CLIN. MIC Flashcards by Josephine Nazareno

Functional Units of Kidney

Nephrons

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Each kidney contains __nephrons

1 to 1.5 million

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Each kidney weighs approximately____ or equivalent to 0.5% of total body mass

150g

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The human kidney receives approximately __of blood pumped through the heart

25%

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It supplies blood to the kidney

Renal artery

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The difference of the between the sizes of afferent and efferent arterioles help to creates ___ pressure

Hydrostatic pressure

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Renal blood flow

1200ml/min

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Renal plasma flow

600-700ml/min

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Part of the kidney that resembles as sieve

Glomerulus

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The glomerulus is a non-selective filter of plasma substances with a molecular weight of less than _____

<70,000 Daltons

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The system that regulates the flow of blood to and within the glomerulus that also responds to changes in blood pressure

stimulus:

Renin-angiotensin
aldosterone system

Stimulus: decrease BP and/or decrease plasma sodium level

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found in the DCT, sensor of change in blood pressure

Macula Densa cells

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found in the afferent arteriole, secretes the Renin enzyme

Juxtaglomerular cells

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Renal threshold for glucose

160-180mg/dl

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Value of ADH and urine volume in dehydration state

Increase ADH, decrease
urine volume

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Passive reabsorption of water takes place in all parts of the nephron except the ________.

ALH

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Sodium is actively transport in all part of the nephron except in the

ALH

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The major site of removal of non-filtered substances

Kidney tubules

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A force that repels molecules with a negative charge even molecules are small enough to pass in the
glomerulus

Shield of negativity

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Intertwining foot processes found in the glomerulus that inhibits the filtration of large molecules

Podocytes

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Blood and Urine pH during in cases of metabolic acidosis/Renal tubular acidosis

Blood pH: Acidic
Urine pH: Alkaline

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The single most useful substance that identifies a fluid as urine is its uniquely high _______level
(approximately 50 times that of plasma).

Creatinine

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A waste product of muscle metabolism that is produced enzymatically by creatine phosphokinase from
creatine, which links with ATP to produce ADP and energy.

Creatinine

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The most commonly used clearance test for assessing GFR

Creatinine clearance test

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By far the greatest source of error in any clearance procedure using urine is the use of _______urine specimens

Improperly timed urine

creatinine clearance results can vary by as much as ________ within a single individual, 24-hour collections are preferable.

15% to 20%

Parameters that are added in Cockroft and Gault formula for computing eGFR

BAS!!!!! Body wt., age, and Sex

Parameters that are added in MDRD formula for computing eGFR - 4- variables = - 6- variables =

4- variables = Serum creatinine, ethnicity, Age, Sex (SEAS) 6- variables = BUN, Age, Sex, Ethnicity, Serum creatinine, and serum albumin (BASES)

Most frequently used formula for eGFR

MDRD

polymer of fructose, is an extremely stable substance that is not reabsorbed or secreted by the tubules

Inulin

a small protein (molecular weight 13,359) produced at a constant rate by all nucleated cells. It has potential as a marker for long-term monitoring of renal function its plasma ▪ its plasma concentration is inversely related to GFR. (Increase in blood = Decrease GFR) ▪ The rate of production is not affected by muscle mass, sex, or race

Cystatin C

It dissociates from human leukocyte antigens (MHC class I) at a constant rate and is rapidly removed from the plasma by glomerular filtration. ▪ a better marker of reduced renal tubular function than of glomerular function

Beta-2-Microglobulin

An obsolete tubular secretion test

PSP dye excretion test

Most commonly used test for renal blood flow and renal secretion

P-ammino Hippurate (PAH)

This measures only the number of particles or solute in a solution

Osmolality

This measures number and size of particles or solute in a solution

Specific Gravity

Normal random urine volume

600-2000 mL

decrease urine output

Oliguria <400ml/24 hours

increase in daily urine output

Polyuria >2000ml/24hours

increase excretion of urine/urine output at night

Nocturia >500 ml at night

Cessation /no urine output within 24 hours

Anuria

can be rather abrupt in onset, as can acute renal failure, or it may be due to a chronic progressive renal disease.

Oliguria

Normal urine volume at night

<400ml at night

S.G of urine in patient with Diabetes mellitus

Increase / Hypersthenuria

S.G of urine in patient with Diabetes insipidus

Decrease / Hyposthenuria

The yellow color of urine is caused by the presence of a pigment, which Thudichum named ________

Urochrome

Urochrome levels in standing urine sample at room temperature

Increase

Produces yellow foam in urine when shaken

Bilirubin and Phenazopyridine (Pyridium)

Produces white foam in urine when shaken

Protein/albumin

Major organic substance in urine

Urea

Major inorganic substance in urine

Chloride

Procedure for checking both urine clarity and Color

Mixed sample, View the urine against a white background using adequate room lighting.

Checking for urine color

Examine the specimen under a good light source, looking down through the container against a white background

Checking for urine clarity

Visually examining the Mixed specimen while holding it in front of a light source. View through a newspaper print

Defined as the density of a solution compared with the density of a similar volume of distilled water (SG 1.000) at a similar temperature

Specific gravity

Principle of refractometer Refers to the index of the velocity of light in air / velocity of light in solution

Refractive index

Most common and easiest Can be used for microbiological studies PRECIPITATES AMORPHOUS CRYSTALS

Refrigeration (up to 24 hours)

Does not interfere with routine test

Toluene and Phenol

Excellent sediment preservative Fixative for Addis counting

Formalin

For automated instrument

Yellow plain UA

For culture and sensitivity and protein testing

Boric acid

Used for cytology

Saccomano (preferred) and Formalin (Brunzel,3rd ed.)

Catecholamines (e.g epinephrine)

Concentrated HCL

For quantitative analysis of steroids, hormones,

Acids (HCl, glacial acetic acid)

For catecholamines, vanillylmandelic acid (VMA), or 5-hydroxyindoleacetic acid (5-HIAA) collections, _____ is added to a 3- to 4-L container

10 mL of 6N HCl

Boric acid in a concentration of 1 g/dL preserves urine elements such as estriol and estrogen for up to _______

7 days

can be added to 24-hour urine for glucose determinations to inhibit bacterial growth and cell glycolysis but not growth of yeast.

Sodium fluoride

Saccomano fixative composition

50% ETHANOL + 2%CARBOWAX (POLYETHYLENE GLYCOL)

Analyte least affected or unaffected in unpreserved urine

Protein / albumin

Trichomonads on unpreserved urine will ______ due to loss of characteristic motility and death

Decrease

Carotene urine color

Orange

Phenol when oxidized urine color

blue-green or Green (Brunzel)

Phenol derivatives urine color

Black or Brown (Brunzel)

Rifampin urine color

red or orange red

Myoglobin (25mg/dl), RBC, and beets urine color

Red

Porphyrin urine color

Port-wine or Burgundy Red

Fucsin /aniline dye in candy urine color

Red

No visible particulates, transparent

Clear

Few particulates, print easily seen through urine

Hazy

Many particulates, print blurred through urine

Cloudy

Print cannot be seen through urine

Turbid

May precipitate or be clotted

Milky

Amorphous urates, radiographic contrast media

Acidic urine

Amorphous phosphates, carbonates

Alkaline urine

Soluble with heat

Amorphous urates, uric acid crystals

Soluble in dilute acetic acid

RBCs, Amorphous phosphates, carbonates

Insoluble in dilute acetic acid

WBCs, Bacteria, yeast, spermatozoa

Soluble in ether

Lipids, lymphatic fluid,chyle

Routine urinalysis Specimen volume: Container capacity: Opening of at least:

Specimen volume: 10 to 15 ml (average of 12ml) Container capacity: 50 ml Opening of at least: 4 to 5 cm

Drug testing Specimen volume: Container capacity: Temperature:

Specimen volume: 30 to 45ml Container capacity: 60ml Temperature:32.5 to 37.7 ‘C within 4 minutes

Individual who submits urine specimen for drug testing

DONOR /CLIENT

Types of specimen for glucose monitoring

a. first morning urine sample b. second morning urine sample c. 2-hours post prandial urine sample

For Culture and Sensitivity

a. Midstream clean catch b. Catheterized urine sample c. Suprapubic aspiration (especially for anaerobic microbes)

Used to differentiate kidney infections

Catheterized, ureteral collection technique

Used with patients (e.g infants and newborn) unable to urinate voluntarily * the patient is checked every 15 minutes to see if an adequate specimen has been collected.

Pediatric collection bag (weigh bag)

For ease and convenience, routine screening. It is collected at any time, usually during daytime hours, and without prior patient preparation

Random urine

Used for quantitative measurements of analyte that shows diurnal/circardian variation (e.g hormones, proteins, glomerular filtration rate)

Time specimens

To obtain an accurate timed specimen, the patient must begin and end the collection period with an ______.

empty bladder

All specimens should be ______during the collection period and may also require addition of a chemical preservative.

refrigerated or kept on ice

In timed specimen a sufficient aliquot _____ is removed for routine testing and possible repeat or additional testing; the remainder is discarded

50 mL

For determination of urine albumin, creatinine, and the albumin-to creatinine ratio is an ideal specimen to screen for microalbuminuria

4 hour or 12 hour urine specimen

Preferred specimen for urobilinogen measurement

Afternoon urine (2pm to 4pm)

Urine specimen for cytology

-Suprapubic aspiration (1st answer niyo ito dahil galing sa Strasinger ) -First morning = often preferred for cytology studies because the number of epithelial cells present can be significant -Random urine “clean catch” with prior hydration = ideal for cytology

One method that can be used to increase the cellularity of the random urine specimen is to have the patient exercise for __minutes by skipping or jumping up and down before specimen collection.

5 minutes

Ideal specimen for screening microalbuminuria

12 hours urine specimen

For diagnosis of PROSTATIC INFECTION 1st container = 2nd container = 3rd container=

Three glass collection 1st container = first portion of urine 2nd container =midstream portion. THIS WILL SERVE AS CONTROL 3rd container= last portion of urine with prostatic fluid

a device used to measure urine S.G in the base of refractive index

Refractometer

Refractometer specimen volume

1 to 2 drops

Refractometer Calibrating solution

a. 3% NaCL = 1.015 +/- 0.001 b. 5%NaCL = 1.022 +/- 0.001 c. 7%NACL = 1.035 +/- 0.001 d. 9% sucrose = 1.034 +/- 0.001

A weighted float attached to a scale w/c requires correction for temp, glucose, and protein

Urinometer

Urinometer specimen volume

10 to 15 ml urine volume

urinometer is added with a ______ & the reading of urinometer in taken at the _______

-spinning motion in the urine sample -lower meniscus

Urinometer calibrating solution

Calibrating solution: a. Water = S.G reading should be 1.000 b. Potassium sulfate= S.G reading should be 1.015

Based on the principle that the frequency of a sound wave entering a solution changes in proportion to the density of the solution

Harmonic oscillation densitometry

Harmonic oscillation densitometry linearity?

linearity up to 1.080

Harmonic oscillation densitometry was initially used on a semiautomated urinalysis workstation known as the ______

Yellow IRIS

Glass tube used in Harmonic oscillation densitometry

U-shaped glass tube

The frequency (the oscillating cycle period) observed is ______ to the sample density, and a microprocessor converts the frequency to a corresponding specific gravity value.

directly proportionate

Isosthenuric is the term to describe urine with a S.G of

1.010

Hyposthenuric/Diluted urine – term to describe urine with S.G of

<1.010

Hypersthenuric/Concentrated urine- term to describe urine with S.G of

>1.010

Normal random urine S.G

1.002 to 1.035

Condition Associated with urine S.G of greater than 1.035 or >1.040 (Strasinger ,6th)

Radiographic contrast dye/x-ray film, Dextran, and plasma expanders

Methods for measuring urine S.G (give its principle) -Refractometer -Urinometer / Hydrometer -Harmonic oscillation densitometry -Reagent strip

-Refractive index -Density -Density -pKa changes of a polyelectrolyte

In refractometer and Urinometer S.G reading, for every 1 gram of glucose you need to subtract ___-

-0.004

In refractometer and Urinometer S.G reading, for every 1 gram of protein you need to subtract

-0.003

Formula for S.G Dilution = (?) Example: A specimen diluted 1:5 with a reading of 1.010 would have an actual S.G of___

Diluted S.G x dilution 1.050

Pungent odor or distinctive cause

Asparagus, Garlic, Onion ingestion UTI, or increase urinary urea

Fruity odor cause

DM, and ketones

Mousy, musty, or Barny odor cause

PKU

Odorless urine cause

Acute tubular necrosis

Mercaptan cause

Asparagus, garlic, and egg

Sulfur / rotten egg odor

Cystinuria

Galunggong/ fishy odor/rotten fish

Trimetylaminuria

11th parameter of reagent strip

Vitamin C

Handling and storing of reagent strip

✓ Stored in cool and dry area ✓ Dark container or bottle ✓ Stored at room temp ✓ Stored in opaque, tightly closed container ✓ With dessicant to protect light and moisture

To ensure against run –over, blot the ___ of the strip with adsorbent paper and holding the strip horizontally while comparing it with color chart.

Edge

When new reagents are prepared, they should be tested in ________ with current “in-use” reagents to ensure equivalent performance

Parallell

Bilirubin principle & (+) result & reading time

-Diazo reaction -Violet, tan, or pink - 30 secs

Glucose principle & (+) result & reading time

-Double sequential enzymatic reaction -Potassium iodide = blue-green to brown -30secs

Ketones principle & (+) result & reading time

-Sod. Nitroprusside (Legal’s rxn) -Purple -40secs

S.G principle & (+) result & reading time

-pKa change of polyelectrolyte -Diluted = blue Concentrated =yellow -45secs

pH principle & (+) result & reading time

-Double indicator system -Acidic = red to yellow Alkaline = green to blue -60secs

Protein principle & (+) result & reading time

-Protein (sorensen’s) error of indicator -Blue-green -60secs

Blood principle & (+) result & reading time

-Pseudoperoxidase activity of hemoglobin -Green to blue -60secs

Urobilinogen principle & (+) result & reading time

-Ehrlch’s reaction -Red -60 secs

Nitrite principle & (+) result & reading time

-Greiss reaction -Pink -60secs

Leukocyte principle & (+) result & reading time

-Leukocyte esterase -Purple -120secs

What is the first morning urine pH?

5 to 6

Normal random urine pH

4.5 to 8.0

Common reasons for urine pH greater than 8

1. urine specimen that was improperly preserved 2. old urine specimen 3. adulterated specimen (i.e., an alkaline agent was added to the urine after collection) 4. patient was given a highly alkaline substance (e.g., medication, therapeutic agent)

Causes of Acid Urine

-Emphysema -Diabetes mellitus -Starvation -Dehydration -Cranberry juice -High protein diet -Presence of acid producing bacteria (E. coli) -Medications such as Mandelamine and Fosfomycintro methamine -Ethylene glycol and methanol -Chronic lung disease

Causes of Alkaline Urine

-Renal tubular acidosis -Hyperventilation -Vomiting -Vegetarian diet -Citrus fruits -Old specimens -Presence of urease producing bacteria -Alkaline tide (during and after following meals) -Presence of urease producing bacteria (Proteus spp. and Pseudomonas spp)

The reagent strip specific gravity test does not measure the total solute content but only those solutes that are __

Ionic

S.G of urine with end stage renal disease

1.010

Normal amount of protein in normal urine

less than 10 mg/dL or 100 mg per 24 hours Henry’s and Brunzel = <150mg/24hrs or 1 to 14mg/dl for 24 hours

What is the minimum sensitivity for the detection of albumin the urine strip test?

10mg/dl

The SSA test is performed on clear supernatant urine following centrifugation. The urine supernate and the reagent are added together and mixed by inversion. After a ___ minute, room temperature incubation, the tube is inverted and evaluated

10minutes

The SSA method is sensitive to _____ of protein, regardless of the type of protein present.

5 to 10 mg/dL

SSA Interferences -False increase/positive

-Radiographic contrast dye/x-ray film -Drugs (Tulbotamide, Penicillin, Sulfonamide, cepalosphorin) -para-amino-salicylic acid/Salicylates

SSA Interferences -False decrease/negative

-Highly alkaline urine -Quaternary ammonium compounds (e.g Detergents, and soap)

MICROSCOPICALLY, WHA T IS THE SSA PATTERN IF PROTEINS CAUSE A POSITIVE REACTION?

Amorphous

MICROSCOPICALLY, WHAT IS THE SSA PATTERN IF DRUGS AND RADIOGRAPHIC CONTRAST DYE CAUSE A POSITIVE REACTION?

Crystalline

It precipitates/coagulates/Insoluble at 40-60’C and dissolves/soluble at 100’C

BJP

Amyloidosis, pre-eclampsia/eclampsia, and immune complexes is associated with ______

Proteinuria

Earliest indicator of diabetic nephropathy and kidney problem refers to the presence of albumin in urine above the normal level but below the detectable range of conventional urine dipstick methods.

Microalbuminuria

Albumin Excretion Rate (AER) of microalbuminuria

20-200ug/min or 30-300mg/24hrs