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AUBF > M1: U2 Renal Physiology > Flashcards

M1: U2 Renal Physiology Flashcards

1
Q

composes 60-90 percent of nitrogenous material in urien

A

urea

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2
Q

nitrogenous substance from muscle tissue

A

creatinine

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3
Q

from nucleic acid catabolism, forming renal calculi

A

uric acid

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4
Q

high in high vegetable diet

A

hippuric acid

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5
Q

principal salt in urine

A

NaCl

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6
Q

portion of the plasma filtered by the glomeruli

A

renal blood flow/ renal plasma flow

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7
Q

ability of kidney to remove excess solutes, water and waste from plasma, measured as volume of plasma per unit time

A

renal clearance

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8
Q

characteristics of substances that can be used for clearance tests

A
  1. neither reabsorbed nor secreted
  2. excreted solely through glomerular filtration
  3. stable in urine for 24 hrs
  4. constant plasma concentration
  5. readily available in body
  6. has tests for plasma and urine
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9
Q

earliest test for GFR

A

urea clearance

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10
Q

why is urea not the substance of choice

A

40-60 % reabsorbed
affected by protein intake
affected by urine flow rate

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11
Q

the slower the urine flow rate is, the ____ urea is reabsorbed

A

more

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12
Q

routine screening for GFR test

A

creatinine clearance

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13
Q

disadvantage of creatinine clearance

A
  1. depends on muscle mass and metabolism
  2. 7-10% secreted by PCT
  3. secretion blocked by cimetidine, cephalosporin, salicylates, trimethoprim
  4. Jaffe method for plasma is non specific
  5. affected by bacterial decomposition
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14
Q

specimen for creatinine clearance

A

24 hr urine
plasma collected midway through urine collection

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15
Q

creatinine clearance formula

A

urine/plasma creatinine × urine volume/1440 mins × 1.73/BSA

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16
Q

body surface area formula

A

log BSA = (0.425 × logW) + (0.725 × logH) - 2.144

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17
Q

Refenrece values for creatinine clearance

A

Males: 107- 139 ml/min
Females: 87 - 107 ml/min

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18
Q

Other tests for glomerular filtration rate

A

beta 2 microglobulin
cystatine
inulin
radionucleotides

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19
Q

single polypeptide chain that is an HLA component of all nucleated ces

A

beta 2 microglobulin

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20
Q

renal processing of B2 microglobulin

A

constant concentration in all body fluids – all passes through GFB – all are reabsorbed

therefore if increased in plasma – decreased GFR

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21
Q

potential marker for long term monitoring of renal function

A

cystatin

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22
Q

renal processing or cystatin

A

passes through GFB > reabsorbed > catabolized > does not return to blood

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23
Q

cystatine advantage and disadvantage

A

not affected by age or gender
higher costs and intraindividual variability

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24
Q

extremely stable exogenous polymer of fructose that is the reference method for renal clearance test

A

inulin

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25
Q

can be used to visualize glomerular filtration

A

radionucleotides

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26
Q

test for renal concentrating ability

A

tubular reabsorption test

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27
Q

Two types of tests for tubular reabsorption

A

conventional method
modern methods

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28
Q

2 conventional methods for tubular reabsorption

A

Fishberg concentration test
Mosenthal concentration test

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29
Q

test that makes use of fluid deprivation

A

Fishberg concentration test

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30
Q

how many hours is the fluid restriction for the Fishberg concentration test

A

at least 24 hrs

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31
Q

normal patients have a urine specific gravity of ____ after 24 hr fluid deprivation

A

> 1.025

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32
Q

conventional method for tubular reabsorption that has no fluid and diet restriction

A

Mosenthal concentration test

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33
Q

What urine samples are collected for Mosenthal concentration test

A

Two 12 hr urine samples in the day and in the night

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34
Q

The night time urine specific gravity of a healthy person in the Mosenthal concentration test should be ____

A

> 1.018

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35
Q

Modern methods of tubular reabsorption test

A
  1. osmolality
  2. specific gravity
  3. free water clearance
36
Q

measurement of the number of solute particles per kilogram of solvent

A

osmolality

37
Q

osmolality of urine is measured through ____

A

colligative properties

38
Q

4 colligative properties used to measure osmolality of urine

A
  1. freezing point
  2. vapor pressure
  3. boiling point
  4. osmotic pressure
39
Q

two colligative properties that are inversely proportional to the osmolality of a sample

A
  1. freezing point
  2. vapor pressure
40
Q

two colligative properties that are directly proportional to osmolality of sample

A

boiling point
osmotic pressure

41
Q

temperature sensitive probe using heat of fusion to determine freezing point

A

thermistor

42
Q

determines heat of condensation for vapor pressure measurement

A

thermocouple

43
Q

principal solute for urine osmolality

A

urea

44
Q

principal solute for blood osmolality

A

NaCl

45
Q

osmolality of initial ultrafiltrate

A

300 mosm/kg

46
Q

normal serum osmolality

A

275-300 mosm/kg

47
Q

normal random urine osmolality

A

50-1400 mosm/kg

48
Q

normal urine to serum osmolality ratio

A

1:1

49
Q

urine to serum osmolality ratio during controlled fluid intake

A

2:1

50
Q

1 mol of non ionizing substance lowers 1 kg of H20 freezing point by ____

A

1.86

51
Q

diabetes with higher osmolality

A

diabetes mellitus

52
Q

diabetes with lower osmolality

A

diabetes insipidus

53
Q

initial osmolarity of patient with polyuria is <200 mmol/kg

A

water diuresis

54
Q

initial osmolarity of patient with polyuria is ~300 mmol/kg

A

solute diuresis

55
Q

test after determining that polyuria is caused by water diuresis

A

fluid deprivation test

56
Q

tests after determining cause of polyuria as solute diuresis

A

plasma glucose and urea

57
Q

> 800 mmol/kg after fluid deprivation test

A

caused by excessive fluid intake

58
Q

< 800 mmol/kg after fluid deprivation test

A

additional 2 hrs of fluid deprivation

59
Q

urine still < 800 mmol/kg after additional 2 hrs deprivation

A

ADH challenge (synthetic ADH)

60
Q

normal response/ hyper osmolal after ADH challenge

A

neurogenic diabetes insipidus

61
Q

no response/ hypoosmolal after ADH challenge

A

nephrogenic diabetes insipidus

62
Q

high plasma glucose causing solute diuresis

A

diabetes mellitus

63
Q

normal plasma glucose in solute diuresis

A

Na or mannitol diuresis

64
Q

high urea in solute diuresis

A

hypercatabolism or renal disease

65
Q

typical fluid deprivation protocol

A

6 pm to 8 am
additional 2 hrs - 8 am to 10 am

66
Q

expression of density of urine relative to density of water

A

specific gravity

67
Q

based on number and mass of solutes in sample

A

specific gravity

68
Q

osmolality or specific gravity:
affected by number of solutes only

A

osmolality

69
Q

osmolality or specific gravity:
affected by number and mass of solutes

A

specific gravity

70
Q

osmolality or specific gravity:
each particle contributes equally

A

osmolality

71
Q

osmolality or specific gravity:
some solutes contribute more due to mass

A

specific gravity

72
Q

osmolality or specific gravity:
influenced by glucose and protein

A

specific gravity

73
Q

osmolality or specific gravity:
not affected by glucose and protein

A

osmolality

74
Q

range of physiologically possible specific gravity values

A

1.001 to 1.040

75
Q

two possible reasons why SPG can be greater than 1.040

A

mannitol infusion
radiographic contrast media

76
Q

unchanging specific gravity

A

isosthenuria

77
Q

maximum spg detected by rgt strip

A

1.030

78
Q

max spg detected by refractometer

A

1.050

79
Q

assess how kidney responds to body hydration status

A

free water clearance

80
Q

deyermine quantity of water NOT REABSORBED by the kidney

A

free water clearance

81
Q

volume of plasma that is cleared of free water per minutes

A

free water clearance

82
Q

free water clearance formula

A

urine volume - osmolar clearance

83
Q

volume of water that must be cleared to produce urine with the same osmolality as plasma

A

osmolar clearance

84
Q

osmolar clearance formula

A

OC = (urine osmolality/ plasma osmolality) urine volume

85
Q

when total urine volume = clearance volume

A

isoosmotic urine (no renal concentration or dilution)

86
Q

urine osmolality is less than serum osmolality
total urine volume cleared is greated than osmolar clearance

A

hypoosmotic urine (excess diuresis)
positive number

87
Q

urine osmolality is greater than serum osmolality, total urine volume is less rhan osmolar clearance

A

hyperosmolal urine (lower diuresis)
negative number

AUBF (12 decks)

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