Rodriguez Notes

Question 1

What are the two regions two the Kidney?

Answer 1

Outer Cortex
Inner Medulla

Question 2

What does the Outer Cortex consist of?

Answer 2

Glomeruli and Proximal Distal Tubules

Question 3

What does the Inner Medulla consist of?

Answer 3

Loops of Henle and Collecting Ducts

Question 4

What forms the main size of the discriminant barrier in filtration?

Answer 4

Semipermeable Glomerular Basement Membrane

Question 5

What is set up that is 3 times greater than the pressure in other capillaries?

Answer 5

A steep hydrostatic pressure difference

Question 6

What charge does the basement membrane have?

Answer 6

A negative charge
Negatively charged proteins are repelled

Question 7

What is the most metabolically active part of the Nephron?

Answer 7

The Proximal Tubule

Question 8

What does Tubular Reabsorption require?

Answer 8

Active Transport (ATP)
Passive Transport (No ATP)

Question 9

What is the function of the Distal Tubule?

Answer 9

Small adjustments to achieve electrolyte and Acid-Base homeostasis

Question 10

What is the final site for concentration or diluting Urine?

Answer 10

Collecting Tube

Question 11

What are the primary hormones produced by the kidneys?

Answer 11

Renin
Erythropoietin
Vitamin D3

Question 12

What will patients not on Recombinant Erythropoietin likely develop?

Answer 12

Anemia
May need blood transfusions

Question 13

What is often associated with Osteomalacia and Rickets?

Answer 13

Chronic Renal Insufficiency

Question 14

What are some examples of secondary functions of the Kidneys?

Answer 14

Insulin
Aldosterone
ADH

Question 15

Where is Aldosterone produced and what is it’s function?

Answer 15

Produced by the cortex of the Adrenal Glands
Sodium Reabsorption

Question 16

What is the purpose of the Juxtaglomerular Apparatus (JGA)?

Answer 16

Maintaining blood pressure and sodium concentration

Question 17

What is Angiotensin II?

Answer 17

Vasoconstrictor that increases blood pressure and causes Aldosterone to be released
Tells the JGA to stop

Question 18

What do evaluations of renal function rely on to make measurements?

Answer 18

Waste products in the blood

Question 19

What is Ammonia converted to in the Liver?

Answer 19

Urea

Question 20

What happens to Urea during Water Reabsorption?

Answer 20

Freely filtered by Glomerulus
40%-60% reabsorbed in Collecting Ducts

Question 21

What can impact the Central Nervous System?

Answer 21

Elevated Ammonia in the blood

Question 22

How can we prevent Elevated Ammonia in the blood from becoming fatal?

Answer 22

Treating by Dialysis or Transplantation

Question 23

What is the enzyme Urease responsible for?

Answer 23

Hydrolyzing Urea and the Ammonium ion is then quantified

Question 24

What can we use to measure Urea levels?

Answer 24

Plasma, Serum, Urine
If plasma, Ammonium Heparin cannot be used

Question 25

How does the Glomerulus treat Creatinine?

Answer 25

Readily filters it

Question 26

What is used to determine Kidney function and monitor disease?

Answer 26

Creatinine

Question 27

What is the method to measuring Creatinine?

Answer 27

Jaffe Reaction

Question 28

Describe the

Question 29

What have clinical laboratories been strongly recommended to report?

Answer 29

Estimated GFR Does not require a timed urine collection

Question 30

Define the Kinetic Jaffe Method

Answer 30

Serum and Alkaline Picrate are mixed Absorbance is measured Positive interference by a-keto acids and Cephalosporins Negative interference by Bilirubin and Hemoglobin

Question 31

What is the name of the alternative Jaffe Reaction?

Answer 31

Kinetic Jaffe Method

Question 32

What is the primary waste product of Purine metabolism?

Answer 32

Uric Acid

Question 33

What happens to Uric Acid as it goes through the Nephron?

Answer 33

Gets filtered but then 98% - 100% is reabsorbed Secreted at the Distal tubule Only 6%-12% Is finally excreted

Question 34

What are measurement of Uric Acid used to confirm/monitor?

Answer 34

Patients with Gout Uric Acid Nephropathy Kidney Dysfunction

Question 35

What is the role of Uricase?

Answer 35

Catalyze the oxidation of Uric Acid to Allantoin Color produced is proportional to Uric Acid

Question 36

How do we collect a Uric Acid Specimen?

Answer 36

Heparinized plasma, Serum, Urine Serum should be removed immediately Serum refrigerated for 3-5 days EDTA should not be used

Question 37

What have clinical laboratories been strongly recommended to report?

Answer 37

Estimated GFR Does not require a timed urine collection

Question 38

What is the Gold Standard of infusion urinary clearance?

Answer 38

Inulin Clearance

Question 39

What is the most sensitive and specific measure of number of functioning Nephrons?

Answer 39

Glomerular Function Rate (GFR)

Question 40

What is present in all forms of progressive disease?

Answer 40

A decrease in GFR preceding Kidney Failure

Question 41

What is required for a specimen collection of Creatinine?

Answer 41

24 hour urine collection and Serum Creatinine value Collected at the midpoint

Question 42

What must happen for a 24 hour urine collection?

Answer 42

Discarding of the first morning specimen of the first day

Question 43

What are sources of error regarding 24 hour collection?

Answer 43

Recording incorrect time Loss of portions during urine Vigorous exercise Failure to properly hydrate Incorrect values used

Question 44

What can be used to easily and rapidly measure Immunoassays?

Answer 44

Serum and Urine Myoglobin

Question 45

What is the normal pH range?

Answer 45

4.7 - 7.8

Question 46

What is the normal range for Urine SG?

Answer 46

1.003 - 1.035

Question 47

What is the method used to measure SG?

Answer 47

Refractometer

Question 48

What is more valid than measuring SG in assessing the concentrating abilities of the Kidneys?

Answer 48

Measuring Osmotic Concentration of Urine

Question 49

Which analyte test is specific for Albumin?

Answer 49

Protein

Question 50

Which Analyte detects presence of bacteria?

Answer 50

Nitrite

Question 51

How much bacteria needs to be present for it to be clinically significant?

Answer 51

20

Question 52

What is diagnostic for glomerular damage and inflammation that result in Hematuria?

Answer 52

RBC casts

Question 53

What is the value of GFR that is specific before kidney damage?

Answer 53

< 60mL/min/1.73^2

Question 54

What do abnormal lab findings usually include?

Answer 54

Rapid onset of Hematuria Proteinuria RBC casts

Question 56

What does Nephrotic Syndrome almost always yield?

Answer 56

Massive Proteinuria ( > 3.5g/d) Hypoalbuminemia

Question 57

What are other symptoms of Nephrotic Syndrome?

Answer 57

Hyperlipidemia and Lipiduria

Question 58

Hypoproteinemia stimulates protein synthesis in the Liver. What does this result in?

Answer 58

Overproduction of Lipoproteins and an increase in their filtration

Question 59

What is the presence of Renal Calculi or Kidney Stones known as?

Answer 59

Nephrolithiasis

Question 60

What are the clinical symptoms of Nephrolithiasis?

Answer 60

Hematuria UTI's Nausea Abdominal Pain

Question 61

What is SECOND to diabetes as a primary diagnosis of Chronic Renal Failure?

Answer 61

Renal Hypertension

Question 62

What are the forms of Dialysis/Filtration available for patients?

Answer 62

Hemodialysis Hemodiafiltration Peritoneal Dialysis

Question 63

What uses a synthetic membrane and filters from outside the body?

Answer 63

Traditional Hemodialysis

Question 64

What occurs inside the body using gravity to introduce and remove Dialysate?

Answer 64

Peritoneal Dialysis Ambulatory and Continuous Cycling

Question 65

What does Kidney Transplantation offer?

Answer 65

The greatest chance for a full return to a healthy life