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Clinical biochem. > Renal function > Flashcards

Renal function Flashcards

1
Q

relationship b/ blood vol. & blood pressure ( give scientific names)

A

Hypovolemia => hypotension (lo BP)

Hypervolemia => hypertension (Hi BP)

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2
Q

Meaning of Polyuria, Oliguria, Anuria

A

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

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3
Q

GFR reference range for normal peroson

A

80-140 mL/min

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4
Q

normal reference range for creatine

A

80-120 umol/L

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5
Q

Difference b/wCockcroft-Gault equation & MDRD equation

A

C-G equ: “Body weight-Age-sex”

MDRD equ: “Ethnicity-age-sex”

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6
Q

kidney filtrates _L/day of plasma and reabsorb more than _% of the amount filtered

A

180L/day

99%

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7
Q

Function of kidney (3)

A
  • regulate fluid & electrolytes
  • excrete metabloic wastes
  • endocrine function (make Vit. D)
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8
Q

T/F: Each nephron produces ~100 µL of urine per day.

A

T

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9
Q

In the kidney, the tubular secretion of ——– from the blood into the tubular fluid helps the blood to keep its pH in the normal level?

A

H+ and NH4+

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10
Q

Most of the blood acids are coming from

A

CO2 bc its volatile & can easily dissociate w/ water

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11
Q

renal threshold

A

The plasma concentration above which the substance appears in the urine

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12
Q

What is desmopressin

A

ADH analougue (ADH drug)

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13
Q

What is the reference range for GFR?

A

80 – 140 mL/min

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14
Q

Plasma creatinine [inc. OR dec.] as GFR decrease

A

increas

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15
Q

T/F: plasma creatinine is influenced by muscle mass, age and ethnicity.

A

T

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16
Q

What are the front line tests in assessing GFR?

A

Plasma/serum urea and creatinine

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17
Q

What was a major con for measuring the actual GFR (aka creatinine clearance test)? so what’s the alternative test?

A

24hr urine collection

eGFR (estimated GFR)

18
Q

Equation for GFR when doing the creatinine clearance test

A

[plasma creatinine] x 24 x 60 min

19
Q

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

A

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

  1. 815 (OR 0.85 fem.) x serum creatinine (mmol)
20
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
21
Q

what happens in kidney damage? (GFR, urine vol. [waste products])

A
  • Lo GFR
  • Lo urine vol
  • High [waste product]
22
Q

name & describe the 3 ways acute renal failure can occur

A
  1. prerenal: interupted blood flow to kidneys = dec. blood vol.
  2. Intrarenal: damage in the kidneys (e.g inflammation) => tubular necrosis
  3. Postrenal: obstruction of urine flow (e.g. prostate gland)
23
Q

What is the BUN test?

A

BUN = blood urea nitrogen

- measures amount of N in blood (usually from urea) => helps indicate renal function

24
Q

Define uremia & cause

A

inc. urine in blood

bc low blood flow = inc. urea in blood = urine in blood

25
Q

define hematuria

A

inc. blood in urine

26
Q

the BUN:Cr ratio expected in prerenal, renal & postrenal uremia

A 
Pre= BUN:Cr >20
Renal= BUN:Cr <15
Post= BUN:Cr >15
27
Q

What’s the difference b/w pre-renal disorders (aka a systemic problem) & renal disorders (aka kidney problem) referring to BUN:Cr ratio

A
  • Pre= BUN:Cr > 20 folds

- Renal: [urea] = [N] & both at Hi [ ] means they are not excreted in urine

28
Q

What does the fractional excretion of sodium (FENa) determine?

A

Look at tubular function & determines if drop in urine production is bc:

  • Pre-renal damage: Hypovolemia => FENa <1% (& hi urine osmolarity)
  • Renal damage: FENa > 1%
29
Q

What occurs in pre-renal uremia? (condition in plasma, urine osmolarity, FANa, BUN:Cr ratio)

A
  • inc. urea, inc. creatine, hyperkalemia, metabolic acidosis
  • inc. urine osmolarity (less fluid excreted = concentrated)
  • FENa <1%
  • BUN:Cr > 20
30
Q

What occurs in renal uremia / intrinsic renal damage? (condition in GFR, plasma, urine osmolarity & vol, FANa)

A
  • glomerulinephritis
  • GFR decreases
  • inc. urea, inc. creatine, hyperkalemia, metabolic acidosis
  • Urine = plasma osmolarity.
  • polyuric urine
  • FENa >1%
31
Q

What occurs in post-renal uremia? (condition in plasma, urine osmolarity, FANa, BUN:Cr ratio)

A
  • gall stones, enlarged prostate

- BUN:Cr >15

32
Q

what is renal canaliculi & the main types & how each detected

A

kidney stones / Nephrolithiasis

  • calcium stones detected by X-ray
  • uric acid stones can’t be detected by X-ray
33
Q

Chronic renal failure aka (a) is when renal function progressively deteriorates resulting in (b). And treatment is by _ or _

A

a. ESRD (End stage renal disease)
b. Fatal uremia
c. Dialysis or transplant

34
Q

What test is used to assess tubular function and transplant patients?

A

Beta2-microglobulin

35
Q

Symptoms of chronic renal failure

A
  • symptoms of acute renal failure: inc BUN, creatinine, hyponatremia & kalemia, acidosis
  • repro disturbance: infertility, reduced sperm mobility
  • uremic frost (white/yellow crystals), brittle hair
  • patient smell like urine
36
Q

symptoms of nephrotic syndrome (3) & cause

A
  • Hi plasma cholesterol & TG
  • Hi Alb in urine (>3.5g/day) = low Alb in blood
  • swelling
    CAUSE: glomerularnephritis
37
Q

Renal tubular acidosis (RTA) is a syndrome due to either a defect in proximal tubule (a) reabsorption, or a defect in distal tubule (b) secretion, or both. Resulting in (c) blood and (d) urine.

A

a. bicarbonate ion
b. Hydrogen ion
c. acidic
d. alkaline (pH>7)

38
Q

what are the 3 reasons you would see protemia (protein in urine)

A
  • glomerulus dysfunction => Hi MW proteins (e.g. Alb) filtered
  • dysfunction in tubular reabsorption of Low MW proteins
  • filtration rate > reabsorption capacity (Bence-Jones)
39
Q

What is rhabdomyolysis & what can it lead to?

A

breakdown of muscle => release myoglobin

@ large [myoglobin] can damage the kidney bc it breaks down to a toxic compound => kidney failure

40
Q

How can you tell if someone is dehydrated vs having renal failure by comparing their urea & creatinine values with reference intervals?

A
  • dehydration: values not far from RI

- renal failure: values are far from RI

Clinical biochem. (12 decks)

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