15 Urine as an Indicator of Disease

Question 1

Name 3 advantages of urinalysis

Answer 1

non-invasive diagnosis
easily obtained
normal composition well understood

Question 2

Normally, what proportion of our urine is water?

Answer 2

95%

Question 3

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

Answer 3

preservatives

could affect urinalysis

Question 4

Why might we want to test random samples ASAP?

Answer 4

to limit bacterial multiplication which may affect urinalysis

Question 5

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

Answer 5

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

Question 6

What might foamy urine suggest?

Answer 6

proteinuria

conjugated bilirubin

Question 7

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

Answer 7

cloudy, phosphates

Question 8

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

Answer 8

what stage in passing is it red?

Question 9

What would early haematuria suggest?

Answer 9

urethral problem

Question 10

What would haematuria throughout passing suggest?

Answer 10

bladder problem

Question 11

What would end haematuria suggest?

Answer 11

bladder problem

Question 12

What might cause pseudomaturia? (4)

Answer 12

free Hb
myoglbin
porphyrins
drugs

Question 13

What drugs might cause pseudomaturia?

Answer 13

laxatives
desferrioxamine
rifampicin
anti-inflammatories

Question 14

What might cause a red/brown urnie?

Answer 14

conjugated bilirubin

Question 15

What might cause black urine?

Answer 15

melanin

disseminated melanoma

Question 16

What might cause urine to darken on standing?

Answer 16

alkaptonuria

porphyuria

Question 17

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

Answer 17

dipstick tests for nitrite production

culture to quantitate

Question 18

How many white cells would suggest kindey function issues?

Answer 18

10 or more per ml

Question 19

What does the presence of red cells suggest in urine?

Answer 19

kidney damage

Question 20

When might you expect casts in urine normally?

Answer 20

post-exercise

Question 21

What crystals are present in acidic conditions/

Answer 21

oxalate crystals

cysteine

Question 22

What crystals are present in alkaline conditions?

Answer 22

triple phosphate

Question 23

What dietary factors may cause acidic urine?

Answer 23

meaty

Question 24

What dietary factors may cause alkaline urine?

Answer 24

citrus fruit

vegetables

Question 25

What diseases may cause alkaline urine?

Answer 25

urinary tract obstruction | some respiratory disorders (hyperventilation)

Question 26

What diseases may cause acidic urine?

Answer 26

uncontrolled DM starvation respiratory disorders

Question 27

Why do we use creatinine over urea to measure GFR?

Answer 27

urea is too variable

Question 28

Why might CC be less useful?

Answer 28

when levels of excreted creatinine vary

Question 29

What might cause CC to decrease?

Answer 29

wasting disease malnutrition poor renal blood flow function

Question 30

What might cause an overspill pre-renal issue?

Answer 30

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

Question 31

What might decrease solute filtration in pre-renal issues?

Answer 31

``` decreased production decreased delivery (cardiac failure, haemorrhage, burns) ```

Question 32

What might cause a glomerular malfunction?

Answer 32

infection AI disease inflammation

Question 33

What might cause tubular malfunction?

Answer 33

``` infection AI disease inflammation necrosis drugs toxins ```

Question 34

What might happen as a result of glomerular malfunction?

Answer 34

protein leakage

Question 35

What might happen as a result of tubular malfunction?

Answer 35

``` defective reabsorption (glucose) defective secretion (H+) ```

Question 36

What is the normal urea excretion rate?

Answer 36

12-20g a day

Question 37

What 2 main factors increase urea excretion?

Answer 37

XS protein intake | greater protein catabolism

Question 38

What might increase protein catabolism?

Answer 38

protein energy malnutrition uncontrolled DM1 infections, burns, wasting...

Question 39

What pre-renal issues might decrease urea excretion?

Answer 39

low protein diet liver disease genetic defects poor renal blood supply

Question 40

What renal issues may decrease urea excretion?

Answer 40

glomerular nephritis | acute tubular necrosis

Question 41

What are the consequences of renal decreased urea excretion?

Answer 41

hyperammonaemia, NH4+ crosses BBB lethargy, irritability, finally coma

Question 42

what might cause high glucose in urine?

Answer 42

metabolic hyperglycaemia reduced renal threshold tubular malfunction

Question 43

What might cause metabolic hyperglycaemia?

Answer 43

DM1 anxiety/stress phaeochromocytoma

Question 44

What might reduce renal threshold?

Answer 44

``` pregnancy renal glycosuria (genetic) ```

Question 45

What is Fanconi Syndrome?

Answer 45

defective tubular reabsorption of most amino acids

Question 46

When might galactose be abnormally excreted in urine?

Answer 46

galactosemia (spill over of Gal 1-P)

Question 47

When might lactose be abnormally excreted in urine?

Answer 47

lactation primary lactase deficiency coeliac disease

Question 48

When might fructose be abnorally excreted in urine?

Answer 48

fructose intolerance | essential fructosuria

Question 49

When might ketones be abnormally excreted in urine?

Answer 49

uncontrolled DM1 | starvation

Question 50

What might cause amino acidurias?

Answer 50

general tubular damage specific transporter defects raised plasma amino acids

Question 51

What specific transporter defects cause amino acidurias?

Answer 51

cystinuria | Hartnup's disease

Question 52

What might cause raised plasma amino acid levfels?

Answer 52

PKU | cystinosis

Question 53

What might cause unconjugated bilirubin to be released in urine?

Answer 53

liver damage | obstructed bile ducts

Question 54

what causes phaechromocytoma?

Answer 54

an adrenal medullary tumour

Question 55

What does excessive adrenaline secretion cause?

Answer 55

``` HTN headaches sweating anxiety palpitations........ ```

Question 56

How is phaeochromocytoma diagnosed?

Answer 56

excessive adrenaline breakdown products in urine

Question 57

What adrenaline breakdown products may be found in urine?

Answer 57

``` Metadrenaline VMA (vanillylmandelic acid) ```

Question 58

How might you treat phaeochromocytoma?

Answer 58

adrenal surgery | blockers (propranolol)

Question 59

What is the single most sensitive indicator of renal disease?

Answer 59

proteinuria

Question 60

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

Answer 60

3.5g/24h

Question 61

What level of proteinuria is considered abnormal?

Answer 61

> 200mg/24h

Question 62

What are the pre-renal causes of proteinuria?

Answer 62

high concentration, low Mr protein in plasma Bence Jones protein

Question 63

What is Bence Jones protein?

Answer 63

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

Question 64

what does Bence jones protein suggest?

Answer 64

multiple myeloma

Question 65

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

Answer 65

albumin

Question 66

What kind of proteinuria might we expect with tubular defects?

Answer 66

beta2-macroglobulin

Question 67

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

Answer 67

Tamm-Horsfall protein

Question 68

What is orthostatic proteinuria?

Answer 68

develops only after subject has been standing upright

Question 69

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

Answer 69

Low Mr - pre-renal | medium- high Mr - renal

Question 70

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

Answer 70

myoglobulin

Question 71

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

Answer 71

albumin