Term
| T/F We estimate CrCl to estimate GFR. |
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Definition
| TRUE. We estimate CrCl to estimate GFR. |
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Term
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Definition
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Term
| T/F The Cockcroft & Gault Equation can only be used for adults. |
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Definition
| TRUE. The Cockcroft and Gault equation can only be used for adults. |
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Term
| Which ADME is affected by kidney disease? |
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Definition
| ALL of them. A, D, M, and E |
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Term
| What is the Cockroft & Gault Equation? |
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Definition
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Term
| What is the Ideal Body Weight Equation? |
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Definition
Male: 50k+(2.3kg)(height in inches>60)
Female: 45k+ (2.3kg)(height in inches >60) |
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Term
Calculate the estimated CrCl, what is the true GFR?
56 yo old Female
5'5'' 130 lbs SCr: 1.5 |
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Definition
IBW: 45+(2.3)(5)= 56.5
CrCl: ([140-56]*56.5)/(72*1.5) * 0.85=
43.9 (0.85)= 37.4mL/min
so true GFR is <37mL/min |
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Term
| when using the Cockcroft & Gault equation, the true GFR= less than ___ |
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Definition
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Term
| F/T The Cockcroft & Gault equation estimates GFR by estimating CrCl. |
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Definition
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Term
| What is the formula for Adjusted Body Weight? |
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Definition
|
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Term
| When do we use the adjusted body weight? |
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Definition
| if the actual body weight is 120% of IBW |
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Term
| What are the limitations to the Cockcroft & Gault equation? |
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Definition
1. developed for adults only
2. SCr must be at steady state
3. SCr< 0.8mg/dL should be rounded up to 0.8mg/dL
4. it overestimates GFR at all points, particularly as GFR declines |
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Term
| When would you consider a 24hr CrCl? |
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Definition
1. extremes of age & body size
2. severe malnutrition
3. disease of skeletal muscle
4. paraplegia or quadriplegia
5. vegetarian diet
6. rapidly changing kidney function
7. pregnancy |
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Term
| What is the MDRD4? and what does it do? |
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Definition
Modification of Diet in Renal Disease.
1. It predicts GFR using four variables- SCr, age, gender, race
2. It estimates GFR directly. (not CrCl)
3. It's more accurate than the 24hr CrCl or est Cr Cl (Cockroft-Gault) |
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Term
| What are the MDRD considerations? |
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Definition
1. SCr should be rounded up to 0.8mg/dL
2. only for adults 18-70yrs
3. Originally studied in Chronic Kidney Disease and is less accurate for persons with normal renal function or mild impairment.
4. Has not been validated in >70yr, pregnancy, co-morbid conditions, extreme body size, muscle mass, or nutritional status |
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Term
| T/F The MDRD4 is the standard for determining GFR. |
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Definition
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Term
| T/F You should use the MDRD4 to compute drug dosages. |
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Definition
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Term
| T/F MDRD4 loses its predictive value of GFR over 60. |
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Definition
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Term
| T/F The MDRD4 is better to screen and monitor CKD (more accurately predicts GFR) |
|
Definition
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Term
|
Definition
| Blood Urea Nitrogen (BUN) is the concentration of nitrogen (as urea) in the serum (not blood) |
|
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Term
| What is the normal range for BUN? |
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Definition
8-20mg/dL
Concentrations depends on:
a.a. metabolism in the liver (urea production)
tubular reabsorption (50% of filtered urea)
GFR |
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Term
| What can BUN be used to assess/monitor? |
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Definition
| renal function, hydration, protein metabolism, and risk for uremic syndrome |
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Term
| What is the term for an elevated BUN (>20mg/dL)? |
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Definition
| Azoemia: pre-renal, blood flow problem (increase time to absorb urea)...a result of dehydration or blood loss. |
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Term
| What are the causes of Pre-Renal azotemia? |
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Definition
1. Decreased renal perfusion (renal blood flow); dehydration, blood loss, shock, severe heart failure.
2. increased protein breakdown (GI bleeding, crush injury, burn, excessive a.a/protein intake, tetracyclines and corticosteroids. |
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Term
| What are the intr-renal (intrinsic causes)- damage to renal parenchyma. |
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Definition
between 10-20 (need more information)
1. acute renal failure: nephrotoxic drugs, severe HTN, glomerulonephritis
2. Chronic renal dysfunction: pyelonephritis, diabetes, etc |
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Term
| What are the post-renal causes? |
|
Definition
| obstruction of the ureter, bladder neck, or urethra |
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Term
|
Definition
>20 pre-renal
<20, need more information |
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Term
| What is the normal BUN:SCr ratio. |
|
Definition
|
|
Term
| What is the prerenal BUN:SCr ratio? |
|
Definition
|
|
Term
| What is the intrinsic BUN:SCr ratio? |
|
Definition
| <20:1 ...need more info, intrinsic or postrenal? |
|
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Term
| What is the postrenal BUN:SCr ratio? |
|
Definition
| <20:1, need more info. Is it intrinsic or postrenal? |
|
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Term
| What is the difference between Intrinsic and Postrenal? |
|
Definition
| The Urine Specific Gravity for postrenal is variable, whereas the intrinsic value is <1.015 |
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Term
| Urinalysis undergoes what 3 types of testing? |
|
Definition
|
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Term
|
Definition
| cylindrical massesof glycoproteins that form in the tubules: hyaline, cellular, granular and waxy. (sometimes released into urine) |
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Term
| Hyaline is released into the urine during periods of low volume, concentrated urine. This could be because... |
|
Definition
dehydration
CHF
Generally not related to kidney disease |
|
|
Term
| Where do crystals come from? |
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Definition
| urate and phosphate crystals |
|
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Term
| Proteinuria indicates _____ or______ damage and is associated with increase mortality. |
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Definition
|
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Term
| What is the normal pH range for urine? |
|
Definition
|
|
Term
| What pH of urine usually deters bacterial colonization? |
|
Definition
|
|
Term
| What pH of urine might indicate a UTI or tubular defects? |
|
Definition
| a high pH (basic/alkaline) |
|
|
Term
| What drugs can cause acidic urine? |
|
Definition
| ammonium chloride, ascorbic acid (high dose), acetic acid (bladder irrigation) |
|
|
Term
| What is the normal range for urine's specific gravity? |
|
Definition
1.010-1.025
measure of urine weight relative to water (1.0)
best measure for kidneys concentrating ability |
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|
Term
| Dilute/concentrated urine has a low specific gravity? |
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Definition
| Dilute (<1.010) urine has a low specific gravity. |
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Term
| Dilute/concentrated urine has a high specific gravity? |
|
Definition
| Concentrated urine (>1.018) has a high specific gravity. Prerenal causes: dehydration, renal artery stenosis, CHF, ACEI, NSAIDS |
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Term
| What is a Leukocyte Esterase? |
|
Definition
enzyme released from lysed WBCs
normal is 0-trace |
|
|
Term
| What does it mean if you test positive for leukocyte esterase? |
|
Definition
| indicates pyuria associated with UTI |
|
|
Term
| How can you show a false negative for a leukocyte esterase? |
|
Definition
| vitamin C and phenazopyridine can cause false negatives. |
|
|
Term
| gram ____ bacteria converts nitrates into nitrites |
|
Definition
|
|
Term
| What is the difference between Prerenal, Intrinsic, and Postrenal? |
|
Definition
BUN:Cr in prerenal (>20:1)
intrinsic and postrenal (15:1)
Urine specific gravity:
prerenal (>1.018)
intrinsic (<1.015)
postrenal (variable) |
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Term
| What drug's volume of distribution is changed by renal dysfunction? |
|
Definition
| Digoxin, because of decreased tissue binding as a result of competitive inhibition of endogenous substances. (Buildup of endogenous cations/anions that competes with the drugs) |
|
|
Term
| What are some drugs with active or toxic metabolites excreted by the kidney? |
|
Definition
meperidine (demerol) -> nomeperidine (seizures)
Primadone ->phenobarbital (barbituate to control seizures)
Propoxyphene-> norpropoxyphene (cardiotoxic) |
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|
Term
| What does drug dosing have to do with renal insufficiency? |
|
Definition
| many medications accumulate, are inherent nephrotoxins, or are ineffective. |
|
|
Term
Calculate CrCl and BUN:SCr ratio...
58yo, male, 106kg, 6'1'', SCr 2.2, BUN 82 |
|
Definition
IBW: 50+2.3(inch>60)-> 50+2.3(13)=79.9
ABW: IBW+0.4(TBW-IBW)= 79.9+0.4(106-79.9)=90.34kg
[(140-58)*90.4]/(72*2.2)= 46.8mL/min
true GFR<46.8mL/min
BUN:SCr-> 82/2.2= 37.27 prerenal (dehydrated, dec renal blood flow, etc) |
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Term
|
Definition
BUN:SCr ratio--> >20:1
urine specific gravity--> >1.018 |
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|
Term
|
Definition
BUN:SCr ratio-> 15:1 (or <20:1)
Urine specific gravity-> <1.015 |
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Term
|
Definition
BUN:SCr ratio-> 15:1 (<20:1)
Urine specific gravity-> variable |
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|
Term
| Hyaline casts could be an indicator of.... |
|
Definition
|
|
Term
| muddy brown granular casts and tubular epithelial casts could be an indicator of... |
|
Definition
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