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5a. Without references, identify 5a. Without references, identify the the basic facts and general basic facts and general principles of principles of renal function renal function tests with a minimum tests with a minimum of 70% accuracy.of 70% accuracy.
(1) Categories of renal function (1) Categories of renal function teststests
(2) Nature of urea nitrogen(2) Nature of urea nitrogen(3) Creatinine(3) Creatinine(4) Creatinine clearance(4) Creatinine clearance(5) Uric Acid(5) Uric Acid(6)(6) Urine ChemistriesUrine Chemistries
RENAL FUNCTIONSRENAL FUNCTIONSكليه كليه وظايف وظايف
5a5a ، ماخذ موجوديت ، بدون ماخذ موجوديت بدونو اساسي هاي و فكتور اساسي هاي فكتور
در را عمومي در قواعد را عمومي قواعدمعاينات به معاينات ارتباط به ارتباط
دقت به كليوي دقت وظايف به كليوي وظايفنمايد% 7070اصغري اصغري نمايد% تعين تعين
معاينات (1)(1) معاينات گتگوري گتگوريكليوي كليوي وظايف وظايف
يوريا )2()2( نايتروجن يوريا طبيعت نايتروجن طبيعتكرياتينين كرياتينين )3()3(كرياتينين )4()4( كرياتينين پاكسازي پاكسازياسيد )5()5( اسيد يوريك يوريكادرار )6()6( ادرار كيميا كيميا
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Renal Function Testsكليوي وظايف معاينات
Testتست Specimenنمونه
Exampleمثالغلظت ادرارConcentration Urine Specific Gravity
Osmolalityانسداد سیرومRetention Serum BUN, Creatinine
Uric Acidشفافیت سیروم و ادرارClearance Urine and Serum Creatinine
Clearance
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Nature of Urea NitrogenNature of Urea Nitrogenادرار نايتروجن ادرار طبيعت نايتروجن طبيعت
AMINO ACIDSAMINO ACIDS
UREAUREA
PROTEINPROTEIN
AMMONIAAMMONIA(Toxic)(Toxic)
VIAVIALIVERLIVER
*Urea is eliminated from the body by the kidneys*Urea is eliminated from the body by the kidneys
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Clinical SignificanceClinical Significanceكلينيكي كلينيكي اهميت اهميت
• Increased levelsIncreased levels• High protein dietHigh protein diet• Reduced renal filteringReduced renal filtering• Kidney diseaseKidney disease• Mechanical obstructionsMechanical obstructions
• Decreased levelsDecreased levels
• Advanced liver diseaseAdvanced liver disease • DialysisDialysis
مقدار • مقدار افزايش افزايشاز • غني غذايي از رژيم غني غذايي رژيم
پروتين پروتين كليوي • فلتر كليوي كاهش فلتر كاهشكليوي • كليوي امراض امراضميخانيكي • ميخانيكي بندش بندش
مقدار • مقدار كاهش كاهشانكشاف • انكشاف امراض امراض
كبد كبد يافته يافتهديااليزسديااليزس•
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BUN Normal ValuesBUN Normal Valuesان يو بي نارمل ان اندازه يو بي نارمل اندازه
است : متفاوت نارمل اندازه است : نوت متفاوت نارمل اندازه نوتمردان% 2525جندر : جندر : نزد مردان% بلندتر نزد بلندتر ميابد : ازدياد سن افزايش با ميابد : سن ازدياد سن افزايش با سن
: پروتين گرفتن افزايش غذايي : رژيم پروتين گرفتن افزايش غذايي رژيمان يو بي مقدار ان افزايش يو بي مقدار افزايش
NOTE: Normal values are variableNOTE: Normal values are variable
GENDER: 25% higher in malesGENDER: 25% higher in malesAGE: Increases with ageAGE: Increases with ageDIET: Increased protein intake can DIET: Increased protein intake can increase BUN levelsincrease BUN levels
SERUM SERUM URINE URINE 7 - 18 mg/dl7 - 18 mg/dl 12 - 20 mg/24 hours 12 - 20 mg/24 hours
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Lipemia and hemolysis
• Unpreserved urine• False decrease• Use
Hydrochloric acid or Toluene as a preservative
Sources of errorنادرست منابع
و ليپيمياهيمواليزس
ادرار • نقضنادرست • كاهشاستفاده •
هايدروكلوريد تولوين يا اسيد
ماده بطوركننده جلوگيري
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Creatine to Creatinine cycleCreatine to Creatinine cycleكرياتينين سيكل در كرياتينين كراياتين سيكل در كراياتين
Creat
ine
Creat
ine
For
med
in
Form
ed in
the
live
r
the
liver
Creatine combines Creatine combines with with
inorganic phosphateinorganic phosphateto form Creatine to form Creatine
PhosphatePhosphate Stored inStored inBrain and Muscle Brain and Muscle
tissuetissuePhosphate isliberated to
release energy
Creatine is convertedCreatine is convertedto creatinineto creatinine
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Normal Valuesنارمل اندازه
SERUM URINEMales
0.6 - 1.2 mg/dl 0 – 40 mg/24 hrsFemales
0.5 - 1.1 mg/dl 0 – 80 mg/24 hrs
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Creatinine Clearanceكرياتينين پاكسازي
فلتريشن • اندازه براي اساس بسيار معاينهيا (GFR)گلوميرول
ميشود • فلتر كليه طريق از يكه خون مقدارميكند تخمين
ندارد • كلينيكي ارزش كدام آن افزايش• Most sensitive test for glomerular
filtration rate (GFR)• Estimates the amount of blood flow
through the kidney• Increases have no clinical significance
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Decreased Creatinine Clearance
كرياتينين پاكسازس كاهش Reduced Renal Filtration Damage to Glomerulus Tubular Damage
كليوي فلتريشن كاهشميكند تخريب را ها گلوميرول
تيوبولر تخريبات
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Creatinine ClearanceFormulaكرياتينين سازي پاك فورمول
U = Urine Creatinine Concentration (mg/dl)
S = Serum Creatinine Concentration (mg/dl)
TV = 24 hour urine volume (ml)
US
x TV1440
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Creatinine ClearanceCreatinine Clearanceكرياتينين سازي كرياتينين پاك سازي پاك
نارمل • هاي نارمل اندازه هاي اندازهml/minml/min 145145 - - 9595 مردان :مردان :•ها :• ها :خانم ml/minml/min 132132 - - 9292 خانم
نادرست • نادرست منابع منابع
• Normal ValuesNormal Values
• Males: 95 - 145 ml/minMales: 95 - 145 ml/min• Females: 92 - 132 ml/minFemales: 92 - 132 ml/min
• Sources of errorSources of error
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Uric AcidUric Acidاسيد اسيد يوريك يوريك
مانده • باقي عمده قسمت اسيد مانده يوريك باقي عمده قسمت اسيد يوريكاست پروتين است ميتابوليزم پروتين ميتابوليزم
پيورين پيورين •است • اسيد نوكلويك از است متشكل اسيد نوكلويك از متشكل
• Uric acid is the main end Uric acid is the main end product of purine metabolismproduct of purine metabolism
• PURINES PURINES •Constituents of Nucleic AcidsConstituents of Nucleic Acids
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CLINICAL SIGNIFICANCEكلينيكي اهميت
ها • اندازه افزايشنقرس•لوكيميا•سايتميا • پوليكليوي • شديد امراض
شده • ديده دوايي تداوي در آن كم مقدار• Increased levels
• Gout• Leukemia• Polycythemia• Severe kidney disease
• Decreased levels found in drug therapy
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Uric Acidاسيد يوريك
نارمل • اندازهسيروم •
mg/dl 7.2 - 3.5: مردان •ها • mg/dl 6.0 - 2.6: خانم
:ادرار •است • موثر غذايي رژيم بوسيلهmg/day 750 - 250 اوسط •
• Normal Values• Serum:
• Males: 3.5 - 7.2 mg/dl• Females: 2.6 - 6.0 mg/dl
• Urine:• Effected by diet• Average 250 - 750 mg/day
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Sources of errorنادرست منابع
يا • اند اجزا تمام داراي يكه خون از استفادهپالسما گواگوالنت انتي
حجرات • از سيروم جدايي در ناكامي• Use of whole blood or anti-
coagulated plasma• Failure to separate serum from cells
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Quantitative Urine Chemistries
ادرار مقداري كيميانمونه“ • به ضرورت نمونه“ اكثرا به ضرورت دارد 2424اكثرا دارد ساعت ساعتكيمياوي • گان شونده تجزيه كيمياوي قواعد گان شونده تجزيه قواعد
پروتين پروتين •ها • ها الكتروليت الكتروليتگلوكوزگلوكوز•
• Most require a 24 hour specimenMost require a 24 hour specimen• Principle chemistries analyzedPrinciple chemistries analyzed
• ProteinProtein• ElectrolytesElectrolytes• GlucoseGlucose
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5a. 5a. Without references, Without references, identify the basic facts identify the basic facts and general principles of and general principles of renal function tests with a renal function tests with a minimum of 70% minimum of 70% accuracy.accuracy.
(1) Categories of renal (1) Categories of renal function testsfunction tests
(2) Nature of urea nitrogen(2) Nature of urea nitrogen(3) Creatinine(3) Creatinine(4) Creatinine clearance(4) Creatinine clearance(5) Uric Acid(5) Uric Acid(6)(6)Urine ChemistriesUrine Chemistries
SUMMARYSUMMARY خالصه
5a5a .، ماخذ موجوديت ،. بدون ماخذ موجوديت بدونو اساسي هاي و فكتور اساسي هاي فكتوردر را عمومي در قواعد را عمومي قواعد
وظايف معاينات وظايف ارتباط معاينات ارتباطدقت به دقت كليوي به % % 7070كليوي
نمايد نمايد شناسايي شناساييمعاينات )1()1( معاينات گتگوري گتگوري
كليوي كليوي وظايف وظايفيوريا )2()2( نايتروجن يوريا طبيعت نايتروجن طبيعتكرياتينين كرياتينين )3()3(كرياتينين )4()4( سازي كرياتينين پاك سازي پاكاسيد )5()5( اسيد يوريك يوريكادرار )6()6( ادرار كيميا كيميا