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IPAP > ClinLab Block 2 > Flashcards

ClinLab Block 2 Flashcards

1
Q

Kidney’s selectively clear what waste?

Kidney’s maintain homeostatic regulation by ?

A

Urea

Water/electrolyte balance
Acid/base balance

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2
Q

What are the four functions of the nephron?

A

Concentrate urine
Filter blood
Excrete waste products
Reabsorb nutrients

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3
Q

What are four factors that affect renal function?

A

Renal blood flow
Glomerular filtration
Tubular reabsorption
Tubular secretion

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4
Q

Substances with a molecular weight less than ______ pass into filtrate

A

70K daltons

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5
Q

Glomerular filtration rate is maintained through what three methods?

A

Renal autoregulation using myogenic control
Extrinsic neural responses to stress
RAAS mechanism to increase SBP by inc Na reabsorption

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6
Q

Tubular reabsorption begins when _______ and involves near total reabsorption of ___ and is hormonally regulated____ and ___

A

Filtrate enters PCT
Organic nutrients
Water and Ions

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7
Q

When the plasma level of a substance exceeds the renal threshold, what happens?

What happens if the plasma level of a substance stays above the renal threshold?

A

Substance appears in urine

Active transport can’t reabsorb substance from filtrate

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8
Q

Define Tubular Secretion

What are the two functions of Tubular Secretion?

A

Active transport of substances from peri-tubular capillaries into tubular filtrate

Eliminate substances no found in blood
Regulate acid-base balance by secreting H+ and NH4+

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9
Q

Where does final concentration of urine begin?
How is this process regulated?
Average adult daily volume of urine output per day?

A

Late DCT, continues through collecting duct
ADH
1200-1500mL w/ pH slightly acidic

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10
Q

If we were so over hydrated we would have no ADH which would cause a decrease in what factors?

A 
Osmality
ADH release
Number of aquaporins
Water reabsorption in CD
Large volume of diluted urine
(Exact opposite if max ADH is present)
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11
Q

Define Polyuria
Define Oliguria
Define Anuria

A

Inc urine output >2.5L/day
Dec urine output <400ml/day
Severe low output <100ml/day

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12
Q

Diabetes insipidus results from decreased production of ? causing urine to take on a ? appearance

A

ADH

Truly diluted and low SpecGrav

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13
Q

Whats the difference in DM and DI urine samples?

A 
DM= Looks dilute, high osmality
DI= Truly diluted and low SpecGrav
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14
Q

When is oliguria usually seen?

Anuria can be a result of what two factors?

A

Dehydration

Serious kidney damage
Decreased blood flow to kidneys

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15
Q

Purpose of Random Samples

Purpose of First Morning samples

A

Routing Screening

Routine screening, Pregnancy, Orthostatic protein

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16
Q

Fasting specimens are collected for?

Why are 2H postprandial collected?

A

Diabetic screening/monitoring

Diabetic monitoring

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17
Q

When are glucose tolerance tests performed?

Why are 24hr urine collections performed?

A

Accompanied with blood samples in glucose tolerance tests

Quantitative chemical tests

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18
Q

Why are catheter urine samples performed?

When are mid-stream collections taken?

A

Bacterial culture

Routine, Bacterial culture

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19
Q

Why are suprapubic aspiration urine samples taken?
Why are three-glass collections taken?
Urine specimens need to be delivered to the lab within _hrs or need to be ___

A

Bladder urine for bacterial infections, Cytology
Prostate infections
2hrs or refrigerated at 2-6*C

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20
Q

What are some reasons specimens will be unaccepted by the lab?

A 
Not labeled
Labels don't match
Contaminated 
Insufficient quantity
Improper transportation
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21
Q

What factors will INCREASE in a urine sample?

A

Odor- bacteria breaking urea down to ammonia
pH- urea breakdown produces loss of CO2
Nitrite- multiplication of nitrate reducing bacteria
Bacteria- multiply

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22
Q

Urine samples under go what three tests?

A

Physical exam, Chemical analysis, Microscopic

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23
Q

What give urine it’s normal yellow color?
Normal urine color ranges are ?
Variations are due to ?

A

Urochrome- product of endogenous metabolism which is naturally produced at a constant rate
Pale yellow to straw/very dark yellow to amber
Hydration levels

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24
Q

What causes urine samples to be dark amber or orange?

A

Conjugated bilirubin

Photo-oxidation of urobilinogen to urobilin produces color change too

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25
Q

Pink/red or brown urine samples are indicative of ?

A

RBCs in acidic urine due to oxidation of hemoglobin to methmeglobin

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26
Q

RBCs in urine give samples a ___ appearance

If HgB or myoglobin is present in urine the specimen will appear as ?

A

Cloudy

Red and clear

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27
Q

What causes urine to be brown/black?

A

Methemoglobin- HgB iron in acidic urine oxidized to methemoglobin
Melanin if PT has metastatic malignant melanoma

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28
Q

Homogentisic Acid is AKA and causes what change to urine color?

A

Inborn-error of metabolism
Increased excretion in alkaptonuria
Alkaline urine turns brown

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29
Q

Why does melanin appear in urine?

What turns urine orange in color?

A

PT w/ metastatic malignant melanoma

Pyridium- UT analgesic for bladder infections or Rifampicin

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30
Q

What causes urine to be blue/green?

A

Bacterial infection of Pseudomonas

Intestinal tract infection from increased urinary indican

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31
Q

Normal non-pathologic urine haziness can be due to what five factors?

A 
Amorphous crystals
Squamous cells
Seminal fluid
Fecal contamination
Mucus
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32
Q

Pathologic urine haziness can be caused by what five factors?

A 
WBCs
RBCs
Bacteria
Renal cells
Lipids
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33
Q

What conditions cause urine to take on abnormal odors?

A

Bacterial- noxious
Ketones- sweet
Maple Syrup
Food- asparagus

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34
Q

Clinitests are often performed on pediatric PTs up to what age? This is performed to test for?

A

2 y/o

Reducing sugars- Galactose, Fructose, Pentose, Lactose

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35
Q

Bilirubin is the result of broken down ____

Conjugated bilirubin can be excreted because?

A

Heme ring

Water soluble

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36
Q

Why is urobilinogen found in urine?

A

Water soluble, excreted through kidneys

Most is converted to stool pigmentation

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37
Q

Why would leukocyte esterase be found in urine sample?

Renal threshold for glucose is exceeded when serum glucose exceeds what level?

A

UTI

170mg, causes glucosuria

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38
Q

Glucosuria w/out hyperglycemia (renal glucosuria) is caused by tubular reabsorption impairment from what two issues?

A

Pregnancy or heavy metal poisoning

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39
Q

Significance of positive urine glucose results that are renal associated?

A

Fanconi Syndrome
Advanced renal disease
Osteomalacia
Pregnancy

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40
Q

How are urine samples tested for ketones?

A

Chemstrip, detects acetoacetic acid only

Not Acetone or hydroxybutyric acid

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41
Q

Positive ketones in urine sample can significant because?

A 
Starvation/acute diet
DM
High fat/protein, low carb diet
Severe exercise
Malabsorption
Frequent vomiting
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42
Q

Study and review Slides

A

Slide 52 - 65

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43
Q

Define Specific Gravity

A

Density of substance to reagent grade water
Proportions of solids to toal volume of specimen and degree of concentration of samples and reported to the third decimal place

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44
Q

Deydration with oliguria will cause what shift in specific gravity and what type of issue?
Diabetes Insipidus will have what type of specfic gravity and urination urge?

A

High, Solute diuresis, positive glucose and polyuria

Polyuria and low concentration

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45
Q

Define Isosthenuria

What are the three most common causes of isosthenuria chronic renal failure?

A

Consistent SG of 1.010 isosthenuria= renal tubular damage and loss of tubular function

Diabetic neuropathy, HTN renal Dz, Chronic Glomerulonephritis

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46
Q

What is a more exact measurement of urine concentration, osmolality or SH?

A

Osmolality- Number of particles in a fluid sample

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47
Q

What are the major clinical uses of osmolality?

A 
Evaluating renal concentration ability
Renal Dz tracking
Fluid/electrolyte therapy
Differential diagnosis of Hyper/Hyponatremia
Renal response to ADH
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48
Q

What are the normal ratios of urine to serum osmolality?

A

At least 1 : 1

After controlled fluid intake 3 : 1

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49
Q

The ratio of urine to serum osmolality can be used to differentiated whethere diabetes insipidus is caused by what two factors?

A

Dec ADH production= Neurogenic

Inability of renal tubules to respond= nephrogenic

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50
Q

What is indicated if there is a failure to achieve an osmolality ratio of 3:1 aafter ADH?

A

Collecting duct does not have functional ADH receptors

If concentration takes place after ADH injection= inability to produce adequate ADH

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51
Q

Positive blood results are further tested and can be reactive to what three things?

A

Intact RBCs, Free HgB, Myoglobin

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52
Q

Hematuria can be caused by what four conditions?

A

Glomerulonephritis
Lower UTI
Strenuous exercise/menses
Renal calculi

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53
Q

Hemoglobinuria from intravascular hemolysis can be caused by what two conditions?

A

Hemolytic anemia

Transfusion reaction

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54
Q

hemoglobinuria can be caused by what four conditions?

A

Intravascular hemolysis
Strenuous exercise
RBC lysis in UT in dilute, alkaline urine

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55
Q

Why is free HgB dangerous to the kidney?

What can cause myoglobinuria?

A

Damages nephrons

Trauma, rhabdo

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56
Q

How does myoglobinuria appear?

A

Normal serum

Elevated Ck and LDH

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57
Q

Slide

A

82 focus on?

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58
Q

Why is urine pH useful?

A

Acid-base disorder
Acidosis- acidic urine
Alkalosis- alkaline urine

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59
Q

What type of urine pH discourages renal calculi formations?

What is the major serum protein found in normal urine?

A

Alkaline pH

Albumin- presence tested by Chemstrip

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60
Q

Define Uromodulin

A

Tamm-Horsfall protein, a mucoprotein synthesized in DCT and involved in cast formation

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61
Q

What is the follow on test for a positive urine protein test?

A

24hr urine protein determination

>150mg/day triggers electrophoresis test to ID proportion testing

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62
Q

When is protein in the urine considered pathologic?

What level is considered massive proteinuria?

A

Exceeds 150mg/day or 30mg/dl

3.5g/day

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63
Q

What are the 3 major groups of proteinuria?

A

Prerenal- non renal diseases
Renal- kidney diseases
Postrenal- protein from below UT/kidney parenchyma

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64
Q

What type of proteinuria result is indicative of pre-eclampsia

A

Significant proteinuria w/ HTN and edema

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65
Q

What are the low molecular weight plasma proteins?

A

HgB
MgB
Acute phase reactants to infection/inflammation

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66
Q

Proteinuria can be caused by what five conditions?

A 
Multiple myeloma
Renal artery stenosis
HTN
Fever
Muscle injury
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67
Q

What are the two types of renal proteinuria?

A

Primary- glomerulonephritis

Induced- drug/toxin, systemic diseases

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68
Q

Define Tubular Proteinuria

A

Defective tubular reabsorption characterized by increased levels of low-molecular weight proteins
(Drug/toxin, severe viral/bacterial infection, Fanconi Syndrome)

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69
Q

Define Polynephritis

What can cause postrenal proteinuria?

A

Ascending UTI that reaches pyelum or pelvis of kidney

Inflammation of bladder, urethra or prostate

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70
Q

What urinary tract pathogens can cause a color change on a chemstrip nitrite test?

What type of urine sample is preferred for testing for nitrites?

A

E Coli, Proteus

First morning

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71
Q

What can cause a false negative urine nitrite result?

What can cause a false positive urine nitrite test?

A

UTI pathogens don’t reduce nitrates
Urine wasn’t in bladder long enough for nitrate reduction to occur

Improper preservation

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72
Q

How are positive bacteriuria results confirmed?

A

Microscopic examination of urine sediment and culture

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73
Q

Urine sample that tests positive for leukocyte esterase indicates?

A

Pyuria from infection/inflammation of GU system

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74
Q

Bacterial UTIs that generate positive leukocyte esterase results often generate what other positive result?

A

Positive nitrite

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75
Q

What type of infections can cause a positive leukocyte esterase result without a positive nitrite result?

A 
Vaginal/urethral Trichomonas infections
Yeast
Chlamydia
Mycoplasma
Virus
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76
Q

A positive LE sample but negative for nitrates will be confirmed with what methods?

A

Microscopic sediment exam

Yeast, bacteria or Trichomonas are observable

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77
Q

What is the purpose of microscopic examinations of urine sediments?

A 
Detect/ID insoluble materials in urine
R/WBC
Epithelial cells
Casts/Crystals
Bacteria, yeast, parasites
Junk- mucus, sperm, artifacts
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78
Q

Microscopic exams of urine are conducted under two situations

A

Requested

Abnormal Chemstrip result

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79
Q

RBCs seen on a microscopic exam is associated with ?

Hematuria associated with UTIs ill be associated ?

A

Glomerular damage

Pyuria

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80
Q

Bleeding into the UT from renal pelvis to urethra is usually seen without ?

A 
Significant proteinuria
UT stones
Neoplasms
Trauma
Prostatis
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81
Q

Nephronal hematuira is seen with ?

A

Proteinuria and RBC casts

Glomerular or tubular disease

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82
Q

A combination of what 3 findings in a urine sample are indicative of a kidney infection?

A

Mod/heavy proteinuria
WBC casts
Hematuria

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83
Q

How does cystitis present in lab findings?

A

Hematuria
Small amount of protein
No casts

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84
Q

What is the most frequently seen yet least clinically significant cells found in urine?

A

Squamous epithelial cells
From entire female urethra
Only lower male urethra

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85
Q

Where do transitional epithelial cells originate from?

What type of procedure can increase the number of transitional eipithelial cells in a urine sample?

A

Renal pelvis, ureters, bladder and upper male urethra

Catheter

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86
Q

Renal tubular cells in a urine sample can be indicative of ?

A

Heavy metals
Drug induced toicity
HgB/MgB toxicity
Pyelonephriits

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87
Q

Lipids that pass across the glomerular membrane are absorbed by ?

Renal Tubular Cells that contain lipids are described as oval fat bodies and are commonly seen in ?

A

Renal tubular cells

Nephrotic syndrome

88
Q

Casts are unique to what kidney structure and are made where?

Casts are usually found in urine with what chemical properties?

A

Nephrons, Formed in DCT and CD

Acidic and high concentration, favor precipitation of proteins

89
Q

Define Stasis

What is the major constituent of casts?

A

Diminished flow of urine through nephrons allowing time for protein to precipitate in tubules, such as in oliguria

Tamm-Horsfall protein- mucoprotein excreted by renal tubular cells

90
Q

Where do casts form depending on the substance they’re made out of?

A 
RBCs- highest DCT
WBCs- high DCT
Epithelial- mid DCT
Broad- CD
Hyaline- Lower DCT
91
Q

Hyaline casts can be formed as a result of what four non-pathological things? Pathloglogical?

A

Non- Strenuous exercise, Dehydration, Fever, Emotional stress
Path- acute glomerulonephritis, polynephritis, chronic renal disease

92
Q

Presence of cellular casts are indicative of ?

WBC casts are indicative of ?

A

Serious renal disease

Nephron infection/inflammation

93
Q

RBC casts are primarily associated with damage to ?

WBC casts are most frequently associated with ?

A

Glomerulus

Polynephritis

94
Q

Renal tubular epithelial cell casts are indicative of ?

Fatty casts are associated with?

A

Intrinsic renal tubular disease and often seen in conjunction with R/WBCs

Renal disease, Nephrotic syndrome, Toxic tubular necrosis, DM

95
Q

Non-pathologic granules are a by-product of?

Pathologic?

A

Protein metabolism excreted by tubular cells

Path- degenerated white/epithelial cells and can be seen in any disorder causing cellular cast formation

96
Q

Waxy casts mark the end stage of ?

A

Disintegration of cellular casts

Presence indicates severe urine stasis in renal tubules and found in chronic renal failure

97
Q

Where are broad casts formed and what do they indicate?

A

In dilated tubules of enlarged nephrons/CDs during severe stasis
Renal failure/end stage renal failure casts

98
Q

Amorphous urates form in ? urine
Amorphous phosphates form in ? urine?
What type of crystals are seen in ethylene glycol poisoning?

A

Acidic
Alkaline
Oxalate crystals

99
Q

What yeast organism is most commonly found in urine?

What parasite?

A

Candid albicans

Trichomonas, if others are seen indicates fecal contamination

100
Q

What type of findings can indicate a urine sample was not a clean-catch sample?

A

Several starch granules
Squamous epithelial cells
Bacteria

101
Q

Unpreserved urine experiences numerous changes but only three factors increase

A

pH
Nitrite
Bacteria

102
Q

Prerenal proteinuria is associated with ? diseases such as?

A 
Non-renal
CHF
Renal hypoxia from stenosis
HTN
Fever
103
Q

Renal proteinuria is acused by ? and contain what two types?

A

Kidney diseases

Primary or induced- protein leaks through glomerulus due to change in hydrostatic pressure

104
Q

Primary and induced proteinuria include what diseases?

A

Primary- glomerulonephritis, nephrotic syndrom

Induced- drug/toxin, systemic diseases

105
Q

Define postrenal proteinuria

A

Protein from UT below level of kidney, inflammation of the UT
Cystitis, urethritis, prostatitis

106
Q

Hyperglycemia is a problem of ?

Hypoglycemia is a problem of ?

A

Osmotic water loss

Cerebral problems

107
Q

What is the panel for DM management?

A

BMP
Glycosylated HgB
Anion gap
Lipid profile

108
Q

Ketone bodies are acute and typically only occur in ? type of diabetes?
What is an early indicator of diabetes?

A

Type 1

Microalbumin

109
Q

Fructosamine and glycated albumin tests are used primarily as monitoring tools for ?

How is serum fructosamine formed?

A

Help people with diabetes control glucose, not as diabetes diagnosis

Nonenzymatic glycosylation of serum proteins, mostly albumin

110
Q

A1C can show longer picture if PT is managing their diabetes but what test can be helpful if PT has hemolytic disease or pregnant?

A

Fructosamine or Glycated Albumin

111
Q

What are the two testing methods for detecting ketone bodies?

A

Acetest or KetoDiastix

Most sensitive for acetoacetate only

112
Q

What are four non-diabetic reasons for hyperglycemia

A

CF related diabetes
Meds (corticosteroids, BBs)
Organ failure
Shock

113
Q

For every 100mg/dL increase in blood sugar, plasma sodium decreases by ?

A

1/7 mmol/L, results in dilutional hyponatremia

114
Q

What are non-insluin causes of hypoglycemia?

A

ETOH
Addisons Dz
Hyperinsulinemia

115
Q

What studies are included in a BMP?

A 
Ca
CO2/HCO3- buffer
Cl- ECAnion to maintain acid-base balance and facilitates O/CO2 exchange by RBCs
SrCr- break down from muscle
Glucose 
K- cardiac muscle contraction
Na- nerve conduction
BUN
116
Q

Electrolytes have key roles i nwhat four processes?

A

Homeostasis
pH regulation
Heart/nerve function
RedOx reactions

117
Q

What is the major extracellular cation?
What is the major intracellular cation?
What is the major extracellular anion?

A

Na
K
Cl

118
Q

Functions of Na as an electrolyte

How are Na levels regulated in the body?

A

Maintains osmotic pressure, Acid-base balance, Musclular depolarization, Electrical neutrality

Aldosterone, ANP

119
Q

S/Sx of hyponatremia

A

Nausea
Weakness
Confusion
Mental impairment

120
Q

Define Hypo-osmotic Hyponatremia

A

Depletional:
Loss of ECF water
Low urine Na- extrarenal loss
High urine Na- renal loss

Dilutional- hypervolemia
High urine Na- renal failure
Low urine Na- blood volume decreased

121
Q

Define Hypo-osmotic Hyponatremia Normovolemic

A 
Isolated NaCl deficit
Normal TBF
SAIDH
Diuretics
Hypothyroid
Hypoaldernalism
122
Q

Define Hyperosmotic Hypernatremia

A

Inc solutes in ECF from extracellular shift of water or intracellular shift of Na to maintain balance between ECF and ICF

123
Q

Define Isosmotic Hyponatremia

A

Dec plasma Na

Plasma osmolality, glucose and urea are normal= pseudohyponatremia from electrolyte exclusion

124
Q

Define Hypernatreima

A

Always hyperosmolar

Presents w/ tremors, irritability, ataxia, confusion/coma

125
Q

Hypernatremia can develop from what three situations

A

Hypovolemia
Hypercolemia
Normovolemia

126
Q

Define Hypovolemic Hypernatremia

A

Dec ECF from extra/renal loss of hypo-osmotic fluid leading to dehydration
Extrarenal- concentrated urine, low Na
Renal loss- less concentrated and high Na

127
Q

Define Normovolemic Hypernatremia

A

Prelude to hypovolemic hypernatremia
Extrarenal- concentrated urine
Low urine osmo- water diuresis from diabetes insipidus

128
Q

Define Hypervolemic Hypernatremia

A

Commonly in hospitalized PTs on hypertonic saline/soidum bicarb
Hyperaldosteronism
Cushings

129
Q

How are K levels regulated?

A

Insulin
Catecholamines cause K movement into cells
Acidosis- K into plasma
Alkalosis- K into cells

130
Q

Define Pseudohyperkalemia

A

Redistribution of K from ICF to EFT

131
Q

What is Cl’s physiologic role?

A

Maintain osmotic pressure and electrical neutrality
Moves passivley with Na and inversely varied to HCO3
Inc nerve resting potential

132
Q

Where is Cl found?

A 
Serum
Plasma
CSF 
Tissue fluid
Urine
133
Q

What will Cl levels be in metabolic alkalosis/respiratory acidosis

A

Hypochloremia
Hyponatremia
Vomitting
Inc HCO3

134
Q

What will Cl levels be in metabolic acidosis/respiratory alkalosis

A

Hypernatremia
Diabetes inspidus
Dehydration

135
Q

How is BiCarb levels measured?

A

As the principle component of total CO2

136
Q

What is the measurement of the metabolic component of the acid-base balance?

Phosphate levels are inverse to what electrolyte?

A

BiCarb

Ca

137
Q

What electrolyte is the cofactor for enzymatic reactions?

Define Anion Gap

A

Mag

Difference between anions (Cl and HCO3) and cations (Na and K)

138
Q

WHat is the mnemonic for the elevated anion gap acidosis?

A

MULEPAKS

139
Q

What does an increase serum anion gap mean?

What does a decreased anion gap measure?

A

Presence of unmeasured anion which results in increase in the corresponding measured cation

Increase in unmeasured cations resulting in an increase in corresponding anions

140
Q

An increase in a cationic protein will increase?

A

Multiply myeloma increases cationic protein which will increase it’s anion chloride

141
Q

Normal anion gap metabolic acidosis mean?

A

Non-Gap Acidosis
Gastrointestinal BiCarb loss from diarrhea
Renal BiCarb loss from CAIs, renal tubular acidosis, aldosterone inhibitors or hypoaldosteronism

142
Q

ABGs measure ? things

A 
pH
PO2
PCO2
O2 sats
BiCarb
Base excess/deficit
143
Q

Causes of metabolic acidosis

A 
Diabetic ketoacidosis
Lactic acidosis
Methanol poisoning
Ethylene glycol poisoning
Renal failure
Diarrhea
144
Q

What are the causes of metabolic alkalosis

A

Prolonged vomiting
Diuretic therapy
Hyperadrenocortical disease
Exogenous base excess

145
Q

Causes of respiratory acidosis

A

Emphysema
Pneumonia
Pulmonary fibrosis
COPD

146
Q

Causes of preparatory alkalosis

A

Hysteria
Fever
Salicylate poisoning
Asthma

147
Q

What are the four parts of a nephron?

A

Glomerulus
Proximal tubule
LoH
Distal Tubule

148
Q

What four factors can affect renal function?

A

Blood flow
Glomerular filtration
Tubular reabsorption
Tubular secretion

149
Q

What are the four types of nonprotien nitrogen?

A

NH3
Uric Acid
Urea- majority 75%
Creatinine

150
Q

How does hyperammonemia occur?

A

Defect of urea cycle, manifests as neurological abnormality

151
Q

Majority of ammonia produced in the body is excreted as ? but is not useful for determinating ?

A

Urea

Kidney function

152
Q

How is creatinine formed?

Where is creatinine synthesized?

A

Cyclic anhydride produced as final product of decomposition of phsphocreatine

Kidney, Liver, Pancreas

153
Q

Creatinine is proportional to ? but is not?

What is the final end state product of purine catabolism?

A

Muscle mass, Reabsorbed

Uric acid

154
Q

Define Hyperuricemia

What are the three physiological components of renal function?

A

Precipitation of salt crystal monosodium urate; Gout

GFR, Renal blood flow, Glomerular permeability

155
Q

What are four methods of testing renal function on a routine basis?

A

eGFR
Assess glomerular permeability
Measure non-protein nitrogen containing compounds
Measurement of tubules concentrating ability

156
Q

What test is a reliable measure of functional capacity of the kidney and is indicative of number of functioning nephrons?

A

GFR

Urine concentration x urine flow/plasma concentration

157
Q

Rate of formation of glomerular filtrate depends on ?

A

Balance between hydrostatic and oncotic forces along afferent arteriole and across glomerular filter

158
Q

What are four uses of an acquired GFR?

A

Detect renal insufficiency
Adjust drug doses
Eval therapies for chronic RDz
Pts for PTs waiting kidney transplants

159
Q

What are the three lab tests to determine eGFR?

A

Insulin clearance test
Creatinine clearance test
Cystatin C

160
Q

What test is indicative of the number of functioning nephrons?

The lower a GFR is, ? is present or increasing?

A

Creatinine clearance from 24hr collection

Kidney function/failure

161
Q

What are the four methods to assess glomerular permeability?

A

Dipstick- qualitative, sensitive for detecting albumin
Spot urine ablumin:creatinine ratio
24hr urine protein test- quantitative
Bence-Jones protein

162
Q

What are the two methods in measuring the tubules concentrating ability?

A

SpecGrav

Osmolality- more valid

163
Q

What is the role of Phosphorus and what does an inc indicate?

A

Strutural integrity of cell membranes

Renal tubular damage and nonrenal acidosis

164
Q

Definition of CKD

A

Damage or GFR less than 60mL/min for at least 3mon

165
Q

What are the three types of acute renal failure?

A

Pre-renal: hypovolemia
Renal: glomerulonephritis
Post-renal: obstruction of lower UT

166
Q

What are the causes of chronic renal failure?

A 
Primary glomerular Dz
Renal vascular Dz
Metabolic Dz w/ renal impairement
HTN nephrotpathy
Nephrotoxins
167
Q

What are the two key markers for CKD?

A

Estimated glomerular filtration

Urine Albumin

168
Q

AMA renal function panel includes ? tests?

A 
Albumin
Ca
CO2
Cl
Creatinine
Urea Nitrogen/creatinine ration
Glucose
Phosphorus
K
Na 
Urea Nitrogen
eGFR
169
Q

What are the three historical marker combos for the diagnosis of acute myocardial infarction?

A

Myoglobin
Total CPK
CK-MB

170
Q

What are the seven steps of the pathogenesis of an acute MI

A 
Endothelial injury/inflammation
Plaque formation
Plaque rupture/thrombogenesis
Reduced blood and inc o demand
Ischemia
Necrosis
AMI
171
Q

What is the gold standard of cardiac biomarkers

A 
Troponins
Troponin C- Ca binding
Troponin 1- inhibitory component
Troponin T
1 and T- derived from myocardium
172
Q

When do troponin levels peak and reside after a MI?

A

Inc: 3-12hrs
Peak: 24-48hrs
Return to baseline: 5-14days

173
Q

What are causes of acute cTN elevation in the absence of acute ischemic heart disease

A 
Trauma
CHF
Severe valve disease
HTN/HOTN
Sepsis
Vital exhaustion
174
Q

Which inflammatory marker is secreted into bloodstream within a few hours of infection/inflammation?

A

C reactive protein- acute phase reactant made by liver

175
Q

When is CRP levels elecated?

A

After MI
Sepsis
After surgical procedure

176
Q

Characteristics of Pentraxin 3

A

Marker of vascular inflammation made by vascular endothelial cells, smooth muscles, macrophages and neutrophils
More specific the CROP for vessel wall inflammation

177
Q

Which inflammatory marker is a prognostic biomarker of adverse outcomes in PTs with unstable angina pectoris, MI or CHF?

A

Pentraxin 2

178
Q

Characteristics of Homecysteine

A

Inc risk of coronary heart dz, stroke, vascular disease
Inc due to B9, B6 or b12 deficiencies
More useful as a “potential” marker when family Hx is present

179
Q

Characteristics of interleuking

A

Early atherosclerosis marker
Stimulates liver to produce acute phase protein
Elevated IL-6 and CRP associated with development of atherosclerosis and Type 2 diabetes

180
Q

Characteristics of Myeloperoxidase

A

Produced by polymorphonuclear leukocytes and macrophages
Inc level is marker of plaque instability
Predictive marker for future CV adverse events

181
Q

Characteristics of soluble cluster of differentiation 40 ligand

A

Release indicated plaque rupture and subesquent MI

182
Q

Characteristics of TNF-a

A

Pleiotropic cytokine produced by endothelial cell, smooth muscle and macrophage
Produces tissue inhibitors of metalloproteinases by fibroblasts
Elecated levels are indicative of recurrent non-fatal MI or fatal CV event

183
Q

Characteristics of H-FABP

A

Transport of FAs, inc levels appears 30min after MI and peaks 6-8hrs, return to normal at 24hrs
Predictive biomarker of mortality after acute coronary syndrome

184
Q

Characteristics of BNP

A

32 aa secreted by heart ventricles in response to excessive stretching
Marker for identifying PTs with CHF

185
Q

Characteristics of IMA

A

Inc during ischemic conditions

Occur immediately after onset of ischemia and enables early identification of ischemia

186
Q

Define Stellate cells and their function

A

AKA Ito cells, located between endothelial lining of sinusoids and hepatocytes
Store Vit A
Synth NO

187
Q

What are the excretory, synthetic and metabolic functions of the liver?

How are organic anions excreted from the body?

A

E- bile production, S- plasma proteins, M- barb, aa, lipid, drugs

Extracted from sinusoidal blood, transformed and excreted in bile or urine

188
Q

How is liver excretory functions assessed?

A

Plasma concentration of bilirubin and bile acids
Determination of rate of clearance (aminopyrine, lidocaine, caffeine)
Drug metabolic tests in liver transplant/liver dz

189
Q

Unconjugated bilirubin is tranported to ? by ?

What are the major sources of circulating ammonia is ?

A

Liver, On albumin, Excreted in bile or urine

Bacterial proteases, Ureases, Amine oxidases

190
Q

Most ammonia is metabolized into ? by the ?

A

Urea
In hepatocytes
Krebs-Henseleit urea cycle

191
Q

The common acquired causes of hyperammonemia are?

A

Advanced liver disease

Renal failure

192
Q

Characteristics of Reye Syndrome

Abnormal ? is common in liver disease?

A

CNS disorder with minor hepatic dysfunction

Abnormal hemostasis

193
Q

Elevations in unconjugated bilirubin pose greater risk for development of ?

When/how does prehepatic jaundice occur?

A

Kernicterus

Increased amounts of unconjugated bilirubin are brought to liver cells most commonly from RBC destrution

194
Q

What are five situations that can cause prehepatic jaundice?

A

Hemolytic anemia
Chemical exposure
Transufusion reaction
Infant hemolytic Dz

195
Q

How will prehepatic jaundice present clinically?

A 
Increase:
Total bilirubin
Conjugated bilirubin
Unconjugated bilirubin
Urine urobilinogen

Urine Bilirubin- Neg

196
Q

What causes Hepatic Jaundice

A

Direct damage to liver cell
Gilberts Dz
Crigler Najjar Syndrome- dec UDP-G transferase
Dubin Johnson Syndrome- no con-bilirubin removal
Rotor’s Syndrome- reduced intracellular binding
Cirrhosis
Hepatitis
Drug induced liver Dz
Neonatal physiological jaundice

197
Q

How will hepatic jaundice present clinically?

A

Total bilirubin- inc
Conjugated bilirubin- inc
Unconjugated bilirubin- norm/inc
Urine urobilinogen- norm, inc/dec

Urine Bilirubin- Pos or Neg

198
Q

How will post-hepatic jaundice present clinically?

A

Total bilirubin- inc
Conjugated bilirubin- inc
Unconjugated bilirubin- norm/inc
Urine urobilinogen- dec or none

Urine Bilirubin- Pos

199
Q

What are the liver enzymes AST and ALT responsible for?

A

Metabolizing aspartate and alanine
ALT- primarily liver and kidney
AST- liver, heart, kidney, pancreas and skeletal muscle

200
Q

An increased level of AST or ALT is seen in what issues?

A

Any involving necrosis or hepatocytes, myocardial cells, erythrocytes, or skeletal muscle cells

201
Q

____ is the most important cause of increase transaminine activity in serum

A

Liver Dz- ALT is higher than AST

ALT is more specific to hepatocyte damage

202
Q

Under what conditions to AST levels rise above ALT?

A

Hepatic Hypoxia in CHF
Liver neoplasia
Alcoholic hepatitis
Active cirrhosis

203
Q

Increase AST and ALT indicates liver Dz while an increased ALP and GGT indicates?

A

Biliary disease

204
Q

Function of GGT

A

Increased before noticeable increase of AST/ALT in obstructed bile ducts
Common elevation in chronic alcohol abuse (parallel to intake)
Highest in cases of intrahepatic/posthepatic obstruction in liver Dzs

205
Q

Function of ALP

A

On cell surfaces of most tissues and catalyzes alkaline hydrolyses of substrates especially in small intestine, bone, liver and placenta
Elevated during bone disorders and liver Dz, Cholestasis, Pagets Dz, disorders involving osteoblasts

206
Q

Function of Glutamate dehydrogenase (GLD)

A

Mitochondrial enzyme found in liver, heart and kidney and small amounts in brain, muscle and leukocytes

207
Q

When are GLD increases seen?

A

Chronic hepatitis- 4-5x

Cirrhosis- 2x

208
Q

When are NTP increases seen?

A

3-6x in hepatobiliary Dz with interference in bile secretion

209
Q

Function of Glutathione S-Transferases

A

Catalyze nucleophilic addition for detox reactions

A-GST signals hepatocellular damage of any type of injury

210
Q

What kind of elevations will be seein in Hepatitis or Alcoholic Liver Disease?

A

H: Inc AST and ALT
ALD: Inc GGT

211
Q

Define Cholestatic Liver Dz

A

Stoppage/inpeded flow of bile
Extrahepatic- obstruction of duct
Lab indicators- Inc Canalicular enzymes (ALP and GGT)

212
Q

What labs are in an AMA Hepatic Function panel?

A 
Albumin
Total protein
Prothrombin time
Bilirubin
GGT ALT AST ALP
213
Q

Elevated level of amylase indicates?

A

Acute pancreatitis, mumps or parotitis

Level inc 5-8hrs of Sx and return to normal in 3-4days

214
Q

Function of Amylase

Function of Lipase

A

Catalyze breakdown of glycogen and starch

Hydrolyze ester linkage of fats to make alcohols and FAs

215
Q

How does lipase levels increase with acute pancreatitis?

A

In 4-8hrs, peak at 24hrs and dec in 7-14 days

216
Q

Trypsin levels rise in conjunction with what other enzyme?

A

Amylase

Used to determine severity but of limited clinical value due to delayed results

217
Q

Done with

A

Lect 4

IPAP (212 decks)

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