1030 Unit 4 Flashcards
Most glomerular disorders are caused by what?
Immunologic disorders
Dysmorphic RBC casts would be significant findings in what?
—good pasture syndrome
—AGN
—Henoch-Schonlein purpura
Occasional episodes of macroscopic hematuria over periods of 20 or more years are seen in patients with what?
IgA nephropathy
What is Antiglomerular basement membrane antibody is sent with?
—Goodpasture syndrome
What is ANCA a diagnostic for?
GPA
Respiratory and renal symptoms are associated with what?
—GPA
—Henoch-Schonlein purpura
—good pasture syndrome
the presence of fatty casts is associated with what?
–nephrotic syndrome
–FSGS
–MCD
where are the highest levels of proteinuria seen?
–NS
what does ischemia frequently produce?
–acute renal tubular necrosis
what disorder is associated with polyuria and low specific gravity?
Nephrogenic DI
what inherited disorder produces a generalized defect in tubular reabsorption?
–fanconi syndrome
A teenage boy developed gout in his big toe and has high serum uric acid should be monitored for what?
–uromodulin-associated kidney disease
what is the only protein produced by kidney?
–uromodulin
what does presence of RTE cells and casts indicate?
ATN
The presence of what can differentiate between cystitis and pyelonephritis?
–WBC cast
what does the presence of WBCs and WBC casts with no bacteria indicate?
–AIN
What are some characteristics of ESRD?
–isothenuria
–azotemia
–electrolyte imbalance
what can cause prerenal acute renal failure be caused by?
–massive hemorrhage
what is the most common component of renal calculi?
calcium oxalate
uranalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed what?
–microscopic hematuria
abnormal urine screening tests categorized as an overflow disorder include what?
–alkaptonuria
–melanuria
–galactosemia
why do all states require newborn screening for PKU?
–for early modification of diets
what disorders can be detected by newborn screenings?
–tyrosyluria
–MSUD
–galactosemia
what is the best specimen for early newborn screening?
–blood specimen
what disorders are associated with the phenylalanine-tyrosine pathway?
–Alkaptonuria
–albinism
–tyrosinemia
what is the least serious form of tyrosylemia?
–immature liver function
what overflow disorder of phenylalanine-tyrosine pathway that would produce a positive reaction with reagent strip for ketones?
–MSUD
what overflow disorder can produce a false-positive reaction with the clinitest procedure?
–alkaptonuria
A urine that turns black after sitting by the sink for several hours could indicate what?
–alkaptonuria
–melanuria
what is ketonuria in a newborn indicate?
–methylmalonic acidemia
–MSUD
–isovaleric acidemia
what urine characteristic would be expected in newborns with MSUD?
–sweet odor
Hartnup disease is disorder that is associated with the metabolism of what?
–tryptophan
5-HIAA is a degradation product of what?
–serotonin
what are elevated urinary levels of 5-HIAA associated with?
carcinoid tumor
what are false-positive levels of 5-HIAA can be caused by?
–a diet high in bananas`
cystinuria or cystinosis in IEM?
cystinosis
cystinuria or cystinosis in “inherited disorder of tubular reabsorption”
cystinuria
cystinuria or cystinosis in Fanconi syndrome?
cystinosis
cystinuria or cystinosis in cystine deposits in the cornea?
cystinosis
cystinuria or cystinosis in early renal calculi formation
cystinuria
what is blue diaper syndrome associated with?
Hartnup disease
what is homocystinuria caused by?
–failure to metabolize methionine
what will the Ehrlich reaction detect?
porphorbilinogen
what is the classic urine color for porphyria?
–port wine
what specimens can be used for porphyrin testing?
–feces
–blood
–urine
Acetyl acetone is added tp the urine before performing Ehrlich test when checking for what?
–porphobilinogen
what are two stages of heme formation affected by lead poisoning ?
–aminolaevulinic acid and protoporphyrin
Hurler, Hunter, and Sanfilippo syndromes are hereditary disorders affecting what?
the metabolism of mucopolysaccharides
what do many uric acid crystals in pediatric urine specimen indicate?
–Lesch-Nyhan disease
deficiency of the GALT enzyme with produce what?
–positive clinitest
–galactosemia
what odor is associated with PKU?
mousy odor
what color is associated with indacinuria?
blue color
what odor is associated with cystinuria?
–sulfur odor
what color is associated with alkaptonuria?
black color
**also homogentisitic acid
what appearance is associated with Lesch-Nyhan disease
– orange sand in diaper
what odor is associated with isovaleric acidemia?
–sweaty feet odor
what conditions are marked by Nephrotic syndrome?
–massive proteinuria
–low levels of serum albumin
–pronounced edema
–high levels of serum lipids
what is most commonly found in patients with renal calculi
–hematuria
what is seen is all cases of renal disease?
proteinuria
Describe Goodpastures Syndrome
–autoimmune disease seen following a viral infection where attachment of autoantibodies to the glomeruli membrane that results in proteinuria, hematuria, and RBC cases
–often progresses from glomerulonephritis to end stage renal failure
describe cystinuria
a hereditary problem of the kidney tubules that do not reabsorb cystine
describe cystinosis
IEM - mild to fatal elevated amounts of cystine
what is alkaptonuria
–rare inborn error of metabolism where the patient lacks the enzyme homogentistic acid
what is seen in patients who have defects in the metabolism of homocystine?
–cataracts
–thromoembolytic problems
what are screening tests for melanuria?
–Ferric chloride tube test (gray-black precipitate
–sodium nitroprusside test (red color)
–Ehrlich test
what are urine tests for phenylketonuria?
–ferric chloride tube test
–clinitest
–alkalization of fresh urine
what condition shows an increased amount of 5-HIAA in urine?
–Argentaffin cell tumors
what test is for MSUD?
DNPH
what is most significant sign of Lesch-Nyhan
–orange sand in diaper
what are the tests for tyrosyluria?
–ferric chloride tube test (transient green color)
–nitroso-naphthol (red color)
describe minimal change disease
–also known as lipid nephrosis that affects children due to an allergic reaction (after immunization) that responds well to treatment and has good prognosis
describe porphyrinurias
–can be hereditary or acquired
–most common acquired cause is lead poisoning
*Newborn with severe vomiting’s and metabolic acidosis.
*uranalysis positive for ketones, negative for glucose.
*what screening would come back positive?
DNPH
When a ferric chloride test was performed the urine produced a green-gray color. Is this an expected result? Why or why not?
Yes, this is the color produced in ferric chloride when ketones are present
For the most accurate diagnosis of the newborn’s condition, what additional testing should be performed?
MS/MS
describe immunological reaction
–immune complexes from an immunological reaction-increased immunoglobulins
–IgA: deposit on the glomerular membrane
–components of immune system (complement, lymphocytes, neutrophils, monocytes and cytokines) are attracted to the deposit and change or damage the membrane
–results in thickening of glomerular basement membrane
what are non immunological reaction causes?
–exposure to chemicals and toxins
–disruption of the electrical membrane charges (nephrotic syndrome)
–deposits of amyloid material may create chronic inflammation
–thickening of the basement membrane with diabetic nephrography
describe acute poststreptococcal glomerulonephritis
–AGN or PSGN
–sudden onset commonly in children after respiratory infection (strep. Group A)
–no permanent damage to kidneys
–findings : hematuria, oliguria, and proteinuria
–increased BUN
–RBC cast, RBC, granular cast, and WBCs
–anti-streptolysin O (ASO) and anti-Dnase B = positive
–contains M protein in cell wall
what is BUN?
blood urea nitrogen
what are the symptoms of acute poststreptococcal glomerulonephritis?
–fever
–nausea
–edema
–fatigue
–hypertension
–oliguria
–hematuria
–proteinuria
describe classic clinical features of glomerulonephrit
–inflammatory process affecting the glomerulus
–findings: proteins, blood, and casts
–antigen-antibody complex from recent strep infection
–antigen-antibody complex in the glomeruli causing: inflammation and decrease in Glomerular filtration rate
what are symptoms of classic glomerulonephritis?
–proteinuria
–hematuria
–oliguria
–dysuria
–low grade fever
–headache
–high BP
–facial/periorbital edema
–lethargic
–weight gain (edema)
what is the classic order of glomerulonephritis disorders?
Acute–> chronic–> nephrotic syndrome – renal failure
what is the treatment of acute poststreptococcal glomerulonephritis ?
–successful treatments of management of secondary complications
–ASO
–Anti-DNase B
describe rapidly progressive glomerulonephritis
–(Crescentic)
–RPGN
–more serious than AGN w/ poor prognosis resulting in renal failure
–findings: same as AGN. Becomes more abnormal as it progresses
–increase protein
–GFR very low
–may result in fibrin degradation products, cryoglobulin, and deposits of IgA
what are symptoms of rapidly progressive glomerulonephritis?
–immune complexes due to another disorder such as SLE
–Damage to capillary wall causing crescentic formation from macrophages, fibroblast and fibrin causing permanent damage to Bowman capillary walls
what is hallmark characteristic of acute glomerulonephritis?
RBC casts
what does the presence of Broad cast indicate?
–seen in chronic glomerulonephritis that progresses to ESRD
describe goodpastures syndrome
–resembles RPGN in that is it an autoimmune disorder
–cytotoxic autoantibodies appear in the glomerulus after a viral infection
–findings: protein, blood, and RBC casts
–chronic glomerulonephritis and ESRD is common
what are symptoms of goodpastures syndrome?
–onset hemoptysis and dyspnea followed by hematuria
how is goodpastures syndrome detected?
antiglomerular basement membrane antibody
describe granulomatosis with polyangiitis
–GPA
–also known as Wegners granulomatosis
–granuloma is small blood vessels of the kidney and respiratory system
–this is a vascular issue as well
–neutrophil antibodies attach to vascular walls forming granuloma
what are the symptoms of granulomatosis with polyangiitis?
–hematuria
–proteinuria
–RBC cast
–Serum creatinine
–increased BUN
–respiratory issues changing into renal problems
what are testing procedures done for granulomatosis with polyangiitis?
-ANCA
what is p-ANCA?
–formed if neutrophils are fixed in ethanol
– creates perinuclear pattern