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30 Cards in this Set
- Front
- Back
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What is the breakdown product of creatine & phosphocreatine in muscle
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Creatinine
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Serum concentration of creatinine is dependent on its production as well as its ____________
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Elimination
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Normal range of Creatinine in the body is
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~ 0.7-1.4 mg/dl
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Creatinine is frequently used to estimate _______
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GFR
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Why does eating lots of protein increase your BUN?
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Protein broken down to amino acids which is broken into ammonia which is converted to urea.
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Where in the body is ammonia converted in to urea?
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Ammonia is metabolized in the Liver to urea.
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In the dipstick urine test which lab value is most important to pharmacists monitoring kidney function?
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Protein
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What is a normal BUN value?
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10 to 15 : 1
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What does a BUN/SCr Ratio>20:1 indicate?
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possible pre-renal disease (decreased effective circulating volume)
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An increased BUN/SCr ratio > 20:1 implies an increased reabsorption of what?
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Ratio increases in pre-renal disease due to an increase in passive reabsorption of urea with enhanced reabsorption of Na+ & H2O in the proximal tubule
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Name 2 conditions that can inhibit expected rise in the BUN/SCr ratio
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Liver disease or decreased protein intake
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Elevations in protein in the urine indicates what?
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Kidney damage
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What is a normal value of protein in the urine?
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Normal Excretion = up to ~ 150 mg/day protein
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What is a normal albumin value in the urine?
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30mg/day albumin
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What does 1+ mean on a dipstick protein analysis?
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30 mg/dL (200-500 mg/day) This is well above normal of up to 150mg/day
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What does Trace mean on a dipstick protein analysis?
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10-20 mg/dL (150-200 mg/day)
Remember normal is up to 150mg/day |
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On an albumin specific dipstick a value of (+) would mean what?
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>2 mg/dL (>30 mg/day)
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_________________ = early indicator of subclinical renal damage
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microalbuminurea
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When is a spot urine sample taken?
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1st morning specimen after waking
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A spot ratio (mg albumin/g Creatinine) <30 means what?
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Normal Albuminuria*
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Sally just ran 20 miles and comes exhausted and sweating into your clinic. you perform a spot urine test and her albumin level is 50mg albumin/g creatine.
What category would you place Sally's albumin? |
No category. Sally just ran an marathon and maybe dehydrated. Tell herh to come back in 3 days and retest again.
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Jose' s albumin level is spot tested. The value that comes back is 28. What is his albumin level classefied as?
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Normal Albumin.
Normal is < 30 mg albumin/g creatinine |
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Jennifer has a routine spot test performed on her albumin. The level comes back as 228. How would you assess this?
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Jennifer's level is indicative of microalbuminurea but 2 out of 3 posistive tests are needed to diagnose the condition.
Microalbuminurea = 30 to 299 |
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Raphael, who is recovering from a strep infection, is given a spot albumin test. His level comes back as 275. How would you assess this?
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Raphael needs to be retested in a week when he is feeling better. Recent infection can interfere with the spot albumin test.
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Raphael returns to the clinic a week after his infection has ended. His spot urine test is 306. How would you assess this?
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A spot albumin level of 306 is indicative of macroalbuminuria but 2 of 3 tests must be positive to confirm the diagnosis.
Macroalbuminuria > 300mg/g creatinine |
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Raphael's urine sediment shows rbc cells, wbc cells and rbc casts. What does this analysis indicate?
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Glomerular nephritis (infection of the glomerulus).
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Kareem has a sodium level of 45 meq/L and a urine osmolality of 276. What does this indicate?
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Acute Tubular Necrosis
Sodium > 40 meq/L Urine Osmolality < 350 - 450 (less concentrating ability of the kidneys). |
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Will a patient with ATN have higher or lower fractional excretion of sodium.
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Higher. Lost concentrating ability. Damage to tubules can't reabsorb sodium, so more is secreted than normal.
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Raphael is taking smz/tmp for his infection and his Scr comes back as 2.0. What assessment would you make?
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No assessment can be made. Raphael is using Smz/TMP. The trimethoprim can competitively inhibit his tubular secretion of creatinine leading to increased creatinine levels. His Scr should be taken about a week after he stops using the SMZ/TMP.
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Will Raphael's Scr be higher in the morning or the evening or does time of day matter?
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Peaks in PM. Be consistant in the time of day you measure a patient's Scr if you are doing continuous monitoring.
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