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Bloc D - Renal > Jan17 M1-Hematuria, Urinalysis, Proteinuria > Flashcards

Jan17 M1-Hematuria, Urinalysis, Proteinuria Flashcards

1
Q

3 reasons to evaluate urine

A
  • hematuria or proteinuria found incidentally
  • high Cr
  • systemic disease to check for renal involvement
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2
Q

8 common urine tests

A 
UA (dipstick)
U microscopy
U culture
U electrolytes
U Cr, albumin and protein
24 hr protein
24 hr urine 
CrCl over 24 hr urine (need blood Cr too)
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3
Q

normal urine pH

A

5 to 6.5

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4
Q

U pH, glucosuria, ketones and nitrites used and seen in what

A

pH: for RTA

glucosuria: unc diabetic, SGLT2 inh, proximal (type 2) RTA
ketones: DKA
nitrites: bacteria (they do nitrate to nitrite)

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5
Q

U WBC seen in what

A

infection or acute interstital nephritis

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6
Q

dipstick detects what level of proteinuria and normal disptick proteinuria result

A

above 0.3g/L. normal is negative

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7
Q

Hb dipstick detects what and why need further investigation

A

-Hgb w/ 1-2 RBCs per high power field
-myoglobin
-free Hb
need microscopy to check if really RBC in there (might me myoglobin from muscle injury)

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8
Q

significant hematuria def

A

3 or more RBCs per hpf

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9
Q

things to check for hematuria on microscopy

A
  • amount
  • shape of RBCs
  • casts (RBC, WBC, mixed)
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10
Q

hematuria on microscopy: what points to a kidney problem

A

dysmorphic RBCs
RBC casts
acanthocytes (glomerulus)

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11
Q

GN on U micro

A

dysmorphic RBCs, casts (any or mixed)

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12
Q

normal looking RBC in the urine point to what

A

malignancy, stones, infection, PCKD

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13
Q

workup for hematuria (gross) of unclear etiology

A
  • bloodwork (CBC, Cr, lytes)
  • UA and micro
  • U culture
  • U spot protein/Cr ratio
  • US
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14
Q

how blood test can reinforce a glomerular disease dx

A

if Cr is high

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15
Q

what proteins are normally filtered at the glomerulus

A

small amount of albumin and LMW proteins

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16
Q

how filtered proteins are handled by the nephron

A

most of albumin is reabso at the PCT (intact or degraded)

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17
Q

daily protein qt excreted and albumin in that

A

150 mg. 5 mg is albumin

18
Q

4 mechanisms of proteinuria

A
  • functional
  • overproduction
  • tubular protein loss
  • glomerular protein loss
19
Q

functional proteinuria def

A

fever, exercise, CHF, orthostatic

20
Q

overproduction proteinuria def

A

protein produced in another part of the body excreted by the kidney

21
Q

example of overprod proteinuria

A

free light chains (LMW prots made by plasma cells), typically in myeloma

22
Q

myeloma free light chains effect on kidney

A

direct tubular toxicity and formation of casts causing tubular obstruction

23
Q

tubular proteinuria def

A

impaired reabso of prots along the tubule

24
Q

ex of disease where get tubular proteinuria and cause

A

Fanconi syndrome (PCT prob). chemo is the cause

25
Q

glomerular proteinuria def

A

loss of negative charge on GBM, pore size prob

nephrotic (MCD, FSGS, MN, diabetic renal disease)

26
Q

criteria for nephrotic syndrome

A

3.5+ g/day proteinuria (alone)

27
Q

criteria for mixed nephrotic nephritic

A

3.5+ g/day proteinuria + dysmorphic hematuria and RBC/cellular casts

28
Q

proteinuria (so above 150mg/day) but less 1g a day means what

A

tubular (failure to reabso) or hemodynamic (hypertensive nephrosclerosis for ex)

29
Q

proteinuria 1-2.9 g/day meaning

A

kidney disease for sure but is either glomerular, tubular or overprod proteinuria

30
Q

proteinuria more 3g a day meaning

A

glomerular (ex. MCD)

31
Q

how to qtfy proteinuria (3)

A
  • UA
  • urine albumin/Cr or protein/Cr ratio (spot)
  • 24 hr urine collection
32
Q

how to calculate albumin/Cr ratio

A

albumin conc in mg/Cr conc in g (or in mmol)

33
Q

normal albumin/Cr ratio men and women

A

women: 0-2.7 mg/mmol
men: 0-1.9 mg/mmol

34
Q

how to convert U alb/Cr ratio from mg/mmol to ALBUMIN g/day (not proteins g/day..)

A

divide by 100

2.7mg/mmol max in women is therefore 0.027g albumin/day so 27mg.

35
Q

how to convert alb/Cr ratio from mg/mmol to mg of albumin/g

A

multiply by 10.

2 mg/mmol is 20 mg/g

36
Q

two factors in CKD staging

A
  • GFR

- albuminuria

37
Q

3 categories of albuminuria and values

A
  • normal to mild elevation: less 3mg/mmol or less 30 mg/g
  • moderately increased: 3-30 mg/mmol or 30-300 mg/g
  • severly increased: over 30 mg/mmol or over 300 mg/g
38
Q

4 indications for biopsy

A
  1. proteinuria +1g/day
  2. proteinuria + hematuria or casts
  3. systemic disease
  4. AKI/CKD unexplained on imaging
39
Q

why would you not biopsy a diabetic with proteinuria

A

it is part of the normal progression of the disease. diabetic nephropathy.

40
Q

most common tests ordered to screen for kidney disease

A

UA, U micro and U alb/Cr ratio

41
Q

thing that is widely used to follow and prognosticate patients with kidney disease

A

spot albumin/Cr ratio

Bloc D - Renal (32 decks)

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