Intro Flashcards
the urinary system is composed of what four main components and their functions
- Kidneys- produce urine/ metabolic balance / produce hormones ( erythropoitin, renin, calcitrol)
- ureters- carry urine to bladder
- bladder- stores the urine produced
- urethra - delivers the urine for excretion
The renal artery, renal vein and ureter all leave the kidney through the indentation of the ___ of each kidney
Hilus
The internal kidney consists of what:
- cortex
- medulla ( pyramids
- minor calyces, major calyces
- renal pelvis
what is the main functional unit of the kidney
nephron
where are the nephrons located
renal cortex
renal medulla
the nephron consists of:
glomerulu - for blood filtration
- proximal convuluted tubule
- loop of hence
- distal convoluted tubule
T/F
proximal convoluted tubule, loop of henle and distal convolutes tubule are for blood filtration
False
glomerulus is for blood filtration .. the rest is for reabsorption and secretion
Nephrons empty into ____ that run out to the minor calyx, major calyx , renal pelvis
collecting ducts
Name the 2 nephron types and their location
- cortical nephrons are mostly within the cortex, have short length of the loop of hence
- Juxtamedullary - extend deep into the medulla and ;have long loop of henle
____ % of the blood leaving the left ventricle of the heart enters the kidneys via the renal arteries
20-25
what is the rate of the blood passes through the kidneys
1200 ml/min or 600ml/min/kidney
T/F
the Efferent arterioles form the capillary tuft known as the glomerulus
False
afferent
what surrounds each glomerulus
bowman’s capsule
The outer layer of Bowman’s capsule is composed of squamous epithelium … what is the AKA of those cells
parietal epithelial cells
the visceral layer of bowman’s capsule is composed of what kind of specialized cells
podocytes
aka visceral epithelial cells
what are the three major components of glomerular capillary wall accounting for the glomerular filtration
- endothelial cells with fenestra
- glomerular basement membrane
- visceral epithelial cells aka podocytes
T/F
glomerular walls are ultra filters that are very permeable to water
true
approximately ___ or ___ of the renal plasma is filtered in the glomeruli
- 90- 120
- one- fifth
Ultrafiltrate is composed of what:
- water electrolytes - glucose - amino acids - urea - uric acid - creatinine - ammonia
what is a key indicator of kidney function and is used to monitor kidney disease progression
Glomerular filtration rate ( GFR)
AKA for dipstick
reagent strip testing
what are the two main objectives of pH
- diagnostic ( metabolic abnormalities )
2. Therapeutic ( regulation of diet )
pH color chart
- acid indicator= ?
- alkaline indicator = ?
- methyl red
- bromthymol blue
T/F
read dipstick 90 seconds after dipping
false
60 seconds
what is the pH ranges
5.0 to 8.5
List the factors in persistent acidity
- acidifying drugs
- dehydration
- diarrhea
- fever
- diabetes
- gout
- high protein diets
- pulmonary emphysema
List the factors resulting in persistent alkalinity
- alkaline drugs
- acute and chronic renal failure
- diuretics
- urinary tract infections
T/F
Mucoprotein Tamm- Horsfall (T-H) is derived from blood plasma
False
it is not derived from blood plasma
is secreted by the renal tubules
less than ___ or ___ of T-H protein is excreted
- 150 mg/24h
- 20 mg/dl
T-H is a matrix for formation of ___ or ___
- calculi
- casts
what is testing for protein based on phenomenon what does it mean
- which protein is most sensitive
- which is the most common indicator
protein error of indicators
- ability of protein to alter the color of some acid - base indicators without altering the pH
- albumin
- tetrabromphenol blue
urine protein false positive may result from
- highly buffered alkaline urine (meds or old pee)
- prolonged exposure to the sample
- container cleaning compounds
- some skin cleaners
- blood in urine
urine protein false negative may result from :
- dilute urines
- elevated amounts of proteins other than albumin
list the factors that could result in temporary proteinuria (transient proteinuria)
- strenuous exercise
- postural proteinuria
- dehydration
- exposure to heat or cold
- fever
- emotional stress
- pregnancy
name the diseases causing persistent proteinuria
- glomerulonephritis
- pyelonephritis
- malignant hypertension
T/F
Glucose is usually present in urine
False
usually not present unless threshold levels exceeded 160–180 in blood mg/dl
List the factors for urine glucose : false positive :
- after using oxidizing cleaning agents for urine containers
- peroxide - hypochlorite - patients taking levodopa
- when high levels of ketones are present in urine
Urine glucose False negative:
- cool urine
- urine with high specific gravity due to uricosuria
- alkaline urine due to bacterial contamination of old urine
- ascorbic acid ( vitamin C) in high doses
What is know ass Transient glucosuria
- glucose can be present in urine in two hours after sweet food
Glucosuria dependent on :
- blood glucose levels
- glomerular filtration rate
- tubular reabsorption
- seen in diabetes mellitus and congenital forms of glucosuria
Persistent glucosuria develops in
- diabetes mellitus
- CNS problems (stroke , neoplasms)
- kidney problems
- endocrine problems
- liver disorders
- pharamaceutical agents
what test is used as a method for the measurement of sugars in urine
- Clinitest
Clinitiest detects all reducing sugars except ___
glucose
Clnitest is used predominately for diagnosis of ____ because the dipstick test does not work
galactosemia
Clinitest false positive
- ascorbic acid
- cephalosporins
- probenecid
- urinary preservatives
Clinitest false negative
technique errors
This test is a screening test for diagnosis of genetic disorders of carbohydrate metabolism
Urine reducing sugar test
the urine reducing sugar test predominately used for early detecting of what disorder
Galactosemia
____ are produced normally by the liver as part of fatty acid metabolism
Ketones
when may it occur that ketones would show up in the urine
if the body cannot get enough glucose for energy it will switch to using body fats - resulting in an increase in ketone production
Ketones bodies that commonly appear in the urine when fats are burned for energy are:
- acetoacetic acid
- beta- hydroxybutric acid
- acetone is also produced and is expired by the lungs
T/F
the urine should contain a noticeable concentration of ketones to give a positive reading
False
it should not contain
T/F
dipstick test determine acetoacetic acid and acetone but not beta- hydroxybutric acid
False
it only determines acetoacetic acid
T/F
dipstick test determine acetoacetic acid and acetone but not beta- hydroxybutric acid
False
it only determines acetoacetic acid
name the characteristics of urine ketones with false positive or atypical color
- highly pigmented urines
- combination of high specific gravity and low pH
- dehydration
- phenlketones
- meds
- ascorbic acid
What determines urine ketone falls negative
delay in testing (old purine)
ketone bodies can be determined in :
- diabetes mellitus
- malabsorption syndrome
- exposure to cold
- fasting - fever
- insufficient carbohydrate intake
- maltutrition
- strenous exercise
- vomiting
Urine blood test false positive
- oxidizing contaminants
- hypochlorites
- bacterial peroxidases
- menstrual blood
Urine blood test false negative
- technique errors inadequate mixing
- formalin preservative
- high concentrations of absorbic acid
- high specific gravity
- nitrates
- proteins
what is the significance of hematuria
- intact RBCs are found in urine sediment
- if they are lysed - ghosts cells
- urine may appear normal with small amounts of RBCs
- urine gets red color with greater amounts of blood
Transient hematuria may result from :
- strenous exercise
- menstrual contamination
when would persistent hematuria occur
- renal diseases
- patients with
- urolithiasis
urinary tract infections - urinary tract tumors
when would persistent hematuria occur
- renal diseases
- patients with
- urolithiasis
urinary tract infections - urinary tract tumors
- prostatic cancer
-related to anticoagulant therapy
significance of hemoglobinuria ?
- incompatible blood transfusion
- hemolytic anemias
- immunohemolytic anemias
- burns
- electric shock
Myoglobinuria may be due to
- damage to cardiac or skeletal muscles
- rhabdomyolysis
- electric shock
- myocardial infection
- heroin abuse
- alcoholism
- after strenuous physical activity
T/F
both hemoglobin and myoglobin will produce positive reagent strip blood results because both contain heme
True
clear plasma plus red urine equals ____
myoglobulin
Red plasma plus red urine equals ___
hemoglobin
Red plasma plus red urine equals ___
hemoglobin
Red plasma plus red urine equals ___
hemoglobin
The amount go conjugated bilirubin present in serum in healthy subjects is less than ___ %
10
An elevated level of conjugated serum bilirubin implies:
- liver disease
- cholestatic diseases
- bilirubinuria also implies what
liver or cholestatic diseases
urine bilirubin false positive
- technique errors
- atypical color reactions produced by some medicines
- confirm results with ictotest
urine bilirubin false negative
- large amounts of ascorbic acid decrease the sensitivity of the dipstick
- high levels of nitrite
- exposure to light and room temp
when bilirubin is present in urine it may indicate :
- gallbladder - bile duct obstruction
- liver pathology
when bilirubin is present in urine it may indicate :
- gallbladder - bile duct obstruction
- liver pathology
urobilinogen (colorless) oxidizes to ____
urobilin
what is the normal level of urobilinogen
1-4mg/24h or less than 1.0 ehrlich
urine urobilinogen false positive
- aspririn
- sulfonamides
- nitrites
- porphyria
urine urobilinogen false negative
- use of stale urine that has been exposed to light
- formalin
what is the significance of urine urobilinogen significance
- normally present in low amounts
- peak levels between 2-4 pm
- elevated in
- liver disease
- intestinal obstruction
- hemolytic anemia
- hemolysis
urine nitrite false positive
dipstick is highly sensitive to air exposure
- specimen contaminating by bacteria
urine nitrite : false negative
- specimen containing non- nitrate reducing pathogens
- insufficient time in the bladder
- low or no nitrate diet
- elevated specific gravity of urine
- high level of urobilinogen in urine
- ascorbic acid
what is the appearance of a RBC when specific gravity is more than 1.025
it becomes crenated the RBC loses the smooth texture
the urine becomes hypertonic
when urine is hypotonic urine .. the speicif gravity is less than ____
1.025
what does the RBC appear like in hypotonic urine
it appears as Ghosts cells ( partially lyesd)
More than 3 RBC per high power field is ____
hematuria
list the causes of Hematuria
- Glomerular disease
- Other renal diseases
- other urniary tract diseases
- pathology outside of urinary system
what is the normal amount of WBC in a high power field
0-5 per high power
More than 20 WBC per HPF may indicate _____
pyuria
T/F
WBC contain nuclei and granules
True
Increased WBC could be found in what type of physiological states
- dehydration , fever
- strenous exercise
Increased WBC could also be found in what other type of diseases
- acute pyelonephritis
- kidney stones
- inflammation of ureter , bladder, urethra
- urolithiasis
- prostatis
- balantis
name the three type of epithelial cells found in urine
- rena
- transitional
- squamous cells
Name the origin of the epithelial cells
- renal
- transitional
- squamous
- convuluted tubules
- renal pelvis to proximal two thirds of urethra
- lower urethra or vagina
T/F
renal cells are very common to be seen in urine
False
very rare
increased numbers of renal epithelial cells may suggest tubular damage in
- pyelonephritis
- acute tubular necrosis
- acute trauma of kidney
- kidney transplant rejection
- neoplasms
Oval Fat bodies are what kind of epithelial cell
Renal tubular epithelial
What are Oval Fat bodies
absorbed lipoproteins with cholesterol and triglycerides leaked from nephrotic glomeruli
The presence of any oval fat bodies may be accompanied by what kine of problems
- proteinuria ( nephrotic syndrome)
T/F
Fat is detected by chemical tests
False
Lipilduria develops due to :
- degeneration of tubules
- fat embolism
- extensive injuries
- fractures of the long bones
What type of cell originates outside of kidneys .. look like hard boiled egg and contains small nucleus
Transitional cell
What is the normal amount of transitional cells
0-few
increased amount of transitional cells could be found in what disorders
- urinary tract infection
- cetherterisation
- cancer of unrinary tract
Which cell is flat scale - like
contains small nuclei
Squamous
larger number of squamous cells could represent in what
- vaginitis
- urethritis
- testicular tumor
what is the normal amount of squamous cells
- 30 cells per field
what is smooth, colorless
- may be budding
- can be mistaken as RBC
Yeast
T/F
crystals are usually not found in freshly voided urine
true
what are the prerequisites for identification of crystals
- pH of urine
- morphology of crystals
- crytsals solubility
- crystals polarization
What type of light is used for identification of crystals
polarized
Normal crystals found i acidic urine
- uric acid
- calcium oxalates
- amorphous urates
uric acid is commonly formed when urine pH is ___
when are uric acid crystal pathological
when seen in freshly voided uroine
a high uric acid level in urine may be due to what
- gout
- high purine diet
- Lesch- Nyhan syndrome
- cancer metatases
- rhabdomyolisis
- myeloproliferative disroders
Low uric acid levels may indicate what
- inability of kidney to get rid of uric acid well
- chronic glomerulonehritis
- lead poisoning - long- term alcohol use
Amorphous urates often seems in :
- acidic urine
- ## after refrigeration
Sodium urates are formed in urine when pH is what
6.8 - 7
What are the crystals commonly found in alkaline urine
- triple phosphates
- calcium carbonates
- ammonium biurate
AKA for triple phosphate crystals
magnesiums ammonium phospahte
Ammonium Biurate in alkaline urine pH ___
9
what are the abnormal crystals of metabolic origin
- Cystine
- tyrosine
- leucine
- cholesterol
Cystine are typically found in ___ urine with pH ___
acidic
pH
Cystine stones which fill in ___ system , results in formation of ____
renal collecting
- staghorn
Which abnormal crystal is found in severe liver disorders
Tyrosine
Cholesterol crystals are accompanied by
- positive biochem test for protein
- oval fat bodies
- fatty casts
- free fat droplets
Epithelial cell casts may be present in what type of kidney problems
- acute tubular necrosis after exposure to nephrotoxic agents
- due to damage that accompanies glomeerular injury
- in rejection of a kidney allograft
which casts can result from either from breakdown of cellular casts or inclusion of aggregates of plasma proteins or immunoglobulin
- usually indicate chronic renal diseases
Granular casts
___ casts represent the end stage of cast evolution , suggest the very low urine flow associated with severe longstanding kidney disease such as renal failure
Waxy Casts
GFatty casts are present in which type of degenerative tubular disease
- nephrotic syndrome with heavy proteinuria
- diabteticnephropathy ( diffuse glomerulosclerosis Kimmelstiel- Wilson lesions)
- Luppus nephritis
- toxic renal poisoning
The formation of casts at the distal convoluted tubule may produce structures with a tapering end, referred to as _______
cylindroids
what are some congenital variations affecting the urinary tract
- duplicate set of ureters
- horeshoe kidney
- Vesicoureteral reflex
what are some acquired problem affecting the urinary tract
- accidents and injures damage the kidneys or UT
- Benign prostatic hyperplasia
which is the most common renal congenital abnormality which is characterized by presence of additional ureter
Duplicated ureter
Renal fusion or super kidney is a congenital disorder affecting 1 out 500 people
horseshoe kidney
what are the most common disorders seen with horseshoe kidney
- turner syndrome
- trisomy 18
T/F
Trisomy 21 is a serious chromosome abnormality characterized by defects in nearly all organs and systems , including development of kidney in 20% of affected children
False
it is trismoy 18
T/F
horseshoe kidney is most common in females
True
T/F
horseshoe kidney is often very symptomatic
False
it is asymptomatic
Horseshoe kidney may increase risk for development of :
- kidney obstruction
- hydronephrosis
- pyelonephritis
- urolithiasis
- kidney cancer
_______ is an abnormal retrograde movement of urine from bladder into ureters
Vesicoureteral Reflux (VUR)
T/F
VUR primary occurs when an obstruction in the bladder or urethra causes urine to flow backward into kidneys
False — secondary
- primary is the defect in development of the uretral valve at the end of the ureter ( only in children)
VUR may result in :
- hydronephrosis
- pyelonephritis
Name the signs and symptoms for acute cystitis
- dysuria
- increased frequency of urination
- increased urinary urgent
- lower abdominal pain
- rare fever, chills
list the signs and symptoms of pyelonephrits
- fever, chills
- flank pain
- dysuria
- nausea, vomitting
what are the urinary tract infection urinalysis findings
- increased count of leukocytes
- positive leukocyte esterase
- prescience of bacteria
- may be positive for nitrite
- WBC ssts may be present, they indicate only kidney infection
______ are common cause of upper urinary tract obstruction
Kidney stones
what is the classic presentation for a patient with acute renal colic
sudden onset of severe pain originating in the flank and radiating inferiorly and anteriorly
chemical substances that forms stones
- calcium oxalte
- calciumm phosphate
- magnesium ammonium phosphate
- uric acid
- cystine
Diabetic neuropathy is characterized by
- glomerular lesions
- renal angiopathy
- pyelonephritis
what is the significance of good pasture’s syndrome
- autoimmune
formation of autoantibodies againsts glomerular and alveolar basement membranes
– lungs are also affected
Berger’s disease is characterized by deposition of IgA and IgA immune complexes into mesangium
T/F
True
the most common disease associated with nephrotic syndrome in adults
mebranous glomerulunephritis
what is characterized with membranous glomerulunephritis
diffuse thickening of the glomerular capillary wall
what is the most frequent cause of nephrotic syndrome in children
minimal change disease ( Lipoid Nephrosis)
what is characterized by Lipod Nephrosis
diffuse loss of foot processes of podocytes that cannot be detected by light microscopy but can be found by electron microscopy
this lesion is characterized by sclerosis of some glomeruli and in the affected glomeruli and in the affected glomeruli only a portion of the capillary tuft is involved
Focal segmental glomerulosclerosis
