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3006 Clin. Biochem > Renal function > Flashcards

Renal function Flashcards

1
Q

Meaning of Polyuria, Oliguria, Anuria

A

Polyuria: urine vol. >3000ml
Oliguria: urine vol. <400ml
Anuria: urine vol. <100ml

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2
Q

total body of water in extra- & intracellular fluid

A

ICF: 2/3
- 10.5L interstitial fluid
ECF: 1/3
- 3.5L plasma

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3
Q

How many

a) times does the kidney filtrate the blood per day?
b) liters of blood does the kidney filter per day?
c) av filtrate produced per min

A

a) 25-30
b) 180L / day
c) 125ml/min

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4
Q

3 Function of kidney

A
  • regulate fluid & electrolytes
  • excrete metabloic wastes
  • endocrine function (make Vit. D)
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5
Q

Each nephron filters ~__ µL of urine per day.

A

100uL

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6
Q

percentage the following is excreted

a) Creatinine
b) Glucose
c) Urea

A

a) 100% (bc toxic waste made by muscle)
b) Glucose (if <11mM in blood)
c) 50% (form breakdown of AA)

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7
Q

The osmolality (mOsmol/kg) can be approximately calculated from the equation:

A

osmolality = 2*(Na + K) + Glucose + Urea

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8
Q

how osmolality is affected w/ overhydration & dehydration

A 
Overhydration = dec (bc dilute) = swell 
Dehydration = inc (bc [ ]trated)
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9
Q

common causes of hyponatremia

A
  • Diuretic therapy = inc Na excretion
  • Diabetes mellitus = Na low
  • High lipids or protein = psuedohyponatremia
  • SIADH (secretion inappropriate ADH)
  • Addisons = low aldosteron = inc Na excretion
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10
Q

common causes of hypernatremia in terms of water & salt

A
  • Decreased circulating volume = loss water
  • Decreased fluid intake = “ “
  • Vomiting/Diarrhoea = “ “
  • Ventilation (e.g. ICU) = “ “
  • Diabetes insipidus = “ “
  • Mineralocorticoid excess (top of normal range) = gain salt
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11
Q

In case of low urine Osmolality. How can you tell if it is due to kidney problem or lack of ADH?

A
  • give desmopressin (ADH analogue = work like ADH)
    = If urine [ ]trated = lack ADH
    OR
    = urine non-[ ]trated = kidney problem
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12
Q

body’s response to hypovolemia & inc osmolality

A
  • Renin secretion by kidneys => activate aldosterone secretion = stimulate eNAC enzyme =inc Na reabs. = water reabs.
  • ADH in thypothalumas = water reabsorption
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13
Q

Characteristic of Barter’s syndrome and Describe its affect on ion/waster secretion/excretion

A

Hi Na in blood bc defect in Na+ transport

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14
Q

Characteristic of Cushing’s syndrome and Describe its affect on ion/waster secretion/excretion

A

inc Cortisol w/ inc eNAC (enzyme responsible for reabs Na & excrete K)

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15
Q

Characteristic of Liddles syndrome and Describe its affect on ion/waster secretion/excretion

A

high eNAC => inc Na & dec K & dec H+ intake

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16
Q

[Na] is higher in _CF while [K] is lower in _CF

A

[Na] is higher in ECF while [K] is lower in ICF

17
Q

ATPase pump push _x Na [out/in] and take _x K [out/in]

A

3x Na out

2x K in

18
Q

hyperkalemia is likely to be caused by

A
  • hypoxia
  • acidosis (H+ go in cell & K go out)
  • diabetics = low insulin = gluc not fuel pump = Na/K pump works less (coming in < come out)
  • tissue injury
19
Q

psuedohyperkalemia is causes by

A
  • haemolysis
  • Leukocytosis
  • Phelobotomy
  • KEDTA anticoagulant
20
Q

difference b/w Factitious hyponatremia & pseudohyponatremia

A

Factitious hyponatremia: water moves out of cells

pseudohyponatremia: water doesn’t move out of cells
- osmolality & tonicity normal
- lab errors due to multiple myeloma bc hyperlipidemia & hi protein = contain Na (trapped)

21
Q

Factors INCREASING K+ excretion

A
  • Aldosterone
  • Increased sodium and water delivery (flow rate): eg such as in diuretic use.
  • High K+ diet
  • Alkalosis
  • Tubular damage (eg acute tubular necrosis)
22
Q

Factors DECREASING K+ excretion

A
  • Hypoaldosteronism (Eg Addisson’s disease)
  • Reduced glomerular filtration rate
  • Acidosis
  • Reduced fluid delivery to the distal tubule
23
Q

The following are the major symptoms of acute/chronic renal dysfunction.

A
  • inc urea, inc creatinine, hyperkalaemia, metabolic acidosis
  • Urine volume may be high in polyuric phase.
  • Urine osmolaity ~ plasma osmolality;
  • FENa>1
24
Q

consequence of renal dysfunction in plasma

A
  • inc K, PO4, Mg
  • dec pH
  • inc urea, creatinine, uric acid
25
Q

Proteinuria is the term used when the concentration of albumin exceeds ——— gram per day.

A

> ~0.3 g/day in urine

26
Q

Nephrotic syndrome is a group of symptoms including

A
  • protein (Alb) in the urine (> 3.5 g/day)
    = low Alb in blood = swelling
  • high cholesterol levels
  • high triglyceride levels [when mild, elevated LDL, and in more severe cases VLDL]
27
Q

Nephrotic syndrome caused by

A

immune complexes in glomerulus

28
Q

why is glomerular filtration rate (GFR) important?

A
  • INDICATOR of functioning renal mass.
  • MONITORING progression/resolution of renal disease: acute/chronic.
  • PREDICT time left to development of end-stage renal failure, (In chronic renal failure)
  • ADJUST DOSE of renally excreted drugs.
29
Q

Equation for GFR when doing the creatinine clearance test

A

[plasma creatinine] x 24hr x 60 min

30
Q

Cockcroft–Gault equation “Body weight – Age - Sex” to give Creatinine clearance (mL/min)

A

[140 - age(yrs)] x weight(kg)

  1. 23 (OR 1.04 fem.) x serum creatinine (mmol)
31
Q

What circumstances would force the use of GFR test (e.g. 24hr creatinine test) instead of eGFR?

A
  • malnutrition or obesity
  • disease in skeletal muscle
  • extreme body size & age
32
Q

marker for kidney disease, why & equ it uses

A
  • cyastin made my cells (endogenous)
  • more accurate than creatinine in children & elderly
  • use Larson equ. = 77.24 x sCystatin C^(–1.2623)
33
Q

Difference b/wCockcroft-Gault equation & MDRD equation

A

C-G equ: “Body weight-Age-sex”

MDRD equ: “Ethnicity-age-sex”

34
Q

___ levels are altered in patients with:
Cancer
__ dysfunction
__ therapy

A

a) Cyastin
b) Thyroid
c) Glucocorticoid

35
Q

gold std for measuring glomerulus filtration rate & why

A

inulin bc completely excreted

36
Q

a) What is Fractional Excretion of Urinary sodium (FeNa)? b) & what does it mean if FENa >1%
c) FENa <1%

A

a) The amount of Na filtered by the glomerulus but escapes tubular reabsorption (more sodium is excreted in urine)
b) acute tubular necrosis (intrinsic renal damage)
c) prerenal problem from hypovolemia = dec blood flow

3006 Clin. Biochem (13 decks)

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