Exam 1 Flashcards by Sarah VanFossen

two dominant manifestations of acute glomerulonephritis

Proteinuria and hematuria

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causes of acute glomerulonephritis

immune complex disease, hereditary, metabolic disorder

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clinical manifestations of acute tubular necrosis

decreased urine flow, inability to concentrate urine, and loss of many tubular epithelial cells into urine

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what is acute tubular necrosis associated with

reduced blood supply to renal tubules

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three manifestations of nephrotic syndrome

proteinuria, hypoproteinemia, and edema

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common causes of urinary obstruction

congenital malformation, stricture from infection, tumors, and calculi

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explain pyelonephritis

infection of kidney and renal pelvis which initially affects renal interstitial but progresses into renal tubules

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two main clinical findings in urine that may indicate diabetes mellitus

glycosuria and ketonuria

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what would you expect to see in regards to volume and SG in diabetes mellitus

increased SG and increased volume

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what is unconjugated bilirubin

linked loosely to albumin, insoluble in water so not found in urine

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what is conjugated bilirubin

unconjugated bilirubin that has been conjugated by esterification by glucuronic acid in the liver, now water soluble

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what is urobilinogen

conjugated bilirubin that is reduced by the intestinal flora of the small intestine

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What is PKU

patient lacks phenylalanine hydroxylase for the conversion of phenylalanine to tyrosine

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how would PKU be detected

the metabolite phenylpyruvic acid appears in the urine; diagnosed by phentest which uses ferric ions: dk green to blue green

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what is alkaptonuria

patient lacks homogentistic acid oxidase

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how is alkaptonuria detected

homogentistic acid accumulates in the blood, body fluids, and urine; gives orange color with Clinitest tablet

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what is maple syrup disease

patient lacks enzyme needed in branched-chain amino acid metabolism

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how is maple syrup disease detected

accumulation of leucine, isoleucine, keto, and hydroxy acid in urine, blood, and CSF; maple syrup odor; gives purple color with Acetest tablet

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what is Fanconi’s syndrome

the proximal convoluted tubule function of the kidney is impaired

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how is Fanconi’s syndrome detected

produces a deficiency of blood phosphates, aminoaciduria, and glycosuria

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what is cystinuria

urinary excretion of large amounts of the amino acid cystine, as well as arginine, lysine, and ornithine

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how is cystinuria detected

cystine calculi are produced due to the ability of cystine to readily precipitate in acid pH

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what is galactosemia

patient is able to break down lactose to glucose and galactose, but lack the enzyme to convert galactose to glucose causing galactose to accumulate

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how is galactosemia detected

detected in infancy as diarrhea, vomiting, and failure to thrive; neg on dipstick and pos on Clinitest

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what is hematuria

presence of abnormal number of RBCs accompanied by urinary system disease

causes of hematuria

glomerular disease, tubular disease, interstitial disease, vascular disease, lower UT infection, tumors, and calculi

urine culture container and specimen

sterile with clean catch midstream

overall patient health urine sample

random specimen in a clean, dry, clear disposable plastic container with lid; 50-100 mL capacity

Addis count specimen and container

large container for 12 hour specimen; approx 3000 mL

postprandial urine specimen

2-3 hours after meal

protein urine specimen

first morning in regular container or 24 hours

glomerular filtration rate or renal clearance specimen

24 hour large container

quantitative glucose specimen

24 hour specimen

chemical changes in urine at room temp

pH increases, glucose decreases, ketones decrease, bilirubin decreases, urobilinogen decreases, nitrite increases

physical changes in urine at room temp

color darkens, clarity decreases

cellular changes in urine at room temp

blood cells decrease, casts decrease, bacteria increase, trichomonads decrease

time limit for examination of urine held at room temp

one hour

what is Addis count used for

follows progress of renal disease; 12 hour period overnight

what should the status of pH and concentration for an Addis count

low pH and high concentration

what is catheterization

insertion of sterile catheterization into the bladder

when should catheterization be used

patients with urinary tract infections or if they are unable to pass urine due to obesity or severe illness

what is suprapubic aspiration

puncturing the abdominal wall and distended bladder with needle and syringe

when should suprapubic aspiration be used

bacterial cultures of anaerobes and in infants where contamination is unavoidable

three characteristics of urine routinely recorded in physical examination

color, odor, and clarity

what preservative gives false positive result for albumin in protein precipitation test

Thymol

what urine preservative for the preservation of bacteria

refrigeration

what urine preservative preserves cellular elements

formalin

which reactions are not time critical on Multistix

pH and protein

total time to read a Multistix

two minutes

ten Multistix tests

pH, protein, glucose, ketones, blood, leukocytes, specific gravity, bilirubin, nitrite, urobilinogen

abnormal colors for urine

red, dark brown to black, green

cause for red urine

RBCs and hemoglobin

cause for dark brown to black urine

due to melanin, associated with malignant melanoma

cause for green urine

Pseudomonas UTI, small intestine infection

what causes urine to be cloudy

crystals, epithelial cells, fat, microbes, white blood cells, radiographic contrast media

what causes large amounts of white foam

protein

what causes large amounts of yellow foam

bilirubin

what causes a pungent odor

UTI

what causes a sweet or fruity smell

increased ketones, diabetes mellitus, starvation

what causes a mousy odor

phenylketonura

what causes a maple syrup odor

maple syrup urine disease

what is the specific gravity range of normal urine

1.002 - 1.030

three substances that may cause high SG readings

glucose, protein, radioactive dye

what is refractive index

ratio of velocity of light in air to velocity in the solute

what is osmolality

expression of concentration in terms of the number of solute present (no dependent on the size of solutes)

what is specific gravity

ratio of density of an equal volume of pure water (dependent on the number and size of solutes)

two constituents of urine that contribute most to SG

NaCl and urea

one condition may be responsible for abnormally low SG

diabetes insipidus

what is oliguria

decreased urine excretion (<400 mL/day); elevated SG and decreased volume

cause of oliguria

dehydration, urinary tract obstruction, nephrotic syndrome

what is anuria

complete lack of urine excretion, potentially fatal

what causes anuria

major hemolytic transfusion reaction, acute renal failure, urinary tract obstruction

what is hyposthenuria

low SG, lack of ADH

what causes hyposthenuria

diabetes insipidus

what is polyuria

excessive excretion (>3 L/day) aka diuresis

what causes polyuria

diabetes mellitus

what is nocturia

increased urine excretion at night (>500 mL), form of polyuria

what causes nocturia

kidney disease, diabetes mellitus, diabetes insipidus

what is isosthenuria

fixed specific gravity around 1.010

what causes isosthenuria

chronic renal disorder where kidneys cannot concentrate or dilute

what is hypersthenuria

high specific gravity

what causes hypersthenuria

radiographic dye, nephrotic syndrome with proteinuria, diabetes mellitus with glycosuria, dehydration

what causes refrigerated urine to become cloudy

increased amorphous

what properties are used in the determination of urine osmolality

freezing point depression

average normal urine output for average adult

1200 - 1500 mL/day

what happens to urobilinogen

99% excreted as feces and some reabsorbed by intestinal mucosa and then travels back to liver

brown/amber color urine cause

bilirubin

pink color urine cause

blood

what causes rancid odor

tyrosonemia

what causes phenolic odor

disinfectant like lysol

normal urine excretion

600-1800 mL/day with <400 mL at night

what can cause urine to be concentrated

dehydration, low fluid intake, first morning

what can cause urine to be diluted

increased intake and or excretion