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Chemistry > Renal Function > Flashcards

Renal Function Flashcards

1
Q

Function of Kidney

A

Concentration of Urine
Reabsorption of Nutrients
Acid base and electrolyte balance
Excretion of waste
Blood pressure
Water reabsorption and concentration

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2
Q

Hormonal Regulation of Body Water

A

Anti-Diuretic Hormone (Vasopressin)
Regulates water reabsorption

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3
Q

Vasopressin Regulation

A

Increase ADH, increases water absorption
Decrease ADH, decreases water reabsorption

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4
Q

Disease state with Increase ADH

A

Inappropriate ADH secretion

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5
Q

Disease state with Decrease ADH

A

Diabetes insipidus

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6
Q

Osmolality Defintion

A

Concentration of solutes dissolved in a body’s water
Expressed in milliosmoles (mOsm)/kilogram of water

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7
Q

Osmolality Measure

A

Osmotic pressure across body membranes
Measure of the osmoles of solute or dissolved particles per kg

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8
Q

Osmometry

A

Term used for the analysis osmolality

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9
Q

Formula 1 for Osmolality

A

2.0(Na+) + (glucose/20) + (BUN/3)

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10
Q

Formula 2 for Osmolality

A

1.86(Na+) + (glucose/18) + (BUN/2.8) + 9

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11
Q

Osmolar Gap

A

Difference between the calculated and measures osmolalities

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12
Q

Urine Osmolarity 24 hr Collection

A

300-900 mOsm/kg

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13
Q

Urine Osmolarity Random

A

50-1200 mOsm/kg

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14
Q

Urine to Serum Ratio

A

1.0-3.0

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15
Q

Serum Osmolarity

A

275-295 mOsm/kg

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16
Q

Osmolar Gap

A

5-10 mOsm/kg

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17
Q

Principles of ABG Measurement

A

Freezing Point Decrease
Vapor Pressure Decrease
Boiling Point Increase
Osmotic Pressure Increase

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18
Q

Freezing Point Osmometry

A

Determined super-cooling the sample below the freezing point
- Initiated by physical shock or very cold stir wire
- Water-ice mixture produced which remains at freezing point plateau long enough for temperature to be measured
- Uses a 2 point calibration against salt solutions

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19
Q

Vapor Pressure Osmometry

A

Changes in concentration of solutes are accompanied by linear and proportional chances in properties
- Vapor pressure is a force exerted by the gaseous phase of a two phase system
- The pressure of the vapor that is formed above its liquid is called the vapor pressure

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20
Q

Common Increases to Osmolar Gap

A

> 10 mOsm/kg
Mannitol
Glycine
Methanol
Ethylene glycol
Higher the gap, the worse the prognosis

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21
Q

Basic Body Fluid Compartments

A

Two basic compartments
Intracellular Fluid Compartment (ICF)
Extracelluar Fluid Compartment (ECF)

22
Q

Water Osmolality

A

Moves passively across semi-permeable membranes
Lytes and other molecules do not
Osmotic Pressure

23
Q

Thirst Mechanism

A

Thirst Center in Hypothalamus
Osmoreceptors stimulated by increase in ionic concentration

24
Q

Renal Clearance

A

Determined by Glomerular Filtration Rate (GFR)
The mL/minute blood filtered by the kidney

25
Q

Creatinine Clearance Calculation

A

(U x V)/P x 1.73/A
U = Urine Creatinine
V = Volume/min
P = Plasma Creatinine
A = Area of patient - obtained via chart

26
Q

Non-Protein Nitrogen Compounds

A

NPN
Nitrogen containing compounds that are not proteins
BUN, Uric Acid, Creatinine/Creatine, Ammonia

27
Q

Renal Disease Marker

A

Creatinine

28
Q

Muscular Disorders Marker

A

Creatine

29
Q

Jaffe Reaction

A

Picric Acid reacts with NaOH
Reaction creates Alkaline-Picrate Creatinine Complex
Yellow-Orange Color inidicator

30
Q

BUN

A

Blood Urea Nitrogen

31
Q

Urea

A

Urine compound of Nitrogen
Secretion of Ammonia to remove excess Nitrogen

32
Q

Azotemia

A

Increase levels of BUN in plasma

33
Q

Uremia

A

Increase BUN with renal failure

34
Q

BUN Increases Means

A

Low renal profusion
Renal Disease
High Protein Intake
Dehydration

35
Q

BUN Decrease Means

A

Low Protein Intake
Severe Liver Disease
Severe Vomiting or Diarrhea

36
Q

Enzymatic detection of BUN

A

Conversion of urea to ammonia by enzyme urease
BUN — urease reaction to create ammonia + CO2

37
Q

Berthelot Reaction

A

Ammonium ion is reacted with phenol and hypochlorite in an alkaline medium to form indophenol
Nitroprusside is used to catalyze the reaction - blue color

38
Q

Enzymatic Assay

A

Ammonia generated from urease
Urease reacts with oxo-glutarate in presence of glutamate dehydrogenase and NAD(P)H

39
Q

Chemical Method

A

Urea is reacted directly with diacetyl to produce diazine
- Not as commonly used as enzymatic methods

40
Q

BUN/Creatinine ratio in healthy individuals

A

10:1 to 20:1 ratio

41
Q

Pre-renal azotemia ratio

A

Increase ratio
20:1 to 30:1

42
Q

Post-renal azotemia ratio

A

Increase ratio of&raquo_space;>20:1 with high creatinine level

43
Q

Low BUN coniditions

A

Decrease ratio <10:1
Associated with low urea production as in liver disease or malnutrition

44
Q

Uric Acid Product from

A

Purine Metabolism

45
Q

Increased Uric Acid

A

Gout - abnormal deposition or uric acid crystals
Renal Insufficiency - not filtered
UA can also elevate in malignancies (ie myelogenous leukemia)

46
Q

Decrease Uric Acid

A

Rare

47
Q

Uric Acid Methodology

A

Conversion of Uric Acid to Allantoin
Uric Acid + Phosphotungstic acid = Tungsten Blue

48
Q

Formation of Allantoin

A

Breakdown of uric acid under action of enzyme uricase
Use heparinize plasma, serum or urine
Avoid lipemia and hemolysis
Urine pH 8 to avoid precipitation

49
Q

Ammonia General Info

A

Produced from deamination of amino acids
Bacterial metabolism in the gut
Converted to BUN in liver
Can be toxic especially to neural cells

50
Q

Ammonia Clinical Application

A

Increase hepatic failure
Reyes Syndrome
Pediatric disorder
Post Viral Infection with Aspirin Administration
Shows fatty infiltration of liver
Inherited deficiencies of urea cycle

51
Q

Ammonia Methodology

A

Direct measurement
Using Ion Selective Electrode
- Ammonium ion converted to ammonia dependent on pH
Enzymatic Method
- Measuring conversion of NADPH to NADP
- Glutamate dehydrogenase

Chemistry (11 decks)

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