wk 6 - Renal function II Flashcards
______ blood pressure is a sign of pre-renal uraemia.
Low blood pressure is a sign of pre-renal uraemia.
The estimated glomerular filtration rate (eGFR) doesn’t take into account the ______ sample.
The estimated glomerular filtration rate (eGFR) doesn’t take into account the urine sample.
_____ blood pressure is a sign of post-renal obstruction.
High blood pressure is a sign of post-renal obstruction.
why are plasma creatinine & urea (UCE) tests done together?
urea and creatinine both have differing limitations as markers of GFR - so both are tested to eliminate these
_____________ is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure.
Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure.
Patients with ———————————— could have metabolic acidosis blood, whereas their urine is alkaline, pH > 7.
Patients with Renal tubular acidosis could have metabolic acidosis blood, whereas their urine is alkaline, pH > 7.
During acute renal failure, sodium appears in low concentration in the blood due to ________________.
During acute renal failure, sodium appears in low concentration in the blood due to pseudohyponatremia.
In the kidney, drugs are moved by active transport from the blood into the ————- to urine
In the kidney, drugs are moved by active transport from the blood into the Distal convoluted tubule to urine
Renal Tubular Acidosis patients could have metabolic acidosis ______ , whereas their ______ is alkaline.
Renal Tubular Acidosis patients could have metabolic acidosis blood, whereas their urine is alkaline.
Brittle hair, thin nails, and white/yellow crystals of urate on skin are symptoms of
a) Acute renal failure
b) Chronic renal failure
b) Chronic renal failure
- decreased protein intake
- pregnancy
- severe liver disease
- severe vomitting
- diarrhoea
are all causes of ___________ BUN/blood urea concentration
- decreased protein intake
- pregnancy
- severe liver disease
- severe vomitting
- diarrhoea
are all causes of decreased BUN/blood urea concentration
a high BUN/plasma urea (ref range: 3.2 - 7.1) indicates a _____ GFR
a high BUN/plasma urea (ref range: 3.2 - 7.1) indicates a low GFR
Using analgesics over a long period of time may cause ————— disease.
Using analgesics over a long period of time may cause chronic kidney disease.
Glomerulonephritis is the most common cause for ________ syndrome in adults.
Glomerulonephritis is the most common cause for nephrotic syndrome in adults.
A useful test for detecting risk of diabetic nephropathy is:
a) Albumin creatinine ratio
b) Creatinine
c) HbA1C
a) Albumin creatinine ratio
Analgesics are safe to use. However, using analgesics over a long period of time may cause _________
a) Cough
b) Cancer
c) Chronic kidney disease
d) Diarrhoea
c) Chronic kidney disease
During acute renal failure, the kidney goes from _______ phase to ________ phase.
During acute renal failure, the kidney goes from oliguric phase to diuretic phase.
What is the gold standard for GFR?
inulin
___________ is a test highly recommended to assess tubular function specifically for renal transplant patients.
beta 2-microglobilin is a test highly recommended to assess tubular function specifically for renal transplant patients.
plasma BUN reference range is?
- 2 - 7.1
- high BUN = low GFR = renal failure
renal tubular acidosis is a syndrome due to either a defect in proximal tubule ___________ reabsorption, or a defect in distal tubule ___________ secretion, or both.
RTA is a syndrome due to either a defect in proximal tubule bicarbonate reabsorption, or a defect in distal tubule hydrogen ion secretion, or both.
80% of patients with Nephrolithiasis have ________ stones.
80% of patients with Nephrolithiasis have calcium stones.
plasma osmolarity reference range?
285 ~10 mOSm/L
During post-renal obstruction, GFR is initially normal but will eventually lead to _______ renal damage where GFR is ________ and tubular function is impaired.
During post-renal obstruction, GFR is initially normal but will eventually lead to intinsic/intra renal damage where GFR is reduced and tubular function is impaired.
Nephrotic syndrome is characterised by how much albumin in urine / day?
>3.5 grams
Anti-diuretic analogue is also termed ——–
desmopressin
————is when you have blood in urine.
Hematuria
The following are expected to be seen in a healthy person’s urine, however, in case of glomerulonephritis, we are more likely to see _________ in urine.
a) Blood and protein
b) Water and sodium
c) Calcium and potassium
d) Creatinine and urea
a) Blood and protein
A __________ is a condition that has a known cause, a fairly consistent set of symptoms, and a quantifiable alteration of a person’s anatomy.
A disease is a condition that has a known cause, a fairly consistent set of symptoms, and a quantifiable alteration of a person’s anatomy.
Normal blood pH is —————-, whereas normal urine pH is —————–.
Normal blood pH is 7.35 - 7.45, whereas normal urine pH is 6.
In chronic renal failure, the patient smells like __________
a) Blood
b) Citric acid
c) Glucose
d) Urine/ammonia
d) Urine/ammonia
What is the most common cause for nephrotic syndrome in adults?
glomerulonephritis
Which test is highly recommended to assess tubular functions?
a) β2-microglobulin
b) Creatinine
c) Myoglobin
d) Microalbuminuria
a) β2-microglobulin
Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the _________________ of the glomerulus. The most common cause in adults is glomerulonephritis.
Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. The most common cause in adults is glomerulonephritis.
___________ is due to muscle damage, as a result myoglobin in the muscle cells is released into the bloodstream and it beaks down to toxic compounds that can damage the kidney.
rhabdomyolysis is due to muscle damage, as a result myoglobin in the muscle cells is released into the bloodstream and it beaks down to toxic compounds that can damage the kidney.
How many liters of blood do the kidneys filtrate a day?
180L
The inflammation and damage of the filtration system of the kidneys due to problem in the immune system is termed ———.
glomerulonephritis
Glomerulonephritis is the damage and inflammation of the filtration system of the kidneys and that can cause
a) Acute kidney failure
b) Acute/chronic kidney failure
c) Chronic kidney failure
b) Acute/chronic kidney failure
Normal GFR is ____ mL/min/1.73m2
However, it is usually written as ≥ ____
(reference range = 80 - 140)
Normal GFR is 100 mL/min/1.73m2
However, it is usually written as ≥ 90
(reference range = 80 - 140)
Glomerulonephritis is due to the damage of the _________, this causes blood and proteins to pass into the urine
Glomerulonephritis is due to the damage of the glomeruli, this causes blood and proteins to pass into the urine
A __________ is a condition where there are a set of signs and symptoms that often go together, but the cause is unknown.
A syndrome is a condition where there are a set of signs and symptoms that often go together, but the cause is unknown.
X-ray can be used to detect patients with renal ________ stones, but it can’t detect patient with uric stones.
X-ray can be used to detect patients with renal calcium stones, but it can’t detect patient with uric stones.
Low urine < 100 mL / 24 hour is termed ———
Anuria
Nephrotic syndrome means less albumin in _______ and more albumin in _______
Nephrotic syndrome means less albumin in blood and more albumin in urine
___________ is the excess of urea and other nitrogenous wastes in the blood and it is the end stage of renal disease (ESRD).
Fatal uremia is the excess of urea and other nitrogenous wastes in the blood and it is the end stage of renal disease (ESRD).
Measurement of the urine sodium concentration (FENa) provides information on the integrity of tubular ___________
Measurement of the urine sodium concentration (FENa) provides information on the integrity of tubular reabsorption
The decrease in blood volume in the body is termed —–.
Hypovolemia
in Acute renal failure - vomiting, diarrhoea, haemorrhage are considered to be due to:
a) Pre-renal uraemia
b) Intrinsic renal damage
c) Post-renal obstruction
a) Pre-renal uraemia
In chronic renal failure, the end stage of renal disease (ESRD) requires:
a) Dialysis or transplant
b) Increase fluid
c) IV sodium
d) IV potassium
a) Dialysis or transplant
80% of patients with Nephrolithiasis have ________ stones.
a) Calcium
b) Magnesium
c) Phosphorous
d) Uric acid
a) Calcium
During pre-renal uremia, GFR __________.
During pre-renal uremia, GFR decreases.
Fractional excretion of sodium is about the relation between sodium in ______ and ________.
Fractional excretion of sodium is about the relation between sodium in urine and plasma.
A typical situation where RTA would be suspected is if urine pH is greater than ____ despite the presence of a metabolic __________.
A typical situation where RTA would be suspected is if urine pH is greater than 7.0 despite the presence of a metabolic acidosis.
(alkaline urine due to hyperchloraemia)
Which test is highly recommended to assess tubular function specifically for renal transplant patients as it is relatively intact molecule?
a) β2-microglobulin
b) Creatinine
c) Myoglobin
d) Microalbuminuria
a) β2-microglobulin
Fractional excretion of sodium helps determine if the drop in urine production is due to reduced blood flow (hypovolemia) to the kidney (________) or to kidney damage itself (________)
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).
T/F
Acute renal failure can be reversible?
True
During acute renal failure, all the following are correct EXCEPT
a) Metabolic alkalosis
b) Hyperkalemia
c) Increase in waste products
d) Hypervolemia
e) Hyponatremia
a) Metabolic alkalosis
Glomerulonephritis is the damage of the _________ system in the kidneys.
Glomerulonephritis is the damage of the filtration system in the kidneys.
Nephrotic syndrome is more likely accompanied by______ plasma TG, _____ plasma cholesterol and _____ plasma albumin.
Nephrotic syndrome is more likely accompanied by high plasma TG, high plasma cholesterol and low plasma albumin.
During acute renal failure, calcium concentration decreases in blood due to _____________, which is necessary to reabsorb calcium from the kidney:
a) Lack of sodium
b) Lack of potassium
c) Lack of 25(OH)Vit D3
d) Lack of 1,25(OH)Vit D3
c) Lack of 25(OH)Vit D3
(inactive Vit D)
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
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.
Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, and it may be caused by specific problems with the body’s ______________, often the precise cause is unknown
Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, and it may be caused by specific problems with the body’s immune system, often the precise cause is unknown
Fractional excretion of sodium helps determine if the drop in urine production is due to pre-renal due to reduced blood flow (hypovolemia), where FENa is ——- and urine osmolality is —— or due to kidney damage itself (renal) where urine osmolality is ——- and FENa is —–.
a) <1%
b) >1%
c) Higher than plasma
d) Similar to plasma
Fractional excretion of sodium helps determine if the drop in urine production is due to pre-renal due to reduced blood flow (hypovolemia), where FENa is <1% and urine osmolality is higher than plasma to kidney damage itself (renal) where urine osmolality is lower than plasma and FENa is >1%
In Acute renal failure, renal stones and enlarged prostate are considered:
a) Pre-renal uraemia
b) Intrinsic renal damage
c) Post-renal obstruction
c) Post-renal obstruction
Renal calculi is also called ___________
a) Kidney functions
b) Kidney stones
c) Liver functions
d) Prostate stones
b) Kidney stones
GFR reference range?
80 - 140
White/yellow crystals of urate on skin is called
a) Hyperkalemia
b) Metabolic acidosis
c) Uremic frost
d) Uremia
c) Uremic frost
Uremia is usually happening in case of
a) Acute renal failure
b) Chronic renal failure
b) Chronic renal failure
What is the best terminology to describe the abnormalities here? Ref Interval
- Sodium 140 mmol/L 135-145
- Potassium 6.0 mmol/L 3.0-5.0
- Bicarbonate 16 mmol/L 22-32
- Urea 40 mmol/L 3-8
- Creatinine 400 µmol/L 50-120
a) Dehydration and acidosis
b) Dehydration and alkalosis
c) Renal failure and acidosis
d) Renal failure and alkalosis
c) Renal failure and acidosis
Patients with renal ________ stones can be detected using x-ray, whereas _________ stones can’t..
Patients with renal calcium stones can be detected using x-ray, whereas uric acid stones can’t..
Normally, low MW proteins (e.g. Cystatin C) are filtered by the GFR, reabsorbed by the kidney tubular cells and been catabolized. Whereas, high MW proteins (e.g. blood cells) won’t be filtered and they will remain in the blood too.
In case of kidney diseases, we will find proteins in urine, which are probably due to the following EXCEPT:
a) Glomerulus dysfunction, thus high MW proteins, e.g. albumin, were filtered.
b) Renal tubular cells dysfunction, thus can’t reabsorb low MW proteins and thus they were excreted in urine.
c) Overflow or excessive filtration rate exceeded reabsorption capacity (Bence-Jones)
d) Overflow or excessive reabsorption rate exceeded filtration capacity
d) Overflow or excessive reabsorption rate exceeded filtration capacity
a BUN:Cr ratio < 15 indicates:
a) prerenal uremia (decreased bloodflow to kidneys)
b) renal uremia (acute renal failure, glomerulonephritis, acute tubular necrosis)
c) post renal uremia (urinary tract obstruction)
b) renal uremia (acute renal failure, glomerulonephritis, acute tubular necrosis)
a BUN:Cr ratio > 20 indicates:
a) prerenal uremia (decreased bloodflow to kidneys)
b) renal uremia (acute renal failure, glomerulonephritis, acute tubular necrosis)
c) post renal uremia (urinary tract obstruction)
a) prerenal uremia (decreased bloodflow to kidneys)
______ renal failure develops over hours or days versus years for _______ renal failure
Acute renal failure: develops over hrs or days versus years for chronic renal failure
a BUN:Cr ratio > 15 indicates:
a) prerenal uremia (decreased bloodflow to kidneys)
b) renal uremia (acute renal failure, glomerulonephritis, acute tubular necrosis)
c) post renal uremia (urinary tract obstruction)
c) post renal uremia (urinary tract obstruction)
plasma creatinine reference range is?
80 - 120
Renal Tubular Acidosis is a syndrome due to either a defect in proximal tubule __________ or a defect in distal tubule ___________ As a result there is ___________
a) Bicarbonate reabsorption
b) Hydrogen ion secretion
c) Metabolic acidosis
d) Respiratory acidosis
Renal Tubular Acidosis is a syndrome due to either a defect in proximal tubule Bicarbonate reabsorption or a defect in distal tubule Hydrogen ion secretion. As a result there is Metabolic acidosis.
Rhabdomyolysis is the breakdown of
a) Brain fibers
b) Kidney fibers
c) Liver fibers
d) Muscle fibers
d) Muscle fibers
Infertility and reduced sperm motility are symptoms of
a) Acute renal failure
b) Chronic renal failure
b) Chronic renal failure
FENa is the percentage of the sodium filtered by the kidney and is excreted in the urine. This can determine whether the patient’s low urine volume can be attributed to either prerenal or renal damage
If the FENa is ________ than 1% - the kidneys are filtering ok and the cause must be prerenal (hypovolemia)
if the FENa is _________ than 1% - the kidneys are not filtering ok and the cause must be renal (acute glomerulonephritis, acute blood loss)
FENa is the percentage of the sodium filtered by the kidney and is excreted in the urine. This can determine whether the patient’s low urine volume can be attributed to either prerenal or renal damage
If the FENa is less than 1% - the kidneys are filtering ok and the cause must be prerenal (hypovolemia)
if the FENa is greater than 1% - the kidneys are not filtering ok and the cause must be renal (acute glomerulonephritis, acute blood loss)
renal tubular acidosis results in a hyperchloraemic metabolic acidosis with normal to moderately __________ GFR.
This results in a hyperchloraemic metabolic acidosis with normal to moderately decreased GFR.
- hyperchloraemic = high chloride levels in urine = alkaline urine (pH >7)
Myoglobin is attached to oxygen to provide extra oxygen to the _________ to maintain high level of activity for a longer period of time. When _________ is damaged, Rhabdomyolysis, myoglobin in the ________ cells is released into the bloodstream. Large amounts of myoglobin can damage the __________ as it breaks down to __________
a) Muscle
b) Kidney
c) Toxic compounds
Myoglobin is attached to oxygen to provide extra oxygen to the muscle to maintain high level of activity for a longer period of time. When muscle is damaged, Rhabdomyolysis, myoglobin in the muscle cells is released into the bloodstream. Large amounts of myoglobin can damage the kidneys as it breaks down to toxic compounds
______________ was replaced by ‘moderately increased albuminuria’.
Microalbuminuria was replaced by ‘moderately increased albuminuria’.
Nephrotic syndrome is more likely accompanied by _______ albumin in urine.
a) > 1 g / day
b) < 1 g / day
c) 2 g / day
d) > 3.5 g / day
e) < 3.5 g / day
d) > 3.5 g / day
In case of pre-renal uremia due to hypovolemia, the kidney is functioning correctly, the response to decreased GFR is to increase ___________ rates.
The increased reabsorption of Na leads to increased _______ and _______ reabsorption from the proximal tubules of the kidney back into the blood.
In contrast, creatinine is actually secreted in the proximal tubule. This generally leads to a BUN:Cr ratio >_____.
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 increased reabsorption of Na leads to increased water and urea reabsorption from the proximal tubules of the kidney back into the blood.
In contrast, creatinine is actually secreted in the proximal tubule. This generally leads to a BUN:Cr ratio > 15
