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what is glomerular filtration rate, what is it used for

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1

what is glomerular filtration rate, what is it used for

volume of blood filtered per minute

  • test for supected kidney issues

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2

what are the five basic parts of the nephron

  1. glomerulus

  2. proximal convoluted tubule

  3. loop of henle

  4. distal convoluted tubule

  5. collecting duct

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3

what is in / not in the glomerulus

  • ultrafiltrate

  • lack HMW molecules

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4

what is the function of the tubules

to reabsorb and secrete

total urine volume of 0.4-2.0 L / 24 hr

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5

what factors facilitate glomerular filtration

  • semipermeable basement membrane

  • high pressure in glomerular capillaries as filtration occurs

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6

function of proximal convoluted tubule

  • reabsorption: returns valuable substances to the blood

  • secretion: secretes products of metabolism

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7

function of loop of henle

aids in reabsorption of water, sodium, chloride

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8

function of distal convoluted tubule

adjusts electrolyte and acid base homeostasis

  • ADH and aldosterone

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9

function of collecting duct

final site of concentrating diluting urine

  • controls reabsorption of water, sodium, chloride, urea

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10

what is the excretory function of kidney

  • getting rid of waste , non protein nitrogen (urea, uric acid)

  • excess water and electrolytes

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11

regulatory function of kidney

blood chemical homeostasis

  • balance reabsorption and secretion

  • Proximal tubule: reabsorption

  • renal threshold (capacity of transport system)

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12

what does the distal tubule do

  • reabsorption and secretion

  • plasma lytes and acid base balance

    • Na , K, H exchange

  • aldosterone

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13

describe aldosterone and what it is involved in

Na reabsorption, H and K secretion

  • renin angiotensin system

  • stimulated by LOW plasma Na and LOW blood flow

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14

function of collecting ducts

ADH increase for water retention/reabsorption

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15

main endocrine function of kidneys

  • erythropoietin

    • RBC production

    • chronic renal failure → anemia

  • renin-angiotensin

    • blood pressure and aldosterone secretion

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16

what are the four endocrine functions associated with the kidneys

  1. renin - angiotensin synthesis

  2. erythropoietin - increases RBC number

  3. 1, 25-dihydroxy vitamin D3 - active, phosphate and calcium balance and bone calcification

  4. prostaglandins- renal blood flow

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17

what are the glomerular diseases

  • acute and chronic glomerulonephritis

  • nephrotic disease

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18

describe acute glomerulonephritis

  • inflammed glomeruli, decreased capillary lumen

  • rapid onset of hematuria nad proteinuria

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19

describe chronic glomerulonephritis

  • scarring and eventual loss of nephron function

  • gradual uremia

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20

describe nephrotic syndrome

  • associated with massive proteinuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria

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21

what occurs in tubular diseases

  • decreased excretion/reabsorption of the protein of certain substances or concentrating ability

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22

example of tubulat disease

RENAL TUBULAR ACIDOSIS - affects acid base balance

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23

what are renal caliculi

kidney stones

  • crystallized substances

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24

acute renal failure

sudden, sharp decline in renal function

can be reversed

soft tissue, MRI, dye allergy, toxin swallowed

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25

chronic renal failure

gradual decline over time

flow rate can go down

medication

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26

renal hypertension

decreased perfusion to kidneys, work hardy

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27

what is the therapy for renal failure

dialysis : removing waste of blood through external, synthetic membrane

transplantation

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28

what does the evaluation of renal function depend on

measurement of waste products in the blood that accumulate when kidneys begin to fail

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29

what is clearance

rate at which creatinine and urea are removed from blood into urine

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30

what is creatinine

endogenous product

  • made at constant rate

  • only made with glomerular filtration

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31

what is the standard lab method to determine GFR

creatinine clearance rate

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32

what is estimated GFR

  • used to predict GFR

  • based on serum creatinine

  • does not require urine collection

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33

what can be used for clearance measurements

  • urea

  • cystatin C

  • creatinine

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34

why is urea no longer used to measure clearance

not a full clearance assessment

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35

what is cystatin C

LMW protein

  • good marker for children and elderly

  • may be more sensitive

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36

what makes creatinine more helpful in helping an individual

within-subject variation < between-subject variation

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37

what does GFR measure

  • blood volume filtered per minute

  • permeability of glomerulus

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38

what do tubular lab tests observe

secretion and reabsorption

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39

what are non-protein nitrogens

  • urea

  • creatinine

  • uric acid

  • amino acids

  • nucleic acid wastes

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40

what does BUN stand for

blood urea nitrogen

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41

how is BUN made

protein catabolism

amino acid deamination → NH3 → urea cycle → urea

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42

what is an increase in urea called, what can it lead to?

azotemia → uremia

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43

what is BUN involved in

kidney

  • urine excretion

  • passive reabsorption

    • urine flow rate, hydration

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44

what kind of types of azotemia are there

pre renal, renal , post renal

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45

what is pre-renal azotemia

INC urea , WITHOUT , INC creatinine

  • DEC renal blood flow

    • shock, congestive heart failure, DEC renal blood volume

  • INC protein catabolism

    • high protein diet

    • fever, upper GI bleeding

  • dehydration

    • urea moves with water

    • DEC water excretion → DEC urea excretion

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46

what is renal azotemia

DEC renal function

  • INC urea, INC creatinine , INC uric acid

  • indicates glomerular / tubular disease

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47

what is post renal azotemia

  • urinary obstruction

    • nephrolithiasis (kidney stone)

    • prostate hypertrophy

    • severe infection

    • tumors

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48

what methods are used to determine BUN

  • coupled enzyme reaction

  • indicator dye (ammonia + pH indicator)

  • conductimetric

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49

what is the reaction for urea

urea -urease→ NH4 + HCO3

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50

BUN interferences

ammonia

  • INC blood ammonia

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51

what can cause increased blood ammonia

contaminated reagents, glassware, water

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52

what specimen is used for BUN

  • serum, plasma, pre-diluted urine

  • NO anticoagulants that inactivate urease

    • Na fluoride , Na citrate AVOIDED

    • urease drives reaction

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53

what is the reference range for BUN

6-23 mg/dL

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54

how is creatinine made

creatine + ATP → creatine phosphate (high energy)

creatine phosphate + creatine → creatinine (waste)

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55

why is plasma creatinine important

  • renal function test

  • constant level proportional to muscle mass

    • can be used as a delta check value : varies <10% / day

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56

what is the reference range of creatinine

0.6-1.1 mg/dL

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57

what is the creatinine clearance test

  • estimates GFR

    • the creatinine produced = filtered = excreted

  • clearance DEC linear to renal function DEC

  • monitor/detect renal failure, nephrotoxicity

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58

why is cystatin c clearance important

more accurate GFR in elderly or children

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59

specimen for creatinine clearance

  • 24 hr urine creatinine

  • serum creatinine drawn at midpoint

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60

what is measured for creatinine clearance test

  • urine total volume

  • serum creatinine

  • urine creatinine

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61

creatinine clearance test interferences

incomplete urine collection

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62

what is the equation of corrected creatinine clearance

Cu/Cs x TV/min x 1.73/SA

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63

what is the reference ranges for corrected creatinine clearance

male : 97-137 mL/min

female : 88-128 mL/min

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64

how is creatinine used for delta checks

  • changes around 10% daily

    • investigate , mislabeled sample

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65

when can creatinine NOT be used for delta check

in renal failure or renal dialysis

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66

how is creatinine used for TDM monitoring

nephrotoxic drugs

  • gentamicin, tobramycin, amikacin, kanamycin (aminoglycosides)

  • cyclosporin, salicylates

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67

what is the specimen for analyzing CREATININE

serum, plasma, pre-diluted urine

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68

what methods can be used for measuring creatinine

  • jaffee reaction

  • kinetic jaffe reaction

  • enzymatic

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69

what is the jaffe reaction

creatinine + alkaline picrate → red-orange

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70

what causes false positive for creatinine

  • hemolysis : RBC contents

  • ketones, glucose, proteins, ascorbic acid

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71

what causes false negative for creatinine assay

icterus

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72

describe kinetic jaffe reaction , what interefers

  • measure reaction rate

  • more specific

  • ONLY KETONES interefere

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73

describe enzymatic creatinine method

  • creatininase or creatine hydrolase

  • greater specificity over Jaffe

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74

how is kinetic jaffe different from regular jaffe?

kinetic is MORE specific , this is because ketones are its only interference

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75

what is uric acid

purine metabolism endproduct

  • dietary and endogenous

  • liver converts purines → uric acid

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76

how can food/diet produce uric acid

extra purines in diet or endogenous nucleic acid → production of uric acid

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77

how is uric acid excreted by kidneys

  • glomerulus filters

  • proximal tubule reabsorbs most

  • distal tubule secretes

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78

uric acid reference range

M: 4.0-8.5 mg/dLF: 2.7-7.3 mg/dL

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79

what kind of foods can trigger gout

foods high in purines

  • beef, pork, lamb, beer, seafood, anchovies, spinach, cauliflower

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80

what is gout

  • hyperuricemia

  • urates precipitaate in joint fluids, renal calculi

  • males 30-50 years

  • enzyme is deficient or missing

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81

gout primary causes

increased purine production

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82

gout secondary causes

alcohol and drugs

  • INC dietary intake

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83

what is associated with hyperuricemia

  • INC cell breakdown

    • chemotherapy, LEUKEMIA

  • chronic renal disease

    • DEC uric acid excretion

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84

what is hypouricemia associated with

Fanconi syndrome

  • defective tubular reabsorption

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85

what are the coupled enzymatic reactions for uric acid

uric acid + O2 → allatonin + CO2 + H2O2

H2O2 + red chromogen → Ox.chromogen (color) +H2O

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86

what interferes with uric acid

bilirubin, ascorbic acid (-)

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87

what other methods are used for analyzing renal function

  • urine electrophoresis

  • beta2 microglobulin

  • myoglobin

  • microalbumin

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88

what is urine electrophoresis for

  • differentiates acute glomerular nephropathy and tubular proteinuria

  • screens for abnormal monoclonal or polyclonal globulins

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89

what does beta2 microglobulin test do

  • assess renal tubular function in renal transplant patients with elevated levels indicating organ rejection

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90

what does myoglobin test do

myoglobin clearance , early indicator of myoglobin induced renal failure

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91

what is rhabdomyolysis

condition where myoglobin is excessively broken down

  • kidneys cannot clear it

  • can lead to acute renal failure

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92

what is microalbuminuria

small amounts of albumin in the urine

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93

what is microalbumin measurement used for

manage diabetes patients due to nephropathy risk

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94

what level of urinary albumin concentration is predictive of diabetic nephropathy

50-200mg/24 hr

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95

what is the risk of nephropathy with type 1 and 2 diabetes

type 1 risk : 30-45%

type 2 risk : 30%

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96

what is involved in water balance

ADH

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97

how is ADH secreted

INC plasma osmolality OR DEC intervascular volume

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98

how does ADH increase water absorption

increases permeability of distal convoluted tubule and collecting ducts to water

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99

what is involved in electrolyte balance

sodium and potassium

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100

what is sodium

  • controlled by renin- angiotensin- aldosterone hormonal system

    • excreted from kidneys

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