AG-ACNP - Renal, GU, STD: Questions With Solutions
RAAS Right Ans - - Liver makes angiotensinogen
- Decrease penal perfusion: kidneys release renin
- Renin turns angiotensinogen to angiotensin I
- Lungs release ACE
- ACE converts angiotensin I to angiotensin II
Angiotensin II:
- Promotes aldosterone secretion: increase reabsorption of sodium and
excretion of potassium
- Causes vasoconstriction
- Triggers ADH secretion
How do Loop diuretics work? Right Ans - Block sodium reabsorption
Ascending limb of Henle
How do thiazide diuretics work? Right Ans - Blocks sodium reabsorption
Distal tubules
What are potassium sparing diuretics? Right Ans - Spirinolactone
Triamterene
How does spironolactone work? Right Ans - Inhibits aldosterone
Distal tubule
How does triamterene work? Right Ans - Inhibit Na reaborption and K
secretion
Distal tubule
Carbonic anhydrase inhibitors - Acetazolamide Right Ans - Inhibit
reabsorption of bicarb
Osmotic diuretics- Mannitol Right Ans - Reduces osmotic reabsorption of
water - pee it out
,Diagnostics to evaluate renal function: Right Ans - 1) GFR
2) Serum creatinine
3) BUN
4) BUN:Cr
5) Urine sodium
6) Fractional excretion of sodium
7) Urinalysis
8) Urine lytes
9) Urine creatinine
10) Urine toxicology
11) Renal ultrasound
12) CT, MRI
13) KUB
14) Pyelogram
15) Cystoscopy
GFR Right Ans - Amount of plasma filtered through glomeruli per unit of
time
- Best index of functioning renal mass
- Normal 60-120
- Kidney disease 15-60
- Kidney failure <15
Creatinine clearance Right Ans - Comparison of serum creatinine to urine
creatinine in 24h to calculate GFR
- Discard first void of the day
- Men: 97-137 mL/min
- Women: 88-128 mL/min
BUN Right Ans - - Measure of urea: byproduct of protein breakdown
- Renal filters but reabsorbs 40-50%
- Normal: 10-20
- Can be altered by abnormal protein breakdown
Creatinine Right Ans - - Measure of renal bloodflow, severity of disease
- Can take 7 days o stabilize after GFR changes
- Normal 0.7-1.2
BUN:Cr Right Ans - - Used to evaluate causes of renal disease
, - Normal - 10:1
- Increased BUN, Normal Cr = prerenal (dehydration, kidneys work fine)
- Increased BUN, Increased Cr = intrarenal (filtration is directly affected)
- Higher BUN than high Cr = postrenal (obstruction forces BUN back into
bloodstream)
Urine sodium Right Ans - - How much sodium in urine
- Distinguish between prerenal and acute tubular necrosis
- < 20 = intact tubules, reabsorb Na correctly
- > 20 = tubules damaged, not reabsorbing Na
Fractional excretion of urine sodium Right Ans - - Comparison of urine
sodium to serum sodium: amount excreted to amount reabsorbed
- Helps distinguish if pre, intra, postrenal
- FeNa < 1 = prerenal
- FeNa > 1-3% = intra or postrenal
What is normal urinary protein exertion a day? Right Ans - < 150/day,
mean = 40-50/day
What is normal albuminuria a day? Right Ans - < 30/24h
Urinalysis Right Ans - - Leukocytes: Negative/Trace 0-10
- Nitrite: Negative 0
- Urobili: 0.2-1.0
- Protein: Negative 0
- pH: 4.5-8.0
- Blood: 0-trace
- USG: 1.015-1.025
- Ketone: Negative 0
- Bilirubin: Negative 0
- Glucose: 0-15
- WBC: < 5
- Epithelial cells: <5 good sample
- Bacteria: absent
Renal ultrasound Right Ans - - Structure and size
- Blood flow by doppler
RAAS Right Ans - - Liver makes angiotensinogen
- Decrease penal perfusion: kidneys release renin
- Renin turns angiotensinogen to angiotensin I
- Lungs release ACE
- ACE converts angiotensin I to angiotensin II
Angiotensin II:
- Promotes aldosterone secretion: increase reabsorption of sodium and
excretion of potassium
- Causes vasoconstriction
- Triggers ADH secretion
How do Loop diuretics work? Right Ans - Block sodium reabsorption
Ascending limb of Henle
How do thiazide diuretics work? Right Ans - Blocks sodium reabsorption
Distal tubules
What are potassium sparing diuretics? Right Ans - Spirinolactone
Triamterene
How does spironolactone work? Right Ans - Inhibits aldosterone
Distal tubule
How does triamterene work? Right Ans - Inhibit Na reaborption and K
secretion
Distal tubule
Carbonic anhydrase inhibitors - Acetazolamide Right Ans - Inhibit
reabsorption of bicarb
Osmotic diuretics- Mannitol Right Ans - Reduces osmotic reabsorption of
water - pee it out
,Diagnostics to evaluate renal function: Right Ans - 1) GFR
2) Serum creatinine
3) BUN
4) BUN:Cr
5) Urine sodium
6) Fractional excretion of sodium
7) Urinalysis
8) Urine lytes
9) Urine creatinine
10) Urine toxicology
11) Renal ultrasound
12) CT, MRI
13) KUB
14) Pyelogram
15) Cystoscopy
GFR Right Ans - Amount of plasma filtered through glomeruli per unit of
time
- Best index of functioning renal mass
- Normal 60-120
- Kidney disease 15-60
- Kidney failure <15
Creatinine clearance Right Ans - Comparison of serum creatinine to urine
creatinine in 24h to calculate GFR
- Discard first void of the day
- Men: 97-137 mL/min
- Women: 88-128 mL/min
BUN Right Ans - - Measure of urea: byproduct of protein breakdown
- Renal filters but reabsorbs 40-50%
- Normal: 10-20
- Can be altered by abnormal protein breakdown
Creatinine Right Ans - - Measure of renal bloodflow, severity of disease
- Can take 7 days o stabilize after GFR changes
- Normal 0.7-1.2
BUN:Cr Right Ans - - Used to evaluate causes of renal disease
, - Normal - 10:1
- Increased BUN, Normal Cr = prerenal (dehydration, kidneys work fine)
- Increased BUN, Increased Cr = intrarenal (filtration is directly affected)
- Higher BUN than high Cr = postrenal (obstruction forces BUN back into
bloodstream)
Urine sodium Right Ans - - How much sodium in urine
- Distinguish between prerenal and acute tubular necrosis
- < 20 = intact tubules, reabsorb Na correctly
- > 20 = tubules damaged, not reabsorbing Na
Fractional excretion of urine sodium Right Ans - - Comparison of urine
sodium to serum sodium: amount excreted to amount reabsorbed
- Helps distinguish if pre, intra, postrenal
- FeNa < 1 = prerenal
- FeNa > 1-3% = intra or postrenal
What is normal urinary protein exertion a day? Right Ans - < 150/day,
mean = 40-50/day
What is normal albuminuria a day? Right Ans - < 30/24h
Urinalysis Right Ans - - Leukocytes: Negative/Trace 0-10
- Nitrite: Negative 0
- Urobili: 0.2-1.0
- Protein: Negative 0
- pH: 4.5-8.0
- Blood: 0-trace
- USG: 1.015-1.025
- Ketone: Negative 0
- Bilirubin: Negative 0
- Glucose: 0-15
- WBC: < 5
- Epithelial cells: <5 good sample
- Bacteria: absent
Renal ultrasound Right Ans - - Structure and size
- Blood flow by doppler
