T1: Non-Protein Nitrogens and Glomerular Function Tests (PART2)
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ESSAY Uric Acid - One specific major source
Catabolism of the purine base nucleosides, adenosine and guanosine (=purine base metabolism)
ESSAY Uric Acid - two specific minor sources
• Food - Conditions of increased nucleic acid turnover (cancer patients)
ESSAY Uric Acid - four sequential steps in its renal handling
• Free glomerular filtration • Reabsorption of >90% in PCT • Tubular secretion in the distal portion of the PCT • Reabsorption in the DCT
ESSAY Uric Acid - One (2) primary cause of hyperuricemia associated with increased formation
• Idiopathic 2. Inherited metabolic disorders
ESSAY Uric Acid - Four secondary causes of hyperuricemia associated with increased formation
• Excess dietary purine intake • Increased nucleic acid turnover • Altered ATP metabolism • Preeclampsia
ESSAY Uric Acid - Once secondary disease state associated with decreased excretion
• acute or chronic renal disease, increased renal reabsorption, lead poisoning (**much more in lecture)
ESSAY Uric Acid - Causes of primary and secondary gout
Primary: overproduction of purines, decreased renal secretion of uric acid, increased dietary intake of purines (problem handling Uric acid) Secondary: consumption of alcohol, fructose drinks, meat, and seafood (dietary gout, acute/chronic renal disease)
ESSAY Uric Acid - Reference range for men and women
Men: 4.0 - 8.5 mg/dL Women: 2.7 - 7.3 mg/dL
Reagents used and scientist’s name associated with the chemical method for uric acid
Caraway method , oxidation of Uric acid with reduction of phosphotungstic acid to tungsten blue
Reagents used in the enzymatic method for uric acid
Uricase method: uricase oxydizes urate to allantoin
ESSAY ammonia - three specific sources
• Deamination of proteins in liver • Bacterial proteases, creases and amine oxidases act on contents of colon in GI tract • Hydrolysis of the glutamine in both the small and large intestines
ESSAY ammonia - one primary cause of increased ammonia
Inherited urea cycle deficiencies
ESSAY ammonia - four secondary causes of increased ammonia
• Advanced liver disease • renal failure • Reye’s syndrome • hepatic encephalopathy in individuals with cirrhosis
ESSAY ammonia - Four special specimen collection and handling procedures
• Good venipuncture technique must be used • Must be put on ice immediately and analyzed within 20 minutes of venipuncture • Patient must not smoke after midnight for a fasting specimen draw; no smoking in phleb area • Lab area and glassware should be free from ammonia contamination
ESSAY ammonia - reference range
14-45 micromol/L
The rate at which the kidneys are able to remove a filterable substance from the blood per unit of time
Clearance
Two factors upon which clearance is dependent
• Plasma concentration of that substance 2. Ability of kidneys to remove it
Two reasons why the creatinine clearance calculation is used to assess glomerular function
• its production is fairly constant day-to-day 2. It is freely filtered at the glomerulus and not secreted by the renal tubules
Corrected creatinine clearance formula and what units will it be in?
[(UxV)/P] x (1/t) x (1.73/SA) mL/min
Four instructions which should be given to a patient who is collecting a timed urine specimen
• void into toilet and note the time • collect every urine thereafter until the collection period is over, refrigerating specimen between voids • At the end of collection period, void and include this specimen in collection • Do not include first AND last voids
Creatinine excretion formula and what units?
[ UCR x TV x (1/1000) x (1/100) ] - grams/volume
What is the usefulness of calculating creatinine excretion in grams/volume
If less than 0.5 it is probably an incomplete collection
Two compounds that may be used instead of creatinine when a more precise assessment of glomerular function is required
• Inulin clearance 2. Cystatin C