Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Renal SB > Biochemistry and Microbiology > Flashcards

Biochemistry and Microbiology Flashcards

1
Q

from what is GFR calculated

A

from 4 parameters

  • serum creatinine
  • age
  • gender
  • race
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where does the urea cycle occur

A

in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the down fall of using serum creatinine to calculate GFR

A

is not useful for showing mild renal impairment

i.e. Creatinine will rise but not greatly.
Small change despite steep fall in GFR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is ‘clearance’

A

the volume of plasma that is theoretically cleared of a substance per minute.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is urinary creatinine clearance calculated

A

[creatinine]urine x urine volume / [creatinine]serum x duration of collection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are confounders of serum creatinine

A

muscle mass&raquo_space; bigger your muscle mass is the more production of creatinine than a smaller person

diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what normally happens to plasma proteins in the kidney

A

they are normally retained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ix for proteinuria

A

albumin/creatinine ratio or

protein/creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what levels of protein in the urine is suggestive of significant glomerular damage

A

Protein >150mg/day in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the different causes of proteinuria

A

Overflow

Glomerular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what happens in overflow proteinuria and what can cause this

A

problem is that you are overproducing one particular protein, glomerular basement cannot handle protein load, leak protein into the filtrate, ability to reabsorb is diminished as it cannot handle volume of protein

multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what happens in glomerular proteinuria and what can cause this

A

normal amount of protein, but glomerulus not working as well, protein let through, overwhelms tubules again

albuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in multiple myeloma, what causes kidney impairment

A

light chain deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is seem on an x-ray in multiple myeloma

A

Pepper pot appearance/punched out lesions in the skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is nephrotic syndrome

A

triad

  • proteinuria
  • hypoalbuminaemia
  • oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what causes the nephrotic syndrome

A

pouring out protein in the urine in severe cases
body cannot make enough protein to replace what you are losing
balance of osmotic forces changes
more fluid in interstitial space
» nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does microalbuminuria mean

A

excretion of albumin in abnormal quantities but still below the limit of protein detection by dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is microalbuminuria the earliest expression of

A

diabetic nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why is microalbuminuria treated

A

to reduce risk of progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx of microalbuminuria in DM

A

ACE-i or ARB
irrespective of blood pressure

manage CV risk factors - stop smoking, reduce cholesterol, consider aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the target BP in DM with kidney problems but NO proteinuria

A

130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the target BP in DM with kidney problems WITH proteinuria

A

125/75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the 3 categories of problem in tubular function in oliguric patient

A

pre-renal
post-renal
renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what mechanism and example of pre-renal problem

A

reduced renal perfusion, kidney’s fine but not perfused properly

e.g. Blood loss, hypovolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what mechanism and example of post-renal problem
an obstruction to urinary outflow tract, ureter to urethra e.g. stones, malignancy
26
what mechanism and example of renal problem
intrinsic kidney tissue damage e.g. glomerulonephritis
27
what does the kidney produce and where do these products work
erythropoietin >> bone marrow 1,25 Dihydroxycholecalciferol >> gut renin >> converts angiotensiogen to angiotensin I
28
how can tubular function be calculated
urine osmolality v serum osmolality
29
what is the bacteria in the normal urinary tract
Urine in kidneys, ureters and bladder is sterile Lower end of the urethra is colonised by bowel flora i.e. Coliforms and enterococci
30
what is definition of UTI
The presence of micro-organisms in the urinary tract that are causing clinical infection
31
what is a lower UTI
infection confined to the bladder (cystitis - inflammation of the bladder)
32
what is a upper UTI
infection involving the ureters +/- the kidneys (pyelonephritis - inflammation of the kidney)
33
why is it important where the UTI is
influences the treatment
34
what is a complicated UTI
UTI complicated by systemic sepsis (infection getting into the blood) or urinary structural abnormality or stones - have to use longer course of antibiotics
35
what is Bacteriuria
the presence of bacteria in the urine | does not always mean infection, esp. in elderly patients or patients with catheters
36
is cystitis always due to infection?
no, there are a number of causes but is commonly due to UTI
37
why do women get UTI more than men
- short wide urethra - proximity of urethra to anus - increased risk with sexual activity - pregnancy (many women presenting with first UTI when pregnant)
38
who gets UTIs
common W > M Catheterised patients Patients with abnormalities of the urinary tract (e.g. horseshoe kidney)
39
what are the routes of infection for UTI
Ascending infection (more important/commoner) From the bloodstream (descending route of infection)
40
how does ascending infection work
bacteria from bowel → perineal skin → lower end of urethra → bladder → ureters → kidneys
41
how does UTI via the bloodstream occur
patient with bacteraemia / septicaemia from another focus of infection → bacteria in blood → seeded into kidneys → multiple small abscesses → bacteria in urine
42
what commonly cause UTI
'Coliforms': E.coli - commonest cause Klebsiella sp. Enterobacter sp. Proteus sp. Other coliforms
43
what is the commonest cause of UTI
E.coli
44
how do coliforms appear on gram stain
gram -ve bacilli
45
what is Proteus sp. associated with
formation of stone (calculi)
46
features of Proteus sp. and how it causes stones
foul smelling Produces urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts
47
what are enterococcus spp.
types of “streptococci” that live in the GI tract that can also cause UTI e.g. Enterococcus faecalis Entercoccus faecium
48
what staph is the most common staph to cause UTI and features of it
Staphylococcus saphrophyticus - a type of coagulase negative staph - usually affects women of child bearing age
49
can staph. aureus cause UTI?
yes but it is less common than coliforms and Staphylococcus saphrophyticus
50
why is Pseudomonas aeruginosa difficult to treat
resistant to most oral antibiotics except ciprofloxacin
51
features of Pseudomonas aeruginosa
Gram negative bacillus but not a coliform | Associated with catheters and UT instrumentation
52
Sx of UTI
dysuria (pain passing urine) frequency of urination / nocturia haematuria fever } suggest involvement loin pain} of rigors } upper urinary tract
53
what is ciprofloxacin associated with
C. Diff infection
54
what are problems with collecting a urine sample for UTI Ix
want to test bladder urine, not the lower end of the urethra which has bacteria normally first urine passed is most likely to be contaminated with bacteria normally in the urethra
55
how should a urine sample for UTI Ix be collected
Collecting a mid-stream specimen of urine (MSSU) - Wash perineum / urethral meatus with sterile saline (not antiseptic - could be passed into urine and kill bacteria of UTI) - Give patient a sterile foil bowl - First urine passed into toilet - Next part collected in foil bowl - Last urine passed in toilet
56
what are other ways urine can be obtained
“Clean catch” urine - children, elderly; nurse tries to catch midstream urine. Bag urine (babies) - often contaminated with bowel flora - negative culture result useful Catheter specimen of urine (CSU) Suprapubic aspiration - normally used after Bag urine in children if bag urine is +ve
57
what in a dip stick urine testing can indicate infection
Leukocyte esterase - Indicates the presence of leukocytes (WBC) in the urine Nitrites - Nitrites indicate the presence of bacteria in the urine - Some bacteria can reduce nitrates to nitrites – mainly coliforms – Enterococcus spp. do NOT give positive test Protein Blood
58
when is microscopy of the urine down
only done on selected (urgent) cases look for presence of polymorphs (pus cells), bacteria +/- red cells
59
what is Kass's Criteria
>10 to the power of 5 organisms / ml | significant =probable UTI
60
what is ESBL-producing bacteria
Makes bacteria resistant to ALL cephalosporins and to almost all penicillins Carried on a plasmid, which often carries genes for other resistance too (e.g gentamicin, ciprofloxacin)
61
what can be used to treat ESBL-producing bacteria
``` Nitrofurantoin (oral), pivmecillinam (oral) fosfomycin (oral), temocillin (IV) meropenem(IV) ertapenem (IV) ```
62
where is ESBL-producing bacteria found
imported chicken
63
what is Carbapenemase-producing Enterobacteriaceae (CPE)
``` Gram negative (coliform) bacilli that are resistant to meropenem This usually means that they are effectively resistant to ALL current antibiotics ```
64
what microorganisms can be found in the urine after travelling to india
Klebsiella pneumoniae Providencia rettgeri
65
how long does an uncomplicated UTI in women need to be treated for
3 days
66
why is amoxicillin a 1st line drug in UTI but what are its drawback
Can be given orally or IV Safe, even in pregnancy Range of organisms treated - Enterococcus faecalis - Some coliforms, but >50% E coli now resistant, and many other coliforms also resistant - not good for empirical treatment
67
what is given for empirical treatment of UTI
Trimethoprim (oral)
68
features of Trimethoprim
Safe, but avoid in 1st trimester (3 months) of pregnancy Can be given as co-trimoxazole (IV or oral) but risk of Stevens-Johnson syndrome Range of organisms treated: most coliforms, Staph aureus incl. MRSA but not Pseudomonas sp.
69
when is Nitrofurantoin useful
in lower uncomplicated UTI as only reaches effective concentrations in bladder urine Range of organisms treated: Most coliforms, Enterococci, Staph aureus incl MRSA, but not Proteus sp and Pseudomonas sp.
70
when should Nitrofurantoin be avoided
Avoid in late pregnancy (can cause neonatal haemolysis), breast feeding and children
71
features of Gentamicin
Hospital use only (has to be given IV) Range of organisms treated: Most coliforms, PSEUDOMONAS sp, Staph aureus incl MRSA, but not enterococci Very effective drug in severe Gram negative (coliform-related) sepsis Should be prescribed for 3 days ONLY - due to toxicity
72
complications of gentamicin and when is it NOT used
risk of toxicity causing renal and VIIIth nerve damage (deafness and balance problems) Avoid in pregnancy
73
Dose of gentamicin
Given once daily – 7mg/kg (ideal body weight) then measure a blood level 6-14 hours later
74
what is Pivmecillinam used for
treating lower uncomplicated UTI | often used in elderly in community
75
what antibiotics have some action against coliforms that produce ESBLs
Pivmecillinam | Temocillin
76
when is Temocillin given
Useful for treating complicated UTI/urosepsis in patients whose renal function is too poor for gentamicin
77
when is Cefalexin used
in pregnancy
78
features of Co-amoxiclav
associated with C. Diff BUT safe to use in pregnancy
79
features of Ciprofloxacin
risk of C.Diff infection not used in pregnant women or young children
80
when do you need to use Ciprofloxacin
Pseudomonas sp infection | - only oral drug that can treat it
81
Empirical antibiotic treatment for UTI
Female lower UTI - Trimethoprim or nitrofurantoin orally (3 days) Uncatheterised male UTI - Trimethoprim or nitrofurantoin orally (7 days) Complicated UTI or pyelonephritis (GP) - Co-amoxiclav or co-trimoxazole (14 days) Complicated UTI or pyelonephritis (Hospital) - Amoxicillin and gentamicin IV for 3 days (cotrimoxazole and gentamicin if penicillin allergy)
82
what is Asymptomatic bacteriuria
Significant bacteriuria (>10 to the power of 5 orgs/mL) Patient is asymptomatic, condition detected incidentally. No pus cells in urine Antibiotic treatment often NOT required, especially in the elderly May recur even if antibiotic treatment is given
83
when are pregnant women screened for Asymptomatic bacteriuria
All pregnant women screened at 1st antenatal visit
84
what can happen is asymptomatic bacteriuria is left untreated in pregnant females
Usually treated with antibiotics in pregnancy. If left untreated: - 20-30% progress to pyelonephritis - May lead to intra-uterine growth retardation (IUGR) or premature labour
85
what is Abacterial cystitis/
Urethral syndrome
Patient has symptoms of UTI Pus cells present in urine, but no significant growth on culture May be an early phase of UTI May be due to urethral trauma - “honeymoon cystitis” May be due to urethritis caused by chlamydia, gonorrhoea
86
what can provide symptomatic relief
Alkalinising the urine may help
87
when should UTI in catheterised patients be treated
>10 to the power of 5 orgs/mL ONLY given antibiotics if there is supporting evidence of UTI (fever, symptoms etc.)

Renal SB (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions