ChemPath: Assessment of Renal Function 1 Flashcards

1
Q

What is glomerular filtrate

A

Ultrafiltrate of plasma without protein (bigger than albumin) and positively charged proteins

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2
Q

What is normal GFR?

A

120 mL/min (7.2 L/hour)

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3
Q

At what rate does age affect GFR?

A

Declines by 1ml/min per year

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4
Q

Define clearance.

A

The volume of plasma that can be completely cleared of a marker substance per unit time.

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5
Q

What are the three criteria for a marker to be used to measure GFR?

A
  • Marker is not bound to serum proteins
  • Freely filtered by the glomerulus
  • Not secreted or absorbed by tubular cells
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6
Q

State the equation that links clearance with urine and plasma concentration.

A

C = (U x V)/P

U = urinary concentration
V = urine flow rate
P = plasma concentration

NOTE: Only valid for steady state

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7
Q

What is inulin and what is its main purpose?

A
  • Neutral, freely filtered fructose polymer that is technically the perfect marker
  • However, measurement of inulin concentrations is difficult and it requires a steady-state infusion
  • So, it is only used as a research tool
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8
Q

Name three single injection plasma clearance markers/

A
  • 51Cr-EDTA
  • 99Tc-DTPA
  • Iohexol
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9
Q

Describe how single injection plasma clearance markers are used.

A

The injection is administered followed by blood samples taken to look for a progressive reduction in radioactivity.

NOTE: this is only used under specific circumstances (e.g. when accurate estimation of GFR is necessary before chemotherapy)

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10
Q

Describe the key features of plasma urea.

A
  • By-product of protein metabolism
  • Variable absorption (30-60%) by tubular cells
  • Dependent on hydration, nutritional state, hepatic function and GI bleeding
  • Limited clinical value
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11
Q

Where does serum creatinine come from?

A

Muscle cells

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12
Q

Which features of serum creatinine make it a useful marker of GFR?

A
  • Freely filtered
  • Produced at a constant rate

NOTE: it is actively secreted into the urine by tubular cells

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13
Q

List some factors that affect the rate of generation of creatinine.

A
  • Muscularity
  • Age
  • Sex
  • Ethinicity
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14
Q

Name and briefly describe three equations that are used to estimate creatinine clearance or GFR.

A
  • Cockcroft-Gault - estimates creatinine clearance by taking into account weight, age and sex (may overestimate when GFR <30ml/min)
  • MDRD - estimates GFR from creatinine clearance and takes into account age, sex, serum creatinine and ethnicity (may underestimate in overweight and young people)
  • CKD-EPI - improvement of MDRD and currently recommended
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15
Q

Name an alternative endogenous marker of GFR.

A

Cystatin C

NOTE: it is constitutively produced by all nucleated cells, is generated at a constant rate and freely filtered. It is almost completely reabsorbed and catabolised by tubular cells.

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16
Q

What is urine protein: creatinine ratio?

A
  • Quantitative assessment of proteinuria
  • Measurement of creatinine corrects for urine concentration
17
Q

How is proteinuria estimated?

A
  • Spot urine protein: creatinine ratio (PCR)

NOTE: this has superseded 24-hour urine collection

18
Q

Aside from blood, what else can cause a urine dipstick to be positive for blood?

A

Myoglobinuria (from rhabdomyolysis)

19
Q

What is specific gravity?

A

A measure of urine concentration

20
Q

What can urine microscopy be used to look for?

A
  • Crystals
  • RBCs
  • WBCs
  • Casts
  • Bacteria
21
Q

What are casts in urine

A

Cells in proteinaceous matrix

22
Q

How can ethylene glycol poisoning cause AKI?

A

It gets converted to oxalic acid which precipitates with calcium to form calcium oxalate stones