Exam 1 Flashcards
two dominant manifestations of acute glomerulonephritis
Proteinuria and hematuria
causes of acute glomerulonephritis
immune complex disease, hereditary, metabolic disorder
clinical manifestations of acute tubular necrosis
decreased urine flow, inability to concentrate urine, and loss of many tubular epithelial cells into urine
what is acute tubular necrosis associated with
reduced blood supply to renal tubules
three manifestations of nephrotic syndrome
proteinuria, hypoproteinemia, and edema
common causes of urinary obstruction
congenital malformation, stricture from infection, tumors, and calculi
explain pyelonephritis
infection of kidney and renal pelvis which initially affects renal interstitial but progresses into renal tubules
two main clinical findings in urine that may indicate diabetes mellitus
glycosuria and ketonuria
what would you expect to see in regards to volume and SG in diabetes mellitus
increased SG and increased volume
what is unconjugated bilirubin
linked loosely to albumin, insoluble in water so not found in urine
what is conjugated bilirubin
unconjugated bilirubin that has been conjugated by esterification by glucuronic acid in the liver, now water soluble
what is urobilinogen
conjugated bilirubin that is reduced by the intestinal flora of the small intestine
What is PKU
patient lacks phenylalanine hydroxylase for the conversion of phenylalanine to tyrosine
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
what is alkaptonuria
patient lacks homogentistic acid oxidase
how is alkaptonuria detected
homogentistic acid accumulates in the blood, body fluids, and urine; gives orange color with Clinitest tablet
what is maple syrup disease
patient lacks enzyme needed in branched-chain amino acid metabolism
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
what is Fanconi’s syndrome
the proximal convoluted tubule function of the kidney is impaired
how is Fanconi’s syndrome detected
produces a deficiency of blood phosphates, aminoaciduria, and glycosuria
what is cystinuria
urinary excretion of large amounts of the amino acid cystine, as well as arginine, lysine, and ornithine
how is cystinuria detected
cystine calculi are produced due to the ability of cystine to readily precipitate in acid pH
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
how is galactosemia detected
detected in infancy as diarrhea, vomiting, and failure to thrive; neg on dipstick and pos on Clinitest
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
