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Flashcards in Renal - Evaluation of Renal Disease Deck (121)
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1

What are some historical indications for renal assessment?

Polyuria, polydipsia, known or suspected exposure to nephrotoxins, familial history of kidney disease
Other: history of hypoalbuminemia or vascular thrombus

2

What are some PE indications for renal assessment?

Abnormal renal size/shape, mucosal ulceration, +/- anemia

3

What are some preventative indications for renal assessment?

Pre-anesthetic bloodwork, pre-nephrectomy, and to help choose medications (aminoglycosides, amphotericin B, and NSAIDs)

4

When we talk about renal function, what are we really talking about?

Glomerular filtration rate (GFR)

5

GFR determines the rate of what?

Urine production, electrolyte excretion, and elimination of metabolic waste products

6

What is azotemia?

Abnormal (excess) accumulation of nitrogen waste products

7

When does azotemia occur?

With >75% decrease of GFR

8

What is uremia?

Clinical manifestations associated with azotemia

9

What are some clinical manifestations associated with azotemia?

GI ulcers, nausea, and anorexia

10

True or False: All uremic patients are azotemic, all azotemic patients are not uremic.

TRUE

11

What is pre-renal azotemia?

hypoperfusion of the kidneys due to dehydration, acute blood loss, and/or congestive heart failure

12

What is renal azotemia?

intrinsic disease of the nephrons due to CKD, nephrotoxic drugsm renal infecitons, renal neoplasia, congenital malformations, and/or glomerulonephritis

13

What is post-renal azotemia?

Obstruction of urine flow distal to the kidney due to urolithiasis, neoplasia, and/or trauma

14

How is GFR evaluated?

Serum markers, clearance tests, and renal scintigraphy

15

What are the serum markers of GFR?

Blood urea nitrogen (BUN), creatinine, and symmetric dimethylarginine (SDMA)

16

Serum markers of GFR are ideal characteristics of markers because they are normally what?

Freely filtered by the glomerulus, undergo no tubular reabsorption, and no tubular secretion

17

What is urea a product of? Where is it made? Where is it filtered? Where is it partially reabsorbed?

Urea is a product of protein metabolism in the liver. It is filtered through the glomeruli and partially reabsorbed in the renal tubules

18

What extra-renal influences can increase urea concentrations?

High protein diet, GI bleeding, and dehydration

19

What extra-renal influences can decrease urea concentration?

malnutrition, low protein diet, severe burns, and hepatic dysfunction

20

What is creatinine a product of?

creatine metabolism

21

Where is creatinine filtered? Reabsorbed?

It is freely filtered by the glomeruli and negligible tubular reabsorption/secretion

22

Is BUN or creatinine a more accurate GFR marker?

creatinine

23

What extra-renal influence can cause a decrease in creatinine?

muscle loss

24

What type of diet can increase creatinine?

high protein diet

25

What breeds have increased creatinine?

Greyhounds and Birmans

26

What is symmetric dimethylarginine (SDMA) a product of?

cytoplasmic proteolysis

27

How is SDMA filtered, reabsorbed, and secreted in the kidneys?

It is freely filtered by the kidneys with no tubular reabsorption/secretion

28

Why is SDMA a good serum marker of GFR function?

Because it allows for earlier detection of renal dysfunction than traditional markers - it is increased with as little as 25-40% loss of GFR

29

True or False: SDMA is influenced by muscle mass.

FALSE

30

What are some possible extra-renal influences of SDMA?

altered metabolic rates - hypo/hyperthyroidism, neoplasia, age, and breed

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