Exam (elaborations)
FPC review (1).
Exam of 6 pages for the course Imse 250 at Imse 250 (FPC review (1).)
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FPC reviewWhat are the major functions of the kidney? - ANS-Regulates:
-fluid volume
-osmolarity
-electrolyte content
-acidity
Excretion:
-metabolic end products (urea, Cr, uric acid)
-foreign substances (drugs)
Production/Secretion:
-renin
-prostaglandins
-erythropoietin
-Vitamin D
Define glomerular filtration rate. - ANS--generally accepted as best index of overall kidney
function (clinical practice)
-rate at which substances are filtered through glomeruli
Define how to measure GFR. - ANS--no direct method
-measure urinary clearance of ideal filtration marker from plasma in a period of time
Describe parameters for an ideal filtration marker. - ANS--stable plasma concentration
-completely filtered @ glomerulus
-not reabsorbed, secreted, or metabolized
-filtered load is equal to rate of urinary excretion
Identify the most common clearance methods of estimating GFR. - ANS-Most common:
-Serum creatinine (sCr) & Creatinine clearance (CrCl)
-Cockcroft-Gault equation
-MDRD study equation
-CKD-EPI equation
-Cystatin C & Cystatin C equation
Less Common
-Inulin clearance: gold standard; exogenous carbohydrate
-radioisotopic filtration markers: Iothalamate, Tc-DTPA, Cr-EDTA
-Iohexol
, What are the advantages and disadvantages of using Creatinine as a filtration marker? -
ANS-Advantages:
-endogenous
-released into circulation @ cst rate
-freely filtered by glomerulus, not reabs or metabolized by kidneys
-easy to measure in serum & urine @ low cost
Disadvantages:
-production varies among & w/in individuals (muscle mass & intake)
-secreted in small amt by renal tubules
--->secretion inc as kidney function dec
--->some drugs inhibit secretion = inc sCr w/o affecting GFR
What are normal serum creatinine values, and why may the sCr not accurately reflect kidney
function? - ANS-Male: 0.70-1.30 mg/dL
Female: 0.55-1.30 mg/dL
-sCr by itself might not reflect actual degree of kidney function b/c multiple factors affect [sCr]
--->inverse relation btw sCr & GFR is parabolic
List factors that affect sCr and what that effect is. - ANS--Old age: dec
-Female: dec
-Af Amer race: inc
-Hispanics: dec
-Muscular: inc
-amputation: dec
-obesity: none
-malnutrition: dec
-liver dz: dec
-vegetarian: dec
-cooked meat: inc
-Trimethoprim/cimetidine: inc (block Cr tubular secretion)
-antibx: dec (extra-renal Cr elimination)
At what level of GFR is sCr affected? - ANS-need to lose ~50% GFR
Describe how to calculate 24h Cr clearance. What are some advantages and disadvantages? -
ANS-CrCl = (Ucr x Uv)/sCr x 1440
Adv: better than sCr @ estimating GFR, not expensive
Disadv: overestimates GFR by 10-30% (b/c tubular secretion), burdensome urine collection for
pt, must do collection 2x to make sure accurate
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