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Clin Med- Renal/GU > Lab Eval- U/A > Flashcards

Lab Eval- U/A Flashcards

1
Q

What is the kidney

A

One of the main excretory organ of the body that maintains the internal environment of the body
-selective secretion or reabsorption of substances according to the body’s specific needs

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2
Q

What is the nephron?

A

the anatomical and functional unit of the kidney, consisting of 2 main parts (glomerulus and tubule).

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3
Q

What is bowman capsule

A

a membrane that surrounds the glomerulus and extends to the opening of the proximal tubule

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4
Q

What is renal threshold

A

the plasma concentration of a substance above which it will be excreted into the urine

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5
Q

what is Tamm-Horsfall protein

A

a mucoprotein produced by the ascending limb of the loop of Henle that is a normal constituent of urine and is the major protein constituent of urinary casts

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6
Q

What is glomular filtration rate?

A

the rate in ml/min that substances (e.g., creatinine) are filtered through the glomeruli; reflects number of functioning nephrons

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7
Q

what is urea?

A

major nitrogen containing product of protein metabolism

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8
Q

What is nephrotic syndrome

A

general name for a group of diseases involving increased glomerular permeability, characterized by massive proteinuria and lipiduria with varying degrees of edema, hypoalbuminemia, and hyperlipidemia

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9
Q

Glomerulonephritis

A

nephritis accompanied by inflammation of the capillary loops in the glomeruli of the kidney; occurs in acute, subacute, and chronic forms and may be secondary to hemolytic streptococcal infection; evidence suggesting possible immune or autoimmune mechanisms

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10
Q

what is nephritis

A

inflammation of the kidney with focal or diffuse proliferation or destructive processes that may involve the glomerulus, tubule, or interstitial renal tissue

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11
Q

What is hemodialysis

A

the exogenous removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane

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12
Q

What is peritoneal dialysis

A

hemodialysis through the peritoneum, the dialyzing solution being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure

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13
Q

What does a urinalysis consist of? (4)

A

Macroscopic examination
dipstick
microscopic evaluation
specialty testing

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14
Q

When should the urinalysis be tested?

A

2 hours of collection

If refrigerated, may be tested within four hours

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15
Q

What are some issues with waiting too long to test the UA sample?

A

Elements (e.g., casts, RBCs, WBCs, Bilirubin) quickly deteriorate at room temperature
Bacteria may overgrow
bacteria may metabolize glucose present in urine
bacteria may interact with urine urea resulting in ammonia formation and elevated pH

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16
Q

Semiquantitative Tests for urine dipstick tests for what?

A 
Protein
pH
Specific Gravity
Bilirubin
Urobilinogen
Blood
Leukocyte Esterase
Nitrite
Glucose
Ketones
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17
Q

What is the procedure for urine dipstick?

A

Mix: Invert sample
Insert reagent strip
Remove excess urine
Hold test strip horizontally & record the results

*Don’t forget about quality control

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18
Q

protein is usually in the form of?

A

Usually in form of albumin or globulins

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19
Q

When would you see proteins in the urine dipstick

A

Small amounts (i.e., microalbumin) in DM and HTN may be first signal of Chronic Kidney Disease (CKD)
Globulins (Bence-Jones) associated with multiple myeloma
Large amounts in nephrotic syndrome and advanced kidney disease

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20
Q

pH for a urine dipstick

A

Normal 5-9, usually around 6
Acidotic or alkalotic can be due to diet, medication, disease or metabolic changes
Some bacteria increase pH

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21
Q

Acidic urine (<7.0) occurs in what? (5)

A

Metabolic acidosis, diabetic ketosis, diarrhea, starvation, uremia
UTIs caused by E. coli
Respiratory acidosis
K deficiency

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22
Q

Alkaline urine (>7.0) occurs in what? (4)

A

UTIs caused by urea-splitting bacteria
Renal tubular acidosis, chronic renal failure
Metabolic acidosis (vomiting)
Respiratory alkalosis involving hyperventilation

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23
Q

When do you see normal specific gravity?

A

(1.010-1.025)

Diabetes, HTN, early chronic renal disease

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24
Q

When do you see Hyposthenuria?

A

SG: 1.001-1.010)

Diabetes insipidus, Glomerulonephritis, pyelonephritis, severe renal damage

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25
Q

When do you see Hypersthenuria?

A

(SG: 1.025-1.035)

DM, nephrosis, Excessive water loss, CHF, Toxemia

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26
Q

what is normal bilirubin found in the dipstick urine?

A

normal (0-0.02 ng/dl)
Early sign of hepatocellular dx or biliary obstruction
Increased levels occur in Hepatitis, liver diseases caused by infections or exposure to toxic agents, and obstructive biliary tract disease

27
Q

what is normal Urobilinogen found in the dipstick urine

A

normal (0.1-1 Ehrlich U/dl or <1mg)
Formed by bacterial conversion of conjugated bilirubin in intestine
One of the most sensitive tests to determine impaired liver fx
One of the earliest signs of liver dz and hemolytic disorders

28
Q

what is normal for amount of blood found in the urine dipstick

A

normal is negative/none
Detects blood & hemoglobin
Can cross react with myoglobin
Presence of RBCs on a urine dipstick needs to be verified microscopically
Any positive test should be rechecked on a new sample

29
Q

Hematuria is found in what?

A

UTI, Urinary calculi, Renal tumor, glomerulonephritis, pyelonephritis, trauma to kidneys, malignant HTN, polycystic kidney disease, leukemia, thrombocytopenia, strenuous exercise

30
Q

Hemoglobinuria is found in what?

A

Extensive burns, transfusion reactions, chemical agents, malaria, post-op prostate procedure, hemolytic disorders, kidney infarction, DIC, strenuous exercise

31
Q

What is the normal amount of glucose found in the urine dipstick

A

normal result is negative
Present if serum glucose is between 160-180 mg/dL which is the renal threshold
Increased primarily in DM

32
Q

What is the normal amount of ketones found in the urine dipstick

A

Normal is negative
Ketones result from the metabolism of fatty acid and fat
Used for screening for ketoacidosis in diabetics

33
Q

what is the normal amount of Leukocyte Esterase found in the urine dipstick

A

negative
Detects esterase (enzyme) that is released by leukocytes into the urine.
Marker of infection or inflammation
All + results should be examined microscopically for WBCs and bacteria

34
Q

What is the normal amount of nitrites found in the urine dipstick

A

: normal- negative
Indirect method of detecting bacteria in the urine
Present in the setting of UTIs and requires further testing (urine culture)
Negative test does not rule out a UTI

35
Q

Urine analysis under the microscope

A

Urine is spun in a centrifuge, liquid is decanted and cellular elements are examined under a microscope

36
Q

Urine analysis under the microscope detects what? (5)

A 
WBC
RBC
Bacteria
Epithelial cells
Casts, crystals
37
Q

U/A: Microscopy= RBC

A

0-3/HPF.
Normal after exertion, trauma, fever
Persistent RBC’s should be investigated.
Seen in: UTI, glomerulonephritis, necrosis, tumors, stones, coagulopathies.

38
Q

U/A: Microscopy Crystals

A

Certain crystals are only seen in acidic or basic urine
Crystals can be normal, abnormal, or can mean a predisposition to form certain stones
Crystals can be identified by their appearance and solubility characteristics
May present w/o symptoms or may be associated with the formation of urinary tract calculi/stones

39
Q

What are some problems that can cause U/A: Microscopic Crystals

A 
Amorphous urates:  
Uric acid:  
Calcium oxalate:  
Triple phosphate:  
Calcium carbonate:  
Calcium phosphate:  
Amorphous phosphates:
40
Q

Microscopy: Hyaline Casts consists of what?

A

Consist only of Tamm-Horsfall protein
Small amount is normal – likely due to relatively concentrated urine at time of collection
Numerous hyaline casts associated with all renal diseases, essential hypertension, and nephrotic syndrome

41
Q

Microscopy: White blood cell casts consists of what?

A

Arise from the kidney tubules
Formed when WBCs are incorporated w/in protein matrix
Presence indicates renal parenchymal infection and can occur in pyelonephritis (most common), acute glomerulonephritis, interstitial nephritis and lupus nephritis

42
Q

Microscopy: Red cell casts consists of what?

A

Arise from the kidney tubules
Formed when WBCs are incorporated w/in protein matrix
Presence indicates renal parenchymal infection and can occur in pyelonephritis (most common), acute glomerulonephritis, interstitial nephritis and lupus nephritis

43
Q

Microscopy: Granular Casts consists of what?

A

Formed from breakdown products of cellular casts and immunoglobulins
Includes coarsely granular and finely granular casts.
Deeply pigmented (i.e., muddy brown) granular cast are characteristic for acute tubular necrosis!
Can occur in advanced glomerulonephritis and pyelonephritis as well

44
Q

Microscopy: Waxy Casts consists of what?

A

Form from the degeneration of granular casts

Associated with severe chronic renal disease, amyloidosis, nephrotic syndrome and localized nephron obstruction

45
Q

Microscopy: Fatty Casts consists of what?

A

Commonly attributed to leakage of lipoproteins through the glomerular filter
Associated with disorders causing lipiduria, such as nephrotic syndrome

46
Q

Urine culture bacterial counts:

A

Clean catch specimen required before antibiotic therapy begins
Bacterial count of >100,000 colonies/ml indicative of infection
Bacterial count of >10,000 colonies/ml in symptomatic, immunosuppressed or abx treated patients is indicative of infection
Mixed bacterial count of <10,000 CFU/ml suggests contamination

47
Q

Microalbumin is used for?– special UA test

A

Urine microalbumin is used as screening tool to assess risk of early diabetic nephropathy and/or hypertensive nephropathy

48
Q

What are indications for a 24 hour urine test

A

Determination of creatinine clearance
Stone analysis after recurrence of nephrolithiasis (generally not performed for first episode)
Hormonal diseases and tumors of the adrenal glands
Quantification of proteinuria in chronic renal diseases

49
Q

BUN background

A

Urea forms in the liver as the end product of protein metabolism and digestion
During ingestion, protein is broken down into amino acids. In the liver, these amino acids are catabolized and free ammonia is formed. The ammonia is combined to form urea which is then deposited in the blood and transferred to the kidney for excretion

50
Q

BUN is an indirect and rough measurement of what?

A

is an indirect and rough measurement of renal function and glomerular filtration rate as well as a measurement of liver function
measures the amount of urea nitrogen in the blood

51
Q

When is BUN increase?

A

Prerenal: hypovolemia, shock, burns, dehydration, CHF, GI bleeding, starvation, sepsis
Renal: renal disease, renal failure, nephrotoxic drugs
Post renal: ureteral obstruction (stones, tumor, anomalies), BPH

52
Q

When is BUN decreased?

A

Liver failure, overhydration, SIADH, malabsorption/malnutrition (low protein diets), pregnancy, nephrotic syndrome

53
Q

What is Creatinine a byproduct of?

A

the byproduct of energy metabolism (breakdown of creatine phosphate) that is used in skeletal muscle contraction therefore levels depend on muscle mass

54
Q

What is Creatinine produced at?

A

Produced at a constant rate depending on the muscle mass of the person and it is removed by the kidneys. Therefore production of creatinine is constant as long as muscle mass remains constant

55
Q

What is Creatinine excreted by?

A

Excreted entirely by the kidneys and therefore is directly proportional to the excretory fx of the kidneys
Not affected by liver fx
Used as an approximation of GFR
A more specific and sensitive indicator of kidney dx than BUN alone

56
Q

normal values of Creatinine

A

Adult: 0.6-1.5mg/dl; Child (3-18y): 0.5-1.0mg/dl; young child (0-3y): 0.3-0.7mg/dl

57
Q

What are 3 diagnositic tests for renal

A

KUB (Kidney, ureter, bladder) X-ray
IVP (intravenous pyelography)
Cystoscopy

58
Q

What is KUB used to demostrate

A

Performed to demonstrate the size, shape, location and any malformations of the kidneys and bladder
Identify stones/calculi in the kidney, ureter or bladder

59
Q

What is KUB used to diagnose

A

diagnose other intra-abdominal diseases (intestinal obstruction, soft tissue masses, ruptured bowel), abnormal gas patterns

60
Q

What is the process of IVP

A

Radiopaque contrast is used to visualize the kidneys, pelvis, ureters and bladder
Dye is injected intravenously, filtered in the kidney by the glomeruli, and passes through the renal tubules
Images are obtained over a period of 30 minutes showing passage of the dye through the kidneys, ureters and into the bladder

61
Q

What are 6 indications for IVP

A 
Persistent pain compatible w/ urinary stones
Blood in urine
Proposed surgery to locate ureters
Trauma to urinary system
Urinary tract obstruction
Suspected kidney tumor
62
Q

What are 3 indications for cystoscopy?

A

Hematuria
Recurrent or resistant UTI’s
Urinary symptoms of dysuria, frequency, urinary retention, inadequate urinary stream, urgency, incontinence

63
Q

What is a cystoscopy?

A

Endoscopic test used to evaluate patients w/ suspected pathologic conditions of the urethra, bladder and lower ureters
Used to perform biopsies

Clin Med- Renal/GU (7 decks)

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