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2nd Semester Final > Lab Approach to a Patient with Renal Disease > Flashcards

Lab Approach to a Patient with Renal Disease Flashcards

Walt

1
Q

Even though albumin is a small enough protein to pass thru the fenestrations of the renal corpuscle, it doesn’t because….
Why is maintaining protein in plasma important?

A

….albumin is negatively charged as well as the filter so it repels it back into the circulation

It helps maintain oncotic pressure

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2
Q

Albumin (protein) in urine tested on disptick is a sign of…

A

…nephrotic syndrome

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3
Q

___% of cardiac output passes thru the kidney per minute

A

25

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4
Q

Afferent arterioels are branches of the ____ arteries and each supply a single ____

A

interlobular, glomerulus

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5
Q

Efferent arterioles divide to form the ___

A

Peritubular microcirculation

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6
Q

Why should you avoid NSAIDS and ASA with vomiting and diarrhea?

A

These irreversibly block prostaglandins in the endothelium, preventing their release to act as dilators of the afferent arterioles that need to dilate to increase GFR

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7
Q

Factors that impact afferent or efferent arteriole tone (5)

A
  • angiotensin II
  • ADH/vasopressin
  • prostaglandins
  • Endothelins
  • Epi/norepi
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8
Q

Endothelin definition

A

Proteins that constrict blood vessels and raise pressure, kept in balance by other mechanisms but when over-expressed contribute to hypertension

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9
Q

In order to compensate for lowered GFR pressure, we will vaso___ the afferent and vaso___ the efferent arteries

A

dilate, constrict

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10
Q

Sympathetic innervation of the bladder vs parasympathetic innervation of the bladder

A

Sympathetic allows for smooth muscle contraction of the bladder, parasympathetic allows for relaxing of internal urethral sphincter

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11
Q

With one kidney removed, blood flow in the remaining kidney will…

A

…compensate quite well nearly double within a few weeks

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12
Q

Increase hydrostatic pressure in Bowman’s capsule, often due to urethral obstruction, can cause…

A

…edema of the kidney

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13
Q

Urine volume is a poor indicator of _____

A

Renal dysfunction

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14
Q

Low urine output may be one of 3 categories

A

prerenal - the blood before the kidney
intrarenal - within the kidney
postrenal - in the ureters, bladder, or urethra

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15
Q

Polyuria, oliguria, and anuria values in mL/day

A

poly - >2L
oligo - <500mL
an - 0-100mL

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16
Q

A CBC is beneficial in evaluation of renal function for these 2 reasons

A

1) checks erythropoietin function

2) checks infection of kidney

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17
Q

The main organ responsible for balancing electroyltes in the body

A

kidney

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18
Q

Renal threshold

A

The amount of glucose (190-220mg/dL) of glucose that will result in sugar in the urine

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19
Q

BUN definition

A

Blood urea nitrogen, waste product of nitrogenous breakdown such as muscle in the body, useful measure in assessing kidney function

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20
Q

Creatinine definition

A

Breakdown of product of muscle in the body, useful measure in assessing kidney function

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21
Q

4 intrarenal disease possibilities

A

1) acute tubular necrosis
2) glomerular
3) vascular
4) tubulointerstitial

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22
Q

In a young patient (20’s) with hypertension, need to see if possible pathology source is…

A

…renal artery stenosis

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23
Q

3 common presentations of renal dysfunction

A
  • hematuria
  • proteinuria
  • azotemia
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24
Q

Azotemia definition

A

Increased plasma conc. of BUN in bloodstream, without symptoms

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25
Q

In liver failure, there is a lack of conversion of ammonia to urea, and this can cause a brain disease called…

A

Hepatic encephalopathy

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26
Q

Uremia definition

A

Toxic effects felt as wastes accumulate in the body resulting from renal failure, sometimes being excreted thru the skin, typically causese elevated BUN and creatinine

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27
Q

What kills from renal failure?

A

-hyperkalemia causing arrhythmia of heart and eventual death

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28
Q

BUN normal value range

A

Between 10-20mg/dL at all times

29
Q

Primary renal disease sees a ___ in urea, which causes a ____ BUN

A

increase, increase

30
Q

What are 4 things that can decrease BUN?

A
  • Overhydration
  • liver failure
  • neg nitrogen balance
  • pregnancy
31
Q

Normal creatinine level and elevated BUN level indicates a ___renal disease

A

Pre

32
Q

BUN/Creatinine ratio

A

A useful measurement to determine the type of renal disease present

33
Q

Creatinine is a direct reflection of ____ because it is always ____

A

Renal filtration rate, filtered

34
Q

Only __renal disorders will affect creatinine levels

A

Intra

35
Q

Rhabdomyolysis definition

A

An emergency disease that if left untreated leads to kidney failure, indicated by presence of myoglobin in urine, muscle pain, and weakness.

36
Q

4 causes of elevated creatinine

A
  • rhabdomyolysis
  • acromegaly
  • myesthenia gravis
  • muscular dystrophy
37
Q

Ceatinine clearance definition

A

A test that helps determine if kidneys are functioning normally by gauging the amount of creatinine in the urine compared to that in the blood

38
Q

Serum creatinine concentration is the most common way to estimate ___, what is its relationship to that value?

A

GFR, the change in serum creatinine is inversely related logarithmically (i.e. creatinine from 1 to 2 is GFR 1 to .5)

39
Q

24 hr urine collection definition, what are some issues with it?

A

Gold standard test for measuring kidney function, involves having patient pee first thing in morning and then collect every following urination up until completing first pee the next morning, patient compliance is the biggest issue with it

40
Q

Normal range for GFR

A

85-115 mLs/min

41
Q

Each year after age 40, there is a reduction of ___ mL/min per year of GFR

A

.75

42
Q

Inulin clearance definition and function

A

A lab test using a compound called inulin that is only filtered by kidney, and is therefore a 100% accurate test of GFR, no longer done anymore

43
Q

Healthy individuals without chronic illness can have unlimited ___ intake because it doesn’t have comorbidity associated with it. In theory, intake of this should equal ___ of it

A

Salt, excretion

44
Q

Fractional excretion of Na+ in urine is extremely useful in distinguishing the most 2 common causes of acute kidney injury, what should it be in euvolemic patients in Na+ balance with normal renal function?

A
  • prerenal azotemia
  • acute tubular necrosis

<1%, if >1% can conclude it is acute tubular necrosis
UNLESS on diuretics

45
Q

Specific gravity of serum, what is urine typically?

A

1.010, somewhere above that unless over hydrating then it will be diluted and lowered

46
Q

Prerenal azotemia vs ATN BUN/Creatinine ratio

A

> 20, 10-20

47
Q

Prerenal azotemia vs ATN urinalysis

A

normal or with hyaline casts, brown granular casts and cellular debris

48
Q

Prerenal azotemia vs ATN specific gravity

A

> 1.020, =1.010

49
Q

Prerenal azotemia vs ATN osmolarity

A

> 500 (conc.), <350

50
Q

Prerenal azotemia vs ATN fractional excretion of sodium

A

<1, >1

51
Q

Positive heme without positive blood on urinalysis, is indicative of this disease…

A

…rhabdo

52
Q

+1 or +2 urine glucose on urinalysis is indicative of serum glucose levels of…

A

190-220

53
Q

Leukocyte esterase on urinalysis indicates….

nitrite reduction on urinalysis indicates…

A

WBC in urine

Infection

54
Q

Bright red blood tainted urine indicates the bleed is coming from the ___, while dark red indicates it is coming from the ____

A

lower urinary tract, kidney

55
Q

A urine specimen that does not test positive via urinalysis for urobiligen is ___ a urine specimen that tests positive for bilirubin via urinalysis is ___

A

bad, bad

56
Q

Sulfosalicylic acid test for protein definition

A

Tests for nonalbumin forms of protein in urine

57
Q

Micral test for microalbuminuria definition

A

The gold standard test for early detection of glomerular disease, test for microalbumin in the urine

58
Q

Microscopic urine analysis detects for these 3 things

A
  • cells
  • crystals
  • casts
59
Q

In a blood positive urinalysis, diabetic, kidney infected, metabolic, or kidney stone patient, what should be ordered alongside a urinalysis?

A

Microscopic urine analysis

60
Q

Red cells on a microscopic urine analysis is indicative of what anatomic location? What about red cell casts and what disease? What about white cell casts and what disease? What disease state is about white blood cells in urine? What do muddy brown casts in urine indicate?

A

Renal pelvis down, nephron (glomerulonephritis), nephron (pyelonephritis), bladder infection, tubular damage

61
Q

Blood present at start of stream and then becomes clear indicates…
Blood present through the middle of the stream indicates…
Blood present at the end of the stream indicates…

A
  • urethral bleeding
  • bladder or above
  • prostate and trigone bleeding
62
Q

Common prerenal diseases (4)

A
  • azoemia
  • congestive heart failure
  • hypovolemia
  • hemorrhage
63
Q

Healthy BUN:Cr ratio

A

between 10:1 and 20:1

64
Q

Common postrenal kidney diseases (2)

A
  • severe acute tubular necrosis

- obstruction

65
Q

Common intrinsic renal diseases (3)

A
  • glomerulonephritis
  • proteinuria
  • nephrotic syndrome
66
Q

Orthostatic proteinuria

A

Benign condition frequently seen in children where proteinuria is seen after periods of standing but not sitting, can be tested for by sampling first urine in morning

67
Q

What kidney conditions would you use ultrasound to detect? (3) Why is this the preferred imaging modality?

A
  • hydronephrosis
  • kidney stone
  • renal artery stenosis

No radiation

68
Q

Significant bacteruria is when there are ____ml of a single organism

A

100,000 (nonpregnant patient)

2nd Semester Final (207 decks)

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