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27 Cards in this Set
- Front
- Back
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What is the normal GFR?
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100ml/min
THis is about 180L/day |
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What are some ways of estimating GFR?
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Serum creatinine
Creatinine clearance eGFR Nuclear Med study |
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What do you have to be careful of if estimating GFR based on urine creatinine levels
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You overestimate because some creatinine is secreted by the kidney.
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What are some normal serum creatinine levels?
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Males: 53-113
Females: 37-96 Kids: 30-50 |
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What are some things that can raise creatinine?
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decreased GFR
Muscle mass Weight lifting High protein diet Creatinine supplements |
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What can decrease creatinine?
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Good GFR
decreased muscle mass Advanced age |
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We can estimate GFR using creatinine clearance:
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24 hour collection (overestimate)
OR Cockroft Gault |
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Describe the Cocroft gault
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creatinie clearance is 140-age times weight, divided by serum creatinine for females. multiply by 1.2 for males.
multiply by 1.2 if male |
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When do we use nuclear medicine studies for GFR?
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Living donor work-up
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When could we see fatty casts?
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Nephrotic syndreom
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When could we see red cell casts?
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Nephritic syndrome
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When could we see muddy brown casts?
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Tubular origin AKI
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Is a urine dipstic specific for RBCs?
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no, it could be myoglobin, myocytes, ...
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What do we need to diagnose hematuria?
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We need 2/3 samples to be positive
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If we get our 2/3 samples, how do we then work-up hematuria?
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Rule out extrarenal causes (Hx, US, physical)
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If we have ruled out extrarenal causes, where do we go?
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It could be glomerular or not glomerular. Thigns that would point us toward glomerular would be:
Masssive proteinuria RBCs RBC casts |
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What should you do if you suspect a glomerular cause?
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Get a biopsy + refer
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What is a normal urine protein level?
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150mg/day
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When would we consider proteinuria to be pathologic?
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>300mg/day
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What do we need to confirm proteinuria?
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2/3 samples
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Once we have confirmed protienuria, what do we have to do?
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We need to quantify it using a 24 hour urine collection. THIS IS GOLD STANDARD!
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Wait, what do we do again when we confirm protineuria?
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GET A 24hour COLLECTION! We should also check urine sediment (send a urinalysis)
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Given proteinuria, when should we refer to nephrology?
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Abnormal renal tests
Proeinturia of +30g/day Age >30yrs |
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What are some causes of benign proteinuria?
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Functional: viruses, colds, exerciese, stress, fever
Orthostatic: only during day |
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What are some causes of pathologic proteinuria?
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Glomerular: disruption of glomerular basement membrane see nephrotic range proteinuria.
Tubular: Occurs when tubule can't absorb small molecular weight proteins, like in tubulointersitital disease. we see like 300-2000mg/day Overflow: Too many small MW protiens like in Multiple Myeloma |
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Will serum creatinie give us an overestimate of GFR?
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YES because some is excreted by the tubule
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What would dysmorphic red cells point toward?
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GLomerular origin
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