UREA CREATININE KFT RFT - ICU BASICS DR TAPESH BANSAL🩺📽🎫

food for thought🤠🙋‍♂️🙋‍♀️
Can a person survive on one kidney ?
Dr.TAPESH BANSALdiscussed the synthesis, factors affecting, and medical relevance of Uria and Creatinine, emphasizing the importance of understanding their levels in diagnosing kidney function. He also highlighted the significance of the blood urea nitrogen (BUN) to creatinine ratio, glomerular filtration rate (GFR), and augmented regional clearance in medical contexts. Lastly, he stressed the importance of accurate lab measurements, the factors affecting creatinine levels, and the need to understand lab investigations for both exams and career progression.
Summary
Uria, Creatinine, and Medical Contexts Discussion
Dr. discussed the topic of Uria and Creatinine, focusing on their synthesis, factors affecting their levels, and their relevance in medical contexts. He emphasized that renal failure is not the focus of this discussion, but rather the specific aspects of Uria and Creatinine. He also mentioned the importance of the blood urea nitrogen (BUN) to creatinine ratio and its relevance in certain situations. Furthermore, Dr. touched on the topic of glomerular filtration rate (GFR) and augmented regional clearance, indicating that these would be covered in future discussions.
Understanding Urea Cycle and Metabolism
Dr discussed the importance of understanding the urea cycle and its relation to the body's metabolism. He explained that urea is produced when ammonia is generated from amino acid turnover, which can be increased due to catabolic stress, steroid use, acute starvation, amino acid infusions, and upper gastrointestinal bleeding. Dr also highlighted the significance of pre-renal conditions, where a decrease in renal blood flow leads to increased urea absorption, causing a disproportionate rise in urea levels compared to creatinine. He emphasized that this distinction is crucial for diagnosing and managing kidney-related issues.
Blood Urea Nitrogen and Creatinine Levels Discussion
Dr. discussed the importance of blood urea nitrogen (BUN) and creatinine levels in diagnosing kidney function. He emphasized that a BUN to creatinine ratio of more than 40 is indicative of pre-renal failure, which is reversible. He also explained that liver disease, malnutrition, and dilutional effects can cause low BUN levels. Dr. concluded by stating that there is no normal ratio for BUN to creatinine, as both values can vary. He also mentioned that liver disease can cause low creatinine levels.
Factors Affecting Creatinine Levels and Interpretation
Dr discussed the factors affecting creatinine levels, emphasizing that they are not solely indicative of kidney injury. He explained that muscle injury, surgery, meat ingestion, aspirin intake, and fluid overload can all impact creatinine levels. He also highlighted the importance of considering dilution effects, particularly in ICU patients, as muscle mass loss can lead to falsely low creatinine levels. Dr also mentioned that pregnancy and liver disease can affect creatinine levels.
Accurate Measurements and Kidney Function Discussion
Dr. discussed the importance of accurate measurements in the lab, particularly in relation to protein values and blood urea nitrogen (BUN) levels. He highlighted that certain drugs and conditions can lead to falsely low BUN levels and explained the concept of the BUN-to-creatinine ratio. Dr. also discussed the relationship between creatinine levels and glomerular filtration rate (GFR) in the context of acute kidney injury. He emphasized the need to understand the current behavior of the kidney and the calculation of the GFR, and clarified the difference between Estimated GFR (eGFR) and Actual GFR. Dr. concluded by stating that he had covered all the necessary points and hoped to have answered all the queries.
Suggestions
Attendees to review and understand the normal ranges and interpretation of blood urea and creatinine values in different clinical scenarios.
• Clinicians to consider using blood urea/creatinine ratio and urine sodium levels to differentiate between pre-renal and renal causes of acute kidney injury.
• ICU team to be aware of augmented renal clearance in sepsis and trauma patients, and adjust antibiotic dosing accordingly to prevent treatment failure.