Renal

Question 1

Regulatory Function

Answer 1

Control composition and volume of blood.
Maintain stable concentrations of inorganic anions such as Na, K, and Ca.
Maintain acid base balance.

Question 2

Excretory Function

Answer 2

Produce urine.

Remove metabolic waste including nitrogenous waste.

Question 3

Hormone Function

Answer 3

Produce renin for blood pressure control.
Produce erythropoietin which stimulates marrow production of red blood cells.
Activates 25(OH) to 1,25(OH)2D (active vitamin D).

Question 4

Metabolic Function

Answer 4

Gluconeogenesis.

Metabolize drugs and endogenous substances like insulin.

Question 5

Nephron Functions

Answer 5

Filtration- glomeruli ultrafiltrate of the plasma.
Reabsorption- tubules selectively reabsorb substances from the ultrafiltrate.
Secretion- tubules secret substances into the urine.

Question 6

Filtration

Answer 6

Glomeruli generate ultrafiltrate of the plasma.

Question 7

Reabsorption

Answer 7

Tubules selectively reabsorb substances from the ultrafiltrate.

Question 8

Secretion

Answer 8

Tubules secrete substances into the urine.

Question 9

Ultrafiltration

Answer 9

Main function of the glomeruli. Filtration is based on size and charge:
Small solutes cross readily
Larger substances are generally restricted
Negatively charged molecules are restricted

Question 10

Volume of Ultrafiltrate

Answer 10

135-180 liters per day

Question 11

Water Reabsorption

Answer 11

99% is reabsorbed

Question 12

Urine Excreted

Answer 12

1-1.5 liters per day is excreted

Question 13

Urine Albumin-to-Creatinine Ratio (UACR)

Answer 13

An elevated UACR is used to identify damages kidneys. Used for screening, diagnosing, and treating CKD. It is a standard of diabetes care. Tool for pt education and self-management.

Question 14

Chronic Kidney Disease (CKD)

Answer 14

Reduced kidney function and/or kidney damage.

Question 15

CKD Kidney Function

Answer 15

glomerular filtration rate (GFR) <60 mL/min/1.73m2 for greater than or equal to 3 months with or without kidney damage.

Question 16

CKD Kidney Damage

Answer 16

Greater than or equal to 3 months, with or without decreased GFR, manifested by either pathological abnormalities or markers of kidney damage i.e. albuminuria with UACR >30 mg/g.

Question 17

eGFR

Answer 17

Is used to assess and monitor kidney function. The eGFR provides an estimate of how much blood is filtered by the kidneys each minute. The formula used to estimate GFR uses serum creatinine, age, gender, and race.

Question 18

Kidney Failure

Answer 18

eGFR <15. Kidneys cannot maintain homeostasis. Kidney failure is associated with fluid, electrolyte, and hormonal imbalances and metabolic abnormalities. ESRD means the pt is on dialysis or has a kidney transplant.

Question 19

Elevated UACR

Answer 19

Associated with risk of renal events; lowering UACR may lower risk of progression.

Question 20

Leading causes of kidney failure in the US…

Answer 20

Diabetes and hypertension.

Question 21

Energy Needs in CKD

Answer 21

Not higher.
Individualized.
Need 23-35 kcal/kg to maintain nutritional status.