Renal Function Test 4 Flashcards
What are the 3 main functions of the kidneys?
1-Excrection
2-Regulation
3-Hormone production
3 principle components of excretion?
1-Urea
2-Creatinine
3-Uric Acid
What is water regulated by?
osmolality and ADH
Electrolytes are regulated by what?
Aldosterone and Renin
What does renin respond to?
changes in fluid volume, blood volume, BP, hyponatremia
Erythropoetin (EPO) responds to?
changes in blood volume
What is 1,25 Dihydroxy vitamin D3 and what does it control?
active form of vitamin D and it controls Phosphate and Calcium balance and bone calcification
Cyclic fatty acids that increase renal blood flow, Control renin release and oppose renal vasoconstriction?
Prostaglandins
Incoming blood is filtered through?
Glomerulus
Basic Renal Process (3 steps)
1-Filtration-incoming blood filtered through glomerulus
2-Tubular reabsorption- returns valuable substance back to body out of glomerular filtrate
3-Tubular Secretion- substances not needed transferred back to filtrate for excretion in urine
Testing of Renal Function (5)
1-BUN 2-Craetinine 3-Uric Acid 4-Ammonia 5-Creat clear and GFR
BUN
– Urea is 75% of all NPN – metabolic waste of protein metabolism
Urea is filtered and excreted, only a small amount is reabsorbed
Plasma BUN will be ______ in renal disease and is _____ to changes in renal function but is not _______ to the kidney
Is influenced by diet
increased
sensitive
specific
Creatine is converted to ________ in _______, and is produced at a _______ rate.
Creatine converted to creatinine in muscle. Produced at constant rate
Plasma BUN will be increased or decreased in renal disease?
increased
TRUE/FALSE
Creatinine is not as senstive to changes in renal function – up to 50% loss in function before elevations seen
Is more specific
True
A waste product of purine metabolism?
Uric acid
* at low pH, excess is deposited as Crystals (GOUT)
A waste product of metabolism?
Ammonia
* will be increased in kidney disease
Creatinine clearance will decrease by ____ for each ______ of life?
6.5ml/min
10 years
Creatinine clearance
Formula?
Corrected formula?
(U)*(V)/P
(U)*(V)/P X 1.73/SA
Estimated GFR
Formula?
EST GFR= (140-age)*Mass (kg)
—————————
72 * Serum Creatine
*multiply by 0.85 if female (correction factor for gender)
Protein/Microalbumin
1-used to monitor?
2-early sign of?
3-get through glomerulus?
1-diabetics and cardiac disease
2-kidney damage (early marker)
3-no
Cystatin-C
1-Cleared by the kidney?
2-affected by age, gender, or mass?
3-best marker for renal disease?
1-small protein normal cleared by the kidney but in renal disease it is not
2-not affected
3-yes, better marker than creatine for renal disease
* can be elevated before decrease in GFR or increase in creatinine
B2 Microglobulin
1-Stable B2 seen in?
2-Increased B2 seen in?
3-used to assess?
4-Increased B2 usually indicates?
1-healty individuals
2-conditions of increased cell turnover, inflammation, renal failure
3-used to assess renal tubular function in renal transplant patients
4-increased- organ rejection
TRUE/FALSE
Myoglobin gives a false + for blood on a dipstick?
TRUE
A low molecular weight protein associated with skeletal and cardia muscle injury?
Myoglobin
*Rhabdomyelosis
Can distinguish acute glomerular neuropathy and tubular proteinuria?
Phoresis
Can differentiate proteinuria due to abnormal monoclonal or polyclonal?
Phoresis
Acute Glomerulonephritis
1-Urinalysis 2-GFR will be? 3-BUN and CREAT? 4-Na and H2O? 5-RBC morphology
1-protein and Hematuria 2-decreased 3-increased 4-increased (causes edema) 5-RBC casts
Often related to group A beta-hemolytic-Strep, auto-immune disease or drug mediated?
Acute Glomerulonephritis
What is Nephrotic syndrome?
several different disease/conditions that injury and increase permeability of glomerular basement membrane.
Key findings of Nephrotic syndrome?
Proteinuria, hematuria
hyperlipidemia
Nephrotic Syndrome SPE
1-Albumin?
2-Alpha 2?
3-Beta?
4-Gamma?
1-decreased
2-increased
3-increased
4-may see a decrease
Renal Tubular Disease
1-influenced by?
2-most important manifestation?
3-key findings (3)?
1-influenced by the changes in GFR 2-cannot regulate electrolytes and pH 3-Decrease reabsorption/secretion -Decrease GFR, loss of Na balance -WBC casts on UA
Acute Renal failure
Pre-renal
Renal
Post-renal
sharp, sudden loss of renal function
Chronic renal failure
Gradual loss of function over time
Treatment with dialysis
1-Traditional hemodialysis?
2-Peritoneal dialysis?
3-Hemofiltration?
1-removal of waste via synthetic membrane outside body
2-Peritoneal wall is used as membrane-can do it at home-takes longer
3-critically ill patients in ICU/CCU, membrane outside body
