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3 REN > 15 Urine as an Indicator of Disease > Flashcards

15 Urine as an Indicator of Disease Flashcards

1
Q

Name 3 advantages of urinalysis

A

non-invasive diagnosis
easily obtained
normal composition well understood

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2
Q

Normally, what proportion of our urine is water?

A

95%

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3
Q

what might you want to add to a urine sample, what problem is associated with this?

A

preservatives

could affect urinalysis

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4
Q

Why might we want to test random samples ASAP?

A

to limit bacterial multiplication which may affect urinalysis

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5
Q

Why would you not perform a urine test first thing in the morning?

A

you get all the bacteria that have multiplied in the bladder overnight

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6
Q

What might foamy urine suggest?

A

proteinuria

conjugated bilirubin

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7
Q

What might someone’s urine look like if they drank a lot of milk?

A

cloudy, phosphates

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8
Q

What extra question do you need to ask if someone presents with haematuria?

A

what stage in passing is it red?

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9
Q

What would early haematuria suggest?

A

urethral problem

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10
Q

What would haematuria throughout passing suggest?

A

bladder problem

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11
Q

What would end haematuria suggest?

A

bladder problem

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12
Q

What might cause pseudomaturia? (4)

A

free Hb
myoglbin
porphyrins
drugs

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13
Q

What drugs might cause pseudomaturia?

A

laxatives
desferrioxamine
rifampicin
anti-inflammatories

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14
Q

What might cause a red/brown urnie?

A

conjugated bilirubin

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15
Q

What might cause black urine?

A

melanin

disseminated melanoma

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16
Q

What might cause urine to darken on standing?

A

alkaptonuria

porphyuria

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17
Q

How would you test for the presence of bacteria in urine?

A

dipstick tests for nitrite production

culture to quantitate

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18
Q

How many white cells would suggest kindey function issues?

A

10 or more per ml

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19
Q

What does the presence of red cells suggest in urine?

A

kidney damage

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20
Q

When might you expect casts in urine normally?

A

post-exercise

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21
Q

What crystals are present in acidic conditions/

A

oxalate crystals

cysteine

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22
Q

What crystals are present in alkaline conditions?

A

triple phosphate

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23
Q

What dietary factors may cause acidic urine?

A

meaty

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24
Q

What dietary factors may cause alkaline urine?

A

citrus fruit

vegetables

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25
Q

What diseases may cause alkaline urine?

A

urinary tract obstruction

some respiratory disorders (hyperventilation)

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26
Q

What diseases may cause acidic urine?

A

uncontrolled DM
starvation
respiratory disorders

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27
Q

Why do we use creatinine over urea to measure GFR?

A

urea is too variable

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28
Q

Why might CC be less useful?

A

when levels of excreted creatinine vary

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29
Q

What might cause CC to decrease?

A

wasting disease
malnutrition
poor renal blood flow
function

30
Q

What might cause an overspill pre-renal issue?

A

increased solute filtration
increased production in the body
abnormal metabolite
no suitable transporter

31
Q

What might decrease solute filtration in pre-renal issues?

A 
decreased production
decreased delivery (cardiac failure, haemorrhage, burns)
32
Q

What might cause a glomerular malfunction?

A

infection
AI disease
inflammation

33
Q

What might cause tubular malfunction?

A 
infection
AI disease
inflammation
necrosis
drugs
toxins
34
Q

What might happen as a result of glomerular malfunction?

A

protein leakage

35
Q

What might happen as a result of tubular malfunction?

A 
defective reabsorption (glucose)
defective secretion (H+)
36
Q

What is the normal urea excretion rate?

A

12-20g a day

37
Q

What 2 main factors increase urea excretion?

A

XS protein intake

greater protein catabolism

38
Q

What might increase protein catabolism?

A

protein energy malnutrition
uncontrolled DM1
infections, burns, wasting…

39
Q

What pre-renal issues might decrease urea excretion?

A

low protein diet
liver disease
genetic defects
poor renal blood supply

40
Q

What renal issues may decrease urea excretion?

A

glomerular nephritis

acute tubular necrosis

41
Q

What are the consequences of renal decreased urea excretion?

A

hyperammonaemia, NH4+ crosses BBB

lethargy, irritability, finally coma

42
Q

what might cause high glucose in urine?

A

metabolic hyperglycaemia
reduced renal threshold
tubular malfunction

43
Q

What might cause metabolic hyperglycaemia?

A

DM1
anxiety/stress
phaeochromocytoma

44
Q

What might reduce renal threshold?

A 
pregnancy
renal glycosuria (genetic)
45
Q

What is Fanconi Syndrome?

A

defective tubular reabsorption of most amino acids

46
Q

When might galactose be abnormally excreted in urine?

A

galactosemia (spill over of Gal 1-P)

47
Q

When might lactose be abnormally excreted in urine?

A

lactation
primary lactase deficiency
coeliac disease

48
Q

When might fructose be abnorally excreted in urine?

A

fructose intolerance

essential fructosuria

49
Q

When might ketones be abnormally excreted in urine?

A

uncontrolled DM1

starvation

50
Q

What might cause amino acidurias?

A

general tubular damage
specific transporter defects
raised plasma amino acids

51
Q

What specific transporter defects cause amino acidurias?

A

cystinuria

Hartnup’s disease

52
Q

What might cause raised plasma amino acid levfels?

A

PKU

cystinosis

53
Q

What might cause unconjugated bilirubin to be released in urine?

A

liver damage

obstructed bile ducts

54
Q

what causes phaechromocytoma?

A

an adrenal medullary tumour

55
Q

What does excessive adrenaline secretion cause?

A 
HTN
headaches
sweating
anxiety
palpitations........
56
Q

How is phaeochromocytoma diagnosed?

A

excessive adrenaline breakdown products in urine

57
Q

What adrenaline breakdown products may be found in urine?

A 
Metadrenaline
VMA (vanillylmandelic acid)
58
Q

How might you treat phaeochromocytoma?

A

adrenal surgery

blockers (propranolol)

59
Q

What is the single most sensitive indicator of renal disease?

A

proteinuria

60
Q

What level of proteinuria would be considered indicative of nephrotic syndrome?

A

3.5g/24h

61
Q

What level of proteinuria is considered abnormal?

A

> 200mg/24h

62
Q

What are the pre-renal causes of proteinuria?

A

high concentration, low Mr protein in plasma

Bence Jones protein

63
Q

What is Bence Jones protein?

A

light chains made rapidly and form their own aggregate protein which is non-functional, and is low Mr to be excreted

64
Q

what does Bence jones protein suggest?

A

multiple myeloma

65
Q

What kind of proteinuria might we expect with a glomerular defect?

A

albumin

66
Q

What kind of proteinuria might we expect with tubular defects?

A

beta2-macroglobulin

67
Q

What kind of proteinuria might we expect to be a result of renal secretion?

A

Tamm-Horsfall protein

68
Q

What is orthostatic proteinuria?

A

develops only after subject has been standing upright

69
Q

How can you distinguish between pre-renal vs renal problems?

A

Low Mr - pre-renal

medium- high Mr - renal

70
Q

What low Mr protein might we detect in urine as a result of pre-renal issues?

A

myoglobulin

71
Q

What medium - high Mr protien might we detect in urine as a result of renal issues?

A

albumin

3 REN (21 decks)

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