Nonprotein Nitrogen & Renal Function, Analysis, and Disease – Flashcards
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| Name 4 Protein-Free Nitrogen-Containing Compounds in Plasma |
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| Ammonia Urea Creatinine Uric Acid |
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| Ammonia is derived from protein breakdown in what 2 organs? |
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| Intestines Muscle |
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| AA taken up by the liver, produce ammonia, then converted into what? |
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| Urea |
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| Where is Urea excreted? |
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| Urine |
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| Neurotoxic = |
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| Encephalopathy |
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| Are Decreased levels of Ammonia Significant or Insignificant? |
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| Insignificant |
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| What are the 3 disease correlations with Ammonia |
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| Hepatic failure Reye's Syndrome Poor Circulation |
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| What is Reye's Syndrome usually preceded by? |
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| Viral infection + aspirin |
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| Reye's Syndrome - Fatty infiltration of what organ? |
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| Liver |
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| What type of tube should you use when collecting for Ammonia? |
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| Heparin or EDTA |
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| After placing the tube in Heparin or EDTA what should you do? |
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| Put on ice Immediately |
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| After putting your ammonia sample on ice what do you do? |
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| Centrifuge at 0-4 Degrees Celsius and assay ASAP Freeze |
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| Which Nonprotein Nitrogen is affected by cigarette smoking? |
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| Ammonia |
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| Enzymatic reaction of Ammonia measure the amount of what consumed? |
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| NADP |
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| Name 2 interfering factors for Ammonia lab analysis |
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| Glassware detergents Impure water |
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| What is the reference range for Ammonia? |
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| 11-35 micromoles/Liter |
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| If the ammonia value is greater than what it is considered a panic value? |
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| 35 micromoles/Liter |
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| What does BUN stand for? |
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| Blood Urea Nitrogen |
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| Where is Urea synthesized? |
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| Liver from NH3 |
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| Almost half of all NPN is found where? |
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| Plasma |
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| What is the major waste product of protein metabolism? |
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| Urea |
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| Urea is filtered by which organ? |
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| Kidneys |
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| Decreased BUN is seen in what 3 conditions? |
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| Low protein diets Starvation Liver Disease |
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| What should the BUN/Cr ratio be? |
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| 10:1 - 20:1 |
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| >20:1 is associated with Pre-renal or Renal? |
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| Pre-Renal |
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| <10:1 is associated with Pre-renal or Renal? |
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| Renal |
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| What word is given to describe High levels of BUN in the blood? |
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| Azotemia |
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| What can cause Pre-renal diseases in association with Urea? |
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| Reduced blood flow to kidneys High Protein Diets Increased breakdown of proteins |
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| What can cause Renal diseases in association with Urea? |
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| Any renal condition that reduces GFR Uremia Uremic Syndrome |
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| What can cause Post-renal diseases in association with Urea? |
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| Obstruction of urine flow |
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| Uremia |
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| High Levels of BUN with Renal Failure |
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| True or False: Uremic Syndrome is fatal if untreated by dialysis or transplant |
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| True |
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| What type of reactions do you perform in the lab when analyzing urea? |
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| Coupled reaction using urease enzyme |
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| What 2 substances inhibit urease? |
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| Fluoride Citrate |
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| What is the reference range for Urea? |
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| 6-20 mg/dL |
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| What 2 collection tubes should be avoided when analyzing urea? |
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| Gray & Blue |
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| Creatine is used in production of what? |
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| Energy in muscles |
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| What is the end-product of Creatine producing energy in muscle? |
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| Creatinine |
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| What is the major waste product of muscle metabolism? |
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| Creatinine |
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| True or False: Creatinine is excreted at a constant rate daily |
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| True |
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| True or False: Creatinine is proportional to a person's muscle mass |
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| True |
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| What non-protein nitrogen-containing substance is NOT affected by exercise? |
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| Creatinine |
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| What is Creatinine filtered by? |
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| Glomerulus |
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| What is the main disease that correlates with Creatinine? |
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| Renal dysfunction affecting filtration |
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| Creatine Clearance Test Formula: |
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| ((Urine cr)/(Serum cr))/ ((Urine Volume)/Urine Collection Time)) |
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| How do you correct Creatine Clearance for body surface area? |
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| CrCl x (1.73/BSA) |
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| Renal Damage = Decrease in what? |
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| CrCl & GFR |
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| Renal Damage = Increase in what? |
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| Serum Cr/BUN |
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| Are Decreased Levels of Creatine Significant or Not Significant? |
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| Not Significant |
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| True or False: 50% of renal function may be lost before CrCl is Decreased |
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| What is the classic method of Creatine lab analysis based on? |
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| Jaffee reaction |
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| What can cause a false negative in Creatine lab analysis? |
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| Bilirubin Hemoglobin |
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| What 4 substances can cause a false positive in Creatine lab analysis? |
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| Cephalosporins Uric Acid Ascorbic acid Glucose |
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| What is the reference range for Creatinine? |
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| 0.6-1.0 mg/dL (m/f average) |
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| Uric acid is the breakdown product of what? |
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| Purines from nucleic acids |
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| What type of reaction is used for the laboratory analysis of Uric acid? |
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| Carraway reaction |
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| What is the carraway reaction? |
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| Reduction of phosphotungstic acid to tunsten blue |
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| What can cause false negatives for the lab analysis of Uric Acid? |
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| Bilirubin Ascorbic acid |
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| What is the reference range for Uric acid? |
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| 3-7 mg/dL |
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| Is uric acid a very sensitive indicator for renal disease? |
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| No |
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| If levels of Uric Acid become high it might precipitate in tissues as what? |
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| Monosodium Urate Crystals |
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| If levels of Uric Acid become high it might precipitate in tubules as what? |
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| Uric Acid Crystals |
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| Gout |
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| Precipitated urates (MSU) in joins cause pain and swelling |
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| Gout is aggrevated by what? |
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| diet drugs alcohol ingestion |
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| Gout correlates with a tendency to form what? |
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| Kidney Stones |
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| What 3 Diseases correlate with Uric Acid? |
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| Gout Increased breakdown of cell nuclei Renal disease |
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| What are often associated with Increased breakdown of cell nuclei? |
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| Chemotherapy for leukemia/lymphoma Tumor Irradiation Hemolytic anemias if WBC count is high |
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| What are the prominent functions of the Renal system? |
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| Waste removal Water, Electrolyte, & Acid-Base Balance Hormone Production |
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| List the steps of Urine Formation & Waste Removal |
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| 1. Filtration by the glomerulus 2. Reabsorption by the proximal convoluted tubule 3. Secretion by the proximal convoluted tubule 4. Concentration in the distal convoluted tubules and collecting ducts |
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| What occurs at the Loop of Henle? |
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| Water, Na, and Cl reabsorption |
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| What occurs at the Distal tubules/collecting ducts? |
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| Sodium reabsorption |
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| What is sodium reabsorption at the Distal tubules/collecting ducts influenced by? |
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| Aldosterone |
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| True or False: Substances exceeding renal threshold cannot be reabsorbed |
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| True |
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| What is the defect in D. insipidus? |
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| ADH/AVP |
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| What is the defect in D. mellitus? |
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| Insulin |
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| True or False: The Plasma osmolality and urine volume INCREASE for both D. insipidus & D. mellitus |
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| True |
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| Does Urine Osmolality Increase or Decrease for D. Insipidus? |
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| Decrease |
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| Does Urine Osmolality Increase or Decrease for D. Mellitus? |
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| Increase |
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| What element is the primary contributor to osmolality? |
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| Sodium |
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| As sodium moves in, what moves out to maintain electrical neutrality? |
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| Potassium & Hydrogen |
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| What will be exchanged to maintain Acid-Base Balance? |
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| H+ HCO3 |
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| What will be reabsorbed along with Sodium? |
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| Chloride |
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| Why is Chloride reabsorbed along with Sodium? |
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| Counter Ion |
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| Define Clearance |
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| The rate at which a substance is removed or cleared from the body |
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| True or False: Creatine is completely filtered and not reabsorbed |
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| True |
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| What is the standard measure for GFR? |
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| Creatinine |
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| When do you correct the Creatinine Clearance? |
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| Big or little people Elderly Amputees Muscle wasting diseases |
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| What is the normal range of CrCl for Men/Women: |
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| 90-140 mL/min |
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| What is the normal range of CrCl for Women: |
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| 90-130 mL/min |
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| What is the normal range of CrCl for Children: |
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| 55-85 mL/min |
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| What is the normal range of CrCl for Newborns: |
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| 35-65 mL/min |
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| Name the 2 types of test for Creatinine where urine is NOT needed |
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| eGFR Cystatin C |
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| What is the formula for eGFR (mL/min)? |
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| ((140-age)(weight in kg))/((72)(Serum Creatinine)) |
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| What do you multiply the eGFR by if the patient is female? |
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| 0.85 |
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| Cystatin C is unaffected by what? |
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| Gender Race Muscle Mass Age |
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| True or False: Cystatin C will be elevated in serum before GFR is decreased |
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| True |
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| What is a better predictor of developing kidney disease? |
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| Cystatin C |
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| What is Cystatin C? |
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| Tiny protein produced by nucleated cells at a constant rate |
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| What test do you perform to detect early renal disease in diabetics? |
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| Microalbumin |
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| Microalbumin will detect as little as ______ / 24 hours? |
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| 30-300 mg |
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| Urine Dipstick is positive for Albumin at what concentration? |
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| 500 mg/24 hours |
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| You perform the following Chemical Urinalysis Exam to determine what: pH |
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| Acid-Base Balance |
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| You perform the following Chemical Urinalysis Exam to determine what: Protein |
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| Glomerular Disease |
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| You perform the following Chemical Urinalysis Exam to determine what: Blood |
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| Renal Disease Infection Trauma Stones |
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| You perform the following Chemical Urinalysis Exam to determine what: SG |
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| Dehydration |
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| What are the 6 Infections correlated with Renal Function |
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| Acute Glomerulonephritis Nephrotic Syndrome Kidney Infection Bladder Infection Chronic Kidney Disease Acute Renal Failure |
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| What type of infection will you see WBCs & WBC CASTS |
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| Kidney Infection (Pyelonephritis) |
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| What type of infection will you see WBCs, +/= nitrites, & Hematuria but NO WBC Casts |
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| Bladder Infection (Cystitis) |
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| Which Disease will you find Massive Proteinuria and Lipiduria? |
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| Nephrotic Syndrome |
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| Which Disease will you find Oval fat bodies, fatty casts, and Cholesterol crystals? |
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| Nephrotic Syndrome |
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| What disease follows group A beta-hemolytic strep infection? |
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| Acute Glomerulonephritis |
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| The following are seen in what disease: RBC casts, hematuria, proteinuria, and oliguria |
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| Acute Glomerulonephritis |
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| With which disease will you see abnormalities of structure or function that persist for more than 3 months? |
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| Chronic Kidney Disease |
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| Chronic Kidney Disease: GFR is what? |
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| <60 |
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| What insufficiency are common in Chronic Kidney Disease? |
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| Anemia Vitamin D |
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| What are the causes of Chronic Kidney Disease? |
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| Glomerulonephritis Polycystic Disease SLE Diabetes Others |
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| You will find albuminuria in what disease? |
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| Chronic Kidney Disease |
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| Which which disease will you find the following: Tubular necrosis from transfusion reactions, poisoning, antifreeze, and other toxic exposures |
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| Acute Renal Failure |
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| Is Acute Renal Failure a sudden shut-down or a long shut-down? |
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| Sudden |
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| Acute Renal Failure from reduced blood flow is consistent with what? |
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| Shock Burns Cardiac Problems |
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| What does Acute Renal Failure lead to? |
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| Electrolyte Imbalances Water Retention CHF Arrhythmias |
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| What decreases in Acute Renal Failure |
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| GFR Anuria |
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| What will you find microscopically with Acute Renal Failure? |
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| Renal tubular cells and casts Waxy casts Anemia |
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| When ADH decreases what happens? |
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| Reabsorption Decreases and Urine Increases |
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| Osmolality |
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| # of particles / kg of solvent |
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| Name 3 Renal Hormones |
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| Renin Prostaglandins Erythropoietin |
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| What is the average GFR? (Hint: it is the same as average adult CrCl) |
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| 120 mls/min |
