Clinical Lab Week 2 - Renal & Ua

Front 1

How much urine is normally excreted daily?

Back 1

2 quarts

Front 2

The kidney has approximately ___ nephrons.

Back 2

1.2 million

Front 3

If you find red cell casts, you should suspect ____,

Back 3

Glomerular nephritis

Front 4

If you find white cell casts, you should suspect ___

Back 4

pyelonephritis

Front 5

The kidney activates ____, and makes ____

Back 5

1. Vitamin D
2. EPO and Renin

Front 6

What three categories of drugs cause 90% of drug-induced nephrotoxicity?

Back 6

1. aminoglycosides
2. contrast dye
3. NSAIDs

Front 7

What is azotemia?

Back 7

Nitrogenous wastes in the blood.

Front 8

What is a signfiicant cause of pre-renal azotemia?

Back 8

dehydration

Front 9

Describe the three types of azotemia.

Back 9

1. pre-renal: decreased blood flow to kidney.
2. renal: kidney not functioning well
3. post-renal urine is obstructed

Front 10

____ is a toxic condition resulting from kidney disease and lack of secretion of toxins. It involves urea in the blood.

Back 10

Uremia

Front 11

Describe the effects of renal failure.

Back 11

1. Na and H20 retention (leads to HTN & CHF)
2. K retention (arrhythmias)
3. dec. vitamin D and retained PO4 (hypocalcemia resulting in hyperparathyroid)
4. decreased EPO (anemia)

Front 12

____ is renal failure >3months. Name some causes.

Back 12

Chronic RF

Loss of functioning nephrons (DM2, HTN, Chronic UTI, renal stones, etc)

Front 13

Name the important tests that can identify problems with the renal system.

Back 13

- 24h creatinine clearance
- GFR
- UA/ microalbumin/ creatinine-protein ratio
- BUN
- ABG
- Urine pH
- H &H
- Vit D

Front 14

Serum Creatinine is ___ related to GFR.

Back 14

Inversely

Front 15

If GFR decreases by 50%, serum creatinine will _____

Back 15

double

Front 16

Creatinine clearance is measured in ____

Back 16

ml/min

Front 17

Creatinine clearance formula:

Back 17

(urinary creat x 24h volume)/ (Serum creat x 1440 (min), kg x 100)

Front 18

Why is creatinine clearance important?

Back 18

Predict renal function

Front 19

What is the formula for creatinine clearance?

Back 19

(urine creat. x 24h vol)/ (plasma creat x 1440)

Front 20

What is the "normal" reference range for creatinine clearance in males?
females?

Back 20

Men: 94-110 mL/min
Women: 72-110 mL/min

Front 21

How can you estimate GFR based on plasma Cr measurement?

Back 21

GFR = 186.3 x serum cr. x age

(x 0.742 if female)
(x 1.21 if african american)

Front 22

How can you calculate CrCl if you don't have a 24h urine?

Back 22

CrCl =
[(140-age) x IBW] /
[PlasmaCr x72}

(*.85 if female)
(use AjBW if obese, ActBW if underweight)

Front 23

Describe the stages of chronic kidney disease.

Back 23

- Stage 1: GFR >90%, asymptomatic
- Stage 2: GFR 60-89%, feels well, no symptoms
- Stage 3: GFR 30-59%, may be co-managed with nephrology if problematic
- Stage 4: GFR 15-29%, requires nephrology for close follow-up, focus on disease stabilization and transplant optons
- Stage 5: GFR <15%, if not currently managed by neph., needs hospitalization and hemodialysis

Front 24

When you are measuring BUN, what are you measuring>

Back 24

The nitrogen contained in the urea in the blood.

Front 25

Why is urea no longer the measurement of GFR?

Back 25

Underestimates it pretty bad

Front 26

Why is BUN important?

Back 26

tell us hydration state of kidneys, protein intake, and if there's blood in the GI tract (if blood metabolized in G, releases urea into the circulation)

Front 27

If the BUN:Cr is greater than 20:1, you should suspect what?

Back 27

pre-renal azotemia

Front 28

When the BUN and Cr are both elevated, then what?

Back 28

look at the BUN: Cr ratio

Front 29

If the BUN:Cr ratio is around 10:1, think ____

Back 29

renal azotemia (or normal)

Front 30

If the BUN: Cr is about 20:1 with outflow obstruction, think ___

Back 30

post-renal azotemia

Front 31

Proteinuria suggests ____

Back 31

something wrong with the kidney (infection, diet, glomerular disease, tubular disease, Bence-Jones antibodies)

Front 32

How much protein in the urine is considered significant? Severe? Normal?

Back 32

a) significant = 1g/dL
b) catastrophic = 3.5g/dL
c) normal = <8mg/dL

Front 33

>2g/dL of protein in the urine is a sign of ___

Back 33

glomerular damage (necrosis of nephrons)

Front 34

___ are lightweight proteins produced by conditions like multiple myeloma, elevated calcium.

Back 34

bence-jones proteins

Front 35

How can you assess renal failure of a diabetic pt?

Back 35

Good sign is albumin (protein) spilled in urine. Should check them annulaly for microalbuminuria.

Front 36

A microalbuminuria only makes sense if the urine dip UA is _____

Back 36

Negative (if it's positive, of course there's albumin there! need 24h urine to quantify)