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Clinical Biochemistry > Renal Function And Kidney Disease > Flashcards

Renal Function And Kidney Disease Flashcards

1
Q

What is the role of the ureter

A

Transport urine towards bladder

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2
Q

What is the role of the bladder

A

Temporarily store urine

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3
Q

What is the role of the urethra

A

Conducts urine to exterior

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4
Q

What is the function of urinary system (3)

A
  • excretion & elimination
  • homeostatic regulation
  • endocrine function
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5
Q

What is excretion and elimination

A
  • removal of organic waste products from body fluids
    Eg, urea, creatinine, uric acid
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6
Q

What is regulated by the urinary system

A

water - salt balance

Acid - base balance

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7
Q

What is the function of the endocrine

A

Release hormones into bloodstream

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8
Q

how much urine is excreted daily

A

1.5l

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9
Q

how much of cardiac output does the renal blood flow contribute to

A

20%

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10
Q

what is the plasma renal flow

A

the volume of blood plasma passing through the kidneys per minute

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11
Q

how much is the plasma renal flow

A

600mL/Min./1.73 M2

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12
Q

What 2 processes does the kidney reflect

A
  • ultrafiltration
  • reabsorption
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13
Q

what is the role of the kidney (3)

A
  • homeostasis
  • endocrine function
  • excretion of waste, drugs, urea
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14
Q

what is homeostasis

A

maintaining total body contents at a stable and normal level, even during changes in dietary intake or endogenous production rate

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15
Q

what is erythropoietin

A

a glycoprotein hormone, naturally produced by the peritubular cells of the kidney, that stimulates red blood cell production.

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16
Q

what hormone is produced from the endocrine system that is needed for the kidney function

A

erythropoietin

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17
Q

what enzyme is produced from the endocrine system that is needed for the kidney function

A

1-alpha hydroxylase to produce 1,25(OH)2D3

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18
Q

What is paracrine and autocrine function in the endocrine system

A

Paracrine - cell signalling on nearby cells
Autocrine -signalling acts on the signalling cell

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19
Q

Which elements does the paracrine and autocrine function produce

A
  • bradykinin
  • prostaglandin
  • endothelial factors
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20
Q

What does bradykinin do

A

Elevate vascular permeability and to cause vasodilation in some arteries and veins

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21
Q

What does vasodilation mean

A

When blood vessels widen to allow more blood to flow through

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22
Q

What does the prostaglandin do

A

Generate inflammatory response

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23
Q

What are the endothelial factors (vasodilators factors)

A
  • nitric oxide
  • endothelin
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24
Q

How is the kidney involved in the catabolism (breakdown) of insulin

A

When the nephron mass decreases, leads to a decreased insulin catabolism and results in longer circulating half life

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25
Q

How can the kidney produce glucose

A

Via gluconeogenesis during fasting

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26
Q

What will changes in kidney function result in

A

Change in plasma concentration

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27
Q

How is the kidney involved in blood pressure regulation

A
  • control renin, angiotensin, aldosterone system
  • homeostasis in sodium and water
  • production of vasodilators substances
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28
Q

Why do sodium and water levels need to be maintained

A

Maintain normal extracellular fluid volume

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29
Q

What is renal threshold

A

Concentration in blood beyond which it is excreted in urine

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30
Q

What is the renal threshold of glucose

A

180mg/dL

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31
Q

What is tubular maximum

A

Maximum capacity of kidneys to absorb a particular substance

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32
Q

What is the tubular maximum for glucose

A

350mg/min

33
Q

What is neutral balance

A

Dietary intake plus endogenous production equals excretion rate of kidney

34
Q

What is a positive balance

A

Intake plus endogenous production > renal excretion

35
Q

What does a positive balance lead to

A

Increased total body content

36
Q

What is a negative balance

A

Intake plus endogenous production < renal excretion

37
Q

What does a negative balance lead to

A

Leading to decreased total body content

38
Q

What are the key parts of the kidney

A

Renal cortex
Renal medulla
Renal pelvis
Renal pyramids
Ureter

39
Q

What are nephrons

A

They are the functional units of the kidney
They do filtration and reabsorption

40
Q

Where is the nephron located

A

Between the cortex and medulla

41
Q

What 2 parts does the nephron contain

A

Glomerulus and renal tubule

42
Q

What is the main function of the glomerulus

A

Bundle of blood vessels responsible to filtrate the blood

43
Q

What is the renal tubule

A

Responsible for absorption or excretion of substances

44
Q

What does the renal tubule consist of

A

Bowman’s capsule, proximal tubule, loop of Henley, distal tubule and collecting duct

45
Q

What are the 2 types of nephrons

A

Cortical nephrons and juxtamedullary nephron

46
Q

What percentage of nephrons is cortical

A

85%

47
Q

What is the role of the juxtamedullary nephrons

A

Long loops that go deep into the medulla, important in production of concentrated urine

48
Q

How many times a day does the kidney filter body’s entire plasma volume

A

60x

49
Q

How much oxygen does the kidney consume

A

20-25%

50
Q

What are the three phase processes involved in the formation of urine

A
  • glomerulus filtration
  • selective and passive reabsorption
  • secretion
51
Q

Where does the glomerular filtration take place

A

Through the semipermeable walls of the glomerular capillaries

52
Q

What is the driving hydrostatic pressure provided by

A

Arterial pressure

53
Q

What happens during reabsorption

A

• In the proximal and distal tubule, the primary urine becomes highly concentrated as the result of the removal of water
• At the same time, many other low molecular weight constituents are reabsorbed by active transport – glucose, AA and organic and inorganic ions

54
Q

What happens during secretion

A

Released into urine in the kidney by active transport

55
Q

What is the role of erythropoietin

A

Controls the differentiation of the bone marrow stem cells. Ensures bone marrow cells are converted to erythrocytes, so concentration in blood increases

56
Q

What is the role of renin

A

an enzyme which converts the plasma protein
angiotensinogen to angiotensin I

57
Q

What is Angiotensin converting enzyme (ACE)

A

formed in the lungs converts angiotensin I to angiotensin II which causes vasoconstriction and an increase in blood pressure

58
Q

What is the role of Angiotensin II

A

stimulates the aldosterone production (water
and sodium retention which together increase blood volume)

59
Q

What is calcitriol

A

steroid-related hormone involved in calcium and phosphorus homeostasis

60
Q

How is renal disease investigated

A

Personal history and physical examination
Blood laboratory findings
Urinalysis
Assessment of renal function
Imaging
Renal Biopsy

61
Q

What are plasma labatory findings

A

• urea, creatinine, Na, K
• Ca, phosphate, parathormone
• pH, HCO3-
• CRP, FW, leucocytosis
• FBC: anaemia
• D dimers
• haptoglobin, myoglobin
• immunology: autoantibodies – ANCA, antiGBM, ANA, antidsDNA, complement

62
Q

When assessing kidney function what should the urine be

A

Sterile
• Clear
• Amber colour
• Characteristic odour
• Slightly acidic pH (0.5 and 0.6)
• A specific concentration range
• Specific gravity (1.010 and 1.030)

63
Q

What amount of urine produced is considered Anuria (dehydration)

A

<100ml/24hours

64
Q

What amount of urine produced is considered oliguria

A

<400L/24 hours

65
Q

What amount of urine produced is considered healthy

A

500ml/24 hours

66
Q

What amount of urine produced is considered polyuria (diuretics, heart failure)

A

<3L/24 hours

67
Q

What can red urine suggest

A
  • blood
  • beetroot ingestion
  • haemoglobin
  • myoglobin
68
Q

What can orange urine suggest

A

Rifampicin

69
Q

What can brown urine suggest

A

Blood, hyperbilirubinemia, nitrofurantoin

70
Q

What can a urinary test strip (dipstick) show

A
  • specific gravity, pH, blood, albumin, nitrates, glucose, ketones
71
Q

What can you check with urinary microscopy

A

Bacteriuria, casts, crystals, phase-contrast

72
Q

What are the normal values of erythrocytes and leukocytes

A

> 10 erythrocytes/ul
20 leucocytes/ul

73
Q

What can glucose indicate in the dipstick testing

A

Diabetes mellitus

74
Q

What can urobilinogen (reduced form of bilirubin) indicate in the dipstick testing

A

Liver function

75
Q

What can haemoglobin indicate in the dipstick testing

A

Multiple intravascular haemolysis

76
Q

What can pH indicate in the dipstick testing

A

Renal tubular acidosis

77
Q

What is proteinuria

A

Renal disease

78
Q

What is the normal range of protein in urine

A

> 150 mg of protein /day in adults and > 140 mg/day in children

79
Q

What is the protein range in someone with proteinuria

A

300mg/day

Clinical Biochemistry (5 decks)

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