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nephrology > labs > Flashcards

labs Flashcards

1
Q

produced as the result of normal muscle metabolism? what is the breakdown from?

A

creatinine– production & excretion are constant/regular
breakdown of phosphocreatine

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2
Q

used to approximate the GFR? what is the normal level

A

creatinine– normal is 0.5-1.5 mg/dL

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3
Q

relationship between GFR & serum creatinine

A

inverse! 2x increase in Cr= 50% decrease in GFR so mild elevation= significant dysfunction even if its in the normal range

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4
Q

what is CrCl

A
  • measure of the GFR
  • normal is 100ml/min; dependent on age and gender (m>f)
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5
Q

how is CrCl measured directly?

A

24 hour urine collection– time consuming & hard for patients; both serum & urine needed; dispose of the first urine
- does NOT give a more accurate estimate than the prediction equations

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6
Q

how is CrCl measured indirectly

A

cockcroft-gault equation– age, kg, sex & serum cr are used in it
- used as the standard for drug dosing

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7
Q

sum filtraion of all functioning nephrons; gold standard for measuring kidney function? what is normal value?

A

GFR– varies by age, gender & body size
normal is above 90

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8
Q

5 uses of GFR

A
  • identify kidney dz
  • select doses
  • avoid certain meds
  • monitor CKD
  • criteria for referral & dialysis
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9
Q

produced in liver, found in blood & secreted and reabsorbed by the kidneys; directly related to metabolic liver function; assuming normal liver, it is estimate of renal function

A

BUN– also affected by protein breakdown, hydration status, liver failure; rises faster than Cr with dehydration

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10
Q

how does serum Cr, eGFR, CrCl, BUN change when kidney is going bad?

A

Decreases– eGFR & CrCl
increase– serum Cr, BUN

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11
Q

symptomatic azotemia– N/V, lethargy

A

uremia

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12
Q

what is the diff. btwn acute and chronic kidney failure

A

time— 3 months

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13
Q

good screening test for obstruction & differentiation btwn acute & chronic renal dz

A

renal US

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14
Q

size difference btwn small & large kidneys

A

small < 10 cm; chronic dz
large > 12 cm; acute (potentially reversible; associated w/ DM, amyloid, infiltrative CA)

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15
Q

5 tests that can help in finding the cause of kidney failure

A

BUN:Cr
Urine NA
fractional excretion Na
urine Sp Gr
urine osmolality

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16
Q

in presence of kidney disease, what does BUN/Cr of over 20 mean?

A

pre-renal: GI bleed, less volume
Urine obstruction

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17
Q

in presence of kidney disease, what does BUN/Cr of under 20 mean?

A

intrarenal
often Chronic (CKD)

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18
Q

random urine Na of what value suggests dehydration? what value sugguests kidney/adrenal disease?

A
  • Na under 10 suggests dehydration– CHF, liver dz
  • Na over 20 suggests kidney/adrenal dsease
  • electrolytes can be used to calculate FENa
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19
Q

helpful to distinguish btwn pre-renal and intrarenal azotemia; over 1% means intra-renal azotemia while under 1% means pre-renal azotemia

A

FENa (fractional excretion of Na)

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20
Q

prerenal vs intrarenal vs postrenal

  • urine Na under 10
  • serum BUN:Cr over 20
  • FENa under 1%
  • Sp Gr over 1.020
  • U osmolality over 500
A

prerenal

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21
Q

prerenal vs intrarenal vs postrenal

  • urine Na over 20
  • serum BUN:Cr under 10
  • FENa over 1%
  • Sp Gr under 1.012
  • U osmolality under 250
A

intra-renal

22
Q

what GFR is considered moderate CKD3 & signals need to refer?

A

30-59

23
Q

what GFR signals dialysis?

A

under 15

24
Q

this measurement is determined by # and size of particles in the urine & varies with osmolality. what is the normal range for this lab value?

A

Specific gravity
normal is 1.005 to 1.025

osmolality is more accurate & is determined by # of particles only

25
Q

what is the normal pH range for urine?

A

4.5 to 8.0; usually 6.0

26
Q

uncontrolled DM, starvation, dehydration, protein changes your urine pH in what way?

A

makes it acidic

27
Q

chronic renal failure, salicylate intox., proteus infection changes your urine pH how?

A

makes it alkaline

28
Q

persistent proteinuria is classified into what 3 ways?

A

glomerular
tubular
overflow

29
Q

what class of persistent proteinuria is this

  • may cause massive proteinuria & has many causes
  • albumin is primary protein
A

glomerular

30
Q

what type of persistent proteinuria

  • malfunctioning tubule cells don’t metabolize or reabsorb normally filtered protein
  • LMW proteins predominate
  • rarely exceed 2g/day
A

tubular

31
Q

what type of persistent proteinuria

  • LMW proteins overwhelm ability of tubules to reabsorb filtered proteins
  • can be seen in multiple myeloma?
A

overflow

32
Q

what do you do if there is mild proteinuria on dip in an asymptomatic patient

A

recheck the dipstick
it can be transietnt d/t many things

33
Q

4 things to do if there is proteinuria in a non-asymptomatic patient

A
  • get 24hr urine
  • microscopic exam of urinary sediment
  • urinary protein electrophoresis
  • assess renal function
34
Q

you get a 24 h urine test and the value is under 3g/24hrs what type of disease is this? over 3g/24hrs?

A
  • under 3g: glomerular or tubular disease (nephritic)– could be either but tends to be tubular
  • over 3g: nephrotic range, typically glomerular
35
Q

what is this called?

excretion of 30-150mg of protein/day found via other test (not dipstick); affected by hydration status and indicates renal tubular disease

A

microalbuminuria
- if patient has this + DM, should start ACEi

36
Q

if patient has glucosuria but not DM after checking for it, what is likely happening?

A

its renal tubular disease

37
Q

other than diabetes & diets, what are 3 other times you may expect to see ketones in urine

A
  • strenuous exercise
  • frequent vomiting
  • pregnancy
38
Q

bilirubin vs urobilinogen– which is normally found in urine in small amounts?

A

urobilinogen

39
Q

if someone has microscopic hematuria w/o e/o renal dz, what do we do? why?

A

recheck it in weeks & if still present, refer to urology
because it can be serious urologic disease or malignancy

40
Q

transitional epithelial cells means what?

A

can be normal but if in large amounts may suggest a UTI

41
Q

which type of cells seen in microscopic UA is the desquamation of tubular epithelium that suggests significant renal pathology

A

tubular epithelial cells

42
Q

over ____ is significant bacteriuia in asymp. pt while over ____ suggests UTI in pt w/ sx. what should you do after diagnosing bacteriuria?

A
  • over 100K mL in asymptomatic = significant bacteriuria
  • over 100 mL in sx suggests UTI
  • after dx, need C & S (culture and sensitivity)
43
Q

what type of cast?

  • small # w/ exercise, dehydration, stress, pyelonephritis but may be normal
  • from distal tubules
  • protein w/o cellular inclusion
A

hyaline cast

44
Q

what type of cast

  • # of casts increses w/ severity of disease
  • indicates glomerulonephritis
A

RBC cast

45
Q

what type of cast

  • seen w/ renal tubule dz
  • seen in ATN, interstitial nephritis, eclampsia, nephritic syndrome
A

epithelial casts

46
Q

what type of cast

  • made up of various cell types in final phase of cellular degeneration
  • very slow tubular transit time
  • severe chronic renal disease (HTN nephropathy)
A

waxy/granular casts

47
Q

what type of cast

-indicates nephrotic syndrome, renal disease, hypothyroidism

A

fatty cast

48
Q

what type of cast

made of various cell types and indicates ESRD

A

broad cast

49
Q

colorless crystal w/ coffin lid appearance associated w/ alkaline urine & UTI (proteus species)

A

triple phosphate

50
Q

colorless hexagonal shaped crystals found in acidic urine; diagnostic of cystinuria

A

cystine crystals

nephrology (13 decks)

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