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Urine Analysis > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What solutes are used to monitor renal function

A

urea and creatinine

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2
Q

What measurements are used to asses quantity of solutes in urine

A

SG and osmo

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3
Q

What are the 3 most abundant solutes in urine

A

urea
chloride
sodium

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4
Q

What are the 3 least abundant solutes in urine

A

Uric acid
glucose
albumin

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5
Q

What is osmolality

A

the number of particles in a solution

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6
Q

Urea ____ dissociate in solution
NaCl ___ dissociates in solution
Which one has the highest osmolality

A

urea does not
NaCl does
NaCl has twice the osmo than urea

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7
Q

IF the osmo of the initial filtrate = the osmo of the plasma

A

isosmotic

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8
Q

Ultrafiltrate in Bowman;s space has ___ solute composition as plasma, but lacks ___

A

the same
lacks albumin

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9
Q

What is the osmolality of the ultrafiltrate in Bowman’s space and plasma

A

300 mOsm

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10
Q

What determines the final osmo of urine

A

the distal tubules and collecting ducts

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11
Q

If ADH is present, does osmo increase or decrease as water absorbed in the collecting ducts

A

increases

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12
Q

What is the max osmo possible
What is the normal osmo

A

max- 1400
normal-275-900

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13
Q

Where can urine be hypertonic

A

medullary interstitium

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14
Q

What produces hypertonic urine

A

posterior pituitary releases ADH

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15
Q

what is the normal urine to serum osmo ratio

A

1-3

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16
Q

Urine osmo should be ___x the serum osmo

A

1 to 3 times

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17
Q

What is polydipsia

A

intense thirst, brought on by diabetes

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18
Q

ADH makes you pee ___ water, making urine ___ concentrated

A

less water
more concentrated

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19
Q

What is specific gravity

A

ratio of mass of solutes to pure water

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20
Q

What is the normal SG range

A

1.002 to 1.035

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21
Q

How do large molecules affect the SG value

A

dramatically increases SG compared to small solutes

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22
Q

What are some large molecules that can be present in urine

A

Glucose

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23
Q

What can cause an extremely high SG

A

> 1.050
X ray dye or mannitol
DOES NOT AFFECT OSMO

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24
Q

What is the difference between osmo and SG

A

osmo-# of solutes
SG- mass of solutes
both measurements of concentration of urine

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25
Q

What is the normal daily urine excretion

A

500-1800

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26
Q

How much urine do the kidneys secrete when a person is dehydrated? and excessively hydrated?

A

dehydrated- small volume
excessively hydrated-large volume

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27
Q

What are the 2 main causes of polyuria

A

water diuresis- low osmo >200, inadequate ADH secretion or inactive action of ADH

solute diuresis- > 300 , usually imbalance of glucose, urea, sodium

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28
Q

what is oliguria? and anuria

A

oliguria- decreased urine- <400
anuria- no urine excretion

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29
Q

Which is preferred? Osmo or Sg and why

A

Osmo- because its more accurate
except for HMW solutes

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30
Q

How is tubular concentration affected in chronic renal disease? What happens to SG and osmo?

A

causes inability to rebsorb and secrete solutes from ultrafiltrate
SG and osmo- same as initial ultrafiltrate in Bowman’s space
causes polyuria and nocturia

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31
Q

What is a fluid deprivation test and what is its purpose

A

Deprive patient of fluids from 6pm to 8am
ADH administered at the end
To find causes of water diuresis, could be defective ADH or lack of a response to ADH

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32
Q

Match neurogenic or nephrogenic

-lack of ADH response
-defective ADH

A

neurogenic- defective ADH
nephrogenic- lack of ADH response

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33
Q

What does a positive response and a negative response to fluid deprivation test

A

positive- urine osmo high- this means the kidneys responded to the ADH, therefore the patient must not be producing enough ADH-neurogenic problem
negative- urine osmo low- this means the renal receptors for ADH must not be working, because there is no response when ADH is present- nephrogenic problem

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34
Q

What is osmolar clearance
What is free clearance

A

osmolar clearance- ratio of urine osmo to serum x urine volume
Free water clearance- additional water that exceeds bodily needs and is eliminated in the urine

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35
Q

When the total urine equal the osmolar clearance volume
urine is _____ with plasma
Ch20 is ___

A

urine osmo = serum osmo
isosmotic
CH2O is zero

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36
Q

When urine is dilute because of water diuresis
urine is _____
The CH2O is ____

A

urine is hypo-osmotic or hypotonic
Uosmo

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37
Q

When urine is concentrated due to dehydration
urine is ___
CH2O ___

A

urine is hyperosmotic
CH2O is negative

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38
Q

How does dehydration affect
Uosm
Sosm
V
Cosm
CH2O

A

Uosm- increases
Sosm- increases
V-decreases
Cosm- decreases
CH2O- decreases

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39
Q

Practice the formula for Osmolar clearance

A

Cosm = (Uosm/Sosm) x V

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40
Q

What units should creatinine clearance be in what other formulas have the same unit

A

mL per minute not hr
RBF

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41
Q

Practice the formula for renal clearance

A

C= U x V/ P
U=urine
P=plasma

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42
Q

What is GFR in general?
What is the measured GFR? and estimated?

A

glomerular filtration rate- the rate of plasma cleared by the glomeruli
measured- using clearance test
estimated- using equation or biomarkers

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43
Q

What is the normal reference range for GFR
What do the abnormal results mean

A

> 60 normal
<60 kidney disease
< 15 kidney failure

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44
Q

What is inulin

A

not absorbed by GI tract, administered before and throughout the inulin clearance test
passes through glomerular filtration and is NOT reabsorbed
ideal substance for determining GFR, not practical for routine/ periodic GFR

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45
Q

What is the most frequently used test for routine assessment of GFR

A

creatinine clearance

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46
Q

How can more accurate creatinine testing be obtained

A

using 24 hr urine collection

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47
Q

What is creatinine

A

a biproduct of muscle metabolism

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48
Q

Is creatinine varied or constant in its production

A

should be steady, constant plasma and urine excretion rate

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49
Q

What influences creatinine production

A

muscle mass, can vary depending on age, gender and physical activity

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50
Q

What is the average persons body surface area, why is it used in calculations for creatinine clearance

A

1.73m^2
accounts for the differences in muscle mass in individuals

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51
Q

Practice the creatinine clearance calculation

A

C= ((U x V)/ P ) x (1.73/SA)
P= plasma
U=urine
SA= patient surface area

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52
Q

What can normal creatinine clearance be?

A

between 30 and 130

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53
Q

What special consideration must be kept in mind for creatinine clearance testing

A

-24 hr urine- to account for diurnal variation in GFR
-must be stored correctly to avoid bacteria proliferation which can breakdown creatinine
-must have the correct urine volume

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54
Q

When do we use estimated GFR

A

when serum creatinine test is done on patients older than 18

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55
Q

What is the reference range for creatinine clearance

A

88-137

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56
Q

What other markers can we use to determine GFR other than creatinine, name the advantages and disadvantages, are the absorbed?

A

Cystatin C- the same in every age group, muscle mass and gender, does not return to blood circulation, expensive
Beta 2 microglobulin- is reabsorbed completely, concentration is constant

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57
Q

As blood cystatin C levels increase, GFR ____

A

decreases

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58
Q

As tubular capacity to reabsorbe decreases, B2 microglobulin ____

A

increases in concentration in the urine

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59
Q

what is the purpose of screening for microalbuminuria

A

to monitor patients with diabetes, can detect early nephropathy

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60
Q

What can lead to proteinuria and what is the most important reason we look for it

A

changes in glomerular filtration barrier-> increased glomerular permeability-> proteinuria

to detect hyperglycemia- caused by too much albumin

61
Q

What is RBF, practice the formula for it

A

Renal blood flow
Renal plasma flow
RBF= RPF / (1-HCT)
practice real problem on pg 63 ch 4

62
Q

What is the most common test used to measure RPF

A

P-aminohippurate clearance test

63
Q

What is the oral ammonium chloride test and what is it for

A

taken and breaks down into urea and HCL
kidneys excrete more titratable acid and ammonium salt, causing acidic urine

if acidic urine is not there- renal tubular acidosis-alkaline urine

64
Q

What are the 4 types of renal diseases

A

glomerular
tubular
interstitial
vascular

65
Q

What are the diseases that damage glomeruli

A

glomerulonephritides
glomerulonephritis

66
Q

What is the primary mode of glomerular injury in glomerular disease

A

immune mediated response
antigen antibody complexes that get trapped in glomeruli
chemical and toxic substances produced by immune response

67
Q

What are features that characterize nephritic syndrome
and nephrotic syndrome?

A

nephritic: hematuria, proteinuria, oliguria, azotemia, edema, hypertension (i, inflammation of gomeruli)

nephrotic: heavy proteinuria, hypoproteinemia, hyperlipidemia, lipiduria, generalized edema

68
Q

What is azotemia

A

buildup of nitrogenous substances

69
Q

What is the most common cause of nephritic syndrome

A

berger’s disease

70
Q

Gomerulonephritis that happens after strep throat in children

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

71
Q

Glomerulonephritis that causes crescent shape in proximal tubule

FSGS, MCD , MGN, IgA nephropathy , RPGN, MPGN, ,chronic glomerulonephritis, AGN

72
Q

Glomerulonephritis that causes loss of foot processes, major cause of nephritic syndrome in adults

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

73
Q

Which glomerulonephritis is characterized by complement activation causing glomerular damage, what specific part of the complement system is activated

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

A

MGN,
MAC us activated

74
Q

Glomerular nephritis that is caused by dysfunstional T cells, most common cause of nephritic syndrome in children

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

75
Q

Glomerulosclerosis that is characterized by the sclerosis of glomeruli, damage to podocytes

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

76
Q

Which gomerular disease can recur after renal translant

77
Q

What glomerulonephritis is mostly immune mediated, by leukocyte proliferation and thickening of glomerular basement membrane

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

78
Q

Which glomerular disease if one of the most prevalent types of glomerulonephritides in the world, activates alternative complement pathway

AGN, RPGN, MGN, MCD, FSGS, MPGN, IgA nephropathy, chronic glomerulonephritis

A

IgA Nepropathy

79
Q

Which glomerulonephritis is characterized by renal failure

A

chronic glomerulonephritis

80
Q

What are the systemic glomerular diseases, briefly describe them

A

systemic lupus erythematosus- SLE-immune system activates complement
amyloidosis- deposition of amyloid a pathologic protein, destroys glomeruli
Diabetes- ends in kidney disease, high blood sugar leads to blood flow issues

81
Q

What is ATN, what are the 2 types

A

acute tubular necrosis
destruction of renal tubular epithelial cells

Ischemic- low bp (hypotension) , less filtering
Toxic ATN- exposure to toxic agents

82
Q

50% of all ATN cases result from _____

A

surgical procedures

83
Q

What are the effects of Ischemic ATN, and toxic?

A

Ischemic- sepsis, shock, trauma
Toxic- nephrotoxins

84
Q

What do both ATN types show

85
Q

What disorders do not affect glomerular function, for the GFR looks normal

A

tubular dysfunction

86
Q

What is Fanconi’s syndrome

A

condition where proximal tubules have lost their function
AAs, glucose, water, phosphorous, potassium, calcium not reabsorbed, show up in pee

87
Q

What is cystinosis and cystinuria

A

excretion of cystine, due to renal tubular dysfunction,

88
Q

What is renal glucosuria

A

excretion of glucose in urine, normal blood glucose levels
decreased Tm for glucose

89
Q

What is renal phosphaturia

A

hereditary, inability of distal tubules to reabsorb inorganic phosphorous

90
Q

What is RTA

A

renal tubular acidosis- tubules are not secreting hydrogen ions correctly, causes alkalline urine when it should be acidic

91
Q

What is tubulointerstitial disease

A

affect renal interstitium caused by infection, toxins, metabolic, vascular, irradiation, neoplasms, transplant rejection

92
Q

What parts of the urinary system do lower UTIs affect

A

urethra, bladder, both

93
Q

What is an infection of the bladder called

A

urethritis

94
Q

What parts of the urinary tract are affected in an upper UTI

A

renal pelvis only can include interstitium

95
Q

What is pyelitis

A

infection of the renal pelvis

96
Q

What is pyelonephritis

A

infection of renal pelvis and interstitium

97
Q

What is the pathogen that most commonly causes UTIs

98
Q

What differentiates lower from upper UTIs

A

no pathological casts- lower UTI
casts- upper UTI

99
Q

What is acute pyelonephritis

A

bacterial infection in renal tubules, interstitium and renal pelvis
most common-bacteria move up from lower urinary tract
rare- bacteria get in from blood

100
Q

What is chronic pyelonephritis

A

persistent inflammation of renal tissue with permanent scarring in renal calyces and pelvis

101
Q

What is the most common cause of acute allograft rejection of a transplanted kidney

A

AIN acute interstitial nephritis

102
Q

What are increased eosinophils characteristic of

A

acute interstitial nephritis AIN

103
Q

What kind of UTI is acute pyelonephritis?

104
Q

What characterizes ARF

A

decrease in GFR, azotemia, oliguria

105
Q

What makes it so that ARF has a high mortality rate

A

oliguria can lead to anuria, causes necrosis and death

106
Q

What are the 3 mechanisms that lead to ARF

A

prerenal-decrease in renal blood flow
renal- renal damage
postrenal- obstruction of urine flow

107
Q

What is CRF characterized by

A

progressive loss of renal function, irreversible and intrinsic renal disease

108
Q

What causes CRF

A

glomerulonephropathies mostly

109
Q

What can CRF eventually progress to

A

end stage renal disease- dialysis or renal transplant to live

110
Q

75% of renal calculi contain ____

111
Q

What factors influence renal calculus

A

supersaturation of chemical salts in urine
optimal urinary pH
urinary stasis
nucleation or initial crystal formation

112
Q

What are the pH changed with a patient that has calculi

A

isohyduria

113
Q

What are staghorn stones

A

stones in the renal pelvis become large and extend into two or more calyces, always associated with upper UTI

114
Q

What is the pain that is produced from kidney stones called

A

renal colic

115
Q

What are the 3 types of aminoacidurias

A

overflow- increase in plasma levels of AAs
no threshold- increased AAs in blood and urine
renal-AAs not reabsorbed due to tubular defect

116
Q

What is cystinosis

A

inherited lysosomal storage disease that results from intracellular deposition of cystine, causes cellular damage and function faulure

117
Q

What type of cystinosis
most common and severe
causes Fanconi’s syndrome
causes growth retardaton, polyuria….

A

Nephropathic cystinosis

118
Q

What type of cystinosis
slower rate of progression, can cause kidney failure by early thirties

A

intermediate cystinosis

119
Q

What type of cystinosis
manifests only in ocular impairment

A

ocular cystinosis

120
Q

What is cystinuria

A

cystine crystals in urine,

121
Q

What changes can you make in your diet to avoid cystinuria

A

change diet to alkalinize urine, hydration especially at night

122
Q

What characterizes MSUD

A

maple syrup urine disease
Leu, Ile, Val in blood CSF and urine

123
Q

What causes maple syrup odor in MSUD

124
Q

What is PKU

A

phenylketouria (PKU) - excretion of phenylpyuvic acid and its metabolites

125
Q

What is the classic cause of PKU

A

phenylalanine hydroxylase enzyme is deficient or defective

126
Q

What disease is characterized by a mousy musty odor, patients with lighter skin, hair and eyes.

127
Q

What is Alkaptonuria

A

large amounts of homogentisic acid HGA
decreased levels of homogentistic acid oxidase

128
Q

What does HGA do

A

binds to collagen in connective tissues, causes abnormal dark blue or black tissue pigmentation

129
Q

What disease is characterized with causing pigmented ears

A

Alkaptonuria

130
Q

What is tyrosinuria

A

increased tyrosine in urine, rarely causes tyrosine crystals

131
Q

What is melanuria

A

increased urinary excretion of melanin, black urine in extreme cases

132
Q

ochronosis

A

pigmented ears, alkaptonuria

133
Q

mousy smelling urine

134
Q

Ketoacids in urine

A

Maple syrup urine disease

135
Q

Hexagonal crystals in urine

A

cystineuria

136
Q

homogentistic acid in urine

A

Alkaptenuria

137
Q

What characterizes diabetes meillitus

A

hyperglycemia and glucosuria

138
Q

Type 1 and type 2 diabetes

A

1- insulin dependant, juvenille
2- non insulin dependant, adult onset

139
Q

What test results can we expect from a patient with diabetes mellitus

A

dilute urine
high SG
ketonuria

140
Q

What are the classic symptoms of diabetes type 1

A

polyuria and polydipsia

141
Q

What are the symptoms of type 2 diabetes

A

hyperglycemia, no insulin needed

142
Q

What is galactosemia with galactosuria and its types

A

carbohydrate disorder
type 1- most common, GALT
type 2- deficiency of GALK, cataracts
type 3- deficiency of GALE

143
Q

Neurogenic vs nephrogenic diabetes insipidus

A

neurogenic- release of ADH is reduced
nephrogenic- defective renal tubular response to ADH

144
Q

What is characterized with bland tasting urine

A

diabetes insipidus

145
Q

What test results can be expected from diabetes insipidus

A

polyuria, polydipsia
low SG

146
Q

What are porphyrias

A

porphyrins- side products of heme production
porphyrias- disorder where there is an accumulation of porphyrins, or precursos of porphyrins

147
Q

What lab findings can we expect from porphyrias

A

dark or purple urine if exposed to light
prophyrins in urine, blood and feces

148
Q

What are the 2 types of porphyrias

A

hepatic or erythropoietic

149
Q

What are the symptoms of porphyrias

A

neurologic- due to neurotoxic porphyrin precursors
photosensitivity- porphyrins absorb light, cause cutaneous burning sensation

Urine Analysis (5 decks)

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