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finals - non protein nitrogen Flashcards

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1
Q

 The term ___originated in the early days of clinical
chemistry when analytic methodology required removal of protein from a
specimen before analysis

A

nonprotein nitrogen (NPN)

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2
Q

The concentration of nitrogen-containing compounds in this protein-free
filtrate was quantified
____

A

spectrophotometrically

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3
Q

The concentration of nitrogen-containing compounds in this protein-free
filtrate was quantified spectrophotometrically by converting nitrogen to
___

A

ammonia

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4
Q

The concentration of nitrogen-containing compounds in this protein-free
filtrate was quantified spectrophotometrically by converting nitrogen to
ammonia and subsequent reaction with what reagent?

A

Nessler’s reagent

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5
Q

nessler’s reagent components

A

double iodide of potassium mercury

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6
Q

end color of converting nitrogen to ammonia using nessler’s reagent

A

yellow

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7
Q

nonprotein nitrogen (NPN)

The majority of these compounds arise from the catabolism of ___

A

proteins and nucleic acids

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8
Q

list down the non protein nitrogen compounds

A

urea
amino acids
uric acid
creatinine
creatine
ammonia4

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9
Q

Major excretory product of protein
metabolism

A

UREA

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10
Q

Formed in the liver from amino groups (-NH2)
and free ammonia generated during protein
catabolism

A

urea

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11
Q

Concentration of urea in the plasma is
determined by ___

A

renal function and perfusion,
the protein content of the diet,
and the rate of protein catabolism

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12
Q

marker of dialysis

A

urea

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13
Q

In severe liver damage, levels of urea
___.

A

decreases

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14
Q

why do urea level decreases in liver damage?

A

ammonia is deaminated in liver from proteins that will subsequently turned as a urea, if there’s no liver that can deaminate ammonia to become urea, urea level will decrease

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15
Q

It is used as a screening test for kidney
disease.

A

BLOOD UREA
NITROGEN (BUN)

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16
Q

Major organic solid in the urine

A

BLOOD UREA
NITROGEN (BUN)

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17
Q

Major inorganic solid in the urine

A

chloride

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18
Q

Urea is readily removed by ___

A

dialysis

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19
Q

____ Urea is excreted; 10% remain in the
blood

A

90%

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20
Q

(<10% of the total BUN) are excreted through the ___

A

gastrointestinal (GI) tract and skin

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21
Q

The concentration of urea in the plasma is
determined by the __

A

protein content of the diet,
the rate of protein catabolism,
and renal function and perfusion

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22
Q

clinical application of BUN

A

 evaluate renal function,
 to assess hydration status,
 to determine nitrogen balance,
 to aid in the diagnosis of renal disease, and
 to verify adequacy of dialysis

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23
Q

oldest technique for urea determination

A

MICRO-KJELDAHL NESSLER

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24
Q

end product of MICRO-KJELDAHL NESSLER

A

Dimercuric ammonium iodide

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25
Q

___ process
 Mixture of sulfuric acid and phosphoric acid

A

Kjeldahl

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26
Q

a nesslerization with a use of enzyme

A

UREASE-NESSLER
METHOD

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27
Q

in UREASE-NESSLER
METHOD

urea is splitted into

A

carbon dioxide and nh3 (ammonia)

then the ammonia is subjected to nesslerization to produce dimercuric ammonium iodide

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28
Q

what is the coupling enzyme used in BUN enzymatic method; urease?

A

gldh - glutamic dehydrogenase

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29
Q

what is being measured in urease kinetic enzymatic method

A

the rate of disappearance of NAD to its reduced form NADH which is measured to 340 nm

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30
Q

a BUN method which is Greater specificity: More expensive

A

enzymatic kinetic method of urease

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31
Q

Greater specificity: More expensive

A

enzymatic kinetic method of urease

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32
Q

Urea is hydrolyzed to ammonium
carbonate by urease and ammonia
reacts with phenol and sodium
hypochlorite in an alkaline medium
forming a blue indophenol.

A

Urease Berthelot Method

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33
Q

in Urease Berthelot Method:

what elements do ammonia reacts with?

A

phenol and sodium

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34
Q

end product of Urease Berthelot Method:

A

blue indophenol.

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35
Q

Urea is hydrolyzed by
urease forming ammonia
which is then titrated
with a weak acid.

A

ENZYMATIC AND
ACID TITRATION

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36
Q

2 methods of ENZYMATIC AND
ACID TITRATION

A

a. Van Slyke Cullen
b. Urograph

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37
Q

DIRECT MEASUREMENT OF UREA measures

A

urea itself, no need to use urease to convert it to ammonia

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38
Q

DIRECT MEASUREMENT OF UREA measures

urea itself, no need to use urease to convert it to ammonia
however, it is only a what type of method?

A

colorimetric method

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39
Q

a method under DIRECT MEASUREMENT OF UREA

A

Diacetyl Monoxime Method (DAM)

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40
Q

in Diacetyl Monoxime Method (DAM)

Urea is made to react with diacetyl monoxime to produce a yellow diazine
derivative known as

A

Fearon’s reaction

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41
Q

what is the end product color of Diacetyl Monoxime Method (DAM)

A

yellow diazine derivative

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42
Q

in Diacetyl Monoxime Method (DAM)

we are adding a color enhancer and to exclude the protein interferences called as ___

A

Arsenic thiosemicarbazide

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43
Q

comments for Diacetyl Monoxime Method (DAM)

A

inexpensive but lacks specificity

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44
Q

CONSIDERATION IN BUN DETERMINATION

The determination is affected by __.

A

high protein diet, hydration and other physiologic functions

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45
Q

CONSIDERATION IN BUN DETERMINATION

Whole blood should be ___ to
eliminate interferences of hemoglobin

A

deproteinized

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46
Q

CONSIDERATION IN BUN DETERMINATION

what anticoagulants are contraindicated in enzymatic methods.

A

Ammonium oxalate-containing anticoagulants

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47
Q

CONSIDERATION IN BUN DETERMINATION

Sodium fluoride and Citrate inhibits the action of __.

A

urease

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48
Q

CONSIDERATION IN BUN DETERMINATION

Upon prolonged standing, ammonia concentration in the sample rises____ times the original value due to enzymatic deamination of labile amide-like
glutamine

A

2-3 times

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49
Q

NORMAL VALUE of BUN

A

6-20 mg/dL (2.1 – 7.1 mmol/L)

8-23 mg/dl in stan bio

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50
Q

Normal value of BUN in 24hr urine

A

12-20g/dL

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51
Q

CONVERSION FACTOR of BUN

A

0.357

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52
Q

Urea nitrogen concentration can be converted to urea concentration by multiplying by ____

A

2.14

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53
Q

the enzymatic method that used pH indicator

A

indicator dye

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54
Q

proposed reference method of urea

A

isotope dilution mass spectrophotometry

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55
Q

quantification using isotopically labelled compounds measuring the fragments of urea

A

idms - isotope dilution mass spectrophotometry

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56
Q

___ is the principal waste product of muscular metabolism derived mainly from creatine (alpha-methyl guanidoacetic acid)

A

Creatinine

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57
Q

CREATININE

It is synthesized forming three amino acids (____)

A

methionine, arginine and lysine

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58
Q

chemical name of creatine

A

alpha-methyl guanidoacetic acid

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59
Q

Used to monitor renal function (an index of overall renal function)

A

creatinine

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60
Q

used to measure Fetal kidney maturity

A

creatinine

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61
Q

the most commonly used assay for Renal Blood Flow

A

createnine

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62
Q

is easily removed by Dialysis

A

nope

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63
Q

is creatinine The production is constant

A

yes

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64
Q

Creatinine is formed from __ and __ in muscle and is
excreted into the plasma at a constant rate related to muscle mass.

A

creatine and creatine phosphate

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65
Q

relationship of GFR to plasma creatinine

A

inversely proportional

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66
Q

it is commonly
filtration function

A

plasma creatinine

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67
Q

increased creatine normal creatinine means

A

problem in muscle

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68
Q

increased in both creatinine and creatine means

A

problem in kidney

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69
Q

Creatinase Method, uses what enzymes?

A

creatininase
creatinase
sarcosine oxidase
peroxidase

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70
Q

Creatinase Method is available on what analyzer

A

Available on Ektachem analyzer

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71
Q

in creatinase coupled enzymatic Method uses what enzymes

A

creatinine aminohydrolase, creatinine kinase,
pyruvate kinase, and lactate dehydrogenase

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72
Q

in Creatinine Aminohydrolase Method what enzyme is used to hydrolyzed creatinine to creatin

A

creatinine aminohydrolase

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73
Q

creatinine aminohydrolase method measures

A

the disappearance of the reduced form nadh to NAD

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74
Q

the working solution of direct jaffe reaction method wherein the acid is added to a base is called as

A

alkaline sodium picrate solution

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75
Q

the alkaline sodium picrate solution in direct jaffe reaction method will result to what end color

A

red orange tautomer

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76
Q

interferences in DIRECT JAFFE REACTION METHODS

falsely increased

A

ascorbate, glucose, uric acid, ∝-ketoacids

77
Q

a creatinine determination method wherein it didn’t use enzyme but is still the most widely used method

A

direct jaffe reaction method

78
Q

interferences in DIRECT JAFFE REACTION METHODS

falsely decreased

A

hemoglobin and bilirubin

79
Q

purpose of adsorbents

A

remove interferences

80
Q

adsorbents example of adsorbent used for direct jaffe reaction

A

Lloyd’s Reagent
fuller’s earth reagent

81
Q

Lloyd’s reagent has __ as an adsorbent

A

sodium aluminum silicate

82
Q

normal range of creatinine using serum for males

A

0.9 - 1.5 mg/dl

0.9 - 1.3 mg/dl in lec

83
Q

fuller earth’s reagent has __ as an adsorbent

A

aluminum magnesium silicate

84
Q

normal range of creatinine using serum for females

A

0.7 - 1.4 mg/dl

0.6 - 1.1 mg/dl in lec

85
Q

normal range of creatinine using urine for males

A

1000 - 2000 mg/24 hr

86
Q

normal range of creatinine using urine for females

A

600 - 1500 mg/24 hr

87
Q

CREATININE METHOD

colorimetric endpoint comments
(jaffe but endpoint)

A

simple and non specific

88
Q

CREATININE METHOD

colorimetric kinetic comments

A

rapid and increased specificity

89
Q

CREATININE METHOD

enzymatic comments

A

Measures ammonia
calorimetrically or with ION
selective electrode

90
Q

what is the reaction time of jaffe method

A

endpoint

91
Q

what is the reaction time of direct jaffe

A

kinetic

92
Q

CLINICAL SIGNIFICANCE of creatinine determination

A

 Aside from renal diseases, it is also elevated in myopathies like:
 Muscular dystrophies
 Familial periodic paralysis
 Myasthenia gravis
 Dermatomyositis

93
Q

previous ref method of creatinine determination

A

direct jaffe method

94
Q

ref method of creatinine method

A

idms - isotope dilution mass spectrophotometry

95
Q

<10:1 B:C ratio means

A

LOW Protein Diet
Repeated Dialysis
Hepatic disease

96
Q

High >20:1(normal creatinine)
B:C ratio means

A

Pre renal Azotemia, Dehydration, CHF
Catabolic states
GI hemorrhage
High Protein Diet

97
Q

High >20:1(increased creatinine)
B:C ratio means

A

Post renal Azotemia, Urinary tract obstruction, Renal calculi, tumor
Renal disease
Renal Failure

98
Q

nitrogen containing a-
biochemical abnormality that refers to
an increase
in BUN and creatinine
levels which is largely
related to decrease glomerular filtration

A

AZOTEMIA

99
Q

defined as the increased in urea and
creatinine (azotemia) with accompanying clinical
signs and symptoms of renal failure

A

UREMIA

100
Q

signs and symptoms of renal failure like seen in uremia

A

❑Metabolic acidosis due to failure of the kidneys to eliminate acidic products of metabolism
❑Hyperkalemia due to failure of potassium
excretion
❑Generalized edema due to water retention
❑(+) Burr cells
❑Anemia, Uremic frost (dry skin), foul breath and sweat (urine like)

101
Q

conditions in
which circulation through the
kidneys is less efficient than usual.

A

Pre-renal causes

102
Q

Pre-renal causes

A

 Hemorrhage (blood loss)
 Cardiac decompression
 Increased protein catabolism
 Heatstroke (Dehydration)
 Burns (Fluid loss)

103
Q

characterized by the presence of lesions
on the parenchyma itself (tubular injury).

A

Renal causes

104
Q

Renal causes

A

 Chronic nephritis
 Acute glomerulonephritis (AGN)
 Polycystic kidney
 Nephroschlerosis
 Tubular necrosis (colorless urine)

105
Q

due to the obstruction in
the-urinary-tract

A

Post-renal causes

106
Q

Post-renal causes

A

 Stones
 Prostatic enlargement
 Tumors

107
Q

___ is the major end product of purine metabolism (Adenine and Guanine)

A

Uric acid

108
Q

Uric acid is formed in the liver and intestinal mucosa from xanthine by the action of ___.

A

xanthine
oxidase

109
Q

BLOOD URIC ACID (BUA) Derived from

A

catabolism of ingested nucleoproteins, endogenous nucleoproteins
and direct transformation of endogenous purine nucleotides

110
Q

Normally, ____% of the filtered UA is reabsorbed

A

89

111
Q

is uric acid It is relatively insoluble?

A

yep

112
Q

uric acid

When it accumulates, it may be deposited in the joints called as

A

tophi

113
Q

Uric acid accumulates in the genitourinary tracts as ___

A

uric acid stones.

114
Q

type of reaction of direct redox method

A

colorimetric

115
Q

Uric acid is oxidized to allantoin and C02 by phosphotungstic
acid reagent (protein
precipitant and color reagent in alkaline solution).

In the process , phosphotungstic acid is
reduced to tungsten blue

A

DIRECT REDOX METHODS (COLORIMETRIC)

116
Q

the acid used in direct redox method

A

phosphotungstic acid

117
Q

in direct redox method

what is the end product of uric acid and phosphotungstic acid

A

allantoin and CO2

118
Q

what is the color of the phosphotungstic acid once reduced under the direct redox method

A

tungsten blue

119
Q

aside from the direct colorimetric reaction for uric acid which is the redox method, we as well have enzymatic method which is known as the ___

A

BLAUNCH and KOCK or URICASE METHOD

120
Q

what is the reaction type of uricase method

A

end point

121
Q

ENZYMATIC METHOD (BLAUNCH and KOCK or URICASE METHOD

is based on what type of spectrophotometry

A

Differential or Absorption Spectrophotometry

122
Q

Uric acid is destroyed by the action of uricase
to form carbon dioxide and allantoin.

A

ENZYMATIC METHOD (BLAUNCH and KOCK or URICASE METHOD)

123
Q

enzyme used in the enzymatic determination of uric acid

A

uricase

124
Q

peak absorbance of uric acid

A

290-293 nm

125
Q

Most commonly used method for uric acid determination employed by coupled enzymatic- Peroxidase

A

BLAUNCH and KOCK or URICASE METHOD

126
Q

interferences of uricase method

A

protein
hemoglobin
xanthine

127
Q

interferences in coupled enzymatic uricase-peroxidase method

A

bilirubin and ascorbic acid

128
Q

what is the indicator used in coupled enzymatic method

A

4-aminophenazone - red color product

129
Q

how to counter interferences of ascorbic acid and hgb in coupled enzymatid method of uri acid

A

use potassium frricyanide and ascorbic oxidase

130
Q

Uric acid is stable for several days (____) at room ‘temperature and longer if refrigerated

A

3

131
Q

uric acid

Addition of ___ increases its stability
to bacterial destruction

A

thymol

132
Q

Any of the common anticoagulants, can be used except for ____ which forms potassium
phosphotungstate promoting turbidity

uric acid topic

A

potassium oxalate

133
Q

Purine like foods like ___ and others may affect uric acid assay

A

legumes, visceral organs

134
Q

Uric acid may be measured in ___.

A

heparinized plasma, serum, or urine

135
Q

Serum should be removed from cells as quickly as possible to prevent ____ by intracellular contents.

uric acid

A

dilution

136
Q

uric acd

Diet may affect uric acid concentration overall, but a recent meal has no significant effect and a fasting
specimen is unnecessary.

fasting is not required but preferred

t or f

A

true

137
Q

Gross lipemia should be avoided. High bilirubin concentration may falsely ____ results obtained by peroxidase methods. Significant hemolysis, with concomitant glutathione release, may result in ___ values.

A

decrease; low

138
Q

Drugs such as ___ have been shown to increase values for uric acid

A

salicylates and thiazides

139
Q

______ additives should not be used for specimens that will
be tested by a uricase method. Urine collections must be alkaline

A

Ethylenediaminetetraacetic acid (EDTA) or fluoride

140
Q

ref method for uric acid

A

IDMS

141
Q

Oldest method for the determination of
Uric Acid

A

CARAWAY METHOD

142
Q

CARAWAY METHOD

Uses ___ as color stabilizer

A

NaCN - sodium cyanide

143
Q

CARAWAY METHOD

Uses ___ as color stabilizer

A

Sodium carbonate

144
Q

a defect in uric acid metabolism which causes an excess of the acid and
salts to accumulate in the bloodstream and joints.

A

gout

145
Q

increases uric acid in the bloodstream because alcohol inhibits its excretion

A

Chronic alcoholism

146
Q

due to increased turnover of
nucleoproteins

A

Leukemia and other malignant conditions

147
Q

Uric acid levels are elevated in decreased renal functions either due to over
production of uric acid or decreased rate of excretion

true or false

A

true

148
Q

Fatal poisoning with chloroform and methanol, excessive exposure to X-rays and
radioactive radiators, due to excessive cell breakdown and nucleic acid catabolism

true or false

A

true

149
Q

(inborn error of purine metabolism) – HGPRT
deficiency

A

Lesch-Nyhan Syndrome

Hypoxanthine-guanine phosphoribosyltransferas

150
Q

Hypouricemia related to kidney

A

decrease reabsorption of uric acid

151
Q

Hyperuricemia

A

 GSDs – Von Gierke’s
disease
 Lactic acidosis
 Toxemia of pregnancy

152
Q

Hypouricemia

A

Fanconi’s syndrome
Wilson’s disease
Hodgkin’s disease

153
Q

ADH
 peptide hormone secreted by the __

A

posterior pituitary

154
Q

response to increased blood osmolality

A

ADH

155
Q

released when blood volume decreases by more than 5%–10%`

A

ADH

156
Q

ADH is also known as

A

vasopressin

157
Q

stimulates water reabsorption

A

ADH/ Antidiuretic

158
Q

Water diffuses passively from the lumen of the tubules → resulting in
more concentrated urine and decreased plasma osmolality

A

ADH

159
Q

Aldosterone
 produced by the __

A

adrenal cortex

160
Q

 Aldosterone
 produced by the adrenal cortex → influence of the _____ mechanism

A

renin-angiotensin

161
Q

Triggered by decreased blood flow or blood pressure in the afferent
renal arteriole

A

Aldosterone

162
Q

Decreased plasma sodium

A

Aldosterone

163
Q

stimulates sodium reabsorption in the distal tubules and potassium and hydrogen ion secretion

A

Aldosterone

164
Q

THREE MAJOR GROUPS OF KIDNEY FUNCTION
TESTS

A

 Test measuring glomerular filtration rate (GFR)
 Test measuring renal blood flow
 Test measuring tubular function

165
Q

The __ is the volume of plasma filtered (V) by the glomerulus per unit of time (t)

A

GFR

166
Q

a gfr that Does not require the collection of timed 24 urine specimen

A

ESTIMATED GLOMERULAR FILTRATION RATE

167
Q

inhibitor of cysteine proteinase

A

cystatin c

168
Q

filtered peptide is completely reabsorbed by the proximal tubule → destroyed rather than
reentering the circulation

A

CYSTATIN C

169
Q

component of the major histocompatibility complex class I molecule

A

β-2-Microglobulin

170
Q

production is increased in multiple myeloma and lymphoma

A

β-2-Microglobulin

171
Q

Common cause of dialysis-associated amyloidosis

A

β-2-Microglobulin

172
Q

 functions as prostaglandin D synthase

A

Β TRACE PROTEIN

173
Q

 plasma level is increased in patients with renal disease because of reduced filtration in the presence of constant
production

A

Β TRACE PROTEIN

174
Q

▪ filtered at the glomerulus freely and is not reabsorbed

A

Tryptophan Glycoconjugate

175
Q

___ freely passes the glomeruli but is neither secreted nor reabsorbed by the nephric tubules.

A

inulin

176
Q

 Considered to be the most accurate measure of GFR

A

 INULIN CLEARANCE TESTS

177
Q

reference method of all the clearance test

A

 INULIN CLEARANCE TESTS

178
Q

___ is freely filtered by the glomeruli but variably reabsorbed in the tubules depending upon the
transit time (rate of urine flow along the course of nephric tubules) of urea filtrate

A

Urea

179
Q

A more reliable method than Urine SG, Affected only by the numbers of
solutes present in the urine and serum

A

OSMOLALITY

180
Q

major contributor of Urine osmolality → ___

A

Urea

181
Q

major contributor of Urine Serum osmolality → __

A

Sodium and Chloride

182
Q
A
183
Q

Sample fr osmolality

A

Serum or Urine (24 hr)

184
Q

Reference value OSMOLALITY

A

S osm= 275-295 mosm/Kg
U osm= 300-900 mosm/Kg

Normal Ratio: 1:1 -3:1

185
Q

Determined by measuring the colligative property of the sample.

autoanalyzer

A

DIRECT METHOD OF OSMOLALITY

186
Q

Parameters of DIRECT METHOD OF OSMOLALITY

A

FREEZING POINT, VAPOR PRESSURE,
OSMOTIC PRESSURE AND BOILING POINT

187
Q

INCREASE IN OSMOLALITY: ___

A

Increase in osmotic pressure
and boiling point

188
Q

Most commonly used Method in OSMOLALITY

A

Freezing Point osmometry

189
Q
A

CLINICAL CHEMISTRY (22 decks)

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