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ClinMedEx 4 > Renal System- Schoenwald > Flashcards

Renal System- Schoenwald Flashcards

1
Q

The main function of the nephron is to _______ blood and so larger substances like protein and rbc usually do not pass and it is BAD if they do

A

filtration

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2
Q

Proximal tubule ________ large quantities of H20 along with glucose, uric acid, Na, Cl and HCO3

A

reabsorbs

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3
Q

Loop of Henle further ________ Na,Cl and H20

A

reabsorbs

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4
Q

Distal tubule controls _______ of Na, K, HC03 and H into collecting duct

A

excretion

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5
Q

Collecting duct ______ amount of water in urine due to effect of Antidiuretic hormone (ADH)

A

regulates

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6
Q

Name the three renal function tests?

A
  • BUN
  • Cr
  • Urinalysis
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7
Q

This test measures the concentration of nitrogen (urea) in serum and is a marker of protein metabolism

A

BUN

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8
Q

This is a product of skeletal muscle contraction and daily production depends on muscle mass. It is entirely excreted by the kidneys/directly related to renal function

A

Creatinine

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9
Q

Elevations in Cr suggest what?

A

Chronicity of renal disease

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10
Q

If you double your Cr, what does this mean?

A

50% decrease in renal fxn

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11
Q

Which two groups have decreased lower Cr assuming no renal disease?

A

females, cachetic patients, spinal cord injury

*not kids

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12
Q

This is the test most accurately used to assess GFR, however, creatinine clearance is generally the test ordered

A

inulin filtration rate

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13
Q

What is the female, normal and male Cr clearance ranges?

A

Female- 90 to 107
Normal 90 to 140
Male 107 to 140

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14
Q

An increase in Cr = a ______ in GFR

A

An increase in Cr = a decrease in GFR

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15
Q

This is useful for assessing kidney function in acute or chronic renal failure, monitoring effects of drug therapy and monitoring therapeutic drugs and determining dosage

A

Creatinine clearance

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16
Q

To determine a CrCl, you need what test?

A

A 24 hr urine

-Serum Cr drawn within 24 hours of urine collection

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17
Q

What is the equation for CrCl?

A

(urine creat x urine volume)/plasma creat

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18
Q

This calculation is based on serum creat and is quick and doesnt need 24 hr urine collection?

A

Estimated GFR

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19
Q

This eqn is used to calculate renal dosing and is nice because you don’t have to use 24 hour urine studies?

A

Cockroft Gault eqn

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20
Q

What factors are needed for the Cockcroft-Gault equation?

A
  • Age
  • Weight
  • Serum Cr
  • M/F
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21
Q

What is the Cockcroft-Gault equation?

A

CrCl = (140-age) x weight/(Cr x 72)

**must multiply by 0.85 if FEMALE to correct for muscle mass

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22
Q

In the Cockcroft-Gault equation you must do something for a female, what is it and why do you have to do it?

A

Multiply X 0.85 if women to correct for mm mass

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23
Q

MDRD eqn stands for: Modification of Diet in Renal Disease and it takes into account these factors:

A
  • age
  • sex
  • ethnicity

*not used as much because only takes into account white & black and no other ethnicities

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24
Q

What is the MDRD eqn?

A

GFR mls/min = 1.86 x PCr x age

25
Q

In the MDRD eqn, you must multiply by ______ for a female and _________ if african american

A
  • Multiply x .742 if female

- Multiply x 1.210 if African American

26
Q

Can you explain why with a decrease in GFR there is an increase in Cr?

A

Lower the GFR = lower the filtration rate so all the Cr can’t be filtered into the urine and it is being built up in the blood serum instead

27
Q

If a urine dipstick is -, what should you do?

A

Microscopic analysis

28
Q

Acidic urine deters _______ _____

A

bacterial growth

*less likely there is a UTI

29
Q

What is a normal specific gravity?

A

1.010-1.025

30
Q

What does a high specific gravity mean?

A

concentrated urine- dehydrated

31
Q

What does a low specific gravity mean?

A

dilute, hydrated OR renal failure because kidneys are not working to filter out

32
Q

_______ is a main contributor to specific gravity

A

Na (sodium)

33
Q

Ketones measure a high _______ diet

A

protein

34
Q

This is positive in excessive vomiting and dehydration

A

ketones

35
Q

What is the threshold for glucose spillage into the urine?

A

> 300

36
Q

Protein in urine + edema= ?

A

Nephrotic syndrome

37
Q

If glomerular membrane is injured, protein is ________

A

elevated

38
Q

These two labs are elevated in liver damage?

A

Bilirubin and urobolinogen (obstruction of bile duct)

39
Q

What can cause a false positive blood urine microscopy?

A

myoglobin

40
Q

What can cause a false negative blood urine microscopy?

A

Vitamin C

41
Q

Painless hematuria + smoking should make you think of what?

A

Bladder cancer

42
Q

If RBCs are + on UA, likely _______ will also be positive

A

protein

43
Q

What test detects WBCs in urine?

A

Leukocyte esterase

44
Q

Leukocyte esterase is pos or neg in UTIs?

A

positive

45
Q

T/F: Leukocyte esterase and nitrate is a color based test so dark urine can give false +

A

true

46
Q

Gram - organisms produce ________ which converts nitrate to nitrite

A

reductase

47
Q

This test is also + in UTIs

A

nitrite

48
Q

If you see WBC on microscopic UA, think…

A

sterile pyuria think TB

49
Q

If you see RBC on microscopic UA, think…

A

infection, renal calculi

50
Q

If you see eosins on microscopic UA, think…

A

interstitial nephritis

51
Q

Casts form in what part of the nephron?

A

distal and collecting tubules- max concentration

52
Q

Hyaline casts think…

A

normal after exercise, can be present with chronic renal failure

53
Q

Red cell casts think…

A

glomerulonephritis, SBE

54
Q

White cell casts think…

A

pyelonephritis

55
Q

epithelial “muddy brown” casts think…

A

tubular necrosis

56
Q

granular casts think…

A

nephrotic syndrome, lead toxicity, glomerulonephritis

57
Q

waxy casts think…

A

renal failure-acute tubular necrosis

58
Q

Crystals can be found in normal urine but can also be marker for _____

A

stones

59
Q

calcium oxylate crystals

A

kidney stones

ClinMedEx 4 (16 decks)

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