Body Fluids Exam 1 Flashcards
1
Q
Kidney anatomy:
Where blood enters the glomerulus
A
Afferent arteriole
2
Q
Kidney anatomy:
Where unfiltered blood exits the glomerulus
A
Efferent arteriole
3
Q
Kidney anatomy:
This part of the nephron is where water and electrolyte exchange takes place
A
Loop of Henle
4
Q
Kidney anatomy:
The microscopic structural and functional unit of the kidney
A
Nephron
5
Q
Kidney anatomy:
Receives/filters blood
A
Glomerulus
6
Q
Kidney anatomy:
Location of glomerulus
A
Bowman’s Capsule
7
Q
Kidney anatomy:
Primary site of reabsorption of water and essential substances
A
Proximal convoluted tubule
8
Q
Kidney anatomy:
Where concentration of urine begins in the nephron
A
Distal convoluted tubule
9
Q
Kidney anatomy:
Where final concentration and secretion takes place in the nephron
A
Collecting ducts
10
Q
Kidney anatomy:
Average amount of blood flowing through kidneys
A
1200 mL/min
11
Q
Kidney anatomy:
Renal blood pressure/blood volume is controlled by
A
Renin-angiotensin-aldosterone system (RAA)
12
Q
Kidney anatomy:
The glomerulus filters substances of what molecular weight?
A
< 70,000
13
Q
Kidney anatomy:
The glomerulus creates a ______ free ultra-filtrate
A
Protein free
14
Q
Kidney anatomy:
The glomerulus creates a protein free ultra-filtrate at what rate?
A
120 mL/min
15
Q
Kidney anatomy:
What is not found in the glomerular ultra-filtrate?
A
Proteins
Protein-bound elements
Cells
Anything with a larger molecular weight than 70,000
16
Q
Kidney anatomy:
What is the glomerular ultra-filtrate of 120 mL/min called?
A
GFR
Glomerular Filtration Rate
17
Q
This is where the return of water and essential substances back into blood occurs
A
Proximal tubule of nephron
18
Q
Where is renin released from?
A
Kidneys
19
Q
What causes the RAA system to “turn on”
A
Decrease in Renal Blood Pressure/Volume
20
Q
Where does aldosterone come from?
A
Adrenal glands
21
Q
Glomerular Filtration Rate
A
120 mL/min
22
Q
Repels molecules with a positive charge (such as proteins)
A
Shield of negativity
23
Q
What makes it through glomerular filtration?
A
Glucose
Electrolytes
Water
24
Q
What substance is reabsorbed in response to aldosterone?
A
Sodium
25
What causes sodium to be reabsorbed?
**Aldosterone**
26
Definition:
Substances go from tubule back into the bloodstream
**Reabsorption**
27
What is reabsorbed in to the bloodstream?
**Mostly water**
**Glucose**
**Amino Acids**
**Other Essential electrolytes**
28
Where does 60-85% of reabsorption occur in the nephron?
**Proximal Convoluted Tubules**
29
Definition:
Plasma concentration of a substance at which reabsorption stops and the substance begins to appear in urine
**Renal Threshold**
30
What is the range for Glucose Renal Threshold?
**160 - 180 mg/dL**
31
Removes large, unfilterable waste products from the blood in to the tubular filtrate
**Tubular secretion**
32
Tubular secretion excretes these for maintenance of blood acid-base balance
**Hydrogen ions**
33
Where does the final reabsorption of water occur in the nephron?
**Distal Convoluted Tubules and the Collecting Ducts**
34
Concentration is controlled by what hormone?
**Anti-Diuretic Hormone (ADH)**
**AKA**
**Vasopressin**
35
Another name for ADH
**Vasopressin**
36
What triggers ADH?
**An increase in plasma concentration of sodium**
37
Functions of kidneys (5)
**Removal of waste products**
**Retention of nutrients and essential compounds**
**Acid-base balance**
**Water balance**
**Hormone synthesis (renin, erythropoiten, vitamin D)**
38
Composition of urine
**Urea (protein metabolism)**
**Uric acid (purine metabolism)**
**Creatinine (muscle cell breakdown)**
**Cl-, Na+, K+, H+ (electrolytes)**
**Few formed elements (squamous epis, possible crystals, bacteria, casts, WBCs, RBCs)**
39
Average output of urine
**600 - 2000 mL/24 hrs**
40
Definition:
Decreased output of urine
**Oliguria**
41
Definition:
No output of urine
**Anuria**
42
Definition:
Increased output of urine
**Polyuria**
43
Definition:
Painful flow of urine
**Dysuria**
44
Definition:
Increased output of urine at night
**Nocturia**
45
What will average output of urine depend on?
**State of hydration**
46
Possible causes of oliguria
| (3)
**Dehydration**
**Diabetes**
**UTI**
47
Possible causes of anuria
| (3)
**Kidney failure**
**Kidney damage**
**Decreased blood flow**
48
Possible causes of polyuria
| (4)
**Diabetes insipidus (Na+ issue)**
**Diabetes mellitus (glucose issue)**
**Caffeine**
**Alcohol**
49
Possible causes of dysuria
| (5)
**UTI**
**Kidney stones**
**Enlarged prostate**
**STD/STI**
**Yeast infection**
50
Possible causes for nocturia
| (2)
**Pregnancy**
**Elderly**
51
Rate at which blood enters the kidneys
**1200 mL/min**
52
Rate at which the kidneys filter blood
**120 mL/min**
53
Hormone that controls final reabsorption of water
**Anti-diuretic hormone (ADH)**
**AKA**
**Vasopressin**
54
Term used to describe the point where reabsorption of a substance stops
**Renal threshold**
55
Included in physical examination of urine
(3)
**Color**
**Clarity**
**Specific gravity**
56
Normal color of urine is due to
**Urochrome**
57
Cause of clear, yellow urine
**Normal**
58
Cause of colorless, pale, or straw colored urine
**Diluted urine**
**Diabetes**
59
Causes of dark yellow or amber colored urine
**Concentrated urine**
**Dehydration**
60
Cause of amber/brownish-orange urine
**Icteric- presence of bilirubin**
61
Cause of orange colored urine
**UTI drugs (pyridium)**
62
UTI drug that is known for causing urine to turn orange
**Pyridium**
63
Cause of blue or green colored urine
**Drugs (such as birth control)**
**or Dyes**
64
Cause of brown urine
**Old bloody urine**
65
Cause for red, cloudy urine
**Intact RBCs (hematuria)**
66
Cause for red, clear urine
**Hemoglobin (hemoglobinuria)**
**Myoglobin (myoglobinuria)**
67
Cause for red-purple urine
**Porphyrins**
68
Cause for black urine
**Melanin**
**or**
**Homogentisic acid**
69
What affects the color of urine? (4)
**Metabolism**
**Ingested materials**
**Diseases**
**Physical activity**
70
Clarity of urine:
Transparent; no visible particulates
**Clear**
71
Clarity of urine:
Few particulates
**Hazy**
72
Clarity of urine:
Print is blurred through the urine
**Cloudy**
73
Clarity of urine:
Print not seen
**Turbid**
74
Clarity of urine:
May precipitate or clot
**Milky**
75
Causes for milky urine
**Increased lipids**
**Increased proteins**
76
Nonpathologic causes of hazy, slightly cloudy, cloudy, or turbid urine
(7)
**Mucus**
**Talc**
**Cream**
**Fecal contamination**
**Sperm**
**Squamous epithelial cells**
**Certian crystals (ammonium biurate, triple phosphate uric)**
77
Pathologic causes for hazy, slightly cloudy, cloudy, or turbid urine
(8)
**RBCs**
**WBCs (infection, STD/STI)**
**Crystals (bilirubin, leucine)**
**Bacteria, yeast, Trichomonas (UTI, genital contamination)**
**Renal epithelial cells (deterioration in kidneys)**
**Lipids (milky urine)**
78
Definition:
A measure of dissolved substances present in a solution. Primarily reflects the patient's state of hydration
**Specific Gravity**
79
Term used for the presence of intact red cells in the urine
**Hematuria**
80
Term used for presence of lysed red cells or free hemoglobin in the urine
**Hemoglobinuria**
81
Assesses the kidney's ability to reabsorb water
**Specific Gravity**
82
What influences specific gravity?
**Size and number of particles**
83
Normal urine specific gravity
**1.003 - 1.035**
84
TRUE or FALSE
Urine can have a specific gravity of 1.000
**FALSE**
**Pure water has this SG**
85
Specific gravity of glomerular filtrate
**1.010**
86
What does having a fixed SG of 1.010 from multiple samples indicate?
**Renal dysfunction**
87
Correlation between volume of urine and specific gravity
**As volume increases, specific gravity decreases (hydrated)**
**As volume decreases, specific gravity increases (dehydrated)**
88
TRUE or FALSE
Diseased kidneys lose the ability to concentrate/dilute urine causing the specific gravity to become fixed at 1.035
**FALSE**
**Specific gravity becomes fixed at 1.010 due to glomerular filtration working but nothing else.**
89
3 ways to measure specific gravity (SG)
**Dipstick**
**Harmonic oscillation**
**Refractometer**
90
Method of measuring Specific Gravity:
The frequency of sound waves will change in proportion to the density
**Harmonic oscillation densitometry**
91
Compares the velocity of light in air with the velocity of light in a solution
**Refractive index**
92
Method of measuring Specific Gravity:
The density of dissolved particles present in the sample will determine the angle at which light passes through a solution
**Refractometer**
93
What "fixed" SG value is associated with kidney problems?
**1.010**
94
Generally, as urine volume increases, specific gravity \_\_\_\_\_\_\_
**Decreases**
95
Steps to follow if SG is off the scale
**Dilute 1:2**
**Rerun**
**Multiply result by dilution factor**
96
Causes for Abnormal Specific Gravity Using a Refractometer
Low
(dilute or hypotonic)
**Diabetes insipidus (impaired ADH, increased plasma Na+, Increased thirst)**
**High water intake**
97
Causes for Abnormal Specific Gravity Using a Refractometer
High
(concentrated, hypertonic)
**Protein**
**Diabetes mellitus (defective insulin, increased plasma/urine glucose)**
**Dehydration**
**Radiographic dyes**
**Some IV fluids**
98
Causes for Abnormal Specific Gravity Using a Refractometer
Fixed 1.010
**Renal disorder**
99
This causes a vivd yellow foam
**Bilirubin**
100
This causes an abundant amount of white foam
**Protein**
101
TRUE or FALSE
A small amount of white foam is normal when urine is shaken
**TRUE**
102
Urine Odor:
Normal
**Faintly aromatic**
103
Urine odor:
Strong unpleasant ammonia-like odor, foul
**Bacterial infection**
104
Urine Odor:
Sweet or fruity due to the presences of ketones
**Diabetes**
105
Urine Odor:
Syrup, sulfur, mousey
**Metabolic defects**
106
Automated method for chemical analysis of urine
**Reflectance photometry**
**(As color increases, reflectance of light decreases)**
107
TRUE or FALSE
Reagent strips should always be protected from moisture, light, heat, volatile chemicals, and should be refrigerated.
**FALSE**
**Reagent strips should always be protected from moisture, light, heat, and volatile chemicals but should NOT be refrigerated.**
108
Normal urine pH
**4.5 - 8.0**
109
Causes of acidic pH
| (4)
**H+**
**Ketones - due to starvatin or Type 1 Diabetes mellitus**
**Dehydration**
**Cranberry juice**
110
Causes of alkaline pH
| (2)
**Certain UTIs (bacteria create ammonia)**
**Old urine (normal flora reproduce creating ammonia)**
111
Principle for testing pH
**Double indicator system**
112
Are there any interfering factors for pH?
**No**
113
What is the best indicator of renal disease?
**Protein**
114
Normal result for protein in urine
**Negative or Trace**
115
What is the only protein detected by dipstick?
**Albumin**
116
Causes of Pre-renal proteinuria
**Excessive blood protein levels**
**-Hemoglobin**
**-Myoglobin**
**-Bence Jones proteins**
117
Functional causes of Renal proteinuria
| (4)
**-Seizures**
**-Fever**
**-Excessive stress/exercise**
**-Hypertension**
118
Pathologic causes of Renal proteinuria
| (3)
**-Glomerular**
**-Tubular**
**-Interstitial**
119
Causes of Post-renal proteinuria
| (3)
**Disease of renal pelvis onwards**
**-Infection**
**-Urolithiasis**
**-Neoplasia**
120
Protein associated with Multiple Myeloma
**Bence Jones proteins**
121
Glomerular disorders or damage by toxins will cause what type of proteinuria?
**Renal proteinuria**
122
Pressure on the renal vein causing a positive protein result when standing upright but a negative protein result after lying down
**Orthostatic or Postural proteinuria**
123
Principle for testing protein
**Protein error of indicators**
124
Interfering factors for a false positive protein
**Alkaline urine - check pH**
125
Interfering factors for a false negative protein result
**Protein other than albumin (Ex. BJ protein)**
**Microalbuminuria (not enough albumin to trigger threshold)**
126
Confirmatory test for positive protein dipstick
**Sulfosalicylic Acid Precipitation (SSA)**
127
Causes of false positive SSA result
**Radiographic Dyes**
**Drug Crystals**
128
Most frequent chemical test performed on urine
**Glucose**
129
Normal Renal threshold for glucose
**160 - 180 mg/dL**
130
When the blood level of gluvose becomes so elevated that tubular reabsorption can't keep up, glucose will appear in urine.
**Renal Threshold**
131
Major cause of glucose in urine
**Diabetes**
132
Term for glucose in urine
**Glycosuria**
**AKA**
**Glucosuria**
133
Principle of the reaction for glucose
**Double sequential enzyme specific for glucose**
134
Interfering factors for a false negative glucose on urine dipstick
**Acorbic acid (vitamin C)**
**High SG**
**Unpreserved specimens (glycolysis from bacteria and normal flora digesting glucose until its gone or too low)**
135
Confirmation test for positive dipstick glucose
**Copper Reduction Test**
**AKA**
**Clinitest**
136
TRUE or FALSE
The Copper Reduction Test reacts with ALL reducing sugars
**TRUE**
137
Reducing sugars convert copper sulfate to cuprous oxide in the presence of heat and alkali
**Copper Reduction Test**
**AKA**
**Clinitest**
138
Positive Glucose dipstick
+
Positive Clinitest
=
**Glucose present**
139
Trace - 1+ Glucose Dipstick
+
Negative Clinitest
=
**Small glucose**
140
2+ - 4+ Glucose dipstick result
+
Negative Clinitest result
=
**Interference or testing error**
141
Negative Glucose dipstick
+
Positive Clinitest result
=
**Other reducing sugars**
**\*Galactose\* - congenital enzyme defect; failure to thrive, retardation,**
**screen kids \< 2 years old**
142
3 by-products of fat metabolism
**Ketones**
143
What are the by-products of fat metabolism?
(3)
**-Acetone**
**-Acetoacetic acid**
**-Beta-hydroxybutyric acid**
144
Clinical significance of ketones
**-Diabetes mellitus**
**-Starvation**
**-Carb-free diets**
**-Vomiting**
**-Malabsorption**
145
Term for ketones in urine
**Ketonuria**
146
What does Diabetes mellitus with insufficient insulin control cause?
(5)
**-Glucosuria**
**-Ketonuria**
**-Acid pH**
**-Positive serum glucose/ketone**
**-Risk of diabetic keto-acidosis (DKA)**
147
Principle of the Reaction for ketones
**Sodium nitroprusside reaction**
148
Interfering factors for a false negative ketone dipstick result
**-Evaporation**
**-Improper storage of specimen**
149
Interfering factors for a false positive ketone dipstick
**-Drugs**
**-Medication**
**-Dyes (radioactive)**
150
Confirmatory test for ketones
**Acetest**
151
Test that is the best indicator for renal disease
**Protein - testing for albumin, specifically**
152
Test that will most likely be positive if a patient is starving
**Ketones**
153
Substance that can cause a false negative glucose result
**Ascorbic acid**
**AKA**
**Vitamin C**
154
3 causes for a dipstick to result as positive for blood
**-Hematuria**
**-Hemoglobinuria**
**-Myoglobinuria**
155
- Presence of intact red cells in urine
- Urine usually appears red and hazy or cloudy
- Sometimes not visible
- Trauma or injury; toxins; tumors
- Kidney stones
- Glomerulonephritis/ Pyelonephritis
- Menstruation
**Hematuria**
156
- Presence of free hemoglobin
- Urine appears clear, reddish-brown
- Intravascular hemolysis (transfusion reactions, hemolyic anemias, burns)
**Hemoglobinuria**
157
- Presence of muscle protein
- Appears clear, reddish-brown
- Muscle crush or muscle-wasting disease (rhabdomyolysis)
- AMI
- Strenuous exercise in an untrained person
- Confirmed with special testing
**Myoglobinuria**
158
Principle of reaction for blood on dipstick
**Pseudoperoxidase activity of hemoglobin**
159
Free hemoglobin or myoglobin will cause what type of reaction on the dipstick?
**uniform color reaction**
160
Intact red cells will cause what type of reaction on the dipstick?
**Speckled pattern**
**Sensitive to as few as 5-10 cells/uL**
161
Interfering factors for false positive blood result on dipstick
Menstrual contamination
162
Interfering factor for false negative for blood on dipstick
**High SG (may crenate cells)**
163
Degradation product of hemoglobin that is normally metabolized in the liver
**Bilirubin**
164
Causes a vivd yellow foam on urine
**Bilirubin**
165
What could cause direct (unconjugated) bilirubin in the urine?
**Hepatitis**
**Cirrhosis and other liver disorders**
**Biliary obstruction (gallstones, tumor, etc)**
166
Principle of reaction for bilirubin on dipstick
**Diazo reaction**
167
Interfering factor for false positive for bilirubin on dipstick
**Pigments from dyes or drugs**
168
Interfering factor for a false negative bilirubin dipstick result
**Exposure to light**
169
Confirmatory test for bilirubin
**Ictotest**
170
- Normal by-product of RBC degradation
- Formed from thereduction of bilirubin by bacterial enzymes in the intestines
- Excreted in both feces and urine
**Urobilinogen**
171
