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Clin Med Exam 4 > Renal System Part 1: Schoenwald > Flashcards

Renal System Part 1: Schoenwald Flashcards

1
Q

what are the functional units of the kidney?

A

Nephrons

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2
Q

Approx. __ million nephrons per kidney

A

1 million

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3
Q

Nephron is composed of:

A
  • Glomerulus
  • Proximal tubule
  • Loop of Henle
  • Distal tubule
  • Collecting Duct
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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
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5
Q

Kidneys: What is the name of the artery that brings blood out of the nephron?

A
  • Efferent arteriole. (‘E’ for exit)
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6
Q

Kidneys: Substances up to what size can pass through renal capillaries?

A

40K daltons

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7
Q

Kidneys: (T/F) Larger substances (i.e. protein, RBCs) usually do not pass.

A
  • True
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8
Q

Main Fx of the nephron?

A

filtration

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9
Q

Kidneys: (T/F) If there is pathology at the nephron level, there could be vasodilation and permeability.

A

True

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10
Q

Nephron: Function of the PCT (Proximal convoluted Tubule)?

A

Reabsorbs large quantities of…

  • H2O
  • Glucose
  • Uric acid
  • Na+
  • Cl-
  • HCO3
    (hint: GUN (glucose, uric acid, and Na) + HCB (h20, cl, bicarb)
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11
Q

Nephron: Function of the Loop pf Henle?

A

reabsorbs Na,Cl and H20

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12
Q

Nephron: what is the fx of the distal tubule?

A

controls excretion of Na, K, HC03 and H into collecting duct

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13
Q

Nephron: Function of the collecting duct?

A
  • Regulates amount of water in the urine due to effect of Antidiuretic hormone (ADH)
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14
Q

Nephron: Substance enter through _______ ______or from interstitial space

A

peritubular blood(secretion)

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15
Q

Nephron: Substances reabsorbed from the tubule back to circulation via the ______ vasculature

A

peritubular

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16
Q

Renal function tests: list 3

A
  • BUN
  • Creatinine
  • Urinalysis

(BUC)

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17
Q

BUN stands for..

A

Blood urea Nitrogen

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18
Q

BUN: normal range

A

8-20 mg/dl

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19
Q

BUN measures the concentration of ______

A

nitrogen(urea) in serum

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20
Q

BUN is a marker of _____ metabolism

A

protein

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21
Q

When is BUN elevated?

A

Elevations in renal failure but other causes as well (CHF, acidosis)

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22
Q

Creatinine is a catabolic product of ______

A

creatine

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23
Q

Daily production of Creatinine depends on _____

A

muscle mass

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24
Q

Creatine is excreted entirely by:

A

kidneys **it’s directly related to renal function

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25
Q

Normal Creatinine Range

A

Normal 0.5-1.1 mg /dl

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26
Q

Elevations of Creatinine suggest..

A

chronicity of renal disease

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27
Q

Doubling of creatinine= ___% decrease in renal function

A

50%

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28
Q

PEARLS: -the importance of muscle mass?

A

-**Muscle mass matters -Decreased muscle mass= lower creatinine

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29
Q

Which 2 groups usually have lower creatinine levels assuming no renal disease?

A

-paraplegics -(or someone with atrophied muscles) -females

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30
Q

When is Glomerular filtration rate considered?

A

-for proper dosing and treatment decisions

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31
Q

How is GFR most accurately assessed?

A

*insulin filtration rate

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32
Q

GFR: clinically, ______ clearance is generally the test ordered

A

Creatinine clearance

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33
Q

Normal Creatinine clearance range in Females

A

Female=90-107 ml/mn

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34
Q

Normal Creatinine clearance range in Males

A

Male=107-140 ml/min

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35
Q

Normal Creatinine Clearance range

A

90-140 ml/min

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36
Q

Creatinine clearance is an approximation of ____

A

GFR

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37
Q

Creatinine: -is a metabolic product of _____ -Day to day variation?

A

-muscle creatine –Day to day variation negligible in healthy kidneys

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38
Q

A rise in creatinine is due to (which 2 things?)

A

-kidney dysfunction or -damage= decrease in GFR

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39
Q

Creatinine Clearance: -what is it used for?

A

-assessing kidney function in acute or chronic renal failure -Monitoring effects of drug therapy -Monitoring therapeutic drugs and determining dosage

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40
Q

Creatinine clearance requires:

A

24 hour urine

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41
Q

Serum creatinine must be drawn within __ hours of urine collection

42
Q

Creatinine clearance equation

A

(Ucr mg/dl x Urine volume ml/min)/(PCr mg/dl)

43
Q

Estimated Glomerular filtration rate (EGFR) is a calculation that is based on _____

A

-*serum creatinine -Advantage of this equation: —No need for 24 hour urine collection –Quick

44
Q

Cockcroft-Gault equation: -Estimates?

A

creatinine clearance without doing 24 hour urine studies

45
Q

Cockcroft-Gault equation: -useful for?

A

renal dosing of medications

46
Q

Cockcroft-Gault equation

A

-CrCl (ml/min)= (140-age) x wt/(cr x72) –*Multiply X 0.85 if women to correct for mm mass

47
Q

which demographic has a higher rate of renal disease?

A

-african americans -native americans

48
Q

MDRD equation= -what does it incorporate?

A

MDRD=Modification of Diet in Renal Disease –Incorporates age, sex, and ethnicity into equation

49
Q

MDRD: list the equation (what are the 2 modifications you have to make?

A

GFR mls/min = 1.86 x PCr x age -Multiply x.742 if female -Multiply x 1.210 if African American

50
Q

Describe the Stages of Kidney Disease

A

(the lower the GFR, the higher the stage (the

51
Q

Urinalysis: consists of _______ and microscopic analysis

52
Q

Urinalysis (UA): -Color and _____ are part of the report

53
Q

Urinalysis (UA): Strips measure (list 8 things measured)

A

specific gravity, pH, glucose, protein, ketones, blood, bilirubin, nitrite and leukocyte esterase

54
Q

Normal pH of urine:

55
Q

UA: must be ______ voided to be reliable

56
Q

Acidic urine ______ bacterial growth

57
Q

Alkalinic urine is seen with which 2 conditions:

A

-UTI -Renal tubular defects

58
Q

Specific gravity: -Normal range for Urine?

A

1.010-1.025

59
Q

Specific gravity (of urine): -is a measure of?

A

concentration of particles

60
Q

Specific gravity (urine):

  • High specific gravity= ?
  • Low specific gravity= ?
A

High=concentrated–> dehydration

Low=dilute–>renal failure, hydration

61
Q

Specific gravity: -correlates well with _____ -what is the main contributor to Specific gravity (SG) ?

A

-Correlates well with osmolality - Na main contributor to SG

62
Q

Keytones: -Normal range=

63
Q

Keytones: -measures _______ acid

A

acetoacetic

64
Q

Keytones may be positive in which Pt demographic?

A

**uncontrolled diabetics

65
Q

Keytones monitor high ______ diet

66
Q

Any situation with Positive keytones is indicative of:

A

*Ketoacidosis

67
Q

Keytone test will be positive in: (list 2 situations)

A

excessive vomiting and dehydration (also positive in high protein diet (keto diet)

68
Q

Is glucose in urine?

A

-Normally negative –If present in urine, reflects amount of hyperglycemia in plasma

69
Q

Renal threshold for glucose:

A

generally >300 mg/dl

70
Q

UA: Normal range for protein?

71
Q

UA: Protein is a sensitive indicator for ___ function.

A

renal (kidney fx)

72
Q

UA: If the glomerular membrane is injured, do protein levels in urine increase or decrease?

73
Q

Proteinuria + edema =

A

nephrotic syndrome

74
Q

UA: Other than multiple myeloma, what other conditions are associated with proteinuria?

A
  • Pyelonephritis - Diabetic nephropathy - Glomerulonephritis - CHF - SLE (lupus)
75
Q

Multiple Myeloma: -UA is + for which protein?

A

Proteinuria (Bence-Jones protein)

76
Q

UA: Normal range of bilirubin?

77
Q

UA: Normal range of Urobolinogen?

78
Q

UA: When would bilirubin and urobolinogen be present and/or elevated in urine?

A
  • Liver damage - Obstruction of bile duct
79
Q

UA: Normal range of blood?

A
  • Negative to trace
80
Q

UA: Why may blood be picked up in a dipstick but not on microscopy?

A

May not match microscopic because the dipstick will pick up **lysed cells

81
Q

UA: what can cause false positive occult blood test in UA?

A

Myoglobin causes false positive (ie crush injury)

82
Q

UA: what can cause false negative occult blood test in UA?

A

High doses of Vitamin C can cause false negative (KNOW that vitamin c can cause a false negative for blood test in UA)

83
Q

Painless hematuria with history of smoking= ____ (what is your top dx?)

A

THINK bladder carcinoma

84
Q

Hematuria can be caused by:

A

infection, stones etc.

85
Q

If RBC’s are present on UA, likely _____ will be positive

86
Q

If a Pt exercises frequently, the protein result on a UA can be

A

negative to trace

87
Q

Leukocyte esterase is an enzyme that is positive in ______ infections

A

*urinary tract infections –90% accurate in detecting WBCs in urine

88
Q

What other enzyme is positive in UTI?

A

**nitrite is + in UTIs (BUT a Pt can still have a UTI and test - for nitrite on UA)

89
Q

Nitrite: -produced by?

A

-Many bacteria produce reductase; converts nitrate to nitrite –Gram negative organisms produce reductase

90
Q

Nitrite on UA: -_____ of urine can interfere with the test

A

color of urine (ie an extremely dark urine)

91
Q

Microscopic UA: -what should normally NOT be seen?

A

WBC, RBC, epithelial cells and casts-normal= none seen

92
Q

Microscopic UA: Cells -WBC +=

A

WBC= infection (sterile pyuria think TB)

93
Q

Microscopic UA: Cells -RBC?

A

RBC=infection, renal calculi

94
Q

Microscopic UA: Cells Eosins?

A

eosins= interstitial nephritis

95
Q

Microscopic UA: Cells -Casts form?

A

Casts form in the distal and collecting tubules–max concentration

96
Q

Casts: What are hyaline casts associated with?

A
  • Normal after exercise - Can be present with chronic renal failure.
97
Q

Casts: What are RBC casts associated with?

A
  • Glomerulonephritis - SBE
98
Q

Casts: What are WBC casts associated with?

A

pyelonephritis

99
Q

Casts: What are epithelial casts associated with?

A

tubular necrosis

100
Q

Casts: What are granular casts associated with?

A
  • Nephrotic syndrome - Lead toxicity - Glomerulonephritis

(G for glomerulonephritis and G for granular casts, (GNL)

101
Q

Casts: What are waxy casts associated with?

A

-renal failure -acute tubular necrosis

102
Q

Crystals: When would you see crystals?

A
  • Can be found in normal urine - Could be a marker for stones

Clin Med Exam 4 (14 decks)

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