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Clinical Chemistry > Renal Function > Flashcards

Renal Function Flashcards

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1
Q

Kidney Anatomy

A

2 bean shaped organs
cortex & medulla housed in fibrous capsule of connective tissue
nephrons

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2
Q

kidney function

A

eliminate NPN compounds
water & electrolyte balance maintained
acid-base balance
endocrine functions

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3
Q

Nephron

A 
glomerulus - end of renal tubule, capillary tuft, sits in Bowman capsule
proximal convoluted tubule
loop of henle
distal convoluted tubule
collecting duct
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4
Q

Glomerular filtration

A

depends on blood pressure through glomerular capillaries & integrity of semi-permeable glomerular membrane
membrane is negatively charged so proteins & others are repelled

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5
Q

GFR

A

volume of blood filtered per minute

glomerular filtration rate

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6
Q

Proximal convoluted tubule

A

returns 75% of water, Na, Cl
100% of glucose, amino acids, vitamins, proteins, & varying amounts of urea, uric acid & ions like Mg, Ca, K, HCO3
water & cl are passive transport; everything else is active

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7
Q

Loop of Henle

A

opposing flows result in osmolality changes & hypo-osmole urine
COUNTER CURRENT MULTIPLIER

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8
Q

ascending limb of henle

A 
Na & Cl are reabsorbed into medulla interstitial fluid along limb
impermeable to water -> hyperosmotic medulla
diluting limb (!)
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9
Q

descending limb of henle

A

highly permeable to water but does not reabsorb Na & Cl
water leaves for the medulla
fluid in loop is hypo-osmotic urine

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10
Q

Distal convoluted tubule

A

adjusts the electrolyte & acid-base homeostasis via ADH & aldosterone actions

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11
Q

aldosterone

A

acts on distal tubule stimulates Na reabsorption & excretion of K & H+

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12
Q

Urea

A

ammonia from amino acid degradation made into urea in liver

40-60% reabsorbed into medulla to maintain high osmolality

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13
Q

creatinine

A

waste from muscle

not reabsorbed by tubules

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14
Q

Uric acid

A

waste from purine metabolism

only 6-12% of original uric acid is excreted; can contribute to crystal in urine, gout & calculi

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15
Q

water balance

A

controlled by ADH, proximal, distal & collecting ducts

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16
Q

sodium balance

A 
aldosterone system (RAS)
governs Na reabsorption
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17
Q

Potassium balance

A

excretion controlled by kidneys

actively reabsorbed through nephron; negatively effected by aldosterone

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18
Q

Chloride balance

A

maintenance of extracellular balance; passive reabsorption in proximal tubule

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19
Q

Phosphate, Mg, Ca balance

A

PTH controls proximal tubule reabsorption of phosphates
Mg filtered by tubule & reabsorbed via PTH action
calcium under PTH & calcitonin control so tubule reabsorption is not significant

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20
Q

Endocrine function

A

makes EPO, 1,25-dihydroxy vitamin D3, & prostaglandins

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21
Q

Kidney renin

A

made by juxtaglomerular cells of renal medulla; released when blood pressure decreases
activates renin-angiotensin system

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22
Q

EPO production

A

made by cells close to proximal tubule, production regulated by 02 levels in blood within 2 hour window

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23
Q

1,25-dihydroxy vitamin D3 production

A

made when kidney enzyme converts 25-hydroxy vit D to this form
adds a methyl group & becomes an active vitamin

24
Q

Prostaglandins

A

made from arachidonic acid
increase blood flow, Na & water excretion & renin release
oppose renal vasoconstriction due to angiotensin II & norepinephrine

25
Q

Creatinine clearance

A

creatinine clearance to assess glomerular filtration rate

males: 97-137 ml/min
females: 88-128 ml/min

26
Q

Urea clearance

A

urea 40% reabsorbed by tubules- not used now

27
Q

Cystatin C

A

low molecular weight protein from nucleated cells; freely filtered by glomerulus;
reabsorbed & catabolized by proximal tubule
constant rate unaffected by age, gender, race, muscle mass;
may be better early indicator of decreased GFR

28
Q

Cystatin C vs Creatinine

A

creatinine - more stable w/in a person so fluctuations seen indicate renal function over time
cystatin C- doesn’t change much between people but within a person there is bioflux; marker better at detecting minor renal impairment

29
Q

Urine electrophoresis

A

normally excrete 50-150 mg/24 hrs
increases in protein indicate disease states
do electrophoresis to ID proteins & define disease type

30
Q

Beta2-Microglobulin

A

small, non-glycosylated peptide found on surface of nucleated cells
shed at constant rate normally
elevated levels indicate myeloproliferative & lymphoproliferative disorders, inflammation or renal failure
filtered by kidney & then 99.9% reabsorbed

31
Q

elevated b2 microglobulin in transplant patients

A

can indicate rejection

32
Q

Myoglobin

A

associated w/ muscle injury (rhabdomyolysis) overloads kidney proximal tubule & see acute renal failure
increased in serum can be early indicator of renal disease

33
Q

Microalbumin

A

increased in diabetics w/ nephrophathy

34
Q

nephrophaty

A

renal hypertrophy
increased glomerular thickness
tubular basement membrane dysfunction
increased microalbumin, blood pressure & leads to increased renal damage

35
Q

Kidney Diseases

A 
glomerular diseases
tubular diseases
infections & obstructions
renal failure
renal hypertension
36
Q

Glomerular diseases

A

damage renal glomerulus directly & lead to tubular disease over time:
actue glomerularnephritis
chronic glomerularnephritis
nephrotic syndrome

37
Q

acute glomerularnephritis general

A

inflamed glomeruli w/ decreased capillary lumen

can recover from acute

38
Q

acute glomerularnephritis labs

A

hematuria, proteinuria, increased BUN, creatinine

Na & water retention

39
Q

acute glomerularnephritis causes

A 
group A Beta hemolytic strep
drug related
infections
systemic lupus
bacterial endocarditis
40
Q

Chronic Glomerularnephritis general

A

lengthy glomerular inflammation

leads to scarring & loss of function of nephrons

41
Q

chronic glomerularnephritis

A

increased BUN & other nitrogen compounds
hematuria
proteinuria

42
Q

labs for nephrotic syndrome

A

proteinuria (>3.5g/day!!), decreased oncotic pressure leading to increased edema, w/ hyperlipidemia

43
Q

Tubular diseases

A

occur as decreased GFR due to progressive tubular defects
damage to excretion/reabsorption functions of tubules
renal tubular acidosis
acute inflammation of tubules & surrounding interstitium

44
Q

Renal tubular acidosis (RTA)

A

primary tubular disease
distal RTA- tubule cannot keep up w/ pH gradient between blood & tubular fluid
proximal RTA- decreased HCO3 reabsorption, resulting in hyperchloremic acidosis

45
Q

acute inflammation of tubules & surrounding interstitium

A

may occur due to analgesics/drugs or radiation toxicity, methicillin hypersensitivity reaction, renal transplant rejection, infections
decreased GFR, decreased metabolic acid excretion
see WBC casts
issues w/ Na control

46
Q

urinary infections

A 
pyelonephritis, cystitis
micro >105 colonies/ml
hematuria
pyuria
WBC casts
47
Q

urinary obstructions

A 
gradual rise in intra-tubular pressure until nephrons necrose & get chronic renal failure
maybe from repeated infections
decreased urine concentrating capacity
decreased metabolic acid excretion
decreased GFR
decreased blood flow to kidney
48
Q

urinary obstructions

A 
gradual rise in intra-tubular pressure until nephrons necrose & get chronic renal failure
maybe from repeated infections
decreased urine concentrating capacity
decreased metabolic acid excretion
decreased GFR
decreased blood flow to kidney
49
Q

renal failure

A

acute renal failure & chronic renal failure

50
Q

acute renal failure diseases

A

pre-renal failure: blood supply defect prior to kidney
renal failure: defect in kidney; often dacute tubular necrosis
post renal failure: defect after urine exits; obstruction or bladder rupture

51
Q

Chronic Renal Failure

A

when progressive loss of GFR occurs & patient has additional factors of risk-> end stage renal failure

52
Q

chronic renal failure increases with:

A 
diabetes mellitus
age
obesity
metabolic syndrome
hypertension
decreased HDL
increased triglycerides 
increased glucose
53
Q

Renal hypertension

A 
decreased perfusion to all of kidney (ischemia)
decreased perfusion to part of kidney
increased Na
decreased serum K
increased urine K
54
Q

Dialysis

A

use semi-permeable membrane in dialysate bath

55
Q

hemodialysis

A

dialysate & blood running in opposite directions to filter out waste

56
Q

peritoneal dialysis

A

less clearance but continuous

57
Q

transplantation

A

survivals vary; living donor lasts longer

3 year survival 65-85%

Clinical Chemistry (23 decks)

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