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Lab Med 2.0 > Renal > Flashcards

Renal Flashcards

1
Q

UREA NITROGEN

A

-Major nitrogen-containing metabolic product of protein catabolism
-Primarily synthesized by hepatocytes
-Freely filtered by glomeruli, reabsorbed (amount varies) by tubules

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2
Q

Urea is synthesized mostly in the ___ as a by-product of the deamination of amino acids

A

Liver
*Urea is filtered by the glomeruli

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3
Q

The urea nitrogen level is greatly influenced by diet

A
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4
Q

BUN is not a sensitive indicator of renal dysfunction because ____

A

renal function must be reduced by more than 50% to result in a rise of BUN

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5
Q

CREATININE

A

-Derived from muscle creatine (1-2% of total muscle mass per day)
-Amount excreted daily is fairly constant and independent of urinary volume
-Average men excrete 1.5 g/d into the urine; women less; athletes more
-Patients with hepatic disease, muscular dystrophy, paraplegia and poliomyelitis may excrete less creatinine due to decreased production (PMPL = less)

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6
Q

Reference Range for serum creatinine

A

M: 0.67 - 1.17 mg/dL

F: 0.51 – 0.95 mg/dL

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7
Q

CR CL EQUATION

A

Reference Range:
male = 117 +/- 20 mL/min; female = 95 +/- 20 mL/min

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8
Q

Cockroft and Gault Equation

A
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9
Q

Urine osmolality is a measure of ___

A

the concentrating power of the kidney
*urine specific gravity is usually directly proportional to osmolality

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10
Q

Recurring values of _____ indicate isosthenuria (fixed specific gravity)

A

1.010 (1.008 - 1.012)

*this finding suggests loss of tubular concentrating and diluting ability and is frequently a prelude to anuria

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11
Q

Normal BUN/CR Ratio

A

~12-20

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12
Q

BUN production is dependent on available protein and liver function. In addition, the ratio is affected by the specificity of the creatinine method.

A

-increased protein intake increases the ratio
-decreased liver function lowers the ratio
-less specific methods give higher creatinine values

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13
Q

INCREASED BUN/CR RATIO =

A

-blood in GI tract
-muscle wasting disease
-severe tissue trauma
-dehydration, decreased cardiac output, or shock (= prerenal azotemia)
-renal disease (early acute glomerulonephritis, malignant nephrosclerosis, or postrenal obstruction)

MD GTR

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14
Q

DECREASED BUN/CR RATIO

A

-chronic glomerulonephritis with protein deficiency
-severe hepatic insufficiency
-starvation
-decreased urea reabsorption (overhydration and rapid hydration)
-hemodialysis
-acute tubular necrosis

im GUSHHN

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15
Q

Prerenal Azotemia

A

is caused by a decrease in renal blood flow, e.g. due to decreased cardiac output
BUN HIGH, CREAT NORMAL

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16
Q

Renal Azotemia

A

results from damage to the kidney

17
Q

Postrenal Azotemia

A

is due to obstruction of urine flow, e.g. by prostatic hypertrophy or tumor

18
Q

Selectivity Ratio Equation

A

IgG cl / Alb cl
-High <0.15 (minimal change)
-Poor >0.30

19
Q

ACUTE GLOMERULONEPHRITIS LABS

A

-Elevated BUN, Cr (>1.17)
-Elevated uric acid (7+, 5.7+)
-BUN/CR > 20
-Decreased CrCl/GFR
-High K (5.1+)
-Acidosis (under 7.35)
-Hematuria (red smoky urine)
-Red cell casts (blood casts)
-Proteinuria

20
Q

CHRONIC GLOMERULONEPHRITIS LABS

A

-Elevated BUN, Cr, uric acid
-Low Na < 136, Ca <8.5
-High K > 5.1, Phos > 4.5
-BUN/CR < 10
-Elevated Alk Phos > 129
-Proteinuria
-Isosthenuria (1.008-1.012 fixed sp gr)
-Cylindruria (tubular casts in urine)
-Anemia

*only one that affects Na/Ca, alk phos, has isosthenuria, LOW BUN/CR ratio

21
Q

NEPHROSIS (NEPHROTIC SYNDROME) LABS

A

-Proteinuria > 3.5 g/day
-Hypoalbuminemia (1-2.5, < 3.2)
-Hyperlipidemia (increase in TG > 170, chol > 200, lipo)
-Edema generally present
-Excretion of red and white cells is common
-BUN/CR ~12 (normal), GFR normal

*NORMAL BUN/CR compared to others, only one that affects lipid panel, has edema, and hypoalbumin

PATCE

22
Q

ACUTE PYELONEPHRITIS LABS

A

-Pyuria (pus in urine)
-Microhematuria
-White cell casts
-Bacteriuria
-Leukocytosis

*only one with pus in urine and bacteriuria

23
Q

Hyaline Casts

A

all renal diseases associated with benign essential hypertension, and nephrotic syndrome

24
Q

WBC Casts

A

associated with diseases with leukocytic exudation and interstitial inflammation.

example: pyelonephritis

25
Q

Red Cell Casts

A

-acute glomerulonephritis
-lupus nephritis
-goodpasture’s syndrome
-subacute bacterial endocarditis (SBE)

GASL

26
Q

Renal Epithelial Casts

A

associated with exposure to nephrotoxic agents and exposure to some viruses

27
Q

Waxy Casts

A

severe chronic renal disease and amyloidosis

28
Q

Fatty Casts

A

nephrotic syndrome, diabetes mellitus, and damaged renal tubular epithelial cells

Lab Med 2.0 (20 decks)

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