K6: TBL Nyre og urinveje

Question 1

Which item is NOT recommended for the diagnosis of “chronic kidney disease” according to current guidelines for chronic kidney disease, evaluation, classification, and stratification, for example, Nation Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines NKF-KDOQI?

1. Kidney damage for more than 3 months.
2. Structural or functional abnormality of the kidney with or without decreased glomerular filtrations rate.
3. Pathological abnormalities or abnormalities in the composition of blood or urine.
4. Glomerular filtration rate less than 60mL/min/1.73m2 for more than 3 months with or without kidney damage.
5. Dry total body fluid volume more than 42 L measured 2 times within 1 week.

Answer 1

Which item is NOT recommended for the diagnosis of “chronic kidney disease” according to current guidelines for chronic kidney disease, evaluation, classification, and stratification, for example, Nation Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines NKF-KDOQI?

1. Kidney damage for more than 3 months.
2. Structural or functional abnormality of the kidney with or without decreased glomerular filtrations rate.
3. Pathological abnormalities or abnormalities in the composition of blood or urine.
4. Glomerular filtration rate less than 60mL/min/1.73m2 for more than 3 months with or without kidney damage.
5. Dry total body fluid volume more than 42 L measured 2 times within 1 week.

Question 2

Which diagnostic test is most suitable for initial, screening evaluation of kidney function in a 60-year-old male patient? The patient has no specific symptoms, his weight is 80 kg, height 170 cm, blood pressure 190/95 mmHg measured on both arms.

1. Plasma creatinine.
2. Determination of inulin clearance.
3. Determination of plasma erythropoietin.
4. Determination of urine neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1).
5. Abdominal nuclear magnetic resonance tomography.

Answer 2

Which diagnostic test is most suitable for initial, screening evaluation of kidney function in a 60-year-old male patient? The patient has no specific symptoms, his weight is 80 kg, height 170 cm, blood pressure 190/95 mmHg measured on both arms.

1. Plasma creatinine.
2. Determination of inulin clearance.
3. Determination of plasma erythropoietin.
4. Determination of urine neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1).
5. Abdominal nuclear magnetic resonance tomography.

Question 3

”Clearance” indicates the removal of substances from plasma. “Renal clearance” indicates the removal of a substance from plasma by the kidney at a given time.

Which answer is NOT correct?

1. The renal clearance of albumin is approximately “zero” in a healthy person.
2. The renal clearance of glucose is approximately “zero” in a healthy person
3. The renal clearance of inulin is approximately “zero” in a healthy person.
4. The renal clearance of creatinine may be reduced in patients with acute or chronic kidney disease.
5. The renal clearance of phosphate may be reduced in patients with acute or chronic kidney disease.

Answer 3

”Clearance” indicates the removal of substances from plasma. “Renal clearance” indicates the removal of a substance from plasma by the kidney at a given time.

Which answer is NOT correct?

1. The renal clearance of albumin is approximately “zero” in a healthy person.
2. The renal clearance of glucose is approximately “zero” in a healthy person
3. The renal clearance of inulin is approximately “zero” in a healthy person.
4. The renal clearance of creatinine may be reduced in patients with acute or chronic kidney disease.
5. The renal clearance of phosphate may be reduced in patients with acute or chronic kidney disease.

Question 4

The creatinine clearance apparently is associated to the plasma creatinine concentration.

In a 60-year-old male patient without any specific symptoms, weight 80 kg, height 170 cm, blood pressure 190/95 mmHg measured on both arms, one can assume one of the following:

Which answer is correct?

1. There is no clear association of plasma creatinine and creatinine clearance, i.e., plasma creatinine is only randomly associated with creatinine clearance.
2. There is a positive linear association of plasma creatinine and creatinine clearance, i.e., higher plasma creatinine is associated with higher creatinine clearance.
3. Medications can never affect the creatinine clearance and plasma creatinine concentrations.
4. Water intake can never affect the creatinine clearance and plasma creatinine concentrations
5. There is an inverse association of plasma creatinine and creatinine clearance, i.e., higher plasma creatinine may be associated with lower creatinine clearance.

Answer 4

The creatinine clearance apparently is associated to the plasma creatinine concentration.

In a 60-year-old male patient without any specific symptoms, weight 80 kg, height 170 cm, blood pressure 190/95 mmHg measured on both arms, one can assume one of the following:

Which answer is correct?

1. There is no clear association of plasma creatinine and creatinine clearance, i.e., plasma creatinine is only randomly associated with creatinine clearance.
2. There is a positive linear association of plasma creatinine and creatinine clearance, i.e., higher plasma creatinine is associated with higher creatinine clearance.
3. Medications can never affect the creatinine clearance and plasma creatinine concentrations.
4. Water intake can never affect the creatinine clearance and plasma creatinine concentrations
5. There is an inverse association of plasma creatinine and creatinine clearance, i.e., higher plasma creatinine may be associated with lower creatinine clearance.

Question 5

You calculated the creatinine clearance in a 30-year-old male patient; weight 70 kg; height 180 cm; body surface area 1.886 m²; 24-hour urine volume 1,500 mL; urine creatinine 9.7 mmol/L; plasma creatinine 120 μmol/L (1.36 mg/dL); creatinine molecular weight 113 Da. The calculation of the creatinine clearance resulted in 77 mL/Min per 1.73m².

Which answer is correct?

1. The patient certainly has end-stage renal disease.
2. The patient certainly has polycystic kidney disease.
3. The patient probably has essential hypertension.
4. Creatinine clearance cannot be calculated in patients less than 70 years
5. The patient may have a kidney disease.

Answer 5

You calculated the creatinine clearance in a 30-year-old male patient; weight 70 kg; height 180 cm; body surface area 1.886 m²; 24-hour urine volume 1,500 mL; urine creatinine 9.7 mmol/L; plasma creatinine 120 μmol/L (1.36 mg/dL); creatinine molecular weight 113 Da. The calculation of the creatinine clearance resulted in 77 mL/Min per 1.73m².

Which answer is correct?

1. The patient certainly has end-stage renal disease.
2. The patient certainly has polycystic kidney disease.
3. The patient probably has essential hypertension.
4. Creatinine clearance cannot be calculated in patients less than 70 years
5. The patient may have a kidney disease.

Question 6

Determination of glomerular filtration is very important for the evaluation of patients with acute or chronic kidney disease.

Which answer is NOT correct?

1. Glomerular filtration is the first step of urine formation.
2. The glomerular ultrafiltrate contains water and small solutes in healthy subjects and in patients with acute or chronic kidney disease.
3. The glomerular ultrafiltrate contains cells and proteins with more than 80,000 dalton in healthy subjects.
4. The glomerular ultrafiltrate is mainly produced by Starling forces.
5. The properties of the glomerular capillary wall mainly determine which substances can be observed in the glomerular ultrafiltrate.

Answer 6

Determination of glomerular filtration is very important for the evaluation of patients with acute or chronic kidney disease.

Which answer is NOT correct?

1. Glomerular filtration is the first step of urine formation.
2. The glomerular ultrafiltrate contains water and small solutes in healthy subjects and in patients with acute or chronic kidney disease.
3. The glomerular ultrafiltrate contains cells and proteins with more than 80,000 dalton in healthy subjects.
4. The glomerular ultrafiltrate is mainly produced by Starling forces.
5. The properties of the glomerular capillary wall mainly determine which substances can be observed in the glomerular ultrafiltrate.

Question 7

The glomerular filtration rate (GFR) is an estimate of the ultrafiltrate from all glomerula. The normal GFR is approximately 127mL/min/1.73m² in males, and approximately 118 mL/min/1.73m² in females. In clinical medicine the glomerular filtration rate (GFR) is often used to evaluate the kidney function.

Which answer is NOT correct?

1. GFR can be measured using the clearance of intratubular markers.
2. GFR can be measured using inulin (molecular weight 5000 Da).
3. GFR can be measured using exogenous marker which are used for scintigraphy, for example 99mTc MAG3.
4. GFR can be estimated using endogenous creatinine, a substance produced in muscles.
5. GFR can be estimated using endogenous cystatin C, a substance produced by several cells.

Answer 7

The glomerular filtration rate (GFR) is an estimate of the ultrafiltrate from all glomerula. The normal GFR is approximately 127mL/min/1.73m² in males, and approximately 118 mL/min/1.73m² in females. In clinical medicine the glomerular filtration rate (GFR) is often used to evaluate the kidney function.

Which answer is NOT correct?

1. GFR can be measured using the clearance of intratubular markers.
2. GFR can be measured using inulin (molecular weight 5000 Da).
3. GFR can be measured using exogenous marker which are used for scintigraphy, for example 99mTc MAG3.
4. GFR can be estimated using endogenous creatinine, a substance produced in muscles.
5. GFR can be estimated using endogenous cystatin C, a substance produced by several cells.

Question 8

The glomerular filtration rate (GFR) is an estimate of the ultrafiltrate from all glomerula. In general, GFR in an individual is quite constant over a short time interval. On the other hand, GFR varies considerably among different people. Several physiological and pathophysiological mechanisms and conditions may affect GFR.

Which sentence is NOT correct?

1. GFR can be affected by age in males as well as in females.
2. GFR can be affected by very high dietary protein intake.
3. GFR can be affected by hyperglycemia due to diabetes mellitus type 1 or diabetes mellitus type 2.
4. GFR can be affected by acute as well as chronic kidney diseases.
5. GFR can be affected by inulin and para-aminohippuric acid.

Answer 8

The glomerular filtration rate (GFR) is an estimate of the ultrafiltrate from all glomerula. In general, GFR in an individual is quite constant over a short time interval. On the other hand, GFR varies considerably among different people. Several physiological and pathophysiological mechanisms and conditions may affect GFR.

Which sentence is NOT correct?

1. GFR can be affected by age in males as well as in females.
2. GFR can be affected by very high dietary protein intake.
3. GFR can be affected by hyperglycemia due to diabetes mellitus type 1 or diabetes mellitus type 2.
4. GFR can be affected by acute as well as chronic kidney diseases.
5. GFR can be affected by inulin and para-aminohippuric acid.

Question 9

The glomerular filtration rate (GFR) in mL/min/1.73m² is an estimate for the stage of chronic kidney disease.

A GFR more than 90 mL/min/1.73m² indicates stage 1, a GFR between 89 and 60 mL/min/1.73m² indicates stage 2, a GFR between 59 and 30 mL/min/1.73m² indicates stage 3, a GFR between 29 and 15 mL/min/1.73m² indicates stage 4, a GFR less than 15 mL/min/1.73m² indicates stage 5.

Which answer is NOT correct?

1. Glomerulonephritis can be the cause for a reduced GFR.
2. Diabetes mellitus can be the cause for a reduced GFR.
3. Pyelonephritis can be the cause for a reduced GFR.
4. Patients with reduced GFR may be asymptomatic.
5. Patients with reduced GFR cannot be treated with medications.

Answer 9

The glomerular filtration rate (GFR) in mL/min/1.73m² is an estimate for the stage of chronic kidney disease.

A GFR more than 90 mL/min/1.73m² indicates stage 1, a GFR between 89 and 60 mL/min/1.73m² indicates stage 2, a GFR between 59 and 30 mL/min/1.73m² indicates stage 3, a GFR between 29 and 15 mL/min/1.73m² indicates stage 4, a GFR less than 15 mL/min/1.73m² indicates stage 5.

Which answer is NOT correct?

1. Glomerulonephritis can be the cause for a reduced GFR.
2. Diabetes mellitus can be the cause for a reduced GFR.
3. Pyelonephritis can be the cause for a reduced GFR.
4. Patients with reduced GFR may be asymptomatic.
5. Patients with reduced GFR cannot be treated with medications.

Question 10

Determination of urinary proteins can help to evaluate the causes of acute or chronic kidney disease.

Which answer is NOT correct?

1. Urinary protein excretion is less than 150 mg/day in healthy persons.
2. Patients with nephrotic syndrome show urinary protein excretion more than 3.5 g/day.
3. Patients with diabetes mellitus may show so-called “microalbuminuria”.
4. Patients with acute infections may show (minimal or moderate) proteinuria.
5. Patients with end-stage renal disease always show proteinuria more than 10g/day.

Answer 10

Determination of urinary proteins can help to evaluate the causes of acute or chronic kidney disease.

Which answer is NOT correct?

1. Urinary protein excretion is less than 150 mg/day in healthy persons.
2. Patients with nephrotic syndrome show urinary protein excretion more than 3.5 g/day.
3. Patients with diabetes mellitus may show so-called “microalbuminuria”.
4. Patients with acute infections may show (minimal or moderate) proteinuria.
5. Patients with end-stage renal disease always show proteinuria more than 10g/day.