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clinical chemistry > Renal function > Flashcards

Renal function Flashcards

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1
Q

What are the three major components of kidney excretion?

A
  • urea
  • creatinine
  • uric acid
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2
Q

What do the kidneys help regulate and how?

A
  • Electrolytes and water – water under control by osmolality and ADH : lytes under control of Aldosterone and Renin
  • Acid – Base balance – Excretion of hydrogen ions, excretion/secretion of HCO3
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3
Q

What hormones do the kidneys help produce/regulate?

A
  • renin
  • erythropoietin
  • 1,25 Dihydroxy vitamin D3
  • Prostaglandins
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4
Q

What does renin respond to?

A

– responds to changes in fluid volume, blood volume, BP, hyponatremia

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5
Q

What does EPO respond to?

A
  • responds to changes in blood O2
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6
Q

What is 1,25 dihydroxy vitamin d3?

A

– Active form of Vit D. Controls Phosphate and calcium balance and bone calcification

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7
Q

What are prostaglandins?

A

cyclic fatty acids that increase renal blood flow, Control renin release, oppose renal vasoconstriction

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8
Q

What molecules are allowed through the glomerulus?

A
  • molecules smaller than Albumin allowed to pass through – larger or neg charged molecules cannot pass through
  • Lytes, Glu, H2O, Amino acids, low MW proteins, dissolved solutes
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9
Q

What substances are regularly reabsorbed in the kidney tubules?

A
  • 75% of H2O, Cl and NA
  • 100% of glucose up to renal threshold
  • Others – amino acids, vitamins, some uric acid, urea, –Ca, Mg, K and HCO3
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10
Q

What substances are passively transferred in the kidney tubules?

A

h2o and CL

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11
Q

What substances are regularly secreted by the kidney tubules?

A

hydrogen ions and drugs

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12
Q

What is the renal threshold for glucose?

A

160-180 mg/dl

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13
Q

Where does water reabsorption happen?

A

descending limb

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14
Q

where does NaCl reabsorption occur?

A

ascending limb

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15
Q

what are common kidney function tests?

A
  • Creatinine
  • BUN
  • GFR
  • uric acid
  • ammonia
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16
Q

What is 75% of all non protein nitrogen?

A

urea

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17
Q

When will plasma BUN be increased?

A
  • renal disease – is sensitive to changes in renal function but is not specific to the kidney
  • Is influenced by diet
18
Q

how do you calculate urea?

A

Bun x 2.14

19
Q

what is biological variation?

A
  • Random fluctuation around homeostatic set point

- Mean values of various individuals will not be the same and can vary over time

20
Q

What is the creatinine clearance equation?

A

(u) (v)/p

21
Q

What do you need for correction of the creatinine clearance?

A

height and weight

22
Q

What are the normal creatinine clearance rates for males and females?

A

Males – 97-137 ml/min

Females – 88-128 ml/min

23
Q

what is the estimated gfr based on?

A

Serum Crea

Age, Gender, Race, Body Size

24
Q

what is protein/microalbumin used for?

A
  • should not get through the glomerulus
  • Used to monitor diabetics, cardiac disease
  • Early sign of kidney damage. Measuring can document progression of disease
25
Q

What can cystatin-c be used for?

A

-Small protein that is normally cleared by kidney

I-n renal disease it is not cleared

26
Q

what can B2 microglobulin be used for?

A
  • Increase B2 seen in conditions of increased cell turnover, inflammation, renal failure
  • B2 Microglobulin used to assess renal tubular function in renal transplant patients – Increased could indicate organ rejection
27
Q

what can myoglobin tests be used for?

A
  • Low molecular wt protein associated with skeletal and cardiac muscle injury
  • Large increase can overload proximal tubules and lead to acute renal failure ( rhabdomyelosis)
28
Q

what can urine electrophoresis be used for?

A
  • Evidence of proteins
  • Can distinguish acute glomerular neuropathy and tubular proteinuria
  • Can differentiate proteinuria due to abnormal monoclonal or polyclonal gammopathy
29
Q

what is acute glomerulonephritis associated with?

A

Often related to group A – beta-hemolytic strep, auto-immune disease or drug mediated

30
Q

what are signs and symptoms of acute glomerulonephritis?

A

urinalysis-protein and RBC
GFR-decreased
BUN and creatinine- increased
sodium and water retention- increased, can leasd to edema

31
Q

what are the signs and symptoms of nephrotic syndrome?

A
  • hypertension
  • proteinuria
  • oliguria
  • hematuria and rbc casts
  • hyperlipidemia
32
Q

what would a SPE look like for nephrotic syndrome?

A

Albumin – decreased
Alpha 2 – increased
Beta – increased
Gamma – may see a decrease

33
Q

What are the key findings of renal tubular disease?

A
  • Decrease reabsorption/secretion of substances
  • Decrease GFR, loss of Na balance
  • WBC casts on UA
34
Q

what is the most important manifestation of renal tubular disease?

A

cannot regulate ph

35
Q

what type of urine cast is considered bad?

A

waxy cast

36
Q

what can be seen in a urinalysis of an individual that has a uti?

A

Leukocyte esterase, Nitrites, WBC, Bacteria

37
Q

what effects can a uti have?

A

Lose the ability to concentrate urine, decrease renal blood flow

38
Q

what are possible causes of acute renal failure?

A
  • traumatic
  • acute intoxication
  • part of multiorgan failure
  • various disease
39
Q

what are possible causes of chronic kidney failure?

A
  • secondary to high blood pressure/diabetes
  • chronic bacterial infection of the kidneys
  • cystic kidneys
  • various autoimmune disease
40
Q

what changes will you see in renal hypertension?

A

Change in blood volume will stimulate RAAS

  • increases serum NA+
  • increase in urine K+ and H+
  • decrease in serum K+

clinical chemistry (5 decks)

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