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kyleannkelsey
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Serum creatinine is a product of creatine metabolism from _________.
muscle
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Serum creatinine is eliminated primarily by ____________.
glomerular filtration
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Thus, SCr and GFR are ________related.
- Inversely
- When GFR increases, SCr decreases and vice versa
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_________________ alone should NOT be used to assess the level of kidney function.
SCr concentration
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(True/False) SCr can be influenced by many factors.
True
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What factors decrease SCr by Reducing creatinine generation, particularly in children, women, elderly, malnourished pts?
Reduced muscle mass
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What factors increase SCr by transient increase in creatinine generation?
Ingestion of cooked meat
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What factors decrease SCr by reducing creatinine generation through mechanisms of reduced muscle mass and reduced meat intake?
Malnutrition
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What factors can increase SCr by Inhibition of tubular creatinine secretion?
Use of cimetidine, trimethoprim, probenecid
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What factors can increase SCr by interference with assays for creatinine
Use of flucytosine, some cephalosporins
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What factors can increase SCr by interference with assays for creatinine
Ketoacidosis
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What are the reasons you might want to obtain a 24 hour urine sample to obtain a directly measured CrCl value (rather than using prediction equations)?
- Extremes of age and body size (variable muscle mass)
- Severe malnutrition or obesity (variable muscle mass)
- Disease of the skeletal muscle (variable muscle mass)
- Paraplegia or quadriplegia (variable muscle mass)
- Vegetarian diet (variable muscle mass)
- Rapidly changing renal function
- Prior to dosing drugs with significant toxicity that is excreted by the kidneys
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Equations for the estimation of GFR and CrCl (CG, MDRD, CKD-EPI) rely on what patient parameters?
Individual having stable renal function/steady state
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What is the Cockcroft-Gault equation?
- Men: CLCr =(140-age)ActBW/(SCr x 72)
- Women: CLCr x 0.85
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The CKD-EPI equation was validated inw hat group of patients?
Those with a GFR over 60
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What equations can be used to obtain eCrCl?
- C-G
- Jeliffe
- Brater
- Salazar-Corcoran
- Schwartz
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What equations can be used to obtain eGFR?
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What are the standard units for CrCl?
mL/min
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What is a normal CrCl for a male?
97 to 137 ml/min
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What is a normal CrCl for a Female?
88 to 128 ml/min
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What is a normal CrCl for Newborns (1 day)?
5-50 mL/min/1.73m2
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What is a normal CrCl for a Newborns (6 days)?
15-90 mL/min/1.73m2
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What does the FDA classify as normal renal function?
> or = to 90
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When should you use adjusted body weight instead of actual body weight?
When a patient weighs more than 20% of their IBW
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What is the Ideal Body Weight (IBW) equation for Males
= 50 kg + 2.3 (inches over 5 ft tall)
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What is the Ideal Body Weight (IBW) equation for Females?
= 45.5 kg + 2.3 (inches over 5 ft tall)
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What is the Adjusted Body Weight (AdjBW) equation?
[0.4 x (ActBW – IBW)] + IBW
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Should you round up to 1 when elderly patients have a CrCl of <1?
No, less biased to use actual number
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What does MDRD Stand for?
Modification of Diet in Renal Disease
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FDA currently supports using which equations for estimating renal function for dosing of medications?
- MDRD or the CG
- However, the MDRD equation has never been validated in large clinical trials to dose lovenox
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What is the Salazar-Corcoran used for?
Has been validated for morbidly obese
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What equation has been validated in patients with CKD and GFR over 60 mL/min/1.73m2?
CKD-EPI equation
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What does CKD-EPI stand for?
Chronic Kidney Disease Epidemiology Collaboration Equation
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CKD-EPI equation is more accurate than ________ for values >60 mL/min/1.73m2
MDRD
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How could you use the CG equation for estimating renal function in a patient with acute kidney injury/rapidly changing function?
Use the highest possible SCr value you could obtain
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Brater and Jelliffe equations use ____________values.
age, weight, two SCr, the days in between those SCr values
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What equation should you use to estimate kidney function in a liver disease patient?
Equations overestimate = draw a direct measurement of GFR
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What equation should you use to estimate kidney function in a pediatric?
Schwartz (FDA supported)
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_________is the primary endogenous biomarker.
SCr
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