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Renal by Minnie: AH Version > 187: Urine > Flashcards

187: Urine Flashcards

1
Q

What kind of urine sediment is this?

What does it indicate?

A

Dysmorphic RBCs

Indicates glomerular disease (nephritic)

  • Immune-complex mediated
  • Anti-GBM disease
  • Pauci-Immune disease
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2
Q

What kind of proteins will be detected by a dipstick?

A

Negatively charged proteins (mostly albumin)

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3
Q

What kind of cast is this?

What does it indicate?

A

Hyalin cast

0-5 HPF may be found in normal urine

More may result from low flow

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4
Q

Normal urine specific gravity:

A

1.000 - 1.030

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5
Q

What is the specific gravity that reflects “maximum urine concentration” for a normal, functioning kidney?

A

1.030 - equivalent to 1100-1200 mOsm

(Normal urine in a healthy person is 280-300 mOsm)

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6
Q

What is the most common cause of proteinuria?

A

Diabetes

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7
Q

What might cause Leukocyturia (too many white cells in the urine)?

A
  • Contamination
  • Infection
  • Inflammation of the kidney or bladder
    • Interstitial cystitis
    • Pyelonephritis (infection of the kidney)
    • Interstitial nephritis (allergic?)
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8
Q

What are the (broad) categories of causes of hematuria?

A
  • GU cause
    • Kidney stone
    • Cancer
    • Cyst
    • Trauma
  • Contamination
  • Infection
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9
Q

What kind of cast is this?

What does it indicate?

A

Pigmented (muddy brown) cast

Indicates ATN or Rhabdomyolysis

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10
Q

Normal urine pH:

A

5-8

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11
Q

Why is it important to diagnose microalbuminuria in patients with diabetes?

A

They should be treated with an ACE-inhibitor; this will delay progressive kidney disease

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12
Q

What kinds of casts result from acute tubular necrosis?

A

Muddy brown casts

Cellular casts if whole cells are coming off

Coarsely granular casts if parts of cells are blebbing off

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13
Q

What kind of casts are pathopneumonic for glomerular disease

A

RBC casts

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14
Q

What is the “nephrotic range” for proteinuria?

A

>3000 mg/day of protein in the urine

(normal is <30, clinical albuminuria is >300)

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15
Q

What are the most likely causes of low urine K+ with low serum K+?

A

GI loss (diarrhea)

Cell shift

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16
Q

What are the components of normal urine on microscopy?

A

Few cells present

If casts, only hyalin

17
Q

How will ADH affect glucose levels in the urine?

A

ADH concentrates the urine

If glucose is present in the urine, ADH will increase the concentration of glucose by removing water

(Ex: urine glucose concentration of 2000 mg/dL does not necessarily indicate a serum glucose of 2000 mg/dL)

18
Q

A patient has a serum potassium of 2.7 meq/L (low). The urine potassium is > 40 meq/L (high). The cause of the low serum potassium is:

A. The Kidney

B. The GI Tract

C. Cell shift

D. Poor intake

A

A. The Kidney

High urine K+ is not an appropriate response to low serum K+ => the kidney is not reabsorbing K+ well

19
Q

What is the usual cause of hematuria with red blood cell casts, proteinuria, or dysmorphic RBCs?

A
  • Glomerular cause
    • Active disease, often autoimmune, affecting and damaging the kidneys
20
Q

What is the equation for the urine anion gap?

A

All are urine values:

K+ + Na+ + NH4+ = Cl-

Can help us evaluate non-gap metabolic acidosis

  • If K+ and Na+ > Cl-, it means that NH4+ is not in the urine
    • If this patient is acidemic, this means they not properly acidifying the urine; indicates RTA
  • If K+ and Na+ < Cl-, it means that NH4+ is in the urine
    • This is an appropriate response to acidemia caused by loss of bicarbonate in diarrhea
21
Q

What kind of cast is this?

What does it indicate?

A

White cell cast, indicates Tubular interstitial disease

  • Allergic interstitial nephritis
  • Pyelonephritis
22
Q

Nitrites in the urine may indicate the presence of…

A

Bacteria

However…

  • Not all bacteria produce nitrates
  • Bacteria may result from sample contamination
23
Q

What defines microalbuminuria?

Clinical albuminuria?

A

Microalbuminuria

  • If spot collection: 30-299 mcg/mg creatinine
  • If 24 hour collection: 30-299 mg/24h

Clinical albuminuria

  • If spot collection: >300 mcg/mg creatinine
  • If 24 hour collection: >300 mg/24h
24
Q

What might cause hematuria with no RBCs on microscopy?

A
  • Rhabdymyolisis
  • Hemolysis
  • Dilute urine (lood at specific gravity
25
Q

What is isosthenuria?

A

Normal urine osmolality (280-300)

26
Q

What are the differences in the urine of a patient with prerenal AKI vs ATN (an intrinsic AKI)?

A
  • Prerenal AKI = decreased perfusion to the kidney
    • Urine Osm > 500
      • High specific gravity
    • U Na < 20
      • A normal response to hypovolemia
    • FE Na <1
  • ATN
    • Urine Osm < 350
      • Low specific gravity - Not concentrating urine well
    • U Na > 40
      • The kidney is having trouble reabsorbing Na+
    • FE Na > 1
27
Q

Why is high protein in the urine bad in diabetics?

A

Indicates increased risk of kidney failure

28
Q

A UTI with a rise in creatinine indicates…

A

Pyelonephritis (kidney infection)

UTIs usually don’t cause a rise in creatinine

29
Q

What kind of cast is this?

What does it indicate?

A

RBC cast

Pathopneumonic for glomerular disease

30
Q

What causes ketones in the urine?

A

Ketones

Diabetic ketoacidosis or poor phosphate intake

31
Q

What cause bilirubin in the urine?

A

Liver disease (check liver function tests)

32
Q

How can you measure proteinuria?

A
  • Dipstick
  • Ratio
  • Actual amount excreted in 24h
    • But requires a 24h urine collection

Renal by Minnie: AH Version (27 decks)

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