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(PA school) Clinical Lab Medicine > Wk 1: Renal function > Flashcards

Wk 1: Renal function Flashcards

1
Q

List the normal lab values (adult/ not fasting) for the following:
1) Glucose
2) Sodium
3) Potassium

A

1) 74 – 106mg/dL*
2) 136 – 145 mEq/L
3) 3.5 - 5.0 mEq/L*

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2
Q

List the normal lab values (adult/ not fasting) for the following:
1) Chloride
2) BUN
3) Creatinine (female and male)

A

1) 98 – 106 mEq/L
2) 10 - 20mg/dL
3) 0.5 – 1.1mg/dL (female) / 0.6 – 1.2mg/dL (male)

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3
Q

List the normal lab values (adult/ not fasting) for the following:
1) WBCs
2) Hemoglobin (f/m)
3) Hematocrit (f/m)
4) Platelets

A

1) 5 – 10 x 109/L*
2) 12 – 16g/dL (female) / 14 – 18g/dL (male)*
3) 37% - 47% (female) / 42% - 52% (male)
4) 150 – 400 x 109/L

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4
Q

Clinical Laboratories Improvement Act of 1967 (CLIA):
1) What labs had a high error rate in the late 60s?
2) What is the significance of this act?
3) What labs did it cover? Was this a lot?

A

1) Labs that read PAP smears (overworked, understaffed)
2) First US law to regulate clinical laboratory medicine
3) Only covered labs doing business across state lines (very few at the time)

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5
Q

1) What did Clinical Laboratory Improvement Amendments of 1988 say? What did this require?
2) How many labs did this include?
3) What was the goal of this?

A

1) All labs required to have a certificate from the Department of Health and Human Services (HHS)
-Req. to have quality control protocols and pass proficiency tests
2) Virtually every lab
3) To establish quality standards for clinical lab testing/pt’s test results accurate & reliable

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6
Q

1) What stratified requirements according to complexity of the tests?
2) What is the purpose of CLIA lab-testing on humans?

A

1) Clinical Laboratory Improvement Amendments of 1988
2) Information for dz, prevention, tx, impairment or health assessment

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7
Q

In 2023:
1) There were how many hospital work related injuries & illnesses?
2) How many out of every 100 hospital FT employees is this?

A

1) 2.6million
2) 2.4/100

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8
Q

What are some costs of hospital-work related injuries?

A

Time off, lawsuits, etc

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9
Q

1) What federal department is related to OSHA?
2) Why was the Occupational Safety and Health Administration formed in 1970?

A

1) Department of Labor
2) To ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, education and assistance.

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10
Q

1) Give an example of why hospital work can be risky
2) Potentially hazardous materials include what?
3) What other entities does OSHA cover?

A

1) Exposed to potentially hazardous materials
2) Chemical, biological, radioactive
3) Landscapers, nail salons, hospitals, shipyards…

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11
Q

1) What published guidance to make labs safe for personnel and workspaces for staff?
2) What is the hierarchy of controls? (OSHA)

A

1) OSHA Laboratory Safety Guidance
2) Ways of dealing with hazards

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12
Q

Hierarchy of controls:
1) What controls involve making changes to the work environment (like fume hoods)?
2) Modifying worker tasks (SOPs for handling chemicals) would are what kind of controls?
3) What is an example of work practices?

A

1) Engineering controls
2) Administrative controls
3) Defining safe and proper tasks (no mouth pipetting)

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13
Q

Hierarchy of controls:
1) What is PPE/ why is it used?
2) What two things involving hygiene are a pt of the hierarchy of controls?
3) What are two controls that are particularly applicable to phlebotomy?

A

1) PPE: providing protective gear to keep workers safe
2) Hygiene plans, policies
3) Bloodborne pathogen policy and needlestick injury

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14
Q

1) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulates what?
2) What did it establish for the first time?
3) The Department of Health and Human Services (HHS) published the Privacy Rule on ________________ and adopted modifications of the Rule on ________________

A

1) How personally identifiable information must be handled by healthcare entities
2) A set of national standards for the protection of certain health information.
3) December 28, 2000; August 14, 2002.

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15
Q

What are the two main sets of standards set by HIPAA (1996)?

A

1) For individuals’ privacy rights to understand and control how their health information is used
2) For the electronic exchange, privacy and security of health information

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16
Q

Give two examples of CLM specific issues related to HIPAA

A

1) Patients have a right to receive a copy of a report (and underlying information) from the lab. The lab does not need to interpret the results and may refer the patient to the provider but can provide educational/explanatory materials.
2) Patient has right to access all their PHI maintained by the lab including orders, provider information, billing information, insurance information

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17
Q

1) When does a test report become part of the record?
2) Do incomplete reports need to be accessible to pts according to HIPAA?

A

1) Only when it is “complete”.
2) No (but the rest of the information would still need to be provided).

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18
Q

BeginningApril 5, 2021,the program rule onInteroperability, Information Blocking, and ONC Health IT Certification, which implements the21st Century Cures Act, requires that healthcare providers give patients what?

A

Access without charge to all the health information in their electronic medical records “without delay.

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19
Q

1) What does HIPAA say regarding labs that take more than 30 days to return to the pt?
2) When can providers disclose reports without a pt’s authorization?
3) What does this include? What is the caveat?

A

1) If a test takes longer than 30 days to interpret given the nature of the study, one extension of 30 days is allowed but lab must provide pt with the reason for the delay (in writing) and expected date for providing access
2) If it is for treatment purposes
3) Includes consulting with other providers
-Must apply “reasonable safeguards” which depends on how the information is being communicated
(Fax: confirming fax number, using a cover sheet
Orally: lowering voice in the proximity of others)

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20
Q

1) What replaced the term “normal range”?
2) What is compared to this range and when?
3) Define therapeutic range

A

1) Reference range
2) Lab tests are compared to a reference range before a provider can interpret the data
3) Range of dosage of a therapeutic agent or its plasma/serum concentration where it is expected to achieve the desired effect

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21
Q

1) What is usually determined as the set of values into which 95% of the “healthy” population falls?
2) What determines therapeutic range and how many ways are there to check?

A

1) Reference range
2) Studies (systematic reviews); 2

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22
Q

Differentiate between accuracy and precision

A

1) Accuracy: The “trueness” of a test
-How well does it measure what it claims to measure
2) Precision: Reproducibility of a test
-How close with the result be if repeated on the same patient/sample

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23
Q

What are the two important factors regarding the accuracy of a test? Define each

A

1) Sensitivity: Ability of a test to correctly detect the disease/condition
2) Specificity: Ability of a test to identify people without the disease/condition

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24
Q

Imagine 100 patients, 25 of which have a specific disease.
How many would 100% sensitivity detect? What about 100% specific?

A

1) 100% sensitivity: detects all 25 patients
2) 100% specific: does not detect any of the other 75

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25
Q

1) Describe how many false positives and negatives a test w 100% sensitivity would have.
2) Describe how many false positives and negatives a test w 100% specificity would have.

A

1) Sensitivity: many false +, few false -
2) Specificity: few false +, many false -

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26
Q

1) What kind of test does not miss positive cases, but might be positive for other things?
2) What kind of test may give a negative result when the disease is present?

A

1) Sensitive tests
2) Specific tests

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27
Q

Differentiate between false positives and false negatives

A

1) False positive: Test is positive, condition is not present
2) False negative: Test is negative, condition is present

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28
Q

Differentiate between prevalence and incidence (definitely on quiz)

A

1) Prevalence: proportion of people who have a condition during a time period
-All cases present during that time (regardless of when it began)
2) Incidence: proportion of people who develop a condition during a time period
-Only new cases that occurred during that time

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29
Q

1) What does it mean if a test has a high sensitivity?
2) What does it mean if a test has low specificity?

A

1) Not many false negatives
2) Many false positives

30
Q

1) Define vacutainer
2) What does the color of the top indicate?
3) What can additives do?

A

1) Sterile tube with colored rubber stopper that creates a vacuum seal to facilitate drawing of blood
2) Additives in the tube
3) Stabilize or preserve the sample

31
Q

1) What are red vacutainers?
2) What do gold/ marble vacutainers contain? What are they useful for? (3 things)
3) What are the components of blood (proportionally)?

A

1) No additives (60min clot)
2) Serum separating gel
-Chemistry, serology, and endocrine
3) 55% plasma, 44% RBCs, 1% platelets,

(don’t need to memorize)

32
Q

1) What do light blue vacutainers contain? What are they used for?
2) What do green vacutainers contain? What are they used for?

(don’t need to memorize)

A

1) Sodium citrate (anticoagulant); coagulation studies (PT, PTT, TT)
2) Heparin (anticoagulant); in some chemistry tests

33
Q

1) What two things do gray vacutainers contain? Why?
2) What are they used for?

(don’t need to memorize)

A

1) Sodium fluoride inhibits glycolysis; potassium oxalate (anticoagulant)
2) Glucose, lactate

34
Q

1) What do yellow vacutainers contain?
2) What 3 tests are they used for?

(don’t need to memorize)

A

1) Acid citrate dextrose A (anticoagulant)
2) Tissue typing, DNA studies, HIV cultures

35
Q

What tubes use EDTA as an anticoagulant? List what tests each is used for

(don’t need to memorize)

A

1) Lavender/purple: whole blood studies like CBC, ESR
2) Pink: blood typing and cross-matching
3) Royal blue: heavy metal, drug toxicology
4) Tan: lead

36
Q

List the general principles of lab tests

A

1) No test is perfect
2) Even high-quality labs can be wrong, be willing to recheck surprising results
3) Reference ranges can vary from one lab to the next
4) Degree of abnormality is useful
5) Avoid excessive repetition of tests
6) Avoid shotgun ordering
7) Will this test alter the management or provide relevant information

37
Q

1) What do the kidneys constantly maintain? How?
2) The kidneys secrete hormones that regulate what 3 things?

A

1) Fluid environment of the cells by adjusting excretion of water, electrolytes, and waste products.
2) Hemodynamics, RBCs, and bone metabolism.

38
Q

Kidney disease has a variety of different clinical presentations; list the two main types and give examples

A

1) Renal: hematuria, flank pain
2) Extrarenal: edema, hypertension

39
Q

Once kidney disease is discovered, what needs to be established?
2) What is the most useful initial study?
3) True or false: GFR doesn’t explain the cause of kidney disease

A

1) The degree of disease
2) Estimated glomerular filtration rate (GFR) and examination of the urinary sediment
3) True

40
Q

1) Define GFR
2) Normal GFR is the sum of what?

A

1) Rate at which fluid is filtered through the kidneys
-Volume of fluid filtered through glomerular capillaries into the Bowman’s capsule over time
2) All filtration rates in all the functioning nephrons; varies considerably even among normal individuals

41
Q

1) Declining GFR indicates what?
2) Is this exactly correlated with nephron loss?
3) Why is this important?

A

1) Declining GFR indicates kidney dysfunction
2) No, bc kidneys attempt to compensate by adjusting filtration through remaining/normal nephrons
3) Stable GFR doesn’t imply stable disease & normal GFR doesn’t mean there isn’t underlying renal disease

42
Q

1) True or false: Losing 50% of kidney mass means losing 50% of normal GFR

2) True or false: Stable GFR doesn’t imply stable disease
Normal GFR doesn’t mean there isn’t underlying renal disease

A

1) False; losing 50% of kidney mass doesn’t mean 50% normal GFR
2) True

43
Q

slide 34
1) GFR must be indirectly measured; what is it important for?
2) Is this practice realistic in most settings?
3) GFR is indirectly estimated from what?

A

1) Toxic medications with narrow therapeutic ranges (chemo) and before kidney transplant
2) Time consuming and impractical in most clinical settings
3) Filtration markers

44
Q

1) What are 3 characteristics of a good filtration marker?
2) What if these 3 criteria are met?
3) True or false: Filtration markers can be expensive, difficult to obtain, and their administration can be complex

A

1) Freely filtered at the glomerulus, neither secreted nor reabsorbed by the tubules, and not changed during the process
2) The filtered amount is equal to the excretion rate
3) True

45
Q

1) In most settings, we estimate GFR through doing one of what two things?
2) What exists in steady state in body (if diet and muscle mass are stable)?

A

1) Measuring creatinine clearance or applying various equations to the serum creatinine value
2) Creatinine

46
Q

1) Where does creatinine come from? (3 places)
2) What are 3 characteristics of creatinine?
3) Name a disadvantage of using it for GFR

A

1) Creatine metabolism in skeletal muscles, ingested meat, & kidney/liver produce it.
2) Freely filtered, not absorbed, not metabolized
3) Need to account for muscle mass (& overestimates GFR)

47
Q

1) 10-40% of urinary creatinine is from what?
2) Does creatinine overestimates or underestimate GFR? By how much?
3) Higher muscle mass means does what to SCr (serum creatinine)?

A

1) Tubular secretion
2) 10-20% (acceptable)
3) Higher SCr given the same rate of clearance

48
Q

Give and explain the formula for GFR

A

GFR = UV / P
U = creatinine concentration of urine that was collected over 24 hours
V= volume of urine (expressed as mL/min)
P= serum creatinine concentration

49
Q

1) What type of person with CKD (chronic kidney disease) may have the same SCr as a young healthy male? Why?
2) Urine collections over smaller windows give ___more/less___ accurate results [regarding creatinine clearance (CC, CrCl)]

A

1) Older female; muscle mass
2) less

50
Q

There are various equations derived from demographic data that can be useful for measuring CrCl (and therefore, eGFR) without the need for urine collection; when are they not an accurate GFR measure?

A

Where GFR is changing rapidly (AKI)

51
Q

Recap:
1) CrCl estimates GFR using ___________ as a filtration marker
2) Decreased CrCl suggests ____increased/decreased____ filtration which suggests _______ dysfunction.
3) Increased CrCl can occur with what?

A

1) creatinine
2) decreased; kidney
3) High cardiac output (HTN, CHF, even exercise)

52
Q

1) Define Blood Urea Nitrogen (BUN)
2) Where is urea formed? From what?
3) Is urea superior or inferior to creatinine as a filtration marker?

A

1) Measures the amount of urea nitrogen in the blood
2) Urea is formed in the liver as the end product of protein metabolism
3) Inferior to creatinine

53
Q

1) What excretes urea?
2) When does urea increase? What disease can affect it?
3) 40-50% of it is reabsorbed where?

A

1) Kidneys
2) Increases with ingested protein; liver disease
3) Proximal tubule

54
Q

1) BUN/Cr Ratio is useful in calculating what?
2) What do both have in common? Which has variable reabsorption? Which is minimally reabsorbed?

A

1) Renal function
2) Both freely filtered by glomerulus; BUN (in tubules); creatinine

55
Q

1) What may cause an increased BUN/Cr ratio? (2 things)
2) What may cause a decreased ratio? (1)

A

1) BUN reabsorption is disproportionately elevated relative to Cr
OR
Renal hypoperfusion, dehydration, heart failure
2) Reduced reabsorption of BUN

56
Q

1) Define Chronic Kidney Disease
2) What is it characterized by?
3) WNL GFR is what?

A

1) Group of disorders characterized by changes in kidney structure and function
2) Presence of kidney dysfunction/damage for 3 months
3) 90-120

57
Q

Acute Kidney Injury (AKI) types are divided according to cause; list & define the 3 categories

A

1) Prerenal: issue with blood flowing to kidney
2) Intrarenal (renal, intrinsic): disease process in the kidney
3) Postrenal: urinary tract obstruction

58
Q

1) List potential causes of prerenal issues with blood flow to kidney (prerenal)
2) List potential causes of disease processes in the kidney (intrarenal (renal, intrinsic))
3) List potential causes of urinary tract obstruction (postrenal)

A

1) CHF, renal artery stenosis, dehydration, cirrhosis, etc.
2) Glomerulonephritis, acute tubular necrosis, acute interstitial nephritis, etc.
3) Kidney stones, BPH (benign prostatic hyperplasia), cancer, obstructed catheter, etc.

59
Q

1) What can you use to help differentiate between causes of acute kidney injury?
2) What does this tool use?

A

1) A table of predicted lab values to help guide clinical approach into these numerous causes
2) Uses BUN/Cr, urine concentration of sodium, urine osmolality, and fractional excretion of sodium (calculation that measures Na excreted vs Na reabsorbed)

60
Q

Takeaways:
1) _______ is used to estimate GFR and therefore evaluate kidney disease
2) Direct measurement is difficult; indirect measurement still involves _______________.
3) Equations estimate GFR using what?

A

1) CrCl
2) 24hr urine.
3) sCr

61
Q

Takeaways:
1) CrCl is not useful in acute settings so _________ is used instead. Use reference table
2) True or false: Declining GFR means declining renal function. Improving GFR means improving kidney function
3) Where does creatinine come from?

A

1) BUN/Cr
2) True
3) Ingested meat and skeletal muscle metabolism etc

62
Q

Takeaways:
1) If factors affecting CrCl are _____________ , CrCl is less useful in estimating GFR
2) Higher skeletal muscle means __________ CrCl without kidney dysfunction
3) True or false: Other filtrate markers can be used if Cr is disrupted by diet or disease.

A

1) unstable
2) higher
3) True

63
Q

True or false: Creatinine =/= creatine

A

True

64
Q

Which accurately detects the presence of a disease (i.e. positives are really positive), a sensitive test or a specific test?

A

Sensitive (rules things in)

65
Q

Which rules conditions out, sensitive tests or specific tests?

A

Specific

66
Q

A test saying someone is pregnant when they’re not is an example of what type of error?

A

Type I (false positive)

67
Q

Give an example of a type 2 error

A

A pregnancy test giving a false negative (i.e. test is negative but pt is pregnant)

68
Q

Currently, the _____________ of measles is low, but we’re keeping an eye for any increasing ________________

A

prevalence; incidence

69
Q

The straight leg raise (SLR) test has __high/low__ sensitivity and __high/low__ specificity. What does this imply?

A

high; low
A positive test doesn’t strongly suggest you have HNP, but you can trust that negatives are true negatives

70
Q

List each stage of chronic kidney disease and its accompanying GFR. Describe each and what your treatment should be.

A

1) Stage 1: >/_90, kidney damage w. normal or ^ GFR.
2) Stage 2: 60-89, kidney damage w. mildly decreased GFR
-1&2: Dx underlying etiology if possible, treat comorbid conditions, estimate progression and try to slow it.
3a) 45-59, mild-moderate decreased GFR
3b) 30-44, moderate-severe decreased GFR
-3s: same as above
4) 15-29
-Prep for end-stage renal disease
5) <15 (or dialysis)
-Dialysis, transplant, or palliative care

(PA school) Clinical Lab Medicine (2 decks)

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