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
Pink/red or brown urine samples are indicative of ?
RBCs in acidic urine due to oxidation of hemoglobin to methmeglobin
26
RBCs in urine give samples a ___ appearance | If HgB or myoglobin is present in urine the specimen will appear as ?
Cloudy | Red and clear
27
What causes urine to be brown/black?
Methemoglobin- HgB iron in acidic urine oxidized to methemoglobin Melanin if PT has metastatic malignant melanoma
28
Homogentisic Acid is AKA and causes what change to urine color?
Inborn-error of metabolism Increased excretion in alkaptonuria Alkaline urine turns brown
29
Why does melanin appear in urine? | What turns urine orange in color?
PT w/ metastatic malignant melanoma | Pyridium- UT analgesic for bladder infections or Rifampicin
30
What causes urine to be blue/green?
Bacterial infection of Pseudomonas | Intestinal tract infection from increased urinary indican
31
Normal non-pathologic urine haziness can be due to what five factors?
``` Amorphous crystals Squamous cells Seminal fluid Fecal contamination Mucus ```
32
Pathologic urine haziness can be caused by what five factors?
``` WBCs RBCs Bacteria Renal cells Lipids ```
33
What conditions cause urine to take on abnormal odors?
Bacterial- noxious Ketones- sweet Maple Syrup Food- asparagus
34
Clinitests are often performed on pediatric PTs up to what age? This is performed to test for?
2 y/o | Reducing sugars- Galactose, Fructose, Pentose, Lactose
35
Bilirubin is the result of broken down ____ | Conjugated bilirubin can be excreted because?
Heme ring | Water soluble
36
Why is urobilinogen found in urine?
Water soluble, excreted through kidneys | Most is converted to stool pigmentation
37
Why would leukocyte esterase be found in urine sample? Renal threshold for glucose is exceeded when serum glucose exceeds what level?
UTI 170mg, causes glucosuria
38
Glucosuria w/out hyperglycemia (renal glucosuria) is caused by tubular reabsorption impairment from what two issues?
Pregnancy or heavy metal poisoning
39
Significance of positive urine glucose results that are renal associated?
Fanconi Syndrome Advanced renal disease Osteomalacia Pregnancy
40
How are urine samples tested for ketones?
Chemstrip, detects acetoacetic acid only | Not Acetone or hydroxybutyric acid
41
Positive ketones in urine sample can significant because?
``` Starvation/acute diet DM High fat/protein, low carb diet Severe exercise Malabsorption Frequent vomiting ```
42
Study and review Slides
Slide 52 - 65
43
Define Specific Gravity
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
44
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?
High, Solute diuresis, positive glucose and polyuria Polyuria and low concentration
45
Define Isosthenuria | What are the three most common causes of isosthenuria chronic renal failure?
Consistent SG of 1.010 isosthenuria= renal tubular damage and loss of tubular function Diabetic neuropathy, HTN renal Dz, Chronic Glomerulonephritis
46
What is a more exact measurement of urine concentration, osmolality or SH?
Osmolality- Number of particles in a fluid sample
47
What are the major clinical uses of osmolality?
``` Evaluating renal concentration ability Renal Dz tracking Fluid/electrolyte therapy Differential diagnosis of Hyper/Hyponatremia Renal response to ADH ```
48
What are the normal ratios of urine to serum osmolality?
At least 1 : 1 | After controlled fluid intake 3 : 1
49
The ratio of urine to serum osmolality can be used to differentiated whethere diabetes insipidus is caused by what two factors?
Dec ADH production= Neurogenic | Inability of renal tubules to respond= nephrogenic
50
What is indicated if there is a failure to achieve an osmolality ratio of 3:1 aafter ADH?
Collecting duct does not have functional ADH receptors | If concentration takes place after ADH injection= inability to produce adequate ADH
51
Positive blood results are further tested and can be reactive to what three things?
Intact RBCs, Free HgB, Myoglobin
52
Hematuria can be caused by what four conditions?
Glomerulonephritis Lower UTI Strenuous exercise/menses Renal calculi
53
Hemoglobinuria from intravascular hemolysis can be caused by what two conditions?
Hemolytic anemia | Transfusion reaction
54
hemoglobinuria can be caused by what four conditions?
Intravascular hemolysis Strenuous exercise RBC lysis in UT in dilute, alkaline urine
55
Why is free HgB dangerous to the kidney? | What can cause myoglobinuria?
Damages nephrons | Trauma, rhabdo
56
How does myoglobinuria appear?
Normal serum | Elevated Ck and LDH
57
Slide
82 focus on?
58
Why is urine pH useful?
Acid-base disorder Acidosis- acidic urine Alkalosis- alkaline urine
59
What type of urine pH discourages renal calculi formations? | What is the major serum protein found in normal urine?
Alkaline pH Albumin- presence tested by Chemstrip
60
Define Uromodulin
Tamm-Horsfall protein, a mucoprotein synthesized in DCT and involved in cast formation
61
What is the follow on test for a positive urine protein test?
24hr urine protein determination | >150mg/day triggers electrophoresis test to ID proportion testing
62
When is protein in the urine considered pathologic? | What level is considered massive proteinuria?
Exceeds 150mg/day or 30mg/dl | 3.5g/day
63
What are the 3 major groups of proteinuria?
Prerenal- non renal diseases Renal- kidney diseases Postrenal- protein from below UT/kidney parenchyma
64
What type of proteinuria result is indicative of pre-eclampsia
Significant proteinuria w/ HTN and edema
65
What are the low molecular weight plasma proteins?
HgB MgB Acute phase reactants to infection/inflammation
66
Proteinuria can be caused by what five conditions?
``` Multiple myeloma Renal artery stenosis HTN Fever Muscle injury ```
67
What are the two types of renal proteinuria?
Primary- glomerulonephritis | Induced- drug/toxin, systemic diseases
68
Define Tubular Proteinuria
Defective tubular reabsorption characterized by increased levels of low-molecular weight proteins (Drug/toxin, severe viral/bacterial infection, Fanconi Syndrome)
69
# Define Polynephritis What can cause postrenal proteinuria?
Ascending UTI that reaches pyelum or pelvis of kidney Inflammation of bladder, urethra or prostate
70
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?
E Coli, Proteus First morning
71
What can cause a false negative urine nitrite result? What can cause a false positive urine nitrite test?
UTI pathogens don't reduce nitrates Urine wasn't in bladder long enough for nitrate reduction to occur Improper preservation
72
How are positive bacteriuria results confirmed?
Microscopic examination of urine sediment and culture
73
Urine sample that tests positive for leukocyte esterase indicates?
Pyuria from infection/inflammation of GU system
74
Bacterial UTIs that generate positive leukocyte esterase results often generate what other positive result?
Positive nitrite
75
What type of infections can cause a positive leukocyte esterase result without a positive nitrite result?
``` Vaginal/urethral Trichomonas infections Yeast Chlamydia Mycoplasma Virus ```
76
A positive LE sample but negative for nitrates will be confirmed with what methods?
Microscopic sediment exam | Yeast, bacteria or Trichomonas are observable
77
What is the purpose of microscopic examinations of urine sediments?
``` Detect/ID insoluble materials in urine R/WBC Epithelial cells Casts/Crystals Bacteria, yeast, parasites Junk- mucus, sperm, artifacts ```
78
Microscopic exams of urine are conducted under two situations
Requested | Abnormal Chemstrip result
79
RBCs seen on a microscopic exam is associated with ? | Hematuria associated with UTIs ill be associated ?
Glomerular damage Pyuria
80
Bleeding into the UT from renal pelvis to urethra is usually seen without ?
``` Significant proteinuria UT stones Neoplasms Trauma Prostatis ```
81
Nephronal hematuira is seen with ?
Proteinuria and RBC casts | Glomerular or tubular disease
82
A combination of what 3 findings in a urine sample are indicative of a kidney infection?
Mod/heavy proteinuria WBC casts Hematuria
83
How does cystitis present in lab findings?
Hematuria Small amount of protein No casts
84
What is the most frequently seen yet least clinically significant cells found in urine?
Squamous epithelial cells From entire female urethra Only lower male urethra
85
Where do transitional epithelial cells originate from? What type of procedure can increase the number of transitional eipithelial cells in a urine sample?
Renal pelvis, ureters, bladder and upper male urethra Catheter
86
Renal tubular cells in a urine sample can be indicative of ?
Heavy metals Drug induced toicity HgB/MgB toxicity Pyelonephriits
87
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 ?
Renal tubular cells Nephrotic syndrome
88
Casts are unique to what kidney structure and are made where? Casts are usually found in urine with what chemical properties?
Nephrons, Formed in DCT and CD Acidic and high concentration, favor precipitation of proteins
89
# Define Stasis What is the major constituent of casts?
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
Where do casts form depending on the substance they're made out of?
``` RBCs- highest DCT WBCs- high DCT Epithelial- mid DCT Broad- CD Hyaline- Lower DCT ```
91
Hyaline casts can be formed as a result of what four non-pathological things? Pathloglogical?
Non- Strenuous exercise, Dehydration, Fever, Emotional stress Path- acute glomerulonephritis, polynephritis, chronic renal disease
92
Presence of cellular casts are indicative of ? | WBC casts are indicative of ?
Serious renal disease | Nephron infection/inflammation
93
RBC casts are primarily associated with damage to ? WBC casts are most frequently associated with ?
Glomerulus Polynephritis
94
Renal tubular epithelial cell casts are indicative of ? Fatty casts are associated with?
Intrinsic renal tubular disease and often seen in conjunction with R/WBCs Renal disease, Nephrotic syndrome, Toxic tubular necrosis, DM
95
Non-pathologic granules are a by-product of? | Pathologic?
Protein metabolism excreted by tubular cells | Path- degenerated white/epithelial cells and can be seen in any disorder causing cellular cast formation
96
Waxy casts mark the end stage of ?
Disintegration of cellular casts | Presence indicates severe urine stasis in renal tubules and found in chronic renal failure
97
Where are broad casts formed and what do they indicate?
In dilated tubules of enlarged nephrons/CDs during severe stasis Renal failure/end stage renal failure casts
98
Amorphous urates form in ? urine Amorphous phosphates form in ? urine? What type of crystals are seen in ethylene glycol poisoning?
Acidic Alkaline Oxalate crystals
99
What yeast organism is most commonly found in urine? | What parasite?
Candid albicans | Trichomonas, if others are seen indicates fecal contamination
100
What type of findings can indicate a urine sample was not a clean-catch sample?
Several starch granules Squamous epithelial cells Bacteria
101
Unpreserved urine experiences numerous changes but only three factors increase
pH Nitrite Bacteria
102
Prerenal proteinuria is associated with ? diseases such as?
``` Non-renal CHF Renal hypoxia from stenosis HTN Fever ```
103
Renal proteinuria is acused by ? and contain what two types?
Kidney diseases | Primary or induced- protein leaks through glomerulus due to change in hydrostatic pressure
104
Primary and induced proteinuria include what diseases?
Primary- glomerulonephritis, nephrotic syndrom Induced- drug/toxin, systemic diseases
105
Define postrenal proteinuria
Protein from UT below level of kidney, inflammation of the UT Cystitis, urethritis, prostatitis
106
Hyperglycemia is a problem of ? | Hypoglycemia is a problem of ?
Osmotic water loss | Cerebral problems
107
What is the panel for DM management?
BMP Glycosylated HgB Anion gap Lipid profile
108
Ketone bodies are acute and typically only occur in ? type of diabetes? What is an early indicator of diabetes?
Type 1 | Microalbumin
109
Fructosamine and glycated albumin tests are used primarily as monitoring tools for ? How is serum fructosamine formed?
Help people with diabetes control glucose, not as diabetes diagnosis Nonenzymatic glycosylation of serum proteins, mostly albumin
110
A1C can show longer picture if PT is managing their diabetes but what test can be helpful if PT has hemolytic disease or pregnant?
Fructosamine or Glycated Albumin
111
What are the two testing methods for detecting ketone bodies?
Acetest or KetoDiastix | Most sensitive for acetoacetate only
112
What are four non-diabetic reasons for hyperglycemia
CF related diabetes Meds (corticosteroids, BBs) Organ failure Shock
113
For every 100mg/dL increase in blood sugar, plasma sodium decreases by ?
1/7 mmol/L, results in dilutional hyponatremia
114
What are non-insluin causes of hypoglycemia?
ETOH Addisons Dz Hyperinsulinemia
115
What studies are included in a BMP?
``` 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
Electrolytes have key roles i nwhat four processes?
Homeostasis pH regulation Heart/nerve function RedOx reactions
117
What is the major extracellular cation? What is the major intracellular cation? What is the major extracellular anion?
Na K Cl
118
Functions of Na as an electrolyte How are Na levels regulated in the body?
Maintains osmotic pressure, Acid-base balance, Musclular depolarization, Electrical neutrality Aldosterone, ANP
119
S/Sx of hyponatremia
Nausea Weakness Confusion Mental impairment
120
Define Hypo-osmotic Hyponatremia
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
Define Hypo-osmotic Hyponatremia Normovolemic
``` Isolated NaCl deficit Normal TBF SAIDH Diuretics Hypothyroid Hypoaldernalism ```
122
Define Hyperosmotic Hypernatremia
Inc solutes in ECF from extracellular shift of water or intracellular shift of Na to maintain balance between ECF and ICF
123
Define Isosmotic Hyponatremia
Dec plasma Na | Plasma osmolality, glucose and urea are normal= pseudohyponatremia from electrolyte exclusion
124
Define Hypernatreima
Always hyperosmolar | Presents w/ tremors, irritability, ataxia, confusion/coma
125
Hypernatremia can develop from what three situations
Hypovolemia Hypercolemia Normovolemia
126
Define Hypovolemic Hypernatremia
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
Define Normovolemic Hypernatremia
Prelude to hypovolemic hypernatremia Extrarenal- concentrated urine Low urine osmo- water diuresis from diabetes insipidus
128
Define Hypervolemic Hypernatremia
Commonly in hospitalized PTs on hypertonic saline/soidum bicarb Hyperaldosteronism Cushings
129
How are K levels regulated?
Insulin Catecholamines cause K movement into cells Acidosis- K into plasma Alkalosis- K into cells
130
Define Pseudohyperkalemia
Redistribution of K from ICF to EFT
131
What is Cl's physiologic role?
Maintain osmotic pressure and electrical neutrality Moves passivley with Na and inversely varied to HCO3 Inc nerve resting potential
132
Where is Cl found?
``` Serum Plasma CSF Tissue fluid Urine ```
133
What will Cl levels be in metabolic alkalosis/respiratory acidosis
Hypochloremia Hyponatremia Vomitting Inc HCO3
134
What will Cl levels be in metabolic acidosis/respiratory alkalosis
Hypernatremia Diabetes inspidus Dehydration
135
How is BiCarb levels measured?
As the principle component of total CO2
136
What is the measurement of the metabolic component of the acid-base balance? Phosphate levels are inverse to what electrolyte?
BiCarb Ca
137
What electrolyte is the cofactor for enzymatic reactions? Define Anion Gap
Mag Difference between anions (Cl and HCO3) and cations (Na and K)
138
WHat is the mnemonic for the elevated anion gap acidosis?
MULEPAKS
139
What does an increase serum anion gap mean? | What does a decreased anion gap measure?
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
An increase in a cationic protein will increase?
Multiply myeloma increases cationic protein which will increase it's anion chloride
141
Normal anion gap metabolic acidosis mean?
Non-Gap Acidosis Gastrointestinal BiCarb loss from diarrhea Renal BiCarb loss from CAIs, renal tubular acidosis, aldosterone inhibitors or hypoaldosteronism
142
ABGs measure ? things
``` pH PO2 PCO2 O2 sats BiCarb Base excess/deficit ```
143
Causes of metabolic acidosis
``` Diabetic ketoacidosis Lactic acidosis Methanol poisoning Ethylene glycol poisoning Renal failure Diarrhea ```
144
What are the causes of metabolic alkalosis
Prolonged vomiting Diuretic therapy Hyperadrenocortical disease Exogenous base excess
145
Causes of respiratory acidosis
Emphysema Pneumonia Pulmonary fibrosis COPD
146
Causes of preparatory alkalosis
Hysteria Fever Salicylate poisoning Asthma
147
What are the four parts of a nephron?
Glomerulus Proximal tubule LoH Distal Tubule
148
What four factors can affect renal function?
Blood flow Glomerular filtration Tubular reabsorption Tubular secretion
149
What are the four types of nonprotien nitrogen?
NH3 Uric Acid Urea- majority 75% Creatinine
150
How does hyperammonemia occur?
Defect of urea cycle, manifests as neurological abnormality
151
Majority of ammonia produced in the body is excreted as ? but is not useful for determinating ?
Urea | Kidney function
152
How is creatinine formed? Where is creatinine synthesized?
Cyclic anhydride produced as final product of decomposition of phsphocreatine Kidney, Liver, Pancreas
153
Creatinine is proportional to ? but is not? What is the final end state product of purine catabolism?
Muscle mass, Reabsorbed Uric acid
154
# Define Hyperuricemia What are the three physiological components of renal function?
Precipitation of salt crystal monosodium urate; Gout GFR, Renal blood flow, Glomerular permeability
155
What are four methods of testing renal function on a routine basis?
eGFR Assess glomerular permeability Measure non-protein nitrogen containing compounds Measurement of tubules concentrating ability
156
What test is a reliable measure of functional capacity of the kidney and is indicative of number of functioning nephrons?
GFR Urine concentration x urine flow/plasma concentration
157
Rate of formation of glomerular filtrate depends on ?
Balance between hydrostatic and oncotic forces along afferent arteriole and across glomerular filter
158
What are four uses of an acquired GFR?
Detect renal insufficiency Adjust drug doses Eval therapies for chronic RDz Pts for PTs waiting kidney transplants
159
What are the three lab tests to determine eGFR?
Insulin clearance test Creatinine clearance test Cystatin C
160
What test is indicative of the number of functioning nephrons? The lower a GFR is, ? is present or increasing?
Creatinine clearance from 24hr collection Kidney function/failure
161
What are the four methods to assess glomerular permeability?
Dipstick- qualitative, sensitive for detecting albumin Spot urine ablumin:creatinine ratio 24hr urine protein test- quantitative Bence-Jones protein
162
What are the two methods in measuring the tubules concentrating ability?
SpecGrav | Osmolality- more valid
163
What is the role of Phosphorus and what does an inc indicate?
Strutural integrity of cell membranes | Renal tubular damage and nonrenal acidosis
164
Definition of CKD
Damage or GFR less than 60mL/min for at least 3mon
165
What are the three types of acute renal failure?
Pre-renal: hypovolemia Renal: glomerulonephritis Post-renal: obstruction of lower UT
166
What are the causes of chronic renal failure?
``` Primary glomerular Dz Renal vascular Dz Metabolic Dz w/ renal impairement HTN nephrotpathy Nephrotoxins ```
167
What are the two key markers for CKD?
Estimated glomerular filtration | Urine Albumin
168
AMA renal function panel includes ? tests?
``` Albumin Ca CO2 Cl Creatinine Urea Nitrogen/creatinine ration Glucose Phosphorus K Na Urea Nitrogen eGFR ```
169
What are the three historical marker combos for the diagnosis of acute myocardial infarction?
Myoglobin Total CPK CK-MB
170
What are the seven steps of the pathogenesis of an acute MI
``` Endothelial injury/inflammation Plaque formation Plaque rupture/thrombogenesis Reduced blood and inc o demand Ischemia Necrosis AMI ```
171
What is the gold standard of cardiac biomarkers
``` Troponins Troponin C- Ca binding Troponin 1- inhibitory component Troponin T 1 and T- derived from myocardium ```
172
When do troponin levels peak and reside after a MI?
Inc: 3-12hrs Peak: 24-48hrs Return to baseline: 5-14days
173
What are causes of acute cTN elevation in the absence of acute ischemic heart disease
``` Trauma CHF Severe valve disease HTN/HOTN Sepsis Vital exhaustion ```
174
Which inflammatory marker is secreted into bloodstream within a few hours of infection/inflammation?
C reactive protein- acute phase reactant made by liver
175
When is CRP levels elecated?
After MI Sepsis After surgical procedure
176
Characteristics of Pentraxin 3
Marker of vascular inflammation made by vascular endothelial cells, smooth muscles, macrophages and neutrophils More specific the CROP for vessel wall inflammation
177
Which inflammatory marker is a prognostic biomarker of adverse outcomes in PTs with unstable angina pectoris, MI or CHF?
Pentraxin 2
178
Characteristics of Homecysteine
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
Characteristics of interleuking
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
Characteristics of Myeloperoxidase
Produced by polymorphonuclear leukocytes and macrophages Inc level is marker of plaque instability Predictive marker for future CV adverse events
181
Characteristics of soluble cluster of differentiation 40 ligand
Release indicated plaque rupture and subesquent MI
182
Characteristics of TNF-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
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Characteristics of H-FABP
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
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Characteristics of BNP
32 aa secreted by heart ventricles in response to excessive stretching Marker for identifying PTs with CHF
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Characteristics of IMA
Inc during ischemic conditions | Occur immediately after onset of ischemia and enables early identification of ischemia
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Define Stellate cells and their function
AKA Ito cells, located between endothelial lining of sinusoids and hepatocytes Store Vit A Synth NO
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What are the excretory, synthetic and metabolic functions of the liver? How are organic anions excreted from the body?
E- bile production, S- plasma proteins, M- barb, aa, lipid, drugs Extracted from sinusoidal blood, transformed and excreted in bile or urine
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How is liver excretory functions assessed?
Plasma concentration of bilirubin and bile acids Determination of rate of clearance (aminopyrine, lidocaine, caffeine) Drug metabolic tests in liver transplant/liver dz
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Unconjugated bilirubin is tranported to ? by ? What are the major sources of circulating ammonia is ?
Liver, On albumin, Excreted in bile or urine Bacterial proteases, Ureases, Amine oxidases
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Most ammonia is metabolized into ? by the ?
Urea In hepatocytes Krebs-Henseleit urea cycle
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The common acquired causes of hyperammonemia are?
Advanced liver disease | Renal failure
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Characteristics of Reye Syndrome Abnormal ? is common in liver disease?
CNS disorder with minor hepatic dysfunction Abnormal hemostasis
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Elevations in unconjugated bilirubin pose greater risk for development of ? When/how does prehepatic jaundice occur?
Kernicterus Increased amounts of unconjugated bilirubin are brought to liver cells most commonly from RBC destrution
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What are five situations that can cause prehepatic jaundice?
Hemolytic anemia Chemical exposure Transufusion reaction Infant hemolytic Dz
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How will prehepatic jaundice present clinically?
``` Increase: Total bilirubin Conjugated bilirubin Unconjugated bilirubin Urine urobilinogen ``` Urine Bilirubin- Neg
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What causes Hepatic Jaundice
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
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How will hepatic jaundice present clinically?
Total bilirubin- inc Conjugated bilirubin- inc Unconjugated bilirubin- norm/inc Urine urobilinogen- norm, inc/dec Urine Bilirubin- Pos or Neg
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How will post-hepatic jaundice present clinically?
Total bilirubin- inc Conjugated bilirubin- inc Unconjugated bilirubin- norm/inc Urine urobilinogen- dec or none Urine Bilirubin- Pos
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What are the liver enzymes AST and ALT responsible for?
Metabolizing aspartate and alanine ALT- primarily liver and kidney AST- liver, heart, kidney, pancreas and skeletal muscle
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An increased level of AST or ALT is seen in what issues?
Any involving necrosis or hepatocytes, myocardial cells, erythrocytes, or skeletal muscle cells
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____ is the most important cause of increase transaminine activity in serum
Liver Dz- ALT is higher than AST | ALT is more specific to hepatocyte damage
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Under what conditions to AST levels rise above ALT?
Hepatic Hypoxia in CHF Liver neoplasia Alcoholic hepatitis Active cirrhosis
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Increase AST and ALT indicates liver Dz while an increased ALP and GGT indicates?
Biliary disease
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Function of GGT
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
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Function of ALP
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
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Function of Glutamate dehydrogenase (GLD)
Mitochondrial enzyme found in liver, heart and kidney and small amounts in brain, muscle and leukocytes
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When are GLD increases seen?
Chronic hepatitis- 4-5x | Cirrhosis- 2x
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When are NTP increases seen?
3-6x in hepatobiliary Dz with interference in bile secretion
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Function of Glutathione S-Transferases
Catalyze nucleophilic addition for detox reactions | A-GST signals hepatocellular damage of any type of injury
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What kind of elevations will be seein in Hepatitis or Alcoholic Liver Disease?
H: Inc AST and ALT ALD: Inc GGT
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Define Cholestatic Liver Dz
Stoppage/inpeded flow of bile Extrahepatic- obstruction of duct Lab indicators- Inc Canalicular enzymes (ALP and GGT)
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What labs are in an AMA Hepatic Function panel?
``` Albumin Total protein Prothrombin time Bilirubin GGT ALT AST ALP ```
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Elevated level of amylase indicates?
Acute pancreatitis, mumps or parotitis | Level inc 5-8hrs of Sx and return to normal in 3-4days
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Function of Amylase | Function of Lipase
Catalyze breakdown of glycogen and starch | Hydrolyze ester linkage of fats to make alcohols and FAs
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How does lipase levels increase with acute pancreatitis?
In 4-8hrs, peak at 24hrs and dec in 7-14 days
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Trypsin levels rise in conjunction with what other enzyme?
Amylase | Used to determine severity but of limited clinical value due to delayed results
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Done with
Lect 4