell carcinoma

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31
Q

What can occur with MRI due to the use of the gadolinium contrast?

A

Gadolinium is linked to nephrogenic systemic fibrosis among patients with renal disease (especially those on dialysis)

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32
Q

What does IVP (intravenous pyelogram) indicate?

A

Provides information about caliceal anatomy and size and shape of the kidney.
Useful in detecting renal stones

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33
Q

Does IVP require administration of contrast and involve radation exposure?

A

Ues

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34
Q

What is IVP used for?

A

Medullary sponge kidney and papillary necrosis

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35
Q

What does IVP have a high sensitivity and specificity for?

A

Detection of stones and degree of obstruction

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36
Q

What is useful and diagnostic if you suspect polyarteritis nodosa?

A

Renal Arteriography

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37
Q

What does renal arteriography show in polyarteritis nodosa?

A

Demonstrates multiple aneurysms and irregular constrictions in larger vessels in the occlusion of small penetrating arteries.

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38
Q

What does renal arteriography show in renal cell carcinoma?

A

Renal cell carcinoma seems well vascularized, has venous lakes, exhibits puddling of contrast medium in vascular spaces or necrotic areas

39
Q

When should a renal biopsy be done?

A

In all patients with elevated proteinuria of more than 3g/day or if non-nephrotic proteinuria is associated with active urine sediment of decreased GFR

40
Q

What can be used to diagnose urinary tract obstruction?

A

Retrograde pyelography (More often by US and CT)

41
Q

What is retrograde pyelography most useful for?

A

In defining obstructing lesions within the ureter or renal pelvis, particularly in the setting of a nonvisualizing kidney on IVP

Ureter stones can be removed during this procedure using a special basket,.

42
Q

When is KUB useful?

A

For calcium-containing, struvite, and cystine kidney stones of sufficient size

43
Q

What is the gold standard for measuring protein excretion?

A

24-hour urine collection

It quantifies the protein

44
Q

What are the limitations for 24-hour urine collection?

A

Cumbersome for patients, often collected incorrectly

45
Q

What are the three ways to test for protein in the urine?

A

24-hour urine collection
Standard urine dipstick
Urine protein-to-creatinine ratio (UPCR)

46
Q

What does the standard urine dipstick detect for protein?

A

Detects albumin and is relatively insensitve to non-albumin proteins (only detects albumin in high concentrations)
Not quantitative

47
Q

What is urine protein-to-creatinine ratio (UPCR)

A

Spot first- or second-morning urine sample after avoiding exercise used to estimate 24-hour proteinuria and to follow effects of treatment in pts with proteinuric kidney diseases

48
Q

What do pH urine values above 5.3 indicate?

A

Abnormal urinary acidification and presence of renal tubular acidosis

49
Q

What is important for urine pH to have a diagnostic use?

A

The urine needs to be sterile.

50
Q

What is urine pH useful for?

A

Useful in assessing the efficacy of treatment in metabolic alkalosis and uric acid stone disease

51
Q

What do high H+ concentrations cause?

A

A build up of uric acid and then uric acid stone disease occurs

52
Q

What do variations in urine osmolality play a role in the regulation of?

A

Plasma osmolality and Na concentration

53
Q

In osmolality what occurs after waterload?

A

After waterload, there is a transient reduction in Posm -> secretion of ADH -> results in excretion of excess water water in dilute urine

54
Q

What does restriction of water do for osmolality?

A

Water restriction -> raises Posm -> water retention and excretion of concentrated urine

55
Q

What should abolish ADH release?

A

Hyponatremia with hypoosmolality

56
Q

What does BUN provide?

A

An estimate of renal function

57
Q

What is BUN most sensitive to?

A

Dehydration, catabolism, diet, renal perfusion, and liver disease

58
Q

What is recorded on urinalysis?

A

Color, appearance, pH, specific gravity, glucose, protein, hemoglobin, LCE, and nitrites

59
Q

What is recorded on micorscopic urinalysis?

A

Cells- RBCs, WBCs, Epithelial
Casts- RBC, WBC, tubular epithelial, Fatty
Crystals

60
Q

What do dysmorphic red cells indicate?

A

Glomerular bleeding

61
Q

What do white blood cells on urine microscopy indicate?

A

Usually infection if they also have nitrite and LCE positive

62
Q

What should you suspect if urine microscopy has red cell casts?

A

Glomerulonephritis

63
Q

What can white blood cell casts in urine microscopy indicate?

A

Pyelonephritis
Tubular interstitial disease
Drug reactions
TB

64
Q

What can fatty casts indicate on urine microscopy?

A

Nephrotic syndrome

65
Q

What are budding hyphae diagnositc of?

A

Invasive candida infection

66
Q

What do uric acid cystals indicate?

A

Uric acid stone formation due to gout

67
Q

What do muddy brown granular casts indicate?

A

Most likely acute tubular necrosis

68
Q

When is GFR decreased?

A

In renal insufficiency and decreased renal blood flow

69
Q

When is creatinine clearance increased?

A

Pregnancy and exercise

70
Q

When is creatinine clearance decreased:?

A 
Renal insufficiency
Drug Therapy (Cimetidine, procainamide, abx, quinidine)
71
Q

How is creatinine removed from the body?

A

Creatinine is removed from the body entirely by the kidneys so if kidney function is abnormal creatinine level increases in blood (less creatinine is being released in urine)

72
Q

What are the medications that affect serum creatinine?

A

Medications that affect: Aminoglycosides, cimetidine, heavy metal chemo drugs, cephalosporins, NSAIDs, trimethoprim

73
Q

When will the serum creatinine be elevated?

A

Renal insuffiiciency (acute and chronic)
Decreased renal perfusion (HPOTN, dehyrdation, CHF)
Rhabdomyolysis
Administration of contrast dyes
Ketonemia
Drug therapies (Abx-aminoglycosides, cephalosporins, ACEI, and diuretics)

74
Q

When is serum creatinine falsely elevated?

A

DKA, admin of some cephalosporins (cefotoxitin & cephalothin)

75
Q

When is serum creatinine decreased?

A

Decreased muscle mass, pregnancy, prolonged dehibilitation

76
Q

When is osmolality elevated?

A

SIADH, dehydration, glycosuria, adrenal insufficiency, high-protein diet

77
Q

When is osmolality decreased?

A

DI, excessive water intake, IV hydration with D5W, acute renal insufficiency, glomerulonephritis

78
Q

What does the BMP measure?

A

Kidney function, blood acid/base balance, blood sugar levels

BUN, CO2, Creatinine, Glucose, Serum Cl, Serum K, Serum Na

79
Q

What is formed when protein breaks down?

A

Blood urea nitrogen

80
Q

When is BUN elevated?

A

Dehydration, renal disease, (glomerulonephritis, pyelonephritis, diabetic nephropathy), urinary tract obstruction (prostatic hypertrophy), drug therapy (aminoglycosides & other abx, diuretics, lithium, corticosteroids), GI bleeding, decreased renal blood flow (shock, CHF, MI)

81
Q

When is BUN decreased?

A

Liver disease, malnutrition, 3rd trimester of pregnancy

82
Q

How is urine pH measured?

A

Using urine dipstick that states level of acid in the urine

83
Q

When is the urine pH high?

A

renal tubular acidosis, kidney failure, stomach pumping, UTI, vomiting

84
Q

When is the urine pH low?

A

DKA, diarrhea, metabolic acidosis, starvation

85
Q

What can affect the results of urine protein?

A

dehydration, x-ray exam with contrast dye w/in 3 days before urine test, vaginal fluid, emotional stress, heavy exercise, UTI

86
Q

What does a 24-hour urine collection measure besides protein?

A

creatinine, how much urine is being produced, sodium, potassium, urea nitrogen

87
Q

What are the indications for a helical CT scan?

A

Suspected acute appendicitis, abdominal/pelvic pain, abdominal/pelvic neoplasm, abdominal/pelvic mass, abdominal/pelvic abcess, suspected complication from acute pancreatitis

88
Q

What are the strengths of the helical CT scan?

A

Fast, imaging of entire abdomen and pelvis in one single breath hold, better imagining that conventional CT, not affected by overlying gas

89
Q

What are the weaknesses of the helical CT scan?

A

Potential for significant contrast reaction, expensive, lacks sensitivity in diagnosis, radiation exposure

90
Q

What are the indications for renal arteriography?

A

Renal stenosis, thrombosis, renal mass, unexplained hematuria, vascular malformation, polyarteritis nodosa

91
Q

What are the indications for a renal biopsy?

A

Nephrotic syndrome, persistent proteinuria, hematuria associated with abnormal urine sediment or proteinuria, unexplained hematuria after exclusion of lower tract causes, systemic disorder with kidney involvement, acute renal failure with atypical feature or failure to recover renal function in 8 weeks, rapidly pregressive renal failure, renal allograft dysfunction, unexplained reduction in kidney function

92
Q

What are the indications for KUB?

A

Abdominal pain, suspected intrperitoneal free air, bowel distention

93
Q

What are the strengths of the KUB?

A

Low cost, readily available, low radiation

94
Q

What are the weaknesses of the KUB?

A

Low diagnostic yield, contrindicated in pregnancy, presence of barium will interfere with interpretation, nonspecific test

Clinical Lab Med (1 decks)

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