Intro to Kidney Disease

Question 1

what signs and symptoms are caused by uremia?

Answer 1

Uremia: worsening renal function (GFR <15ml/min) associated with nitrogenous wastes (BUN, creatinine) in the blood

symptoms: Fatigue, anorexia, nausea, vomiting, difficulty concentrating

signs: pericarditis, peripheral neuropathy, hypertension, edema

Question 2

Azotemia

Answer 2

elevation of BUN, and creatinine in the blood attributed to a decrease in the GFR

Typical of both acute and chronic kidney injury

Question 3

in which 2 settings is urine pH important for diagnosis?

Answer 3

1. urinary tract infections - urine pH above 7.5 indicates infection with urease positive bacteria.
2. Metabolic acidosis - high pH indicates a renal problem

• expected urine pH is between 5 and 6.5

Question 4

Is plasma glucose is normal and urine glucose is high, what does that indicate about renal function?

Answer 4

Renal glucosuria - proximal tubule disorder

Recall, proximal tubule is where majority of glucose should be reabsorbed

Question 5

what does nitrites in the urine indicated?

Answer 5

nitrates are normally found in the urine, but if bacteria are present, nitrate will be converted to nitrite

Indicative of a UTI

Question 6

Which proteins will not be detected by a protein urine dipstick?

Answer 6

protein dipstick will miss non-albumin proteins like immunoglobin light chains

Question 7

which proteins are normally excreted into the urine?

Answer 7

Tamm-Horsfall mucoprotein, aka uromodulin: made by cells in the thick ascending limb, make up matrix of urinary casts

Also, a small amount of albumin (<20mg)

Question 8

Which disorder is microalbuminuria associated with?

Answer 8

diabetic nephropathy - will see persistent albumin excretion (30-300mg/day)

Question 9

where in the nephron do urinary casts form?

Answer 9

urinary casts: precipitated proteins or cells that form within collecting ducts

matrix composed of Tamm-Horsfall protein (uromodulin)

casts without cells are benign - “hyaline” casts

Question 10

what do the following findings in the urine indicate?
a. neutrophils
b. eosinophils
c. WBC casts

Answer 10

a. neutrophils - bladder or kidney infection
b. eosinophils - drug-induced allergic injury to the tubules
c. WBC casts - tubulointerstitial disease

Question 11

what is the classical set of clinical presentation of multiple myeloma?

Answer 11

CRABB:
Calcium disorders
Renal insufficiency
Anemia
Bone pain
Bacterial infection