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Renal > Lab and Dx Assignment > Flashcards

Lab and Dx Assignment Flashcards

1
Q

ID the specific tests included in the Chem-strip 9-10* (dipstick) / usefulness

A
  1. leukocytes–ID infx–improved when combined w/ nitrite
  2. nitrite–support dx of infx–bac convert nitrate->nitrite
  3. urobilinogen–assist in ID of V liver
  4. bilirubin–assist in ID of v liver fx–Hgb breakv product
  5. protein–assist in ID of kidney dz–usually albumine
  6. pH–assist in ID of infx–no normal or abnormal pH
  7. blood–ID infx, stone, tumor
  8. ketones–assist in dx of DM–fasting–breakdown product of fat
  9. glucose–assists in ID of DM–usu. reabsorbed in PCT
    * 10. (specific gravity)–ID dehydration–kidney’s ability to concentrate urine
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2
Q

3 imp steps to minimize error when using Chem-strips

A
  1. follow time specifications
  2. store strips properly
  3. check expiration date
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3
Q

where are monocytes primarily formed

A

spleen

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4
Q

where are granulocyte primarly formed

A

bone marrow

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5
Q

Which of the following tests, when positive, improves the sensitivity of the leukocyte esterase test in detecting a UTI:
nitrite, pH, protein, blood, SG

A

nitrite

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6
Q

which factor improves the accuracy of the nitrite test

A

first void urine in the am bumps it to 90%

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7
Q

what can interfere w/ the nitrite test

A

large amounts of ascorbic acid

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8
Q

why is it important to test clean catch urine right-away

A

pH accuracy

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9
Q

what can high pH (alkaline) indicate

A

dx of infection

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10
Q

what is the predominant protein filtered by the kidneys in pt’s w/ proteinuria

A

albumin

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11
Q

list (5) potential interfering factors in a urine sample w/ proteinuria

A
  1. extreme exercise
  2. ^emotional distress
  3. pregnancy
  4. immediate post-partum
  5. leaving dipstick in sample too long
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12
Q

List (5) conditions when ketones when ketones may be present in urine

A
  1. DM!!!
  2. starving
  3. dieting
  4. anorexic
  5. febrile
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13
Q

where is bilirubin formed

A

the spleen and bone marrow from Hgb breakdown and transport to the liver

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14
Q

what causes bilirubin concentrations to drop rapidly

A

light exposure

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15
Q

what acts on bilirubin (component of bile) converting it to urobilinogen

A

bacteria in the gut

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16
Q

(5) conditions that can cause an increase in the urine concentration of urobilinogen

A
  1. Hep
  2. liver injury
  3. cirrhosis
  4. anemia
  5. malaria
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17
Q

What time of day is urobilinogen highest in urine

A

btwn 12-4 PM

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18
Q

food that can cause a + urobilinogen test

A

bananas

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19
Q

What does specific gravity measure

A

the kidney’s ability to concentrate urine as compared to the weight of distilled H2O (1.000)

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20
Q

(3) factors that determine urine’s SG

A
  1. pt’s hydration status
  2. urine volume
  3. load of solids to be excreted
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21
Q

what affect will radiopaque contrast media have on the SG

A

False High SG

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22
Q

What needs to be done to the urine sample prior to microscopy when performing urinalysis

A

“spun-down” w/ centerfuge

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23
Q

what are the (3) main pathologic elements of interest when examining urine sediment

A
  1. WBCs
  2. Casts
  3. RBCs
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24
Q

What is the implication of excess epithelial cells in the urine sample when performing a urinalysis

A

pt didn’t adhere to clean catch protocol

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25
Q

List (5) causes of hematuria that you should consider in your pt’s w/ blood in the urine

A
  1. stone
  2. acute glomerulonephritis
  3. tumor
  4. BPH
  5. UTI
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26
Q

presence of 6-10+ neutorphils/ HPF of urine

A

pyuria

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27
Q
  • How can you distinguish pyuria caused by a lower UTI from that of pyelonephritis
A

presence or absence of proteinuria

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28
Q

what affect does urine sitting for >2-3 hrs have on WBCs? How can you avoid this problem?

A
  1. WBC’s lyse in alkalinized urine, so test urine sample in timely manner–sample will look normal if allowed to sit too long.
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29
Q

What substance is a necessary ingredient in cast formation

A

protein

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30
Q

These “molds” provide a glimpse of the condition of the nephron where they are formed

A

casts

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31
Q

where does cast formation usually occur

A

distal convoluted tuble and the collecting tubules of the nephron where the [urine] is greatest

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32
Q

which cast types are always of pathologic significance

A
  1. Cellular
  2. fatty
  3. RBC
  4. WBC
  5. waxy
  6. epithelial
  7. granular
    * always significant*
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33
Q

which cast type has little significance

A

hyaline casts–conglomeration of mucoproteins

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34
Q

What is the implication of the presence of WBCs and/or RBCs as part of cellular casts

A

renal origin–indicative of some disease process

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35
Q

if the cast is unrecognizable due to degradation, referred to as

A

granular cast

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36
Q

What is the most important factor in determining whether a cellular cast progresses to a waxy cast

A

time it takes the cast to move from the kidney to the urine

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37
Q

what is the significance of the appearance of waxy casts in the urine

A

indicates severe renal tubular stasis and nephron injury associated w/ severe chronic renal disease and renal amyloidosis

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38
Q

what are renal tubular epithelial casts associated w/ (3)

A

acute tubular necrosis, cytomegalovirus, toxin exposure

39
Q

what are fatty casts and how do they form

A

fat globules, when there is renal tubular damage w/ susequent fatty degredation of the tubular epithelial cells

40
Q

When one sees floating fat droplets in urine – associated w/

A

oval fat bodies,

nephrotic syndromes

41
Q

(5) nephrotic disorders you’ll see fatty casts and/or oval fat bodies

A
  1. subacute glomerulonephritis
  2. SLE (lupus)
  3. amyloidosis
  4. chronic GN
  5. toxic poinsoning
42
Q

Under what circumstances would you expect to see broad casts in the urine

A

wider than normal casts–when there is severe stasis in kidney–> casts form in more distal collecting tubules

43
Q

How long does a urine culture take before results can be available

A

48 hrs

44
Q

what is the most reliably uncontaminated urine sample method

A

suprapubic bladder tap using sterile field and teq

45
Q

How are ABX “sensitivities” obtained during a urine culture

A

ABX discs – zones of inhibition

46
Q

Which pt type is a particularly ^ risk for transitional cell bladder cancer

A

CC often “Blood in my urine”,

Older pt who is a smoker at ^est risk

47
Q

T/F A clean catch urine is not necessary when performing a urine cytology test

A

F – sample may be gathered during cystoscopy

48
Q

What is the purpose of FISH

A

tests the genetic material of the cells in the urine sample thus enabling better cancer detection

49
Q

What is the next step in evaluating a pt w/ an abnormal FISH test

A

cystoscopy and Bx for histo confirmation

50
Q

What medical term is used to describe an evaluated BUN? Describe the (3) main types of this disorder

A

-Azotemia- kidney fx/dysfx-

AKI (1. pre-renal, 2. intrinsic, 3. post-renal)

51
Q

List (4) causes of elevated BUN

A
  1. excessive quantities of urea being present to kidneys
  2. decreased renal blood flow which V GFR
  3. intrinsic renal disease which V glom/tube fx
  4. urinary obstruction causing urine backup
52
Q

What BUN finding constitutes:

  1. normal glomerular function
  2. severe renal impairment (severe Azotemia)
A
  1. 8-20 mg/dL

2. >50 mg/dL

53
Q

T/F Serum Creatinine (Cr) is more sensitive a specific for renal dz than the serum BUN

A

T–breakdown product of creatine phosphate from muscular metabolism

54
Q

What factor strongly determines a person’s serum Cr level

A

body muscle mass–men higher reference range

55
Q

List (5) reasons why a serum Cr could be elevated

A
  1. renal failure (pre/ intrinsic/postrenal)
  2. NSAIDS
    3 .aminoglycocydes
  3. gigantism
  4. muscle necrosis
56
Q

what must be taken into account when deciding what time of day to draw your pt’s serum Cr level (2)

A
  1. muscle mass

2. time of day (lowest 7am–highest 7pm)

57
Q

Which of the 2 kidney fx markers, BUN or Cr, is a better indicator of chronicity of a pt’s renal dz

A

Cr

58
Q

Of what utility is the BUN:Cr ratio to you in working up your pt w/ renal dz

A

helpful in differentiating pre-&post renal azotemia from intrinsic azotemia

59
Q

what affect would a 50% decrease in a pt’s GFR have on their BUN or Cr levels

A

aprx doubling of their BUN or Cr levels

60
Q

List (5) conditions which would DECREASE BUN:Cr ratio

A
  1. malnutrition
  2. low-protein diet
  3. ketoacidosis
  4. pt’s receiving hemodialysis
  5. pregnancy
61
Q

What’s a normal BUN:Cr

A

10:1

62
Q

What BUN:Cr ratio would you expect to find in a pt w/ rhabdomyolysis

A

<10:1

63
Q

You want to check the urine albumin:Cr ratio (UACR) of your pt but do not want to collect a 24hr urine to determine it. What is a reliable alternative test for getting this info

A

a “spot” UACR

64
Q

How is GFR determined

A

clearance of creatinine from kidneys (CrCl)

65
Q

test of kidney function in pt’s w/ DM anually

A

albumin:creatinine

66
Q

What (2) factors directly influence the clearance of a substance from the nephron

A
  1. plasma concentration of substance

2. excretory rate of nephrons

67
Q

Why is Cr clearance (CrCl) a more reliable clearance marker for GFR than urea

A

it has a more constant production rate than does urea

68
Q

*What is considered the most reliable test of renal function

A

Serial CrCl measurements

69
Q

At what time of day would one find the highest CrCl

A

Afternoon

70
Q

what does a CrCl of 35 ml/min/1.73 m2 signify

A

Renal insufficiency

71
Q

what is the major dx utility for measurement of urine Na+

A

integrity of nephron tubule for absorption–assess for acute oliguria, hyponatremia, and volume depletion

72
Q

T/F A clean catch urine is required to accurately measure the urine Na+

A

F

73
Q

Of what utility is a fractional excretion of Na+ (FENa) in your work-up of a renal dz pt

A

differentiate renal failure to:

  1. pre-renal cause
  2. acute tubular necrosis ATN
74
Q

T/F Pt’s w/ acute tubular necrosis ATN excrete less Na+ thus their FENa is low

A

F–in ATN there is sig tubular epithelial damage thus reabsorption of Na+ is hampered and susequently the FENa is higher >2

75
Q

Pre-renal azotemia FENa

A

<1

76
Q

What is urine osmolality a measure of

A

mOsm/kg of solution–evaluation of the concentrating capabilities of pt’s kidneys

77
Q

How are urine osmolality and urine specific gravity related

A

related in that the # of molecules present in the urine (urine osmolality) is a major determinant of its weight (SG)

78
Q

Briefly , how does US tech work

A

cross-sectional view of anatomic structure using ^ fq waves from vibrated crystal–reflected echoes recorded

79
Q

what advantage does Doppler US have over conventional US

A

allows for appreciation of blood flow direction and magnitude of the velocity in structure under eval

80
Q

List (5) stiuations where you would want to use US

A
  1. Hematuria (painless/painful) 1st choice
  2. AKI/CRF –assess size + exclude hydronephrosis
  3. Renal abscess–1st choice CT
  4. UTI–
  5. Polycystic kidney disease (PCKD)–US or CT
81
Q

Why does the US tech ask the pt to drink lots of fluids prior to having a pelvic US

A

the filled bladder displaces the air-filled bowel from the region of interest in pelvis

82
Q

Of what utility is a CT angiogram in evaluating pt’s for renal dz

A

in assessing the renal arteries for atherosclerosis and also as a tool to assess renal blood flow in assessing kidneys for renal transplant

83
Q

What is the main reason you’d order an MRA

A

to assess your pt for renal artery stenosis

84
Q

what might be the 1st clue for renal artery stenosis

A

hearing a bruit over the renal arteries when auscultating

85
Q

List (5) conditions which would warrant order a renal Bx

A
  1. hematuria
  2. proteinuria
  3. renal impairment
  4. pre-renal transplantation
  5. nephrotic syndrome
86
Q

In which pt’s would a Voiding Cystourethrogram VCUG be of utility in the work-up

A

dysuria, infx (infants/children), cystitis, urinary incontinence, vericoureteral reflux

87
Q

(5) conditions what would warrant the ordering of an excretory urogram

A
  1. hematuria
  2. severe flank pain
  3. cystits
  4. bladder outlet obstruction
  5. neurogenic bladder
88
Q

What should be reviewed prior to performing a cystoscopy

A

pt’s meds look for: warfarin, ASA, or other blood thinners

89
Q

A retrograde urethrogram RUG is order to assess

A

structural abnormalities in the urethra

90
Q

When should a RUG always be performed

A

prior to transurethral catheterization in a pt suspected of having urethral injury

91
Q

In what pt’s should Captopril renography be limited (2)

A
  1. pt’s w/ elevated Cr >2.0 mg/dL

2. pt’s w/ advanced atherosclerosis

92
Q

What study, when normal, excludes the dx of renovascular hypertension

A

Captopril renography

93
Q

Describe the stages of creatinine change expected in a pt w/ contrast nephropathy

A
  1. serum Cr increase 24-48 hrs post contrast exposure
  2. peaks at 3-5 days
  3. resoves within 1 wk

Renal (5 decks)

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