Renal System Part 1: Schoenwald Flashcards
1
Q
what are the functional units of the kidney?
A
Nephrons
2
Q
Approx. __ million nephrons per kidney
A
1 million
3
Q
Nephron is composed of:
A
- Glomerulus
- Proximal tubule
- Loop of Henle
- Distal tubule
- Collecting Duct
4
Q
Kidneys: What is the name of the artery that brings blood to the nephron? ( aka blood enters from the renal artery into the _____ _______)
A
- Afferent arteriole
5
Q
Kidneys: What is the name of the artery that brings blood out of the nephron?
A
- Efferent arteriole. (āEā for exit)
6
Q
Kidneys: Substances up to what size can pass through renal capillaries?
A
40K daltons
7
Q
Kidneys: (T/F) Larger substances (i.e. protein, RBCs) usually do not pass.
A
- True
8
Q
Main Fx of the nephron?
A
filtration
9
Q
Kidneys: (T/F) If there is pathology at the nephron level, there could be vasodilation and permeability.
A
True
10
Q
Nephron: Function of the PCT (Proximal convoluted Tubule)?
A
Reabsorbs large quantities ofā¦
- H2O
- Glucose
- Uric acid
- Na+
- Cl-
- HCO3
(hint: GUN (glucose, uric acid, and Na) + HCB (h20, cl, bicarb)
11
Q
Nephron: Function of the Loop pf Henle?
A
reabsorbs Na,Cl and H20
12
Q
Nephron: what is the fx of the distal tubule?
A
controls excretion of Na, K, HC03 and H into collecting duct
13
Q
Nephron: Function of the collecting duct?
A
- Regulates amount of water in the urine due to effect of Antidiuretic hormone (ADH)
14
Q
Nephron: Substance enter through _______ ______or from interstitial space
A
peritubular blood(secretion)
15
Q
Nephron: Substances reabsorbed from the tubule back to circulation via the ______ vasculature
A
peritubular
16
Q
Renal function tests: list 3
A
- BUN
- Creatinine
- Urinalysis
(BUC)
17
Q
BUN stands for..
A
Blood urea Nitrogen
18
Q
BUN: normal range
A
8-20 mg/dl
19
Q
BUN measures the concentration of ______
A
nitrogen(urea) in serum
20
Q
BUN is a marker of _____ metabolism
A
protein
21
Q
When is BUN elevated?
A
Elevations in renal failure but other causes as well (CHF, acidosis)
22
Q
Creatinine is a catabolic product of ______
A
creatine
23
Q
Daily production of Creatinine depends on _____
A
muscle mass
24
Q
Creatine is excreted entirely by:
A
kidneys **itās directly related to renal function
25
Normal Creatinine Range
Normal 0.5-1.1 mg /dl
26
Elevations of Creatinine suggest..
chronicity of renal disease
27
Doubling of creatinine= \_\_\_% decrease in renal function
50%
28
PEARLS: -the importance of muscle mass?
-\*\*Muscle mass matters -Decreased muscle mass= lower creatinine
29
Which 2 groups usually have lower creatinine levels assuming no renal disease?
-paraplegics -(or someone with atrophied muscles) -females
30
When is Glomerular filtration rate considered?
-for proper dosing and treatment decisions
31
How is GFR most accurately assessed?
\*insulin filtration rate
32
GFR: clinically, ______ clearance is generally the test ordered
Creatinine clearance
33
Normal Creatinine clearance range in Females
Female=90-107 ml/mn
34
Normal Creatinine clearance range in Males
Male=107-140 ml/min
35
Normal Creatinine Clearance range
90-140 ml/min
36
Creatinine clearance is an approximation of \_\_\_\_
GFR
37
Creatinine: -is a metabolic product of _____ -Day to day variation?
-muscle creatine --Day to day variation negligible in healthy kidneys
38
A rise in creatinine is due to (which 2 things?)
-kidney dysfunction or -damage= decrease in GFR
39
Creatinine Clearance: -what is it used for?
-assessing kidney function in acute or chronic renal failure -Monitoring effects of drug therapy -Monitoring therapeutic drugs and determining dosage
40
Creatinine clearance requires:
24 hour urine
41
Serum creatinine must be drawn within __ hours of urine collection
24 hours
42
Creatinine clearance equation
(Ucr mg/dl x Urine volume ml/min)/(PCr mg/dl)
43
Estimated Glomerular filtration rate (EGFR) is a calculation that is based on \_\_\_\_\_
-\*serum creatinine -Advantage of this equation: ---No need for 24 hour urine collection --Quick
44
Cockcroft-Gault equation: -Estimates?
creatinine clearance without doing 24 hour urine studies
45
Cockcroft-Gault equation: -useful for?
renal dosing of medications
46
Cockcroft-Gault equation
-CrCl (ml/min)= (140-age) x wt/(cr x72) --\*Multiply X 0.85 if women to correct for mm mass
47
which demographic has a higher rate of renal disease?
-african americans -native americans
48
MDRD equation= -what does it incorporate?
MDRD=Modification of Diet in Renal Disease --Incorporates age, sex, and ethnicity into equation
49
MDRD: list the equation (what are the 2 modifications you have to make?
GFR mls/min = 1.86 x PCr x age -Multiply x.742 if female -Multiply x 1.210 if African American
50
Describe the Stages of Kidney Disease
(the lower the GFR, the higher the stage (the
51
Urinalysis: consists of _______ and microscopic analysis
dipstick
52
Urinalysis (UA): -Color and _____ are part of the report
clarity
53
Urinalysis (UA): Strips measure (list 8 things measured)
specific gravity, pH, glucose, protein, ketones, blood, bilirubin, nitrite and leukocyte esterase
54
Normal pH of urine:
4.5-8.0
55
UA: must be ______ voided to be reliable
freshly
56
Acidic urine ______ bacterial growth
deters
57
Alkalinic urine is seen with which 2 conditions:
-UTI -Renal tubular defects
58
Specific gravity: -Normal range for Urine?
1.010-1.025
59
Specific gravity (of urine): -is a measure of?
concentration of particles
60
Specific gravity (urine):
- High specific gravity= ?
- Low specific gravity= ?
High=concentrated--\> dehydration
Low=dilute--\>renal failure, hydration
61
Specific gravity: -correlates well with _____ -what is the main contributor to Specific gravity (SG) ?
-Correlates well with osmolality - Na main contributor to SG
62
Keytones: -Normal range=
negative
63
Keytones: -measures _______ acid
acetoacetic
64
Keytones may be positive in which Pt demographic?
\*\*uncontrolled diabetics
65
Keytones monitor high ______ diet
protein
66
Any situation with Positive keytones is indicative of:
\*Ketoacidosis
67
Keytone test will be positive in: (list 2 situations)
excessive vomiting and dehydration (also positive in high protein diet (keto diet)
68
Is glucose in urine?
-Normally negative --If present in urine, reflects amount of hyperglycemia in plasma
69
Renal threshold for glucose:
generally \>300 mg/dl
70
UA: Normal range for protein?
negative
71
UA: Protein is a sensitive indicator for ___ function.
renal (kidney fx)
72
UA: If the glomerular membrane is injured, do protein levels in urine increase or decrease?
increase
73
Proteinuria + edema =
nephrotic syndrome
74
UA: Other than multiple myeloma, what other conditions are associated with proteinuria?
- Pyelonephritis - Diabetic nephropathy - Glomerulonephritis - CHF - SLE (lupus)
75
Multiple Myeloma: -UA is + for which protein?
Proteinuria (Bence-Jones protein)
76
UA: Normal range of bilirubin?
negative
77
UA: Normal range of Urobolinogen?
negative
78
UA: When would bilirubin and urobolinogen be present and/or elevated in urine?
- Liver damage - Obstruction of bile duct
79
UA: Normal range of blood?
- Negative to trace
80
UA: Why may blood be picked up in a dipstick but not on microscopy?
May not match microscopic because the dipstick will pick up \*\*lysed cells
81
UA: what can cause false positive occult blood test in UA?
Myoglobin causes false positive (ie crush injury)
82
UA: what can cause false negative occult blood test in UA?
High doses of Vitamin C can cause false negative (KNOW that vitamin c can cause a false negative for blood test in UA)
83
Painless hematuria with history of smoking= ____ (what is your top dx?)
THINK bladder carcinoma
84
Hematuria can be caused by:
infection, stones etc.
85
If RBC's are present on UA, likely _____ will be positive
protein
86
If a Pt exercises frequently, the protein result on a UA can be
negative to trace
87
Leukocyte esterase is an enzyme that is positive in ______ infections
\*urinary tract infections --90% accurate in detecting WBCs in urine
88
What other enzyme is positive in UTI?
\*\*nitrite is + in UTIs (BUT a Pt can still have a UTI and test - for nitrite on UA)
89
Nitrite: -produced by?
-Many bacteria produce reductase; converts nitrate to nitrite --Gram negative organisms produce reductase
90
Nitrite on UA: -\_\_\_\_\_ of urine can interfere with the test
color of urine (ie an extremely dark urine)
91
Microscopic UA: -what should normally NOT be seen?
WBC, RBC, epithelial cells and casts-normal= none seen
92
Microscopic UA: Cells -WBC +=
WBC= infection (sterile pyuria think TB)
93
Microscopic UA: Cells -RBC?
RBC=infection, renal calculi
94
Microscopic UA: Cells Eosins?
eosins= interstitial nephritis
95
Microscopic UA: Cells -Casts form?
Casts form in the distal and collecting tubules--max concentration
96
Casts: What are hyaline casts associated with?
- Normal after exercise - Can be present with chronic renal failure.
97
Casts: What are RBC casts associated with?
- Glomerulonephritis - SBE
98
Casts: What are WBC casts associated with?
pyelonephritis
99
Casts: What are epithelial casts associated with?
tubular necrosis
100
Casts: What are granular casts associated with?
- Nephrotic syndrome - Lead toxicity - Glomerulonephritis
(G for glomerulonephritis and G for granular casts, (GNL)
101
Casts: What are waxy casts associated with?
-renal failure -acute tubular necrosis
102
Crystals: When would you see crystals?
- Can be found in normal urine - Could be a marker for stones
