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Questions and Answers
Which kidney function is primarily responsible for maintaining electrolyte balance?
Which kidney function is primarily responsible for maintaining electrolyte balance?
What is the primary method of creatinine removal from the blood?
What is the primary method of creatinine removal from the blood?
Which of the following conditions can lead to an increase in serum creatinine levels?
Which of the following conditions can lead to an increase in serum creatinine levels?
What does the Glomerular Filtration Rate (GFR) measure?
What does the Glomerular Filtration Rate (GFR) measure?
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Which factor is NOT associated with a decrease in serum creatinine levels?
Which factor is NOT associated with a decrease in serum creatinine levels?
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What is the normal range for GFR in young individuals, adjusted for a 'standard' body surface area of 1.73 m²?
What is the normal range for GFR in young individuals, adjusted for a 'standard' body surface area of 1.73 m²?
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Which of the following substances is considered to give the most accurate measurement of GFR?
Which of the following substances is considered to give the most accurate measurement of GFR?
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Which radioactive tracer is NOT mentioned as a method for accurately measuring GFR?
Which radioactive tracer is NOT mentioned as a method for accurately measuring GFR?
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What is the role of the formula Scr = Ucr x V / PCr in evaluating GFR?
What is the role of the formula Scr = Ucr x V / PCr in evaluating GFR?
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Why is creatinine clearance considered less accurate compared to clearance of exogenous substances in measuring GFR?
Why is creatinine clearance considered less accurate compared to clearance of exogenous substances in measuring GFR?
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Flashcards
GFR (Glomerular Filtration Rate)
GFR (Glomerular Filtration Rate)
The rate at which the kidneys filter blood, measured in ml/min/1.73 m².
Normal GFR range
Normal GFR range
For young adults, normal GFR is between 120-130 ml/min/1.73 m².
Clearance methods
Clearance methods
Techniques to measure GFR using specific substances injected into the bloodstream.
Creatinine clearance formula
Creatinine clearance formula
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Exogenous vs. endogenous substances
Exogenous vs. endogenous substances
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Nephrology
Nephrology
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Main kidney functions
Main kidney functions
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Creatinine
Creatinine
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Glomerular Filtration Rate (GFR)
Glomerular Filtration Rate (GFR)
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Factors raising serum creatinine
Factors raising serum creatinine
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Study Notes
Nephrology
- Nephrology is a medical specialty focusing on kidneys, including normal kidney function, kidney disease, and treatment (from diet to replacement therapy).
Kidney Functions
- Removal of waste products from the body
- Fluid balance regulation
- Electrolyte balance maintenance
- Acid-base balance maintenance
- Vitamin D production (for strong bones)
- Red blood cell production control
- Hormone release for blood pressure regulation
Clinical Urine Analysis
- Color
- Relative density of urine
- Odor
- Turbidity
- Acidity/pH
- Albuminuria
- Glucosuria
- Urinary sediment
Creatinine
- Creatinine is a breakdown product of creatine phosphate in muscle.
- It's produced at a constant rate by the body (depending on muscle mass).
- Primarily removed from the blood by glomerular filtration in the kidneys, with some removal via proximal tubular secretion.
- Minimal tubular reabsorption of creatinine occurs.
Serum Creatinine Increased
- Acute/chronic renal failure
- Acromegaly/giantism
- Nephrotoxic drugs (e.g., mercury compounds, sulfonamides, thiazides, antibiotics)
- Mechanical trauma/massive muscle damage
- Crush syndrome
- Radiation sickness
- Increased concentration of some endogenous metabolites (glucose, fructose, ketone bodies, urea, some drugs)
- High meat intake
- Hyperthyroidism
- Hypohydration
Serum Creatinine Decreased
- Starvation/decreased muscle mass
- Corticosteroid use
- Pregnancy (especially first and second trimester)
- Vegetarian diet
- Hyperhydration
- Myodystrophy
Glomerular Filtration Rate (GFR)
- GFR is the volume of fluid filtered from the renal glomerular capillaries to Bowman's capsule per unit time.
- Normal GFR varies by age, sex, and body size, declining with age.
- It's related to the "standard" body surface area (1.73m²).
- Typical normal GFR range for young adults: 120-130 mL/min/1.73m²
- GFR can be measured using clearance methods or radioactive tracers, with serum creatinine levels also being used.
- Inulin clearance is the most accurate, but less practical. Methods using radioactive tracers (51Cr-EDTA, 125I-iothalamate and iohexol) are less invasive but still accurate.
CKD-EPI Equation
- Equation for estimating GFR on a standard serum creatinine scale for specified race and sex
- Provides detailed GFR estimates according to different races, gender, and creatinine levels.
CKD-EPI Creatinine-Cystatin C
- Equation for estimating GFR based on creatinine and cystatin C levels and age
CKD Criteria
- Markers of kidney damage (one or more): albuminuria, urine sediment abnormalities.
- Decreased GFR (<60 ml/min/1.73 m²).
- Other abnormalities (e.g., Anemia, hyperparathyroidism, etc.).
Hyperparathyroidism
- Increased parathyroid hormone (PTH) levels in the blood.
- Secondary hyperparathyroidism (SHPT) is due to low calcium levels, causing the parathyroid glands to overproduce PTH.
Glomerular Diseases
- Various diseases causing damage to the renal glomeruli, including microhematuria, recurrent gross hematuria, isolated proteinuria, and different glomerulonephritis syndromes
- Proteinuria less than 3.5 g/day
- Proteinuria more than 3.5 g/day
Nephrotic Syndrome
- Characterized by proteinuria exceeding 3.5 g/day, edema, hypoproteinemia, and hypoalbuminemia.
- Proteinuria may lead to reduced renal function worsening
Nephritic Syndrome
- Characterized by proteinuria less than 3.5 g/day, edema, hypertension, and hematuria.
Acute Kidney Injury (AKI)
- Sudden kidney function impairment leading to nitrogenous waste accumulation.
- Defined by increased serum creatinine (SCr) or decreased urine output.
- Stages distinguished based on SCr changes and urine output. Prerenal, Renal, and Postrenal AKI are recognized causes of decreased renal function.
Decreased Renal Excretion
- Includes conditions like polyuria, oliguria, anuria, hyposthenuria, and hypersthenuria.
Renal Replacement Therapy
- Renal replacement therapy is indicated in CKD when symptoms of uremia and/or uncontrolled hydration and/or blood pressure status persist despite conservative measures.
Contraindications to Kidney Biopsy
- Single functioning kidney;
- Abnormalities in the urinary system,
- Hydronephrosis,
- Reduced kidney size (<9cm),
- Local infections
- Uncontrolled hypertension
Nephroprotective Therapy
- ACE inhibitors, ARBs, hypolipidemic agents
Pathogenic Drug Therapy
- Corticosteroids, immunosuppressants (cyclophosphamide, chlorbutin, azathioprine, CNI)
Nephrotic Crisis
- Emergency condition with very low serum albumin
- Requires rehydration therapy and steroid administration
Proteinuria
- Eliminating or reducing proteinuria is essential for nephrotic syndrome treatment
- Proteinuria may negatively affect renal function and increase the risk of other adverse complications
- RAAS inhibitors (e.g., Ramipril, Losartan).
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Description
Test your knowledge on nephrology, focusing on the vital functions of the kidneys and clinical urine analysis. This quiz covers various topics including kidney disease, serum creatinine, and the significance of urine characteristics in diagnosis.
