Renal Function Flashcards

Question

What causes variation in creatinine clearance?

Answer 1

Greatest error in creatinine clearance is collection of timed urine samples. Analytical and Biological variation is 8 - 20%

Answer 2

CC = (Uc x V) / Pc

Answer 3

``` Polyuria Metabolic acidosis Aminoaciduria Phosphaturia Glycosuria Hypokalaemia Tubular proteinuria ```

Answer 4

Urine salt loss -> hyponatraemia Alkaline urine -> Metabolic acidosis Polyuria

Answer 5

Overflow: Excessive production & excretion of protein as in Bence-Jones protein, marked catabolism Glomerular: Glomerular damage - albuminuria Tubular: Tubular damage - α1 β2 microglobulinuria Secretory: Tubular protein secretion – Tamm-Horsfall

Answer 6

``` Protein Glucose Blood pH Nitrite Bile pigments Ketones ```

Answer 7

24 h urine albumin 30mg - 300mg. Therefore, increased urine albumin excretion but urine Dipstick –ve

Answer 8

Cystatin C - Small protein produced by all nucleated cells - Not affected by muscle mass, age, gender or race NGAL- Neutrophil Gelatinase Associated Lipocalin - Marker of acute kidney injury (urine & serum) - Early detection of AKI

Answer 9

Detect ~ 300mg/L albumin Protein error of indicators - don’t detect Bence Jones protein - False positives (alkaline urine, various contaminants)

Answer 10

Creatinine increase ≥ 26μmol/L within 48hrs or increase ≥1.5 to 1.9 X reference Serum Creatinine Urine output 6 consecutive hrs

Answer 11

Creatinine increase ≥ 2 to 2.9 X reference SCr Urine output 12hrs

Answer 12

Creatinine increase ≥3 X reference SCr or increase ≥354μmol/L or commenced on renal replacement therapy (RRT) irrespective of stage Urine output 24hrs or anuria for 12hrs

Answer 13

The reference serum creatinine should be the lowest creatinine value recorded within 3 months of the event If a reference serum creatinine value is not available within 3 months and AKI is suspected repeat serum creatinine within 24 hours

Answer 14

``` 1 2 3A 3B 4 5 ```

Answer 15

Normal kidney function, but urine findings or structural abnormalities or genetic trait point to kidney disease

Answer 16

Mildly reduced kidney function and other finding (as for stage 1)

Answer 17

Moderately reduced kidney function

Answer 18

Stage 3A - GFR=45 - 59 | Stage 3B - GFR=30 - 44

Answer 19

Severely reduced kidney function

Answer 20

Very severe, or endstage kidney failure (sometimes called established renal failure)

Answer 21

``` Stage 1 - 90+ Stage 2 - 60-89 Stage 3A - 45-59 Stage 3B - 30-44 Stage 4 - 15-29 Stage 5 - ```

Answer 22

Retention of: ``` Urea & creatinine Water: Oliguria/Anuria Pulmonary oedema H+: Metabolic Acidosis Electrolytes: K+ - hyperkalaemia Na+ ```

Answer 23

Ultrasound: To exclude obstruction May show intrinsic renal disease Renal Biopsy: Identify cause of renal disease

Answer 24

Characterised by oliguria (

Answer 25

May proceed to Chronic Renal Failure

Answer 26

``` Skin: - Pruritis - Purpura CNS and PNS: - Lethargy - Peripheral Neuropathy CVS: - Hypertension - Pericarditis - Anaemia GIT: - Nausea and vomiting - Anorexia GUS: - Impotence - Nocturia Musculoskeletal: - Myopathy - Stunted growth - Bone pain ```

Answer 27

Similar to ARF - Increased serum urea /creatinine - Increased serum K+ - Metabolic acidosis - Hyperphosphataemia But also loss of endocrine function - Hypocalcaemia & Osteodystrophy (secondary or tertiary hyperparathyroidism) - Normochromic normocytic anaemia

Answer 28

In chronic renal failure lack of erythropoetin (stimulates haemogloblin synthesis) causes anaemia.

Answer 29

``` Loss of 1 alpha hydroxylase leads to Decreased 1,25 (OH)2 Vitamin D leads to Hypocalcaemia: due to decreased gut Ca2+ absorption leads to Increased parathyroid hormone (PTH) leads to Bone disease (renal osteodystrophy) ```

Answer 30

Oliguric Phase: Predominantly impaired glomerular function Diuretic phase: Improved glomerular function but impaired tubular function Recovery phase

Answer 31

``` Water and salt: Low salt diet avoid dehydrate or volume overload Dietary protein restriction Hyperphosphataemia: Oral phosphate binders Hypocalcaemia: 1 (OH) Vitamin D Treat hypertension vigorously Anaemia: Erythropoetin Dialysis - Haemodialysis - Peritoneal dialysis Renal transplantation ```

Answer 32

Patients with chronic renal failure may develop acute renal failure Anaemia and hypocalcaemia in subjects with acute renal failure is indicative of underlying Chronic Renal failure i.e Acute on chronic renal failure