CLS 304 4-6 Flashcards
four types of renal diseases
- glomerular
- tubular
- interstitial
- vascular
glomerular
most often immune mediated
tubular
result from toxic or infectious substances
interstitial
result from toxic or infectious substances
vascular
reduction in renal flow that induces changes in kidney
what diseases damage glomeruli
- immunologic
- metabolic
- hereditary
secondary glomerular diseases
systemic disease that involves other organs but also affect kidneys
primary glomerular diseases
- specifically affects kidney
- consist different types of glomerulonephritis
morphologic changes in glomerulus (mostly immune mediated)
- cellular proliferation
- glomerular basement thickening
cellular proliferation
- increased numbers of endothelial and other cells in glomerular tuft
- drawn by a local chemotactic response
glomerular basement thickening
includes any process that results in enlargement of basement membrane
clinical features of glomerular disease
- hematuria
- proteinuria
- oliguria
- azotemia
- edema
- hypertension
hematuria
red blood cells in urine
proteinuria
protein in urine
oliguria
produce small amount of pee less than 400mL
azotemia
nitrogen in blood
edema
fluid build up in the body (causes swelling)
hypertension
high blood pressure
nephrotic syndrome
kidney disorder that causes the body to pass too much protein in your urine
nephritic syndrome
inflammation of the glomerulus
symptoms of nephrotic syndrome
- heavy proteinuria
- hyperlipidemia
- edema
symptoms of nephritic syndrome
- hematuria
- oliguria
- azotemia
- hypertension
types of glomerulonephritis
- acute glomerulonephritis
- rapid glomerulonephritis
- membranous glomerulonephritis
- minimal change disease
- focal segmental glomerulonephritis
- membranoproliferazive glomerulonephritis
- immunoglobulin A (IgA) nephropathy
- chronic glomerulonephritis
acute glomerulonephritis
result of strep throat antigen
membranous glomerulonephritis
found in adults
minimal change disease
found in children
focal segmental glomerulonephritis
found in HIV
membranoproliferazive glomerulonephritis
interfers with filtration
immunoglobulin A (IgA) nephropathy
most common cause of glomerulonephritis
chronic glomerulonephritis
will take you to renal failure
name 3 systemic diseases and (secondary) glomerular damage
- systemic lupus erythematosus (SLE)
- diabetes mellitus
- amyloidosis
systemic lupus erythematosus (SLE)
- autoimmune disorder with immune complex deposits
- over 50% of patients will develop kidney failure
diabetes mellitus
carbohydrate metabolism disorder due to lack of insulin or cellular resistance to insulin
amyloidosis
group of systemic diseases involving many organ, characterized by deposits of amyloid a pathologic protein substance
acute tubular necrosis
- ischemic ATN (seen in sepsis, shock, trauma)
- toxic ATN (from exogenous or endogenous nephrotoxins
tubular dysfunction
- fanconi’s syndrome
- cystinosis and cystinuria
- renal glycosuria
- renal tubular acidosis
tubulointerstitial disease/infections
- UTI
- actue pyelonephritis
-chronic pyelonephritis - acute interstitial nephritis (AIN)
-yeast infection
renal calculi
- aggregates of mineral salts in a matrix of proteins and lipids
- found in calyces, renal pelvis, ureters, or bladder
factors influence calculi formation
- supersaturation of chemical salts in urine
- optimal urinary ph
- urinary stasis
- treatment depends on type and size of stones
what the #1 reason women go to the doctors
UTIs
what does neph mean
kidney
what does ritis mean
inflammation
what’s the most common disease in children
minimal change disease
acute renal failure (ARF)
- sudden decrease in glomerular filtration rate
- classified as prerenal, renal, and postrenal
chronic renal failure (CRF)
- progressive loss of renal function
what’s the difference between acute vs chronic renal failure
acute has an abrupt start and can potentially reversible and chronic progresses slowly over at least 3 months and can lead to permanent renal failure
name 4 types of kidney stones
- calcium based stones
- struvite stones
- uric acid stones
- cystine stones
amino acid metabolism disorders
- cystinosis and cystinuira
- maple syrup urine disease (MSUD)
- phenylketonuria (PKU)
- alkaptonuria
- tyrosinuria
- melanuria
metabolic disorders
- diabetes mellitus
- diabetes insipidus
- porphyria
diabetes mellitus
- problems with glucose metabolism
- one long term side effect is glomerular damage and chronic renal failure
diabetes insipidus
- decreased antidiuretic horror (ADH) or nephrons are resistant to ADH
- results in polyuria
porphyria
- hereditary defects of theme synthesis pathway
- increased porphyrins and porphyrin precursors in blood and urine
purpuse of routine urine analysis
- aid in disease diagnosis
- screen for asymptomatic, congenital, or hereditary diseases
- monitor disease progression
- monitor therapy effectiveness or complications
why study urine
- urine analysis if a fluid biopsy of kidney
- noninvasive means to evaluate kidney
- specimens readily available usually
- urine is ultra filtrate of plasma
- can be used to evaluate and monitor body homeostasis and many metabolic diseases
specimen types
- first morning
- random
- timed
first morning specimen
- empty bladder at night before going to bed
- collect specimen first thing in the morning
- most concentrate (often preferred specimen)
random specimen
- for routine screening
- can be affected by excess fluid intake or exercise
timed specimen
- collections for predetermined length of time
- collections at a specified time of day
types of collection techniques
- routine void
- midstream (clean catch)
- catheterized specimens
- suprapubic aspiration
- pediatric specimens
routine void
- requires no patient prep
- collected by having patient void into appropriate container
- patient needs no assistance other than clear directions
- can be random or first morning specimen
midstream (clean catch)
- for bacterial cultures or to prevent vaginal contamination
- requires cleaning supplies and additional instructions to patient and possibly sterile container
- requires cleaning and rinsing of loans penis or urethral meatus before collection
- begin urination into toilet, collect midstream portion in container, finish doing in toilet
catheterized specimens
- sterile specimen collected from bladder with a hollow tube (catheter)
- most common test is bacterial culture
suprapubic aspiration
- completely free of contamination for culture and cytology
- external introduction of needle for aspiration from the bladder
- possible pediatric specimen
pediatric specimens
- soft, clear, plastic bags, with hypoallergenic tape applied to genital area
- clean catch method with sterile bag can be used
- bags with tubes to a larger container are available for times specimens
24 hours urine specimens
- test for certain chemicals and hormones by collecting all of the urine voided by a patient in a 24 hour period
- starts in the morning and ends in the morning
- must throw away the first pee in the 24 hour period
- if urine ir discarded or improperly collected you must start all over
collecting a 24 hour urine
- after the first pee, note the time and the period will end at that time the next day
- label with name, room #, date, and time of collection
- must be stored on ice
reasons for specimen rejection
- unlabeled or mislabeled specimen
- mismatch of specimen name or id number with order slip
- inappropriate collection technique for test order
- not properly preserved or time delay in receipt of specimen
- visibly contaminated sample
containers and labels
- clean, dry, and made of clear or translucent material with lid to prevent spillage
- sterile containers required for cultures
- extra large commercial containers are available for large times collections (24 hour specimen)
- label placed on container not on lid
changes in unpreserved urine happen bc
- alteration of urine solutes to a different form
- bacterial growth
- solute precipitation
changes in unpreserved urine
- decreased urine clarity and increased odor
- possible color changes from solute alteration
- false negative glucose
- increased nitrite and PH
- disintegration of formed elements
handling and preservation
- proper techniques to preserve integrity of specimen needed if delay if 2 hours or more
preservation considerations
- type of collection
- tests to be preformed
- time delay before testing
what is the most common way to preserve pee
refrigeration but should not be used for routine testing if urine will be analyzed within 2 hours
preservation of times collections
- 12 and 24 hour times collections require addition of chemical preservative to maintain integrity of analyte to be tested
- keep on ice or refrigerate during collection period
- check collection manual to identify necessary preservative
- deliver specimen to lab immediately after completion of collection period
is this fluid urine
- needed in drug screen collections or when collected by needle aspiration
how much more is urine creatinine is higher than plasma
it is 50 times higher
what is higher in urine than in an other body fluids
urea, sodium, ad chloride
range for urine specific gravity
1.002 to 1.0035
range of ph in pee
5.0 to 8.0
urine from a healthy person should not contain
protein or glucose
kidneys convert _____ ml of filtered plasma
170,000mL
what is the average daily urine output
12000mL
urine composition
- 95% water, 5% solutes
- urea makes up 1/2 pf the dissolved solids
inorganic chloride, sodium, and potassium - urea and creatinine identify a fluid as urine
- may contain cells, crystals, mucus and bacteria
urine volume
- based on body state of hydration
- amount of solutes excreted increases as water required to excrete them increases
normal volume of pee
600 to 1800mL/day
isothenuria
the inaptly of kidneys to change specific gravity or plasma ultra filtrate
normal color is yellow due to ______
urochrome
urochrome is
a lipid soluble pigment in plasma excreted in urine
dark yellow pee =
concentrated urine
pale yellow pee =
dilute urine
substances that change urine color
- blood or myoglobin
- bilirubin
- porphyrins
- melanin
- indican
- homogentisic acid
- ingested substances (meds, dyes,vitamins,pigmented foods)
what happens when normal pee is shaken
white foam will be produces and rapidly dissipates
what does stable white foam mean
large amounts of albumin is in the urine
yellow foam is caused by
increased bilirubin
causes of cloudiness
- contamination from skin or vaginal secretion, bacterial growth, or fecal material
- precipitation of dissolved solutes, X-ray , congrats media
- RBCs, WBCs, epithelial, clots, bacteria, casts
how does urine on standing become ordorous
due to bacterial conversion of urea to amonia
ketones produce what type of odor
sweet or fruity smell
amino acid produces what type of odor
produced very odd orders
can ingesting certain foods or drugs change the odor of pee (true or false)
true
what is a big indicator for concentration of pee
color
what is the formula for specific gravity
SG=density of urine/density of equal volume or pure water
what is specific gravity
- and expression of concentration in terms of density
- mass of solutes present per volume of solution
what is osmolality
- the concentration of a solution expressed in terms of soles of solute particles per kilogram of water
normal urine vales in osmolality is _____
275 to 900 mOsm/kg
normal serum values in osmolality is _____
275 to 300 mOsm/kg
principal uses of osmolality
- evaluate renal concentrating ability of kidneys
- monitor renal disease
- monitor fluid and electrolyte balance
- differentially diagnose cause of polyuria
what is the most common method for chemical testing
reagent strips
what type of result is made based on color change for reagent strips
qualitative results
reasons to use tablet/liquid tests
- confirm results obtained by reagent strip testing
alternative method for highly pigmented urine - some test are more sensitive than strip test such as (ictotest tablets for bilirubin)
- test specificity differs from strip method (sulfosalicylic acid test)
-acetotest to confirm ketones
hemoglobinuria
free hemoglobin in urine
What conditions may large
number of WBC in urine
indicate?
UTI, kidney stones, a pelvic tumor
nitrate reducing bacteria in urine can form______
nitrite
if there’s purine protein its often the first sign of what?
kidney disease
the strip test is most sensitive to _____
albumin
both diabetes and high blood pressure can cause _____
damage to the kidneys which leads to proteinuria
routine test strips are unable to detect what
albumin tha tis <1 to 2 mg
what test is most often used in patients with diabetes
micro albumin and is used to screen for signs of early kidney damage
what is not seen in normal urine
glucose
what will appear if plasma level in urine is over the regular level
glucose will appear at levels of 160 to 180 mg/dL
reducing substances can detect what
- sugars (except sucrose)
- ascorbic acid
- cysteine
ketones breakdown products from large amounts of fatty acids such as
- acetoacetate
- acetone
- Bhydroxybutyrate
what bilirubin is water soluble and found in urine
direct (conjugated) bilirubin
what does bilirubin do to urine
it turns pee into a dark yellow or brown
what bilirubin is NOT water soluble
indirect bilirubin
urobilinogen
- is a product of bilirubin that forms in the intestines
