Urinary

Question 1

Kidney basics

Answer 1

Question 2

Nephron basic

Answer 2

Question 3

Renal clearance

Answer 3

How much of a given substance is removed from the blood per unit time

Markers (inject these substances): inulin, PAH, creatinine

Question 4

Creatinine and renal function test

Answer 4

Creatinine is filtered in Bowman’s capsule, and weakly reabsorbed, so it’s a good way to see filtration ability

Question 5

GFR

Answer 5

Best estimate of renal function

Creatinine is the best endogenous marker

Question 6

Normal renal values

BUN
Creatinine
Eletrolytes: Na, K, Cl
Estimated GFR
Creatinine clearance
Urine volume

Answer 6

BUN: 2.5-8 mmol/L
Creatinine: 53-106 umol/L
K: 3.5-5
Na: 125-145
Cl: 95-105
Estimated GFR: 100-150
Creatinine clearance: 1.78-2.32
Urine volume: 800-2L / 24 hour

Question 7

BUN vs creatinine

Answer 7

BUN is waste product when liver breaks down protein

Creatinine is a waste product by breakdown of muscle

Question 8

Nephrotic vs nephritic

Answer 8

Glomerular disorder includes nephrotic and nephritic

Nephrotic is increased protein in urine
Nephritic is increased RBC in urine

Nephritic: blood in urine, decrease urine, hypertension. (Nephritic disease ‘s exmaple is Goodpastures’ disease); nephritic syndrome is often a autoimmune response triggered by infection
——goal to treat nephritic syndrome: reduce salt, fluid, K; control infection and inflammation, control BP

Nephrotic syndrome: edema (loss albumin), stimulate liver to synthesize LDL, hypercoagulation, loss IgG (prone to infection)

Question 9

Renal failure’s progression

Answer 9

10——30——-50——90——

<10: end stage
10-30: severe: lost 90% nephron
30-50: >75% loss; BUN and Creatinine slightly elevated
50-90: mild: clinical proteinuria
>90: stage1: kidney damage with normal GFR: Microalbuminuria

Question 10

Cause of acute renal failure

Answer 10

Acute renal failure is reversible, but chronic renal failure is not.

1. Prerenal: no blood, no pump, blood doesn’t reach kidney
2. Glomeruli and tubules cannot function: glomerulonephritis, nephritis, tubular necrosis
3. Urine cannot get out: obstruction of uropathy (BPH, blood clot, bladder dysfunction–can;t squeeze out, urine doesn’t go from kidney to bladder)

Question 11

BUN: Cr

Answer 11

Normal: 10:1

> 20: Pre-renal

Low : DKA or rhabdomyolysis

Question 12

ARF vs CRF

Answer 12

1. History: had it in the past, drug change, urine output change
2. Lab: renal US: normal or enlarged kidney: ARF; small increased echo gene city: CKD; low Ca/ high phosphate common in CKD
3. Lab: dysmorphic RBC: ARF; >=2+ proteinuria: CKD

Question 13

Uremia

Answer 13

Toxin built up in blood because kidney can’t filter it out

Question 14

Urea

Answer 14

Endproducts of protein breakdown

Question 15

Renal colic S&S

Stone types

Answer 15

1. Severe pain starts fast and go away suddenly (pain is caused by stone moving and stretch ureter & renal pelvis)
2. Blood in urine
3. Chill/ fever
4. Nausea/ V

Stone types:
1. Ca: most common
2. Uric acid
3. Struvite磷酸铵美
4. Cystine 胱氨酸

Question 16

Renal colic treatment

Answer 16

1. Hydration
2. Remove stone: US, laser, surgery, mechanical removal

Question 17

Hypertonic, hypotonic, isotonic

Answer 17

Hypertonic: more concentrate (more solute than water): make cell shrink: D5+ Nacl/LR

Hypotonic: less concentrate: make cell swollen: < 0.9% NS, 2.5% D5W

Isotonic: don’t change cell: NS 0.9, LR, D5W