Flashcards in Renal - Evaluation of Renal Disease Deck (121)
What are some historical indications for renal assessment?
Polyuria, polydipsia, known or suspected exposure to nephrotoxins, familial history of kidney disease
Other: history of hypoalbuminemia or vascular thrombus
What are some PE indications for renal assessment?
Abnormal renal size/shape, mucosal ulceration, +/- anemia
What are some preventative indications for renal assessment?
Pre-anesthetic bloodwork, pre-nephrectomy, and to help choose medications (aminoglycosides, amphotericin B, and NSAIDs)
When we talk about renal function, what are we really talking about?
Glomerular filtration rate (GFR)
GFR determines the rate of what?
Urine production, electrolyte excretion, and elimination of metabolic waste products
What is azotemia?
Abnormal (excess) accumulation of nitrogen waste products
When does azotemia occur?
With >75% decrease of GFR
What is uremia?
Clinical manifestations associated with azotemia
What are some clinical manifestations associated with azotemia?
GI ulcers, nausea, and anorexia
True or False: All uremic patients are azotemic, all azotemic patients are not uremic.
What is pre-renal azotemia?
hypoperfusion of the kidneys due to dehydration, acute blood loss, and/or congestive heart failure
What is renal azotemia?
intrinsic disease of the nephrons due to CKD, nephrotoxic drugsm renal infecitons, renal neoplasia, congenital malformations, and/or glomerulonephritis
What is post-renal azotemia?
Obstruction of urine flow distal to the kidney due to urolithiasis, neoplasia, and/or trauma
How is GFR evaluated?
Serum markers, clearance tests, and renal scintigraphy
What are the serum markers of GFR?
Blood urea nitrogen (BUN), creatinine, and symmetric dimethylarginine (SDMA)
Serum markers of GFR are ideal characteristics of markers because they are normally what?
Freely filtered by the glomerulus, undergo no tubular reabsorption, and no tubular secretion
What is urea a product of? Where is it made? Where is it filtered? Where is it partially reabsorbed?
Urea is a product of protein metabolism in the liver. It is filtered through the glomeruli and partially reabsorbed in the renal tubules
What extra-renal influences can increase urea concentrations?
High protein diet, GI bleeding, and dehydration
What extra-renal influences can decrease urea concentration?
malnutrition, low protein diet, severe burns, and hepatic dysfunction
What is creatinine a product of?
Where is creatinine filtered? Reabsorbed?
It is freely filtered by the glomeruli and negligible tubular reabsorption/secretion
Is BUN or creatinine a more accurate GFR marker?
What extra-renal influence can cause a decrease in creatinine?
What type of diet can increase creatinine?
high protein diet
What breeds have increased creatinine?
Greyhounds and Birmans
What is symmetric dimethylarginine (SDMA) a product of?
How is SDMA filtered, reabsorbed, and secreted in the kidneys?
It is freely filtered by the kidneys with no tubular reabsorption/secretion
Why is SDMA a good serum marker of GFR function?
Because it allows for earlier detection of renal dysfunction than traditional markers - it is increased with as little as 25-40% loss of GFR
True or False: SDMA is influenced by muscle mass.