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104 theme 3 > role of clinical biochemistry in renal disease > Flashcards

role of clinical biochemistry in renal disease Flashcards

1
Q

what is a U&E

A

serum conc of cr, urea, na, k

e-GFR via cr conc

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2
Q

what is urine tested for

A

albumin-creatinine ratio
protein-creatinine ratio
range of supporting assays for AKI and CKD

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3
Q

how is GFR calculated

A

(UXV)/S

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4
Q

Why creatinine derived from creatinine in muscle

A 
derived from creatinine in muscle
serum conc relatively stable 
24h urine output stable day to day
no absorption and little secretion 
simple to measure
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5
Q

what affects creatinine

A

age
sex
lean body mass
effect of diet

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6
Q

how are the variations in GFR varied

A

GFR related to body surface area - standardise to a given body surface area
allows for comparison against general standard, staging of renal disease, monitoring change in renal filtration

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7
Q

how is glomerular function calculated

A

MDRD equation for e-GFR
allows for age, sex, ethnicity
age - dec GFR, largely offset by reducing muscle mass

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8
Q

relationship between GFR and plasma creatinine

A

plasma creatinine inc exponentially (ish) as GFR dec

ref range creatinine can mean that GFR can dec sig before seen as abnormal

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9
Q

what does high plasma glucose cause

A

osmotic diuresis leading to loss of water and sodium
failure of glucose metabolism - ketoacidosis (inc serum conc of K+ and PO43-)
enhanced by renal impairment

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10
Q

what does vomiting result in

A

fluid loss

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11
Q

what does loss and salt and water lead to

A

volume depletion leading to impaired renal function and dehydration

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12
Q

how is dehydration assessed

A

likely if serum urea-creatinine greater than 100
passive reabsorption of urea in nephron at low flow rates
serum protein may also be high

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13
Q

how is AKI detected

A

rise in serum cr of >26umol/L/48h
>50% serum cr in 7 days
fall in UO <0.5ml/kg/hr >6h adults/8h kids
>25% fall eGFR in <18 y/o’s

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14
Q

what is the AKI alert system

A

alert if AKI likely nd stages
1 >1.5x baseline or >26umol/L in 48h
2 >2x baseline
3 >3x baseline or >1.5 to >354umol/L

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15
Q

causes of AKI

A

poor perfusion - loss of isotonic fluids
sepsis - sev infection
toxins - drugs eg NSAIDs, ahminoglycosides, endogenous eg Hb, light chains
Obstruction - renal calculus, prostatic enlargement
parenchymal - glomerulonephritis

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16
Q

how is Goodpasture’s syndrome treated

A

plasma exchange to remove antibody

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17
Q

how is good pasture’s syndrome diagnosed

A 
elevated cr, CRP
AKI alert 
proteinuria
anaemia, raised WBC
no anti-streptolysin titre
raised anti-GBM antibody
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18
Q

what is not uncommon in boy builders

A

mild hypokalaemia

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19
Q

what is the origin of creatinine

A 
muscle mass - creatine - creatinine 
creatine + ATP + Creatine-P + ADP 
constant decay
creatinine 
CK - creatine kinase
20
Q

what does raised serum CRP indicate

A

septic condition

21
Q

causes of CKD

A

hypertension
diabetes (T2DM more)
hyperlipidaemia
renal infections
chronic glomerulonephritis (IgA nephritis)
system disease - lupus or myeloma
genetic - polycystic kidney, alport syndrome
chronic obstruction - prostate, calculi, reflux
medication - NSAID, Li

22
Q

what does ACR indicate

A

proteinuria common in RD

large proteins not long retained by glomerulus, same for albumin so escape into urine

23
Q

metabolic features of stage 2 CKD

A

elevated serum urea and creatinine conc

inc in PTH conc

24
Q

metabolic features of stage 3 CKD

A

calcium absorption decreased
lipoprotein lipase decreased
malnutrition
anaemia - less EPO

25
Q

metabolic features of stage 4 CKD

A

elevated serum TG and phosphate conc
metabolic acidosis
hyperaemia - elevated serum K

26
Q

metabolic features of stage 5 CKD

A

marked cr and urea conc, more marked other features aforementioned

27
Q

intervention for elevated urea

A

low protein diet

28
Q

intervention for hyperkalaemia

A

diet
diuretics
treat acidosis

29
Q

intervention for low bicarbonate

A

bicarbonate supplements

30
Q

intervention for low Hb

A

iron supplements with possible erythropoietin with target Hb 100-120 g/l

31
Q

intervention for low ferritin and transferrin sat

A

iron supplements with target sat >20% and ferritin 100-600

32
Q

low calcium intervention

A

reduced serum phosphate, vit D supplements (often 1-alpha OH vit D3)

33
Q

raised phosphate intervention

A

phosphate binding drugs

34
Q

raised PTH intervention

A

raised serum calcium, calcimimetic drugs to keep PTH 2-9 X upper limit of RI

35
Q

raised TG intervention

A

diet, weight reduction, fibre or statins

36
Q

what happens when interventions fail

A

dialysis

possible transplant

37
Q

role of lab in finding cause of AKI

A

plasma lactate - prognostic indicator
infection - serum procalcitonin, CRP, WBC, blood culture
AI

38
Q

role of lab in finding cause of CKD

A

serum and urine light chain - myeloma
glycated Hb - diabetic control
antibody tests - ANA, ANCA, anti-GBM
biopsy - histology

39
Q

what are pre and post dialysis samples for

A

effectiveness
requirement of frequency
determine need for other interventions - diet, supplements, phosphate binders, calcimimetic drugs, lipid lowering agents, iron supplements/EPO

40
Q

how are renal transplant patients

A 
serum cr - transplant function 
e-GFR 
ACR/PCR - potential damage to transplanted kidney 
anti-rejection drugs 
tubular dysfunction 
monitoring for CKD3
41
Q

when is real GFR recognised

A

determine dose of renal excreted drugs that are potentially toxic
monitoring dialysis and transplant patients
cock-croft and Gault

42
Q

what is the cock-croft Gault measurement of GFR

A

individual measurement and used for calculating drug dosage

43
Q

treatment to reduce the risk of nephrocalcinosis/renal stone formation

A

potassium citrate
sodium bicarbonate
thiazide diuretics
in RTA

44
Q

what is Fanconi syndrome

A

congenital and acquired condition
elevated conc of AAs, calcium and phosphate
RTA disorder

45
Q

what does the water deprivation test diagnose

A

post dehydration osmolality in serum and urine and post DDAVP osmolality
normal, nephrogenic DI, cranial DI, chronic polydipsia
For DI, RTA disorder

104 theme 3 (15 decks)

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