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Urinalysis > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

nephron is a functional unit of-

A

the kidney

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2
Q

how many nephrons does each kidney contain?

A

1 - 1.5 million

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3
Q

2 types of nephrons-

A

-cortical
-juxtamedullary

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4
Q

cortical nephrons are situated within-

A

the cortex of the kidney

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5
Q

cortical nephron are responsible for- (2)

A

-removal of waste products
-reabsorption of nutrients

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6
Q

cortical nephrons make up appx. ____% of nephrons

A

85%

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7
Q

juxtamedullary nephrons have longer-

A

loops of Henle

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8
Q

you can tell juxtamedullary nephrons from cortical cortical nephrons because-

A

juxtamedullary are longer

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9
Q

juxtamedullary nephrons extend-

A

deep into the medulla of the kidney

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10
Q

primary function of juxtamedullary nephrons-

A

urine concentration

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11
Q

renal functions- (4)

A

-blood flow
-glomerular filtration
-tubular reabsorption
-tubular secretion

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12
Q

renal blood flow path- (7)

A

-renal artery
-glomerulus
-efferent arteriole
-proximal convoluted tubule
-vasa recta/loops of henle
-distal convoluted tubule
-renal vein

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13
Q

afferent arterioles supply blood to-

A

kidneys

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14
Q

glomerulus receives blood from-

A

afferent arteriole

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15
Q

blood leaves the glomerulus & goes to-

A

efferent arieriole

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16
Q

vessels in renal blood flow assist in-

A

maintaining hydrostatic pressure differential

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17
Q

total renal blood flow is appx-

A

1200 mL/min

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18
Q

total renal plasma flow ranges from-

A

600 - 700 mL/min

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19
Q

average body size for total renal plasma flow-

A

1.73 m^2 surface

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20
Q

correction for variance in body surface area must-

A

be calculated

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21
Q

glomerulus consists of-

A

coil of appx. 8 capillary lobes

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22
Q

the glomerulus coil of 8 capillary lobes walls are referred to as-

A

glomerular filtration barrier

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23
Q

glomerulus located within-

A

Bowmans capsule

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24
Q

glomerulus serves as-

A

nonselective filtration

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25
Q

glomerulus filtration factors- (3)

A

-cellular structure
-hydrostatic & oncotic pressure
-renin-angiotensin-aldosterone system

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26
Q

glomerular filtration barrier cellular layers- (3)

A

-capillary wall
-basement membrane
-bowman’s capsule inner layer

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27
Q

endothelial cells of glomerulus capillary walls differ in other capillaries because- (2)

A

-endothelial cells have pores (aka fenestrated)
-large molecules & cells are blocked

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28
Q

the basement membrane causes further restriction of-

A

large molecules as filtrate passes through it

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29
Q

bowman’s capsule inner layer includes-

A

the thin membranes covering filtration slits formed by the intertwining foot processes of podocytes

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30
Q

glomerulus shield of negativity repels-

A

molecules with a negative charge even though they are small enough to pass through the glomerular filtration barrier

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31
Q

the shield of negativity is important because-

A

it is where albumin (associated with renal disease) has a negative charge & is repelled

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32
Q

juxtaglomerular apparatus regulates-

A

arteriole size

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33
Q

juxtaglomerular apparatus maintains-

A

consistent glomerular blood pressure

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34
Q

low blood pressure in juxtaglomerular apparatus-

A

-larger (dilation) afferent arterioles & smaller (constricted) efferent arterioles
-prevents decreased glomerular blood flow

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35
Q

an increase in blood pressure in juxtaglomerular apparatus-

A

-constricts (smaller) afferent arterioles
-prevents overfiltration & damage to glomerulus

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36
Q

Renin-Angiotensin- Aldosterone System (RAAS) regulates-

A

blood flow to & within the glomerulus

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37
Q

RAAS responds to changes in-

A

blood pressure & plasma sodium changes

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38
Q

juxtaglomerular apparatus consists of- (2)

A

-juxtaglomerular cells
-macula densa

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39
Q

juxtaglomerular cells are in the-

A

afferent arterioles

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40
Q

macula densa are in the-

A

efferent arteriole (distal convoluted tubule)

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41
Q

when macula densa senses a change in blood pressure-

A

initiates a cascade of reactions in the RAAS

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42
Q

renin produced/secreted by-

A

juxtaglomerular cells

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43
Q

angiotensinogen is a-

A

blood substrate

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44
Q

angiotensin I passes through-

A

lungs

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45
Q

after angiotensin I passes through the lungs, angiotensin-converting enzyme (ACE) changes it to-

A

the active form angiotensin II

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46
Q

aldosterone-

A

sodium-retaining hormone

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47
Q

angiotensin II corrects renal blood flow by- (5)

A

-dilates afferent arterioles
-constricts efferent arterioles
-stimulates sodium & water in proximal convoluted tubules
-triggers the release of aldosterone
-triggers the release of antidiuretic hormone

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48
Q

normal glomerular filtration-

A

120 mL/min of filtrate

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49
Q

RAAS Composition-

A

ultrafiltrate of plasma

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50
Q

only difference between the compositions of the filtrate & the plasma is-

A

the absence of plasma proteins, protein-bound substances, & cells

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51
Q

analysis of the fluid as it leaves the glomerulus shows the filtrate specific gravity to be-

A

1.010

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52
Q

tubular reabsorption starts when-

A

the plasma ultra filtrate enters the proximal convoluted tubules

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53
Q

for active transport to occur in tubular reabsorption-

A

carrier proteins & cellular energy are needed for transport back to the blood

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54
Q

active transport is responsible for the reabsorption of- (3)

A

-glucose, salts (Na is highest), & amino acids in the proximal convoluted tubules
-chloride in ascending loop of henle
-sodium in distal convoluted tubules

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55
Q

passive transport is controlled by-

A

the differences in substance concentration gradients on opposite sides of a membrane

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56
Q

passive reabsorption of water takes place-

A

throughout the nephron, except in the loop of henle

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57
Q

passive reabsorption of water accompanies-

A

high amounts of sodium reabsorption in proximal convoluted tubules (PCT)

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58
Q

urea is passively reabsorbed in- (2)

A

-PCT
-ascending loop of henle

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59
Q

sodium is passively reabsorbed in-

A

ascending loop of henle

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60
Q

maximal reabsorptive capacity (Tm)-

A

plasma concentration of a substance that is normally completely reabsorbed reaches an abnormally high level

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61
Q

renal threshold-

A

plasma level causing active transport to cease

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62
Q

for glucose, the plasma renal threshold is-

A

160 - 180 mg/dL

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63
Q

renal threshold & plasma concentration can be used to distinguish between-

A

excess solute filtration & renal tubular damage

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64
Q

passive reabsorption of water into the high osmotic gradient of the renal medulla (water removed by osmosis) occurs in-

A

descending loop of henle

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65
Q

actively reabsorbed in the ascending loop of henle-

A

chloride

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66
Q

passively reabsorbed in the ascending loop of henle-

A

sodium

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67
Q

walls of the ascending loop of henle are-

A

impermeable to water

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68
Q

countercurrent mechanisms serves to maintain-

A

the osmotic gradient in the medulla

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69
Q

in countercurrent mechanisms, the medulla is diluted by-

A

water from the descending loop

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70
Q

counter current mechanisms are reconcentrated by-

A

sodium & chloride from the filtrate in the ascending loop

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71
Q

aldosterone controls-

A

sodium (Na) reabsorption if needed by the body

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72
Q

collecting duct concentration is the final-

A

filtrate concentration

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73
Q

collecting duct concentration water reabsorption is controlled by-

A

ADH in response to body hydration

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74
Q

reabsorption in the final filtrate concentration depends on-

A

osmotic gradient in the medulla

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75
Q

the hormone vasopressin is also known as-

A

antidiuretic hormone (ADH)

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76
Q

ADH controls the permeability of-

A

distal convoluted tubules & collecting duct walls to water

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77
Q

amount of ADH produced by the posterior pituitary determines-

A

permeability

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78
Q

final determinant of urine volume & concentration-

A

the chemical balance in the body

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79
Q

increased body hydration =

A

decreased ADH = increased urine volume

80
Q

decreased body hydration=

A

increased ADH = decreased urine volume

81
Q

tubular secretion involves the passage of substances from-

A

the blood in peritubular capillaries to the tubular filtrate

82
Q

tubular secretion differs from reabsorption because reabsorption-

A

carries substances from the tubular filtrate into the blood

83
Q

tubular secretion eliminates non filtered waste by- (2)

A

-protein-bound substances
-regulate acid-base balance

84
Q

eliminating non filtered waste by regulating acid-base balance secretes-

A

H+ ions to return filtered buffers to the blood

85
Q

eliminating non filtered waste by regulating acid-base balance excretes-

A

excess H+ ions

86
Q

normal blood pH-

A

7.4

87
Q

to maintain a normal blood pH of 7.4, the blood must-

A

buffer & eliminate excess acid formed by dietary intake & body metabolism

88
Q

bicarbonate (HCO3) is returned to blood by-

A

secretion of hydrogen ions (H+) into filtrate

89
Q

bicarbonate (HCO3) returned to blood provides for-

A

100% of bicarbonate reabsorption

90
Q

all 3 secretory functions of hydrogen ions occur-

A

at rates determined by the acid-base balance in the body

91
Q

a disruption in these secretory functions causes- (2)

A

-metabolic acidosis
-renal tubular acidosis

92
Q

clearance tests measure-

A

the rate at which the kidneys can remove a filterable substance from the blood

93
Q

to ensure glomerular filtration is being measured accurately-

A

the substance analyzed cannot be reabsorbed or secreted by the tubules

94
Q

factors to consider when selecting a clearance test substance- (4)

A

-stability of substance in urine during a long collection time (poss. 24 hrs)
-consistency of plasma level
-availability to the body
-availability of tests to measure the substance

95
Q

primary substances used in clearance tests- (4)

A

-creatinine
-beta2 microglobulin
-cytatine C
-possibly radioisotopes

96
Q

exogenous procedure is termed-

A

test that requires an infused substance

97
Q

endogenous procedure is termed-

A

the method of choice if a suitable test substance is already present in the body

98
Q

a waste product of muscle metabolism-

A

creatinine

99
Q

creatinine links with-

A

adenosine triphosphate to produce adenosine diphosphate & energy

100
Q

creatinine is found at-

A

a constant level in the blood

101
Q

creatinine clearance is a _____ procedure-

A

endogenous

102
Q
A
103
Q

newer methods of creatinine clearance for GFR have been developed that use-

A

serum creatinine, cystatin C, or B2M values

104
Q

newer methods of creatinine clearance for GFR testing are reported as-

A

estimated glomerular filtration rate (eGFR)

105
Q

greatest error in any clearance procedure using urine is-

A

improperly timed urine specimens

106
Q

GFR is reported in-

A

milliliters per minute (mL/min)

107
Q

principle of a GFR-

A

to determine the amount of creatinine (mL) completely cleared from the plasma during 1 min.

108
Q

urine volume is measured in-

A

milliliters per minute (V)

109
Q

urine creatinine is measured in-

A

mg/dL (U)

110
Q

plasma creatinine is measured in-

A

mg/dL (P)

111
Q

creatinine is produced as a result of-

A

muscle destruction, therefore normal values are based on size (larger person, more creatinine produced)

112
Q

normal creatinine values in men-

A

107 - 139 mL/min

113
Q

normal creatinine values in women-

A

87 - 107 mL/min

114
Q

normal reference range of plasma creatinine is-

A

0.6 - 1.2 mg/dL

115
Q

normal values are lower in-

A

older people

116
Q

used to adjust for actual body surface area-

A

nomograms

117
Q

eGFR equations are superior to serum creatine solely because they include variables for- (3)

A

-race
-age
gender

118
Q

eGFR methods correspond most closely to-

A

isotope dilution mass spectrophotmetry

119
Q

eGFR calculations are Mande on-

A

average body size

120
Q

eGFR results with numerical values below 60 mL/min should be reported as-

A

59 mL/min for example

121
Q

eGFR results with higher values equal or greater than 60 mL/min should be reported as-

A

> or equal to 60 mL//min for example

122
Q

GFR for stage 1 of chronic kidney disease-

A

> or equal to 90 mL/min/1.73 m

123
Q

GFR for stage 2 of chronic kidney disease-

A

between 60 &89 mL/min/1.73 m

124
Q

GFR for stage 3 of chronic kidney disease-

A

between 45 & 59 mL/min/1.73 m

125
Q

GFR for stage 4 of chronic kidney disease-

A

between 15 & 29 mL/min/1.73 m

126
Q

GFR for stage 5 of chronic kidney disease-

A

< or equal to 15 mL/min/1.73 m (end stage renal disease)

127
Q

good procedure for screening & monitoring GFR-

A

cystatin C

128
Q

cystatin C is a small protein produced by _____ & filtered by ______-

A

-produced by all nucleated cells
-filtered by the glomerulus

129
Q

cystitis c is absorbed & broken down by-

A

renal tubular cells, therefore no cystitis c is secreted

130
Q

serum levels directly reflect-

A

GFR

131
Q

monitoring cystitis c levels is recommended for- (4)

A

-pediatrics
-diabetics
-elderly
-critically ill

132
Q

B2M is a small protein that-

A

dissociates from human leukocyte antigens at a constant rate

133
Q

B2M is rapidly removed from the plasma by-

A

the kidneys

134
Q

B2M used to identify- (2)

A

-end-stage renal disease
-early rejection of kidney transplant

135
Q

B2M is a sensitive indicator of-

A

a decrease in GFR

136
Q

B2M isn’t reliable in patients who-

A

have immunologic disorders or malignancy

137
Q

tubular reabsorption tests are a good indicator of-

A

early renal disease

138
Q

tubular reabsorption tests measure-

A

renal concentrating ability (salt & water)

139
Q

tubular reabsorption tests are often termed-

A

concentration tests

140
Q

tubular reabsorption tests are the baseline for determining-

A

the concentration is the 1.010 specific gravity of the original ultrafiltrate

141
Q

necessary for accurate results in tubular reabsorption tests-

A

control of fluid intake

142
Q

tubular reabsorption tests controlled intake procedures can include-

A

overnight deprivation of fluid for 12 hours followed by collection of a urine specimen

143
Q

normal urine osmolality readings-

A

800 mOsm or higher

144
Q

urine to serum ratio indicated normal tubular reabsorption-

A

3:1 or greater

145
Q

osmolarity has replaced specific gravity as the test to assess-

A

renal concentration

146
Q

osmolality is performed for-

A

a more accurate evaluation of renal concentrating ability

147
Q

primary urine method-

A

freezing-point osmometers

148
Q

freezing-point osmometer measured sample is-

A

supercooled & vibrated to form crystals

149
Q

heat of fusion by the crystalizing water temporarily-

A

raises temperature to freezing point

150
Q

probe measures-

A

freezing point

151
Q

1 mol (1000 mOsm) of nonionizing substance in 1 kg water lowers freezing point to-

A

1.86 C

152
Q

clinical osmometers uses _____ as their standard-

A

NaCl

153
Q

vapor pressure osmometers actual measure is-

A

dew point (temperature at which water vapor condenses to a liquid)

154
Q

microsamples on small filter-paper disks are placed in sealed chambers-

A

evaporating samples form vapor

155
Q

when the temperature in the chamber is lowered, vapor condenses & thermocouples measures-

A

heat of condensation that raised the temperature to dew point

156
Q

vapor pressure osmometers requires careful technique because of-

A

micro samples commonly used for serum samples

157
Q

lipemic serum affects- (2)

A

-vapor pressure
-freezing point osmometers

158
Q

lipemic serum insoluble lipids produce-

A

erroneous results

159
Q

lactic acid elevates reading in- (2)

A

-vapor pressure
-freezing point osmometers

160
Q

lactic acid specimens should be separated within-

A

20 minutes

161
Q

volatile/ethanol specimens elevate results for-

A

freezing point osmometers

162
Q

major clinical uses of osmolarity include- (5)

A

-Evaluating renal concentrating ability
-Monitoring course of renal disease
-Monitoring fluid & electrolyte therapy
-Differential diagnosis of hyponatremia & hypernatremia
-Evaluating secretion of & response to ADH

163
Q

serum osmolality reference values are-

A

275 - 300 mOsm

164
Q

can influence urine concentration- (2)

A

-fluid intake
-urine concentration

165
Q

ratio of urine to serum osmolality should be-

A

1:1

166
Q

ratio of urine to serum osmolality after controlled fluid intake should be-

A

3:1

167
Q

the ratio of urine to serum osmolality is used to determine if diabetes insipidus is caused by- (2)

A

-decreased ADH production
-inability of tubules to respond to ADH

168
Q

failure to achieve a 1:1 ratio after ADH injection indicates-

A

no ADH receptors are in the collecting duct

169
Q

achieving a 3:1 ratio after ADH injection indicates-

A

collecting duct has an inability to produce ADH

170
Q

free water clearance expands-

A

urine to serum osmolarity ratio

171
Q

osmolar clearance is preformed first using- (3)

A

-water deprivation
-timed urine
-serum

172
Q

osmolar clearance indicates-

A

how much water must be cleared each minute to produce a urine with the same osmolality as the plasma

173
Q

calculation of free water clearance determines-

A

the ability of the kidneys to respond to the body’s state of hydration

174
Q

tubular secretion & renal blood flow tests are related because-

A

secretion os dependent on renal blood flow

175
Q

tubular secretion & renal blood flow tests interpretation requires an understanding of-

A

the principles & limitations of the tests

176
Q

test most commonly associated with tubular secretion & renal blood flow tests-

A

p-aminohippuric acid test (PAH)

177
Q

PAH in renal blood flow tests is secreted in-

A

proximal convoluted tubule

178
Q

PAH in renal blood flow tests are loosely bound to-

A

plasma proteins

179
Q

PAH in renal blood flow tests is completely removed from the blood each time it-

A

comes into contact with functional renal tissue

180
Q

PAH tests are ____ procedures-

A

exogenous

181
Q

normal values in PAH tests are based on-

A

Hct

182
Q

average renal blood flow in PAH tests-

A

1200 mL/min

183
Q

normal renal blood flow in PAH tests-

A

600 - 700 mL/min

184
Q

appx. _____% of renal blood flow doesn’t come in contact with functional renal tissue-

A

8%

185
Q

Titratable Acidity and Urine Ammonia tests for-

A

tubular secretion of H+ & NH4+

186
Q

normal excretion for Titratable Acidity and Urine Ammonia-

A

70 mEq/day of acid in the form of H+, H2PO4-, & NH4+

187
Q

alkaline tides appear- (2)

A

-first morning
-postprandial 2 - 8 pm (lowest pH at night)

188
Q

renal tubular acidosis is the inability to-

A

produce an acid urine in the presence of metabolic acidosis

189
Q

proximal convoluted tubules secrete-

A

H+

190
Q

distal convoluted tubules secrete-

A

NH3

191
Q

Titratable Acidity and Urine Ammonia measure- (3)

A

-pH
-titratable acidity
-ammonia

192
Q

prime patients for Titratable Acidity and Urine Ammonia with-

A

acid load of ammonium chloride

193
Q

run Titratable Acidity and Urine Ammonia tests can be run on- (2)

A

-2 hr urine specimens
-fresh or toluene specimens

194
Q

by titrating the amount of free H+ &then the total acidity, the ammonium concentrate can calculate the difference of- (2)

A

-titratable acidity
-total acidity

195
Q

total acidity minus titratable acidity=

A

ammonia

Urinalysis (7 decks)

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