1
Q
bean-shaped organs located retroperitoneally on either side of the spinal column, and with two (2) regions, _____ _____
A
kidneys
cortex
medulla
2
Q
outer region called
A
cortex
3
Q
an inner region called
A
medulla
4
Q
the kidneys are composed of five basic parts
A
, glomerulus, proximal
convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct
5
Q
responsible for the reabsorption of electrolytes glucose, amino acids, proteins, urea, and uric acid.
A
proximal convoluted tubule
6
Q
electrolytes pct glucose, amino acids, proteins, urea, and uric acid.
A
sodium, chloride, bicarbonate, and other ions
7
Q
he plasma contains ________ o f non-protein
nitrogenous compounds.
A
20 to 35 mg/dL
8
Q
produces renin that affects the blood pressure by converting angiotensinogen to angiotensin.
A
juxtaglomerular apparatus
9
Q
primarily secreted in the kidney, catalyzes the synthesis of the
active vitamin D
A
1-a-hydroxylase,
10
Q
About _______ of water are filtered daily in humans
A
180 liters
11
Q
are reabsorbed in the proximal tubule and about 5 liters in the descending limb of Henle of cortical nephrons.
A
150 liters
12
Q
the final site for either
concentrating or diluting urine.
A
collecting duct
13
Q
The renal basic metabolic panel is composed of
A
clearance, creatinine, and electrolytes (magnesium and phosphorus).
14
Q
Functions of the Kidneys
A
- Elimination of waste products
2, Maintenance of blood volume - Maintenance of electrolyte balance
- Maintenance of acid-base balance
- Endocrine function (erythropoietin secretion)
15
Q
The human kidneys receive approximately ________ of the blood pumped
A
25%
16
Q
Total renal plasma flow:
A
600to 700 mL/minute
16
Q
Total renal blood flow
A
Approximately 1200 mL/minute
17
Q
Each kidney contains approximately __________ million of functional units called nephrons
A
1 million to 1.5 million
18
Q
functional unit of the kidneys
A
nephron
19
Q
Approximately ________ situated primarily in the cortex of the kidney, and responsible for removal of waste
A
85% of nephrons
20
Q
Have longer loops of Henle that extend deep into the medulla of the kidney and
responsible for concentration of the urine
A
Juxtamedullary nephrons
21
Q
electrolyte balances is controlled in the nephron by the following renal functions:
A
renal blood flow
glomerular filtration
tubular reabsorption
tubular secretion
22
Q
Immediate reabsorption of essential substances
A
proximal convoluted tubule
23
Q
Final adjustment of the urinary composition
A
Distal convoluted tubule
24
Major exchanges of water and salts take place between the blood and the medullary interstitium; this exchange maintains the osmotic gradient(salt concentration)in the medulla, which is necessary for renal concentration
Ascending and descending loop of Henle in juxtamedullary nephrons:
25
Serves as a nonselective filter of plasma substances
Glomerulus
26
MAJOR KIDNEY FUNCTION TESTS
I. TEST FOR THE GLOMERULAR FILTRATION RATE
II. TEST FOR RENAL BLOOD FLOW
III. TEST MEASURING TUBULAR FUNCTION
27
Routine markers GLOMERULAR FILTRATION RATE
Clearance and Cystatin C
28
secondary markers GLOMERULAR FILTRATION RATE
Beta-trace protein
29
It is a measure of the clearance of normal molecules that are not bound to protein and are freely filtered by the
glomeruli, neither reabsorbed nor secreted by the tubules.
It is considered the best overall indicator of the level of kidney function.
Glomerular Filtration Rate
30
glomerular filtrate is produced daily.
150 Liters
31
It is the removal of the substance from plasma into urine over: fixed time.
Clearance
32
It is not routinely done because of the necessity for continuous intravenous (IV) infusion; requires an
intravenous infusion and timed urine collections over many hours.
Inulin Clearance (Reference Method)
33
Priming dose inulin clearance
25 mL of 10% inulin solution
34
Continuous infusion inulin clearance
500 mL of 1.5% inulin solution
35
Disadvantage inulin clearance
IV infusion
36
Reference range of inulin clearance
Male = 127 mL/min
Female = 118 mL/min
37
Alternatives to Inulin
-Radioactive markers
- (51Cr-EDTA)
- Non-radiolabeled iothalamate
38
It provides an estimate of the amount of plasma that must flow through the kidney glomeruli per minute
Creatinine Clearance
39
Excretion of creatinine is not routinely affected by diet
(1.2-1.5g creatinine excreted/day).
40
Sample storage and transport creatinine clearance
Maintained at 4° C
41
Major limitation creatinine clearance
Accurate urine collection
42
Reference range creatinine clearance
Male = 85-125 mL/min
Female 75-112 mL/min
43
Increased Creatinine Clearance
High cardiac output
Pregnancy
Burns
Carbon monoxide poisoning
44
Decreased Creatinine Clearance
Impaired kidney function
Shock, dehydration
Hemorrhage
Congestive heart failure
45
It can demonstrate progression of renal disease or response to therapy
Urea Clearance
46
- its a low molecular weight protease inhibitor.
- It is produced at a constant rate by all nucleated cells
Cystatin C
47
Its plasma concentration is not affected by
muscle mass, age, diet, and gender.
48
Advantage of cystatin c
To assess GFR among pediatric and elderly patients, and renal transplant patients.
49
Specimen of cystatin c
Serum or plasma (fasting is not required)
50
Increased of cystatin c
Acute and chronic renal failure, and diabetic nephropathy
51
Reference range of cystatin c
0.5-1.0 mg/L (adults)
0.9-3.4 mg/L( > 65years old)
52
It is a low-molecular-weight glycoprotein.
It belongs to the lipocalin protein family and functions as prostaglandin D synthase
Beta-Trace Protein (BTP)
53
Increased BTP
Renal disease
54
Markers RENAL BLOOD FLOW
Urea, Creatinine, and Uric acid
55
It is the major end product of protein (dietary) and amino acid catabolism.
Blood Urea Nitrogen
56
Reference range BUN
8-23 mg/dL (2.9-8.2 mmol/L)
57
BUN: Creatinine ratio:
10:1-20:1
58
METHODS of BUN
Chemical Method (Direct Method)
Enzymatic Method (Indirect Method)
59
Chemical Method (Direct Method)
Diacetyl Monoxime Method
60
Enzymatic Method (Indirect Method)
Urease
Coupled Urease/Glutamate Dehydrogenase (GLDH) method
61
- It is the reference method.
- It determines unique spectroscopy fragments through mass spectrometry and quantification using isotopically
labeled compound. rear
- It is not recommended for routine test since the assay is expensive
Isotope Dilution Mass Spectrometry (IDMS)
62
Increased BUN
- Chronic renal disease
- Stress
- Burns
- High protein diet
- Dehydration
63
Decreased BUN
Poor nutrition
Hepatic disease
Impaired absorption (celiac disease)
Pregnancy
64
Itis the end product of muscle metabolism derived from creatine (a-methyl guanidinoacetic acid).
CREATININE
65
Reference range of creatinine
Male = 0.9-1.3 mg/dL (80-115 pmol/L)
Female = 0.6-1.1mg/dL (53-97 mol/L)
66
functional or structural abnormalities or markers of kidney damage including abnormalities in blood, urine, or tissue test
Acute Kidney Injury (AKI)
67
It is also known as acute renal failure.
Acute Kidney Injury (AKI)
68
methods of AKI
Chemical Method - Direct Jaffe Method
ENZYMATIC METHOD
69
A red-orange tautomer of creatinine picrate is formed when creatinine is mixed with ______________________
alkaline picrate reagent
70
false increased level of direct jaffe method (AKI)
ascorbate, glucose, uric acid and a-keto acids
71
false decreased levels direct jaffe method (AKI)
bilirubin and hemoglobin
72
a sensitive but non-specific method
Folin-Wu Method
73
It is a sensitive and specific method.
Lloyd or Fuller's Earth Method
74
Adsorbent: Lloyd's reagent
sodium aluminum silicate
75
Adsorbent Fuller's earth reagent
aluminum Mg* silicate
76
Jaffe Reagent (Alkaline Picrate)
Saturated Picric Acid
10% NaOH
77
It requires automated equipment for precision.
It is a popular, inexpensive, rapid,and easy-to-perform method
Kinetic Jaffe Method
78
false increased levels OF KINETIC JAFFE METHOD
a-keto acids and cephalosporins
79
It is used to eliminate non-specificity of the Jaffe reaction; specific than Jaffe test.
It is free from interference by glucose and other Jaffe chromogens
Enzymatic Method
80
It requires a large volume of pre-incubated sample; not widely used.
Creatinine Amidohydrolase-CK Method
81
It has potential to replace Jaffe method (specific than Jaffe method).
It has no interference from acetoacetate or cephalosporins.
Creatininase-Hydrogen Peroxide Method
82
The consumption of NADH measured as a decrease in absorbance at 340 nm, is used to measure the
concentration of creatinine
Creatinine amidohydrolase/
iminohydrolase Method
83
A known amount of C13 isotope-enriched creatinine is added to the sample and the mass spectrum 1
determined.
Isotope Dilution Mass Spectrometry (IDMS)
84
Increased Serum Creatinine
Impaired renal function
Chronic nephritis
Congestive heart failure
85
Decreased Serum Creatinine
1. Decreased muscle mass
2. advanced and severe liver disease
3. pregnancy
4. inadequate dietary protei
86
Low Ratio (Bun: Crea) <10:1
Low-protein diet
Acute tubular necrosis
. Repeated dialysis
Hepatic disease
87
High Ratio (BUN: Crea) >20:1 with normal creatinine
Prerenal azotemia
Dehydration
Catabolic states
GI hemorrhage
High-protein diet
88
High Ratio (BUN:Crea) >20:1 with increased creatinine
1. Postrenal azotemia
2. Prerenal azotemia with renal disease
3. Renal failure
89
- It is the major product of purine (adenine and guanine) catabolism.
- It is the final breakdown of nucleic acids catabolism in humans.
- It is formed from xanthine by the action of xanthine oxidase in the liver and intestine
Blood Uric Acid
90
It is a weak acid; at_____________ exists as monosodium urate.
ph7.4, > 95%
91
reference range: (Uricase) BUA
Male = 3.5-7.2 mg/dL (0.21-0.43 mmol/L)
Female = 2.6-6.0 mg/dL (0.16-0.36 mmol/L)
92
HYPERURICEMIA
-Gout
- Increased Nuclear
- Metabolism
Chronic Renal Disease
Lesch-Nyhan Syndrome (Inborn Errors Of purine metabolism)secondary to glycogen storage diseases, toxemia of pregnancy and lactic acidosis
increased
dietary intake,
and ethanol consumption
93
- It is a disease found primarily in males and first diagnosed between third and fifth decade of life.
- There is pain and inflammation of the joints(acute inflammatory arthritis).
gout
94
Serum uric acid of gout
> 7.5 mg/dL
95
it is seen in leukemia, lymphoma, multiple myeloma or polycythemia, and hemolytic and megaloblastic anemias.
Increased Nuclear Metabolism
96
For treatment of Increased Nuclear Metabolism
Allopurinol drug
97
It is due to decreased GFR and tubular secretion.
Chronic Renal Disease
98
Itis the deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
Lesch-Nyhan Syndrome
99
hypouricemia
Fanconi's syndrome(renal-type aminoaciduria)
Wilson's disease
Hodgkin's disease
100
the major interferences of hypouricemia.
Ascorbic acid and bilirubin
101
Sodium cyanine (NaCN)
Folin, Brown, Newton, and Benedict Methods
102
Sodium carbonate (Na>CO3)
Archibald, Caraway, and Henry Methods
103
is the incubation period after the addition of an alkali (NaCN/Na>C02) to inactivate non-uric acid reactants.
Lag phase
104
It is the elevated concentrations of nitrogenous substances such as urea and creatinine in blood
azotemia
105
Types of Azotemia
- Pre-renal azotemia
- Renal Azotemia
- Post-Renal Azotemia
106
Itis diminished glomerular filtration with normal renal function
Pre-renal azotemia
107
causes of pre renal azotemia
dehydration, shock and congestive heart failure
108
test result of pre renal azotemia
Increased BUN, normal serum creatinine, and decreased GFR.
109
It is characterized by damage within the kidneys
Renal Azotemia
110
causes of renal azotemia
Acute/chronic renal disease, glomerulonephritis
111
Complications of renal azotemia
Coma and neuropsychiatric changes
112
Test result of renal azotemia
increased BUN > 100
mg/dL), serum creatinine (20 mg/dL), and BUA (12 mg/dL) with decreased GFR
113
- It is usually the result of urinary tract obstruction.
- Urea level is higher than creatinine due to back-diffusion of urea into the circulation; increased urea and creatinine in blood.
Post-Renal Azotemia
114
It measures renal plasma flow.
This method requires clearance of the dye
Para-Amino Hippurate (PAH)/Diodrast Test
115
Reference range of PAH test
600-700 mL/minute
116
It measures excretion of dye proportional to renal tubular mass.
Phenolsulfonthalein (PSP) Dye Test
117
Dose of PSP Dye test
6mg of PSP is administered IV
118
Reference value of PSP Dye test
1200 mL blood flow/minute
119
- it reflects the function of the collecting tubules and the loops of Henle.
- It is used to assess the quantity of solutes present in urine which reflects the ability of the kidneys to produce a
concentrated urine.
Concentration Test
120
Most prevalent solutes excreted:
Urea, chloride, and sodium
121
Sample of concentration test
First morning urine
122
- It is the simplest test of renal concentrating ability.
It compares the weight of a fluid with that of distilled water at a reference temperature
Urine Specific Gravity(USG)
123
increase the "true specific gravity."
Glucosuria, proteinuria, and elevated urinary urea
124
equal to SG of ultrafiltrate in Bowman's space (same as protein-free plasma).
Specific gravity (SG) of 1.010
125
main determinant of the SG of plasma
Protein
126
Physiologic concentrated urine
1.025
127
Concentrated urine
1.025SG
128
Indicates severe loss of concentrating ability of the kidneys
fixation of SG at 1.010
129
High molecular weight substances
x-ray dye and mannitol yield high SG (≥ 1.050)
130
Reference range of USG
1.005-1.030
131
Main determinant of plasma specific gravity is protein
SG iso-osmotic plasma: 1.020-1.030
SG iso-osmotic urine: 1.010
132
-It is an expression of concentration in terms of the total number of solute particles present per kilogram of
solvent(moles/kg solvent).
- It is affected only by the number of solutes present, thus more accurate than specific gravity in assessing renal
tubular function (concentration ability).
osmolality
133
do not contribute to osmolality.
Proteins and lipids
134
Normal ratio of urine osmolality to serum osmolality
1:1
135
Primary organ responsible for osmotic regulation
Hypothalamus
136
Occurs in impaired renal excretion of water
Hypoosmolality and hyponatremia
137
Increased serum osmolality but decreased urine osmolality
Diabetes Insipidus
138
Decreased serum osmolality but normal/increased urine osmolality
SIADH
139
refers to the number of moles of solute
moles of solute in a kilogram of water (solvent).
in a liter of solution
osmolarity
140
is the number moles of solute in a kilogram of water (solvent).
osmolality
141
Osmolality is determined by measuring a colligative property of the sample (urine or serum), such as
freezing point, vapor pressure, osmotic pressure, or boiling point.
142
Sample of osmolality
Serum or urine
143
Normal concentrating ability of the kidney
Urine osmolality > 800 mOsm/kg
144
reference ranges of osmolality
Serum: 275-295 m0sm/kg (Dorwart and Chalmers, 1975; Bishop et al., 2018)
280-295 mOsm/kg
(McPherson and Pincus, 2022)
24-hour urine: 300-900 m0sm/kg
Random urine: 50-1,200 mOsm/kg
145
An increase in osmolality (solute) decreases the freezing point and vapor pressure.
direct method
146
Interferences of osmolality
Turbid serum and avoid reusable sample cups
147
Temperature for Supercooling of Samples of freezing point
-70° C
148
Quality Control/Reference Solution of freezing point
Sodium chloride
149
To use glucose or urea in osmolality,calculations must be converted from milligram units to molar units.
Indirect Method
150
Increased Serum Osmolality
Diabetes insipidus
Diabetic ketoacidosis (DKA)
Hyperglycemia
Uremia
Exposure to toxins (alcohol)
Physiologic factors (dehydration)
151
Decreased Serum Osmolality
- Syndrome of Inappropriate ADH secretion (SIADH)
2. Psychogenic polydipsia
3. Nephrotic Syndrome
4.Hepatic cirrhosis
152
Loss Of Renal concentrating ability:
1.2:1
153
Glomerular disease urine:serum osmolality:
> 1:1
154
Hyperglycemia, uremia, and anion ray acidosis serum osmolality
2.1-2.3 x the value of serum sodium
155
Diabetes insipidus urine to serum osmolality
< 1:1
156
Normal serum osmolality:
Higher in non sodium ions (lessNa+ concentration)
157
can cause high serum osmolality while hyponatremia is the opposite
Hypernatremia
158
is the opposite of hypernatremia
hyponatremia
159
It is the most common intrinsic cause of acute kidney injury
Acute Tubular Necrosis
160
- It is also known as nephritis.
- It is a group of diseases that injure (inflammation) the part of the kidney that filters blood, called the glomeruli.
Glomerulonephritis
161
It is also known as nephrosis.
It is a renal dysfunction that results in severe proteinuria and hypoalbuminemia leading to hypoosmolar serum.
Nephrotic Syndrome
162
primary cause of nephrotic syndrome
focal segmental glomerulosclerosis
163
It is the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 square meters, persisting for three months or more.
It is a state of progressive loss of kidney function ultimately resulting in the need for renal replacement
therapy (dialysis or transplantation).
Chronic Kidney Disease
164
the most common cause of CKD
Diabetes mellitus
165
other causes of ckd
primary and secondary glomerulonephritis
chronic tubulointerstitial nephritis
cystic disease, plasma cell dyscrasias,sickle cell nephropathy
166
Cytoplasmic proteins abundantly expressed
in all tissues, particularly in the proximal
convoluted and straight tubule of the kidney
L-FABP rises within 24 hours unlike serum
creatinine which was detectable at 72 hours
following cisplatin-induced AKI
fatty acid binding protein
167
Renal IL-18 mRNA levels are significantly upregulated in the proximal tubule.
interleukin -18 (IL-18)
168
169
type 1 cell membrane glycoprotein containing an immunoglobulin like domain and a mucin domain in its extracellular region KIM-1 mRNA levels increase more than any other
known gene after kidney injury
Kidney Injury Molecule-(KIM-1)
170
A.k.a.lipocalin 2(LCN2) or human neutrophil Protein initially identified bound to gelatinase in granules of the neutrophil
Neutrophil Gelatinase- Associated Lipocalin NGAL
171
For differential diagnosis of acute renal failure in the presence of oliguria
Renal Failure Index (RFI
CLINCHEM
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