azotemia and urinary abnormalities
TRANSCRIPT
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Azotemia and UrinaryAbnormalities
(Chapter 45)
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Multiple Choice
1. The most widely used marker for glomerular filtration rate determination:a. Urea c. Inulinb. Creatinine d. Creatine
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GFR
• Serum creatinine is the most widely used marker for GFR
• GFR is related directly to the urine creatinine excretion and inversely to the serum creatinine (UCr/PCr)
• Creatinine clearance - defined time period (usually 24 h) and is expressed in mL/min
• In general, patients do not develop symptomatic uremia until renal insufficiency is usually quite severe (GFR < 15 mL/min)
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GFR
• Urea clearance may significantly underestimate GFR because of tubule urea reabsorption.
• Creatinine is useful for estimating GFR because it is a small, freely filtered solute.
• More accurate determinations of GFR are available using inulin clearance or radionuclide-labeled markers such as 125I-iothalamate or EDTA.
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Multiple Choice
2. Calculate for the estimated GFR of a 75 y/o female weighing 75kg with serum creatinine of 5.4 mg/dl using the Cockroft-Gault formula:a. 10 c. 11b. 13 d. 14
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GFR
• Cockroft-Gault formula:
• MDRD (modification of diet in renal disease):
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Multiple Choice
3. In patients with bilateral renal artery stenosis, the drug to be avoided is:a. Metoprolol c. Nifedipineb. Clonidine d. Enalapril
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Prerenal FailureNSAIDS
ACE Inhibitors
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Prerenal Failure
• Patients with bilateral renal artery stenosis (or stenosis in a solitary kidney) are dependent upon efferent arteriolar vasoconstriction for maintenance of glomerular filtration pressure and are particularly susceptible to precipitous decline in GFR when given ACE inhibitors.
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Multiple Choice
4. The finding of eosinophils in the urine, optimally observed by using a Hansel stain, is suggestive of:a. Allergic interstitial nephritis
b. Atheroembolic renal diseasec. Both d. Neither
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Intrinsic Renal Disease
• The finding of eosinophils in the urine is suggestive of allergic interstitial nephritis or atheroembolic renal disease and is optimally observed by using a Hansel stain.
• The absence of eosinophiluria, however, does not exclude these possible etiologies.
• Atheroembolic renal failure can occur spontaneously but is most often associated with recent aortic instrumentation. The emboli are cholesterol-rich and lodge in medium and small renal arteries, leading to an eosinophil-rich inflammatory reaction.
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Multiple Choice
5. Oliguria refers to a 24-h urine output of:a. <500 mL c. <300 mLb. <400 mL d. <50 mL
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Oliguria and Anuria
• Oliguria refers to a 24-h urine output of <500 mL
• Anuria is the complete absence of urine formation (<50 mL).
• Nonoliguria refers to urine output >500 mL/d in patients with acute or chronic azotemia
• polyuria (>3 L/d)
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Multiple Choice
6. The evaluation of proteinuria is typically initiated after detection of urinary protein by a. Dipstick examinationb. 24h urinary protein excretionc. Spot morning protein/creatinine ratio
(mg/g)d. Urine protein electrophoresis (UPEP)
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Proteinuria
• The evaluation of proteinuria is typically initiated after detection of proteinuria by dipstick examination.
• Detects mostly albumin and gives false-positive results when pH > 7.0 and the urine is very concentrated or contaminated w/ blood
• Normal individuals excrete <150 mg/d of total protein and <30 mg/d of albumin.
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Multiple Choice
7. An early marker of glomerular disease that has been shown to predict glomerular injury in early diabetic nephropathy is microalbuminuria of:a. <20 mg/d c. <30 mg/db. <25 mg/d d. 30-300mg/d
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Multiple Choice
8. Presence of this protein by urine protein electrophersis (UPEP) is due to plasma cell dyscrasias:a. Albumin
b. Kappa or lambda light chains c. Tamm-Horsfall d. β2-microglobulin
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Multiple Choice
9. Hematuria is defined as ___ RBCs per high-power field (HPF) and can be detected by dipstick.a. 2-5 c. 4-5b. 3-5 d. >5
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Multiple Choice
10. To distinguish a solute diuresis from a water diuresis and to determine if the diuresis is appropriate for the clinical circumstances, this laboratory examination is measured/done:a. Plasma osmolality
b. ADH level c. Urine osmolality d. Water deprivation test Page
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Multiple Choice
11. The following are causes of water diuresis, EXCEPT:
a. Diabetes mellitusb. Diabetes insipidus, centralc. Diabetes insipidus, nephrogenic d. Primary polydipsia
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Modified True or False
12. Laboratory findings in acute tubular necrosis:a. BUN/PCr ratio >20:1 F
b. Urine osmolality >500mosml/L H2O F
c. Urine sodium (UNa) >40 meq/L T
d. FENa <1% F
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Acute Renal Failure
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Modified True or False
13. Persistent or significant hematuria mean/s:a. >three RBCs/HPF on three urinalyses T b. a single urinalysis with >100 RBCs Tc. gross hematuria Td. 2-3 RBCs/HPF F
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Modified True or False
14. The following are causes of diabetes insipidus central (vasopressin-sensitive):
a. Sheehan’s syndrome Tb. Empty sella Tc. Guillain-Barre syndrome Td. Supra or intrasellar tumor T
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Modified True or False
15. The following are causes of diabetes insipidus nephrogenic (vasopressin-insensitive):
a. Sjogren’s syndrome Tb. Multiple myeloma Tc. Amyloidosis Td. Hypercalcemia T
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