Clinical Application of Creatinine

by Carlo Raj, MD

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    Creatinine: all the different places that you might have to run to, to look for the relevant information of creatinine. It's all here. What does that mean? What is a normal mechanics of creatinine? What does it mean to you in terms of interpretation of creatinine so that you can help you diagnose your patient? Remember this is going to be part of your laboratory investigations and is it the only thing that you are going to use to confirm. No, but it is a darn important one. What is creatinine? We will begin. The breakdown product of the skeletal muscle and how often does that occur? All the time constitutively. Keep that in mind. Constant release into the blood stream. Once again because your muscles are breaking down you get it into your bloodstream. Remember as to what the normal levels of creatinine is? Well, I want you to think of 6 and 12. You double 6 and you get 12. It is 0.6 to approximately 1.2. Keep it simple. There is so many different things that you need to memorize, right? And a couple of things here and perhaps it may help you keep it mind, but 0.6 to 1.2. How does the kidney handle creatinine? Well, I want you to go into the plasma. I want you to go into afferent arteriole. I want you to arrive at the glomerulus and I want you to filter through. Does creatinine get filtered? Is it small enough for it to get filtered? It is. So it gets filtered. Correct. Okay? Next. As it gets filtered, you will continue through your glomerular capillaries and you end up on the efferent arteriole, are you there? and you continue through the peritubular capillaries. We call this what? vasa recta and you tell...

    About the Lecture

    The lecture Clinical Application of Creatinine by Carlo Raj, MD is from the course Renal Diagnostics. It contains the following chapters:

    • The Basics of Creatinine
    • Creatinine: Clinical Application
    • Creatinine Clearance
    • Causes of Increased and Decreased Ccr
    • Experimental Calculations of Renal Function

    Included Quiz Questions

    1. …peritubular capillaries.
    2. …glomerular capillaries.
    3. …renal vein.
    4. …efferent arteriole.
    5. …afferent arteriole.
    1. 24 hour urine sample
    2. Arterial blood sample
    3. Renal vein sample
    4. Single urine sample
    5. Venous blood sample
    1. It is freely filtered, slightly secreted and not reabsorbed.
    2. It is freely filtered, not secreted and not reabsorbed.
    3. It is freely filtered, fully secreted and not reabsorbed.
    4. It is partially filtered, fully secreted and not reabsorbed.
    5. It is partially filtered, slightly secreted and completely reabsorbed.
    1. 0.6-1.2 mg/dL
    2. 1.2-2.4 mg/dL
    3. 0.4-1.2 mg/dL
    4. 0.4-1.5 mg/dL
    5. 0.6-0.8 mg/dL
    1. 50 year old body male body builder.
    2. 40 year old male with a sedentary lifestyle.
    3. 18 year old female with amenorrhea, and low BMI.
    4. 70 year old female with COPD.
    5. 80 year old male with no significant past medical history.
    1. 25 mL/min
    2. 50 mL/min
    3. 25 mL/s
    4. 33 mL/s
    5. 100 mL/min
    1. Younger age
    2. Anuresis
    3. Starvation and muscle breakdown
    4. Decreased glomerular filtration
    5. Increased muscle mass
    1. Diabetic nephropathy
    2. Hypertension
    3. Glomerulonephritis
    4. Polycystic kidney disease
    5. Renal artery stenosis
    1. 95 mL/min
    2. 100 mL/min
    3. 80 mL/min
    4. 75 mL/min
    5. 50 mL/min
    1. (Urine concentration) x (flow rate) / (plasma concentration)
    2. (flow rate) x (plasma concentration) / (urine concentration)
    3. (plasma concentration) / (urine concentration) x (flow rate)
    4. (flow rate) / (urine concentration) x (plasma concentration)
    5. (urine concentration) x (plasma concentration) / (flow rate)
    1. Acute tubular necrosis
    2. Depressed renal blood flow
    3. Microangiopathy
    4. Glomerulonephritis
    5. Intrarenal vasoconstriction
    1. Creatinine is fully reabsorbed.
    2. Creatinine clearance is the measure of how much creatinine is cleared from the plasma in mL/min.
    3. Creatinine is the result of skeletal muscle breakdown.
    4. Creatinine is freely filtered.
    5. Serum creatinine levels are inversely correlated with glomerular filtration rate.
    1. Normal pregnancy
    2. Diabetic nephropathy
    3. Hyaline arteriolosclerosis
    4. Older age
    5. Hyperfiltration
    1. ACE inhibitors are contraindicated with the onset of microalbuminuria.
    2. Early disease involves hyperfiltration due to damage to the glomerulus.
    3. Hyaline arteriolosclerosis occurs distal to the glomerulus.
    4. Early disease involves a pathological increase in GFR.
    5. Non-enzymatic glycosylation causes accumulation of proteins narrowing the lumen of the efferent arteriole.
    1. Lowest glomerular filtration rate in the end of the 3rd trimester.
    2. 50% increase in plasma volume.
    3. Increase in hydrostatic pressure at glomerular capillaries.
    4. Lowered renal threshold for glucose reabsorption.
    5. Elevated plasma glucose levels.
    1. Increased serum creatinine
    2. Increased glomerular filtration rate
    3. Glycosuria
    4. Microalbuminuria
    5. Increased creatinine clearance
    1. Inulin – freely filtered, neither secreted nor reabsorbed.
    2. PAH – freely filtered, completely secreted, not reabsorbed.
    3. None of the answers are correct.
    4. Glucose – freely filtered, not secreted, fully reabsorbed.
    5. Creatinine – freely filtered, slightly secreted and not reabsorbed.
    1. At Tmax
    2. At the renal threshold for reabsorption.
    3. Once it starts being secreted.
    4. At a filtration fraction > 20%.
    5. Once GFR approaches 120 mL/min.
    1. It may be calculated using the clearance of PAH divided by the clearance of inulin. (C-PAH/C-Inulin)
    2. Normal filtration fraction is between 15-20%.
    3. All are correct.
    4. It may be calculated using the glomerular filtration rate divided by the renal plasma flow.
    5. It represents the percentage of renal plasma flow that is filtered through the glomerulus.
    1. PAH acid at low plasma concentrations
    2. PAH at high plasma concentrations
    3. Creatinine
    4. Glucose
    5. Inulin
    1. It is never reabsorbed under physiological conditions.
    2. In severe hyperglycemic states it approaches GFR.
    3. Excretion = filtration – reabsorption.
    4. Plasma glucose concentration that exceeds the renal threshold fore reabsorption will result in glycosuria.
    5. It is never secreted into the urine.

    Author of lecture Clinical Application of Creatinine

     Carlo Raj, MD

    Carlo Raj, MD

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