MTAP AUBF > RENAL FUNCTION TEST > Flashcards

RENAL FUNCTION TEST Flashcards

(46 cards)

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1
Q
  • shows that there are many metabolic functions and chemical interactions to be evaluated through laboratory tests of renal function.
  • Parts of the nephron are related to the laboratory tests used to assess their function.
A

RENAL FUNCTION TESTS

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2
Q

The standard tests used to measure the filtering capacity of the glomerulus
* Measures the rate at which the kidneys are able to remove (to clear) a filterable substance from the blood.

A

CLEARANCE TEST

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3
Q

The substance analyzed must be one that is neither reabsorbed nor secreted by the tubules.
* Stability of substance in urine during __
* Consistency of plasma level
* Substances availability to the body
* Availability of tests for analysis of the substance
* Reported in __

A

CLEARANCE TEST
- 24- hour urine collection
mL/min

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4
Q
  • STANDARD METHOD for GFR
  • Demonstrate progression of renal disease or response to therapy
  • Not give reliable estimates of GFR (Approximately __ is reabsorbed)
  • It is about __ of creatinine clearance.

The earliest glomerular filtration tests
normal values were adjusted to reflect the reabsorption, and patients were hydrated to
produce a urine flow of__ to ensure that no more than 40% of the urea was
reabsorbed

A

UREA CLEARANCE TEST
40% of filtered urea
50%
2 mL/min

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5
Q
  • REFERENCE METHOD for GFR
  • Not routinely done because of the necessity for continuous IV infusion
  • Higher values in male due to larger renal mass
    o PRIMING DOSE: __
    o CONTINUOUS INFUSION: _
A

INULIN CLEARANCE TEST
25 mL of 10% Inulin solution
500 mL of 1.5% inulin solution

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6
Q

REFERENCE VALUES OF INULIN CLEARANCE TEST

A
  • Male: 127 mL/min
  • Female: 118 mL/min
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7
Q

GLOMERULAR FILTRATION RATE

A

CLEARANCE TEST
UREA CLEARANCE TEST
INULIN CLEARANCE TEST
CREATININE CLEARANCE

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8
Q
  • Determines the functional capacity of nephrons.
A

GFR: GLOMERULUS FILTRATION TEST

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9
Q
  • Determines the extent of nephron damage in known cases of renal disease.
  • Monitor the effectiveness of treatment
  • Determines the feasibility of administering medications
A

CREATININE CLEARANCE

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10
Q

DISADVANTAGES OF CCT
* Some Creatinine is secreted by __
o Increases level of creatinine
* __ present in human plasma
o Reaction on the chemical analysis occurs; false positive or false elevation of creatinine
* Some medications cause false __ value (inhibits tubular secretion) (gentamicin, cephalosporins, andcimetidine (Tagamet))
* Creatinine breakdown by some __
* influenced by heavy diet
* Interference by muscle wasting disease.

A

tubule
Chromogens
decreased
bacteria

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11
Q

average person (1.73 m2 body surface) the approximate
amount of plasma filtrate produced per minute is _

A

120 ml/min

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12
Q

The normal reference range of plasma creatinine is

A

0.5 - 1.5 mg/dL

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13
Q
  • used for routinely screening patients as part of a metabolic profile
  • Uses a specialized equipment known as __
A

ESTIMATED GLOMERULAR FILTRATION RATES (eGFR)
- Isotope Dilution Mass Spectrophotometry (IDMS)

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14
Q

________ has formulas that are highly valuable for the medication and tests of CKDs (Chronic Kidney Disease)

A

Modification of Diet in Renal Disease (MDRD) – older version
of IDMS

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15
Q

recommended revision or updated
MDRD using IDMS

A

National Kidney Disease
Education Program (NKDEP)

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16
Q

Stage 1 CHRONIC KIDNEY DISEASE

A

DESCRIPTION
Kidney Damage with Normal or ↑ GFR

GFR (ml/min/173 m²)
≥ 90

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17
Q

Stage 2 CHRONIC KIDNEY DISEASE

A

DESCRIPTION
Kidney Damage with Mild ↓GFR

GFR (ml/min/173 m²)
60-89

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18
Q

Stage 3 CHRONIC KIDNEY DISEASE

A

DESCRIPTION
Moderate ↓ GFR

GFR (ml/min/173 m²)
30-59

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19
Q

Stage 4 CHRONIC KIDNEY DISEASE

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A

DESCRIPTION
Severe ↓ GFR

GFR (ml/min/173 m²)
15-29

20
Q

Stage 5 CHRONIC KIDNEY DISEASE

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A

DESCRIPTION
Kidney Failure

GFR (ml/min/173 m²)
<15 or Dialysis

21
Q

color of creatinine - ________

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A

canary yellow

22
Q

high creatinine - ________

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A

orange (carotene color)

23
Q
  • Indirect estimate of GFR
  • GFR is not useful in indication of early renal
    disease
  • to determine early renal disease – capacity of
    tubules for the reabsorption
  • A low molecular weight protease inhibitor
  • Completely reabsorbed by the PCT, hence its presence in urine denotes damage to the tubules
  • SPECIMEN: __
  • INCREASED LEVELS:
  • METHOD: _
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A

CYSTATIN C
Serum or plasma (fasting is not required)
- Acute & Chronic Renal failure, Diabetic nephropathy
- Immunoassay

24
Q

Dissociates from human leukocyte antigens at constant rate and is rapidly removed from the plasma by __________.

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A

BETA 2 MICROGLOBULIN (B2M)
- glomerular filtration

25
A rise has been shown to be more sensitive indicator of decrease in GFR than creatinine clearance. * Not reliable in patients who have history of immunologic disorders or malignancy * METHOD: __
BETA 2 MICROGLOBULIN (B2M) EIA (Enzyme Immunoassay)
26
* injecting radionucleotides such as __ provides a method for determining glomerular filtration through the plasma disappearance of the radioactive material and enables visualization of the filtration in one or both kidneys * This procedure can be valuable to measure the viability of a transplanted kidney * are and costly; not typically a routine test to determine the function; a very selective method
125 – iothalamate
27
Loss of tubular reabsorption is the capacity in identification to determine affected or impaired function of tubules, to identify if they have renal disease.
TUBULAR REABSORPTION TESTS
28
• Ability of the tubules to reabsorb the essential salts and water that have been nonselectively filtered by glomerulus
CONCENTRATION TEST
29
The specific gravity of urine before entering the renal tubules is __, the specific gravity will vary when the urine enters the renal tubules for the reabsorption process.
1.010
30
Patients were deprived of fluids for 24 hours prior to measuring specific gravity
FISHBERG TEST
31
Compare the volume and specific gravity of urine of day and night urine samples
MOSENTHAL TEST
32
* Most sensitive test * measures only the number of particles in a solution, * __ is influenced by the number and density (molecular weight) of the particles. * Renal concentration is concerned with small particles, primarily _ AND _molecules * Large molecular-weight molecules such as _ AND _ do not contribute to the evaluation of renal concentration. * is performed for a more accurate evaluation of renal concentrating ability.
OSMOLALITY -specific gravity - sodium and chloride - glucose and urea
33
• polyuria is now referring only in _________ today • Normal result: __________ • If the results is not normal, proceed to ________ • If the results are _______ already, you may stop.
- diabetes insipidus - urine > serum - ADH challenge - normal
34
Result after taking ADH (2 hrs after)
• Normal: urine > serum • abnormal: low • >800 the nephron is responding to ADH • <400 the nephron is not responding to ADH
35
* Principle: Measurement of freezing point depression o used in special kidney laboratory or renal laboratory * Freezing Point: Temperature at which water and ice are in equilibrium and is related to solute concentration * Standard Reference: _
FREEZING POINT OSMOMETERS NaCl
36
• Tests to measure tubular secretion of nonfiltered substances and renal blood flow • Impaired tubular secretory ability or inadequate presentation of the substance to the capillaries owing to decreased renal blood flow may cause an abnormal result.
TUBULAR SECRETION & RENAL BLOOD FLOW TEST
37
▶ test most commonly associated with tubular secretion and renal blood flow ▶ To measure the exact amount of blood flowing through the kidney, it is necessary to use a substance that is completely removed from the blood (plasma) each time it comes in contact with functional renal tissue ▶ Disadvantage: they use the dye __ which must be injected. ▶ __– used to evaluate – not recommended as some is sensitive to this dye. ▶ Interpretation/standardization – difficult (old and traditional method)
P-AMINOHIPPURIC ACID (PAH) TEST - phenolsulfonphthalein DYE - PSP – phenolsulfonaphtalein
38
* The inability to produce an acid urine in the presence of metabolic acidosis * This condition may result from impaired tubular secretion of hydrogen ions associated with the proximal convoluted tubule * defects in ammonia secretion associated with the distal convoluted tubule.
RENAL TUBULAR ACIDOSIS
39
• H+ → Secretion • NH3 (Ammonia) → Production & secretion • Titratable acid (H+) - A normal person excretes approximately 70 mEq/day of acid • H2PO4 • NH4 • Alakaline tides (diurnal variation) → 2pm – 8pm • Lowest pH: Night
TITRATABLE ACIDITY AND URINARY AMMONIA
40
, a polymer of fructose, is an extremely stable substance that is not reabsorbed or secreted by the tubules.; It is not a normal body constituent
Inulin
41
is a waste product of muscle metabolism that is produced enzymatically by (CK) creatine phosphokinase
Creatinine
42
* to monitor patients already diagnosed with renal disease or at risk for renal disease. * In addition, the formulas are valuable when medications that require adequate renal clearance need to be prescribed.
ESTIMATED GLOMERULAR FILTRATION RATES (eGFR)
43
* Modification of Diet in Renal Disease (MDRD) – older version of IDMS - Older MDRD – _ - New MDRD – _
6 variables 4 variables (age, sex, ethnicity, serum creatinine)
44
is a small protein (molecular weight 13,359) produced at a constant rate by all nucleated cells. It is readily filtered by the glomerulus and reabsorbed and broken down by the renal tubular cells good procedure for screening and monitoring _.
Cystatin C GFR
45
* Principle: Measurement of dew point (Temperature at which water vapor condenses to a liquid) * Standard Reference:
VAPOR PRESSURE OSMOMETERS NaCl
46
are used primarily to analyze serum and sweat microsamples for disorders not related to renal function, such as __ They are used primarily in the chemistry department.
Vapor pressure osmometers - CYSTIC FIBROSIS
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