wk 6 - Renal Function Flashcards
Creatinine is not a good test for GFR because it is highly affected by _____________.
Creatinine is not a good test for GFR because it is highly affected by hydration status.
accumulation of urea and ammonia in the blood system can cause a _______.
accumulation of urea and ammonia in the blood system can cause a coma.
Low GFR, means a _____ amount of urine volume and a______ amount of waste products.
Low GFR, means a low amount of urine volume and high amount of waste products.
The increase in blood volume in the body is termed ———-
a) Hyperglycemia
b) Hypervolemia
c) Hypovolemia
d) Hypoglycemia
b) Hypervolemia
The estimated glomerular filtration rate (eGFR) doesn’t take into account the __________
The estimated glomerular filtration rate (eGFR) doesn’t take into account the urine sample.
Glomerular Filtration rate (GFR) depends on the difference between two forces: ______ pressure in the glomerular capillaries and ________ pressure in the lumen of glomerular capsule.
Glomerular Filtration rate (GFR) depends on the difference between two forces: blood pressure in the glomerular capillaries and hydrostatic pressure in the lumen of glomerular capsule.
If there is a problem with the GFR, then we expect:
____ urine volume and accumulation of _____________.
If there is a problem with the GFR, then we expect:
low urine volume and accumulation of waste products.
The kidney filtrates ___ L/day of plasma and reabsorb more than _____ % of the amount filtered.
The kidney filtrates 180 L/day of plasma and reabsorb more than >99% of the amount filtered.
BUN test is a measure of the amount of __________ in the blood in the form of urea, and a measurement of renal function.
a) Ammonia
b) Albumin
c) Oxygen
d) Nitrogen
e) Urine
d) Nitrogen
In healthy person, the kidney tubules reabsorb completely or most of all of the following EXCEPT
a) Creatinine
b) Glucose
c) Sodium
d) Water
a) Creatinine
Plasma urea _________ when GFR is low
Plasma urea increases when GFR is low
name the metabolite that correlates to the diagram:
glucose
(unless diabetus)
A decrease in the intravascular volume is probably due to
a) Pre-renal
b) Renal
c) Post-renal
Pre-renal
In the nephron, many molecules are reabsorbed from kidney tubules into the capillary (blood) by what three methods?
- osmosis
- facilitated diffusion
- active transport
the 2 inward forces at the glomerulus are?
a) capsular hydrostatic pressure (18mm)
b) glomerular hydrostatic pressure (60mm)
c) plasma colloid osmotic pressure (32mm)
- plasma colloid osmotic pressure
- capsular hydrostatic pressure
(net outward pressure of 10mm)
Renal threshold does not exist for ______ as it is always transported passively through diffusion down a concentration gradient.
Renal threshold does not exist for water as it is always transported passively through diffusion down a concentration gradient.
[BUN] : [creatinine] ratio is the same and both are high in concentration, then it is a ——– (they don’t get excreted in urine).
a) Pre-renal problem
b) Renal disorder
b) Renal disorder
The _____________________ could be calculated using the Modified Diet in Renal Disease (MDRD) equation, which took into consideration the sex and ethnicity and not the body weight.
The estimated glomerular filtration rate (eGFR) could be calculated using the Modified Diet in Renal Disease (MDRD) equation, which took into consideration the sex and ethnicity and not the body weight.
Hematuria is when you have ______ in urine.
Hematuria is when you have blood in urine.
Which of the following could be an indication of pre-renal uremia:
a) BUN:Cr > 20
b) BUN:Cr < 15
c) BUN:Cr > 15
a) BUN:Cr > 20
______ blood flow to the kidney can cause uremia, which leads to _______ urine in blood.
low blood flow to the kidney can cause uremia, which leads to increased urine in blood.
state the type of renal failure:
- Direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply
intrarenal - tubular necrosis
The osmolarity of ______ is higher than that of _______.
The osmolarity of urine is higher than that of plasma.
In the kidney, the _________ is in charge of filtering the blood, whereas, the __________ are in charge of reabsorption and secretion.
In the kidney, the glomerulus is in charge of filtering the blood, whereas, the proximal tubules are in charge of reabsorption and secretion.
_________ use the industry-preferred freezing point method to determine the osmolality of an aqueous-based solution
Osmometers use the industry-preferred freezing point method to determine the osmolality of an aqueous-based solution
______ is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of ______ function.
BUN is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function.
The golden marker for GFR is ________, as it is completely filtered by the glomerulus and being ______ excreted in urine.
The golden marker for GFR is inulin, as it is completely filtered by the glomerulus and being 100% excreted in urine.
In a healthy person, do you expect to see glucose in blood?
a) Yes
b) No
a) Yes
The _______ produces the active form of Vit D.
The kidney produces the active form of Vit D.
urine volume <400ml over 24 hours is called _________
urine volume <400ml over 24 hours is called Oliguria
Plasma creatinine _________ due to low GFR.
Plasma creatinine increases due to low GFR.
The actual glomerular filtration rate (GFR) or creatinine clearance test main difficulty is the large errors in the collection of:
a) Volume of creatinine
b) Volume of urea
c) Volume of urine
d) Volume of plasma
c) Volume of urine
the protein responsible for a plasma colloid osmotic pressure in the glomerulus is?
albumin
- prevents water from leaving the blood
If filtration in the kidney is deficient, ________ blood levels rise. Therefore, ________ levels in blood and urine may be used to calculate the _________ clearance, which correlates with the glomerular filtration rate (GFR).
If the filtration in the kidney is deficient, creatinine blood levels rise. Therefore, creatinine levels in blood and urine may be used to calculate the creatinine clearance (CrCl), which correlates with the glomerular filtration rate (GFR).
The kidney helps the body to get rid of _________ (in the muscle), ________ (by-product of nucleotide metabolism) and _____ (end product of ammonia from Amino acids which is toxic) in urine.
The kidney helps the body to get rid of creatinine (in the muscle), uric acid (by-product of nucleotide metabolism) and urea (end product of ammonia from Amino Acids which is toxic) in urine.
Actual glomerular filtration rate (GFR) is also called _________________ and it is based on collection of urine in 24 hrs.
Actual glomerular filtration rate (GFR) is also called creatinine clearance test and it is based on collection of urine in 24 hrs.
Abnormally low urine volume < 100 mL / 24 hour is called:
a) Anuria
b) Oliguria
c) Polyuria
d) Urea
a) Anuria
Amount of reabsorbed urea from the tubular lumen after passage through the glomerulus _________ during dehydration.
Amount of reabsorbed urea from the tubular lumen after passage through the glomerulus increases during dehydration.
name the metabolite that correlates to the diagram:
creatinine
There are reabsorbed substances and non reabsorbed substances known as __________ such as inulin, which go directly to the urine.
There are reabsorbed substances and non reabsorbed substances known as tubular fluid such as inulin, which go directly to the urine.
What is the responsible hormone for concentrating urine and increasing osmolality / osmolarity?
a) Anti-diuretic hormone
b) Epinephrine
c) Glucagon
d) Insulin
a) Anti-diuretic hormone
Renal threshold is the plasma concentration above which the substance appears in the urine. Glucose can be seen in urine if its concentration is above ____ mmol/L:
11 mmol/L
Low blood flow to the kidney can cause uremia, which leads to increased _____ in the blood.
Low blood flow to the kidney can cause uremia, which leads to increased urine/urea in the blood.
Fractional excretion of _________ helps determine if the drop in urine production is due to reduced blood flow (hypovolemia) to the kidney (pre-renal) or to kidney damage itself (renal).
Fractional excretion of sodium helps determine if the drop in urine production is due to reduced blood flow (hypovolemia) to the kidney (pre-renal) or to kidney damage itself (renal).
The typical pH of the blood is 7.35-7.45, whereas that of urine is ______.
The typical pH of the blood is 7.35-7.45, whereas that of urine is 6.
tubular reabsorption within the proximal convoluted tubule allows for the reabsorption of what 4 main molecules?
- water (H2O) to pass from the glomerular filtrate back into the circulatory system.
- Glucose - 100% of it (except in diabetes) and various
- NaCl - The sodium chloride that is reabsorbed into the system increases the blood concentration. ↑Na+ →↑Osmolarity (Osmol/L)
- also various Amino Acids are also reabsorbed into the circulatory system.
In the nephron, substances are actively filtered from blood by the __________ and added to tubular fluid (active transport). Some substances such as K+ and HCO3- are reabsorbed and secreted in the ______, whereas creatinine, and some drugs are moved by active transport from the blood into the ___________ to urine.
In the nephron, substances are actively filtered from blood by the glomerulus and added to tubular fluid (active transport). Some substances such as K+ and HCO3- are reabsorbed and secreted in the proximal convoluted tubule (PCT) whereas creatinine, and some drugs are moved by active transport from the blood into the distal convoluted tubule (DCT) to urine.
People with severe malnutrition and extremes of body size and age must do an —–
a) Actual GFR test
b) eGFR test using Cockcroft-Gault equation
c) eGFR test using Modified Diet in Renal Disease equation
a) Actual GFR test
Abnormally low urine volume < 400 mL / 24 hour is called:
a) Anuria
b) Oliguria
c) Polyuria
d) Urea
b) Oliguria
What is the eGFR of a 40 years old male, 80 kg and having a serum creatinine value of 100 µmol/L?
a) 83.43 mL/min
b) 98.16 mL/min
c) 196.3 mL/min
d) 80 mL/min
b) 98.16 mL/min
Fractional excretion of sodium is the amount of sodium which is filtered by the glomerulus but escapes tubular ___________.
Fractional excretion of sodium is the amount of sodium which is filtered by the glomerulus but escapes tubular reabsorption.
What is the reference range for creatinine clearance?
a) 60 – 80 µmol/L
b) 60 – 120 µmol/L
c) 80 – 120 µmol/L
d) 80 – 140 µmol/L
c) 80 – 120 µmol/L
Plasma colloid osmotic pressure (______ pressure), is a form of osmotic pressure exerted by proteins, notably _______ that prevents water from leaving the blood.
Plasma colloid osmotic pressure (oncotic pressure), is a form of osmotic pressure exerted by proteins, notably albumin that prevents water from leaving the blood.
Liver is an organ of the ______ system while kidneys are the organs of the ______ system.
Liver is an organ of the digestive system while kidneys are the organs of the urinary system.
Plasma or serum creatinine is influenced by what 3 things?
- muscle mass
- age
- ethnicity
In a healthy person, do you expect to see creatinine in urine?
a) Yes
b) No
yes
_______ is a by-product of protein (amino acids) in the muscles (Cahill Cycle).
_________ is a breakdown product of creatine phosphate in muscle.
Urea is a by-product of protein (amino acids) in the muscles (Cahill Cycle).
Creatinine is a breakdown product of creatine phosphate in muscle.
what percentage of urea is reabsorbed by the kidney?
~50%
What is the reference range for GFR?
a) 60 – 80 mL/min
b) 80 – 120 mL/min
c) 80 – 140 mL/min
d) 60 – 120 mL/min
c) 80 – 140 mL/min
Plasma/serum urea and creatinine remain the front line tests in assessment of _____________.
Plasma/serum urea and creatinine remain the front line tests in assessment of glomerular filtration rate.
The glomerular capillary membrane could filter the following EXCEPT
a) Blood cells
b) Creatinine
c) Glucose
d) Urea
e) Water
a) Blood cells
In a healthy person, do you expect to see glucose in urine?
a) Yes
b) No
no - diabeetus
The _________________ could be calculated using the Cockcroft-Gault equation, which took into consideration the body weight, sex and age.
The estimated glomerular filtration rate (eGFR) could be calculated using the Cockcroft-Gault equation, which took into consideration the body weight, sex and age.
Urea is not a good test for GFR because it is highly affected by ____________ and ______________
Urea is not a good test for GFR because it is highly affected by hydration status and protein intake/metabolism.
In case of pre-renal uremia (increased [urea] in the blood) due to hypovolemia (decreased blood flow), the kidney is functioning correctly, the response to decreased GFR is to increase ______________.
In case of pre-renal uremia due to hypovolemia, the kidney is functioning correctly, the response to decreased GFR is to increase reabsorption rates.
The filtration process is taking place in the
a) Glomerulus
b) Heart
c) Proximal tubules
d) Spleen
a) Glomerulus
People with severe disease in skeletal muscle must do an —–
a) Actual GFR test
b) eGFR test using Cockcroft-Gault equation
c) eGFR test using Modified Diet in Renal Disease equation
a) Actual GFR test
Most of the blood acids are coming from:
a) HCl
b) H2SO4
c) CO2
d) PO43-
e) SO32-
c) CO2
______ osmolarity is higher than _______ osmolarity in normal patient.
Urine osmolarity is higher than plasma osmolarity in normal patient.
Normal range:
Urine: 300-900 mOsm/L,
plasma: 285 (+-10) mOsmol/L
if a BUN test shows a high amount of urea compared to creatinine, then it is likely due to _________ damage
if a BUN test shows a high amount of urea compared to creatinine, then it is likely due to prerenal damage (systemic problem - drop in blood volume)
Acute tubular necrosis is likely to be due to which type of renal failure?
a) Pre-renal
b) Renal (intrarenal)
c) Post-renal
b) Renal (intrarenal)
The plasma concentration above which the substance appears in the urine is known as _____________.
The plasma concentration above which the substance appears in the urine is known as renal threshold.
Kidney synthesises hormones such as:
- ______ (balance blood pressure)
- ___________ (hormone that stimulates production of RBCs)
- active _________ production
Kidney synthesises hormones such as:
- Renin (balance blood pressure)
- Erythropoetin - EPO (hormone that stimulates production of RBCs)
- active vitamin D production
the kidneys combat prerenal uremia by increaing the reabsorption of ________, which leads to increased water and urea reabsorption from the proximal tubules of the kidney back into the blood.
the kidneys combat prerenal uremia by increaing the reabsorption of Na, which leads to increased water and urea reabsorption from the proximal tubules of the kidney back into the blood.
People with chronic kidney disease are recommended to do eGFR test using which equation?
a) Cockcroft-Gault
b) Modified Diet in Renal Disease
b) Modified Diet in Renal Disease
The principal of GFR is that some substances when filtered by the kidney enter the tubules, are not ________ and thus been ________ so their GFR = _____%
The principal of GFR is that some substances when filtered by the kidney enter the tubules, are not reabsorbed and thus been excreted so their GFR = 100%
Measurement of the ________________________ provides information on the integrity of Tubular reabsorption function.
Measurement of the urine sodium concentration (FENa) provides information on the integrity of Tubular reabsorption function.
state the type of renal failure:
- Sudden & servere drop in blood pressure (shock) or interruption of blood flow to the kidneys from servere injury or illness
Prerenal - drop in blood volume
Urine excreted daily in adults as much as ____ L
Urine excreted daily in adults as much as 1.5 L
Increase of sodium in plasma leads to increase in plasma ___________.
Increase of sodium in plasma leads to increase in plasma osmolarity.
name the metabolite that correlates to the diagram
urea
Most of our food intake is ______, thus kidney regulates the pH of the blood to the normal range __________
Most of our food intake is acidic, thus kidney regulates the pH of the blood to the normal range 7.35 – 7.45
If the urine is not concentrated, there must be a problem with _________ or/and _______ functions
If the urine is not concentrated, there must be a problem with ADH or/and kidney functions
The reabsorption process is taking place in the
a) Glomerulus
b) Heart
c) Proximal tubules
d) Spleen
c) Proximal tubules
The gold standard for GFR is _______ because it should be completely cleared/filtered by the kidney in urine.
The gold standard for GFR is inulin because it should be completely cleared/filtered by the kidney in urine.
Dehydration, or a diet high in protein can make your BUN level ________.
Dehydration, or a diet high in protein can make your BUN level higher.
Renal functions test include all the followings EXCEPT
a) Production of bilirubin
b) Excretion of metabolic waste and by-products
c) Endocrine function
d) Regulation of plasma electrolytes, fluid/water balance, blood pressure
a) Production of bilirubin
Fractional excretion of sodium helps determine if the drop in urine production is due to pre-renal damage from reduced blood flow (hypovolemia), where FENa is ___________ than 1% and urine osmolality is ________ than plasma or due to kidney damage itself (renal) where urine osmolality is _________ to plasma and FENa is _________ than 1%
Fractional excretion of sodium helps determine if the drop in urine production is due to pre-renal damage from reduced blood flow (hypovolemia), where FENa is less than 1% and urine osmolality is higher than plasma or due to kidney damage itself (renal) where urine osmolality is similar to plasma and FENa is greater than 1%
Principle of clearance in kidneys:
Some substances when filtered in the __________, get directly ___________
Principle of clearance in kidneys:
Some substances when filtered in the glomerulus, get directly excreted
state the type of renal failure:
- Sudden obstruction of urine flow due to an enlarged prostate, kidney stones, bladder tumour or injury
Postrenal - stone/enlarged prostate
during tubular secretion, substances are actively removed from the blood and added to tubular fluid via ____________
i.e. H+, creatinine, and some drugs are moved by ___________ from the blood into the _______ convoluted tubule to urine
during tubular secretion, substances are actively removed from the blood and added to tubular fluid via active transport
i.e. H+, creatinine, and some drugs are moved by active transport from the blood into the distal convoluted tubule to urine
Fractional excretion of sodium is about the relation between sodium in _______ and sodium in _______
Fractional excretion of sodium is about the relation between sodium in urine and sodium in plasma
Which of the following solutions freezes faster (at higher temperature)?
a) 5% w/v salt solution
b) 10% w/v salt solution
c) 15% w/v salt solution
d) 25% w/v salt solution
a) 5% w/v salt solution
Desmopressin is a drug that is used as an
a) ADH analogue
b) Anticoagulant
c) Antidepressant
d) Diuretic hormone analogue
a) ADH analogue
Ureteral obstruction is likely to cause what type of renal damage?
a) Pre-renal
b) Renal
c) Post-renal
c) Post-renal
if a BUN test shows urea & creatinine levels are both very high, the problem is likely _______ damage
if a BUN test shows urea & creatinine levels are both very high, the problem is likely intrarenal damage (direct damage in the kidneys)
Hematuria is when you have _____in ______ whereas uremia is when you have ______ in ______
Hematuria is when you have blood in urine, whereas uremia is when you have urine in blood
The kidney receives a very high percentage of the body’s total cardiac output at ~_____ percent
The kidney receives a very high percentage of the body’s total cardiac output at ~25 percent
The actual glomerular filtration rate (GFR) or creatinine clearance test takes into account:
a) The volume of creatinine
b) The volume of plasma
c) The time for urine collection
d) The time for creatinine collection
e) The concentration of creatinine
c) The time for urine collection
______ has an essential role as a buffer in blood.
a) HCl
b) HCO3-
c) H2SO4
d) PO4—
e) SO3–
b) HCO3-
__________ is a measure of the osmoles (Osm) of solute per kilogram of solvent (osmol/kg or Osm/kg), __________ is defined as the number of osmoles of solute per liter (L) of solution (osmol/L or Osm/L).
Osmolarity is a measure of the osmoles (Osm) of solute per kilogram of solvent (osmol/kg or Osm/kg), osmolarity is defined as the number of osmoles of solute per liter (L) of solution (osmol/L or Osm/L).
the single outward pressure acting at the glomerulus is?
a) capsular hydrostatic pressure (18mm)
b) glomerular hydrostatic pressure (60mm)
c) plasma colloid osmotic pressure (32mm)
b) glomerular hydrostatic pressure (60mm)
(net outward pressure = 10mm)
In a healthy person, do you expect to see creatinine in blood?
a) Yes
b) No
no - kidney failure
Each nephron produces ____ µL of urine per day.
Each nephron produces ~100 µL of urine per day.
The right equation to measure the estimated glomerular filtration rate (eGFR) if you don’t know your body weight is ——
a) Cockcroft-Gault
b) Modified Diet in Renal Disease
b) Modified Diet in Renal Disease
Glomerular capillary membranes consist of three layers which allows not all of the blood to perfuse. blood cells and _______ molecular weight proteins are too ________ and cannot pass.
Glomerular capillary membranes consist of three layers which allows not all of the blood to perfuse. blood cells and high molecular weight proteins are too large and cannot pass.
Desmopressin could be used in case of _____ urine osmolality.
Desmopressin could be used in case of low urine osmolality.
to combat prerenal uremia (high BUN), Na is reabsorbed into the proximal tubules to increase H20 reabsorption = increased blood volume.
during this, creatinine is actually secreted in the proximal tubule via tubular secretion. This generally leads to a BUN:Cr ratio _____
to combat prerenal uremia (high BUN), Na is reabsorbed into the proximal tubules to increase H20 reabsorption = increased blood volume.
during this, creatinine is actually secreted in the proximal tubule via tubular secretion. This generally leads to a BUN:Cr ratio > 20
The functional unit of kidney is ________
The functional unit of kidney is Nephron.
Glomerulus allows small molecules to get filtered. Albumin is within the size of filtration. Does it get filtered or not?
In a healthy person, do you expect to see creatinine in urine?
yes
Albumin in blood stops water from leaving the blood.
Albumin is filtered through the glomerulus with a sieving coefficient of 0.00062, which results in approximately 3.3 g of albumin filtered daily in human kidneys
urine volume >3000mL over 24 hours is called _______
Polyuria
urine volume <100mL over 24 hours is called _______
urine volume <100mL over 24 hours is called Anuria
give 2 reasons why inulin is not widely used as a marker for GFR?
- Inulin is injected to the body (invasive)
- Expensive
Glucose appears in the urine when concentration exceeds the renal threshold of ____ mmol/L.
Glucose appears in the urine when concentration exceeds the renal threshold of 11 mmol/L.
_________ clearance is a slightly less accurate measure of the glomerular filtration rate than inulin clearance, unlike inulin, a small amount of __________ is reabsorbed by the kidney tubules and is not excreted in the urine, thereby being lost to measurement.
Creatinine clearance is a slightly less accurate measure of the glomerular filtration rate than inulin clearance, unlike inulin, a small amount of creatinine is reabsorbed by the kidney tubules and is not excreted in the urine, thereby being lost to measurement.
In the kidney, the tubular secretion of ______ from the blood into the tubular fluid helps the blood to keep its pH in the normal level?
a) Calcium
b) Creatinine
c) H+ and NH4+
d) Na+ and K+
c) H+ and NH4+
In the case of renal disease, glomerular filtration rate ________. So urea and creatinine do not get filtered as they normally would and they both are elevated in blood, BUN:Cr ____
In cases of renal disease, glomerular filtration rate decreases. So urea and creatinine do not get filtered as they normally would and they both are elevated in blood, BUN:Cr < 15.
