IV Renal

IV Renal - IV LABORATORY DIAGNOSIS OF RENAL DISEASE...

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IV LABORATORY DIAGNOSIS OF RENAL DISEASE Laboratory Medicine (SPPS 216) Robert L. Fitzgerald, Ph.D. Clinical Professor of Pathology rlfitzgerald@vapop.ucsd.edu 858-552-8585 x 7761 Wiki (ucsdlabmed.wikidot.com)
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OBJECTIVES To understand the use of creatinine and urea nitrogen in diagnosis and monitoring of renal function To be able to differentiate renal tubular dysfunction from glomerular dysfunction To be able to calculate creatinine clearance
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KEY TERMS Albuminuria Anuria Azotemia Bowman’s Capsule Casts Creatinine Creatinine Clearance End-Stage Renal Disease (ESRD) Glomerular Filtration Rate (GFR) Glomerulonephritis Glomerulus Hematuria Hemodialysis Isosthenuria Microalbuminuria Nephritis Nephron Nephrotic Syndrome Oliguria Peritoneal Dialysis Pyelonephritis Pyuria Renal Threshold Tamm-Horsfall Protein Urea Uremia
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BACKGROUND/SIGNIFICANCE Most renal disease causes no symptoms until 50-75% of kidney function is destroyed Lab tests often provide initial recognition renal impairment In therapeutics, knowledge of renal function is essential for recommending proper doses Many drugs are renally cleared and decreased renal clearance can lead to
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Non-protien nitrogenous compounds Contributors Other Minor Contributors Urea Nucleotides Uric acid Purine Creatinine Polypeptides Creatine Glutathione Amino acids Ammonia
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Urea Nitrogen Major nitrogen-containing metabolic product of protein catabolism Primarily synthesized by hepatocytes Freely filtered by glomeruli, reabsorbed (amount varies) by tubules Reference range for serum urea nitrogen: 8-18 mg/dL
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Urea Nitrogen Daily Protein Intake (g/kg body weight) Urea-N Average ( mg/dL) Low protein diet: 0.5 ~5 Average protein diet: 1 ~12 High protein diet: 2 ~22
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Creatinine Derived from muscle creatine (about 1-2% of total muscle mass per day) Amount excreted daily is fairly constant and independent of urinary volume Average men excrete 1.5 g/d into the urine; women less; athletes more Reference range for serum creatinine male 0.6 - 1.3 mg/dL female 0.5 - 1.1 mg/dL
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Clearance Clearance The volume of plasma from which a substance The volume of plasma from which a substance is completely removed by the kidneys per unit is completely removed by the kidneys per unit of time of time In = Out [creat] serum x flow ml/min = [Creat] urine x flow ml/min Flow ml/min = ([Creat] urine x flow ml/min)/ [creat] serum
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Creatinine clearance Creatinine clearance Clearance of creatinine is a reflection of GFR. Clearance of creatinine is a reflection of GFR. Creatinine is largely filtered; minimally Creatinine is largely filtered; minimally secreted (in those with normal renal function) secreted (in those with normal renal function) and not reabsorbed and not reabsorbed Secretion increases (as % of urinary Secretion increases (as % of urinary creatinine) in chronic kidney disease, and can
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IV Renal - IV LABORATORY DIAGNOSIS OF RENAL DISEASE...

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