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Renal > 05.11 - Urinalysis (Huch) - PP + Handout, No reading > Flashcards

05.11 - Urinalysis (Huch) - PP + Handout, No reading Flashcards

1
Q

Renal Tubular Epithelial Cells are most commonly found when there is

A

Acute Tubular Injury

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1
Q

When do you see Waxy Casts

A

CHRONIC Kindey Disease

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2
Q

Nephrotic Range of proteinuira

A

3.5 grams/24 hours

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2
Q

Proteinuria in Renal vs Extra-Renal origin hematuria

A

Renal Origin Hematuria often associated with proteinuria; absent in extra-renal origin

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3
Q

Cast with bright white line around edges, cracks around sides, broken edges

A

Waxy

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4
Q

What forms matrix of all casts

A

Tamm-Horsfall protein

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5
Q

Specific gravity is determined by

A

Numer and weight of solutes

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6
Q

Cystine crystals are associated with

A

Always pathologic, associated with very dense nephrolithiasis

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6
Q

RBC Casts is Pathognomonic for

A

Glomerulonephritis

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7
Q

Diseases affecting only the glomerular basement membrane in a non-inflammatory manner should lead to

A

Pure Nephrotic Urine

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7
Q

Negative Anion Gap means

A

GI losses, and kidneys are excreting as much acid as possible into urine

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8
Q

Which Bilirubin is water soluble?

A

Conjugate (Direct)

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8
Q

Urinary Anion Gap is an assessment of

A

Hyperchloremic Metabolic Acidosis

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9
Q

RBC Casts in Renal vs Extra-Renal origin hematuria

A

RBC casts are pathognomonic for renal origin/glomerulonephritis

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10
Q

Mesangial Pattern Urine

A

Hematuria and probably RBC casts, in absence of major proteinuria

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10
Q

Granular Casts represent

A

Breakdown of cellular debris as it passes thru tubules

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11
Q

RBC range in normal urine

A

0-2 rbc/hpf; Negative diptick

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11
Q

Protein in Hyaline Casts is

A

Tamm-Horsfall

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12
Q

Where is Tamm-Horsfall protein produced

A

Thick Ascending Limb cells - forms matrix of all casts

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13
Q

Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop should result in

A

Nephritic Urine

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13
Q

Crenated RBC’s indicate

A

Concentrated supernatant

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13
Q

Fatty Casts are Pathognomonic for

A

Nephrotic Syndrome

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15
Q

What should lead to Pure Nephrotic Urine

A

Diseases affecting only the glomerular basement membrane in a non-inflammatory manner

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16
Q

Nephritic implies

A

Active inflammation with cellular infiltration (ie proliferative changes)

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17
Q

Which Bilirubin will not be present in urine

A

Unconjugated (indirect) b/c not water soluble

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19
Q

How will Obstructive Uropathy typically present

A

Tubular Pattern of Urine

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20
Q

Lipiduria =

A

Nephrotic Syndrome, Heavy Proteinuria

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21
Q

Tubular Proteinuria

A

Smaller amounts: Failure to reabsorb low molecular weight proteins in proximal tubule

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22
Q

Flat, six-sided crystals

A

Cystine Crystals

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23
Q

Renal Tubular Epithelial Cells are hallmark of

A

Acute Tubular Necrosis (ATN)

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24
Q

Specific gravity of 1.010 corresponds to what Osmolality

A

300 mOsm/kg

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24
Q

RBC morphology in Renal vs Extra-renal origin hematuria

A

Dysmorphic in Renal Origin (pass thru glomerulus)

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24
Q

Conditions with Urinary WBC’s

A

Commonly UTI; Also Pyelonephritis, Allergic Interstitial Nephritis, Intense Glomerulonephritis

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26
Q

When is Leukocyte Esterase positive?

A

Increased numbers of Neutrophils in urine

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27
Q

Alternative to measuring proteinuria over 24 hour period

A

Ratio of urine protein over creatinine is reliable estimate of quantitative proteinuria

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27
Q

Waxy casts are also known as

A

Renal Failure Casts

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29
Q

What leads primarily to Hematuria

A

Diseases which have active proliferative inflammation that involve the mesangium

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31
Q

Tubular Urine

A

No heavy proteinuria, maybe Microscopic Hematuria, maybe Renal Tubular Epithelial Cells, GRANULAR CASTS, High specific gravity

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32
Q

Cellular infiltration and Pyuria in Non-Inflammatory Tubular Injury

A

None or little of either

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32
Q

3+ and 4+ proteinuria suggests

A

Nephrotic Range Proteinuria

32
Q

Type of casts seen in chronic kidney disease

A

Waxy

33
Q

Origin of Tamm-Horsfall proteins

A

Secreted by Tubular Cells

34
Q

What do Squamous Epithelial Cells indicate in urine

A

Nothing, can be predominant if vaginal contamination of sample

36
Q

Cellular infiltrate directly injuring tubules, such as Allergic Interstitial Nephritis

A

Inflammatory Tubulitis

36
Q

When is specific gravity not a marker of concentration

A

When there are abnormal numbers of heavy solutes in urine (glycosuria, contrast media)

37
Q

In metabolic acidosis, urinary pH is below

A

5.3

38
Q

What test detects all protein in urine

A

Sulfosalicylic Acid Test

39
Q

Renal Tubular Epithelial Cells should make you think

A

Acute Kidney Injury, ATN

41
Q

Injury typically caused by Ischemia (ATN)

A

Non-Inflammatory Tubular

42
Q

Larger, denser, acellular casts

A

Waxy

43
Q

Urine with high specific gravity

A

Tubular: damage to tubules causing inability to dilute or concentrate

44
Q

Hallmark of Tubular Urine

A

Granular Casts

45
Q

Urine in Nephrotic Syndrome

A

Proten and Lipid

46
Q

Clots in Renal vs Extra-Renal origin hematuria

A

Clots may be present in Extra-Renal origin

48
Q

What is almost invariably present in Inflammatory Tubulitis

A

Sterile Pyuria

49
Q

Urinary Anion Gap helps you distinguish

A

Whether etiology is GI (diarrhea secretion of HCO3-) or Urinary (inability to excrete H+)

50
Q

Only normal cast in urine

A

Hyaline Cast

52
Q

Which is found in normal urine, Nitrite or Nitrates?

A

Nitrate

53
Q

Are ketones found in normal urine?

A

No

55
Q

Positive Nitrite suggests

A

UTI with Nitrate-Reduing Bacteria (gram negative)

56
Q

Intense Glomerulonephritis is usually a feature of

A

Lupus

57
Q

Glycosuria in presence of normal blood glucose implies

A

Proximal Tubular Dysfunction

58
Q

Urine pH > 7.5-8.0 suggests

A

UTI with Urea-Splitting Bacteria (proteus)

59
Q

When Free Hemoglobin and Myoglobin in urine

A

Dipstick positive, but urinary sediment will be negative for RBC’s

61
Q

What is Pyelonephritis

A

Infected Tubules

62
Q

Heaviest proteinuria is found when

A

source is glomerulus

63
Q

Triple Phosphate Crystals are associated with

A

Infection

65
Q

Injury typically caused by Direct Tubular Toxins

A

Non-Inflammatory Tubular

66
Q

Normal range of Urinary pH

A

5-6.5

67
Q

Most common Uropathogens

A

Gram Negative Bac

68
Q

Urinar Casts represent

A

Precipitates of protein forming in lumen of tubules

69
Q

What is present in urine of Pyelonephritis

A

Pyuria and Bacteruria

69
Q

Normal range for urinary WBC’s

A

0-4/hpf

70
Q

Large, plate-like cell with abundant cytoplasm and very small nucleus

A

Squamous Epithelial Cell

71
Q

Non-inflammatory Tubular Injury would be typical of

A

Ischemia (ATN) or Direct Tubular Toxins

72
Q

Urine: Varying levels of protein, almost invariable hematuria, frequently RBC casts

A

Nephritic Urine

74
Q

What should result in Nephritic Urine

A

Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop

75
Q

When do you seen Uric Acid Crystals in urine

A

Normal urine that’s been sitting or refrigerated

76
Q

When are Ketones present in urine

A

Fasting, DKA, AKA

77
Q

Negative dipstick for albumin, but positive sulfosalicylic acid test indicates

A

Light Chain proteinuria (MM)

79
Q

Any pathologic process that leads to renal injury should also lead to

A

Abnormal urinalysis with potential changes in GFR

80
Q

What does Tubular Proteinuria reflect

A

Promxial Tubular Dysfunction

81
Q

RBC Casts are Pathognomonic for

A

Glomerulonephritis

83
Q

Large cell with nucleus about same size as WBC

A

Renal Tubular Epithelial Cell

84
Q

“Coffin Lid” crystals

A

Triple Phosphate Crystals

86
Q

Specific gravity of 1.030 corresponds to what Osmolality

A

1200 mOsm/kg

87
Q

Osmolality is determined by (as opposed to specific gravity)

A

Only the number of solutes

88
Q

Hyaline Casts are found in healthy persons in states of

A

Volume Depletion

89
Q

Diseases only involving the tubules should lead to

A

Tubular Pattern of Urine

90
Q

Diseases involving the microcirculation will lead to

A

Altered GFR, frequently signs of glomerular injury with proteinuria and hematuria

91
Q

Urine: Heavy proteinuria, Lipiduria, and signs of proliferation/inflammation with hematuria

A

Mixed Nephritic and Nephrotic

92
Q

Morphology of Urinary WBC’s

A

Granular cytoplasm, irregular nucleus, “glitter cells”

93
Q

Diseases which have active proliferative inflammation that involve the mesangium only lead to

A

Primarily to hematuria

94
Q

Most common type of Renal Stone

A

Calcium Oxalate Crystals

95
Q

Nephritic changes will be manifest in urine by

A

Varying levels of protein and hematuria, frequently with RBC casts

96
Q

Elevated levels of plasma conjugated bilirubin lead to

A

Urinary excretion

97
Q

Most common cause of positive dipstick for blood is

A

presence of RBC’s in urinary sediment

98
Q

Normal limit of protein excretion

A

Less than 150mg/day

Renal (31 decks)

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