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Nephro Module > Labs & Diagnostic Studies > Flashcards

Labs & Diagnostic Studies Flashcards

1
Q

What tests are included in Chem-strip 9 and 10?

A

9: leuks, nitrites, urobilinogen, bilirubin, protein, pH, blood, ketone, glucose
10: specific gravity

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2
Q

What factor improves the accuracy of nitrite test?

A

more accurate the longer bacteria has inhabited bladder; more time to convert nitrate to nitrite

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3
Q

What interferes with nitrite test on Chem-Strip?

A

ascorbic acid

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4
Q

What is the dominant protein filtered by the kidneys in patients with proteinuria?

A

albumin

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5
Q

Potential interfering factors in urine sample with proteinuria?

A

extreme exercise, severe emotional distress, pregnancy, newborns, leaving dipstick in urine too long, alkaline or dilute urine, drugs, expired test strip

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6
Q

Conditions where ketones would be seen in urine

A

fasting/starving, dieting, anorexic, fever, prolonged vomiting, after anesthesia

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7
Q

Drugs that can cause false positive ketones in urine

A

insulin, pyridium, Levodopa

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8
Q

Where is bilirubin formed in body?

A

spleen and bone marrow

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9
Q

What causes bilirubin to decrease rapidly?

A

hepatocellular disease or hepatic obstruction

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10
Q

What converts bilirubin to urobilinogen?

A

bacteria in gut

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11
Q

What can cause increased concentration of urobilinogen?

A

hepatitis, liver injury, cirrhosis, CHF, anemia, malaria

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12
Q

When is urobilinogen concentration highest?

A

noon - 4PM

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13
Q

What food can cause positive urine urobilinogen?

A

bananas

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14
Q

What affect does radioplaque contrast media have on specific gravity?

A

false high SG

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15
Q

What does specific gravity measure?

A

kidneys ability to concentrate urine as compared to weight of distilled water

low SG = dilute urine
high SG = concentrated

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16
Q

What is done with urine for UA?

A

centrifuged and placed on slide

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17
Q

Possible causes of hematuria that you should consider

A

stones, tumor, acute glomerulonephritis, BPH, UTI, bleeding/clotting disorder, sickle cell anemia, leukemia, renal infarction, malignant HTN, SBE, SLE, cystitis, urethritis, prostatitis

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18
Q

How can you distinguish pyuria of lower UTI from that of pyelonephritis?

A

pyuria in kidney (pyelonephritis) usually has significant proteinuria

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19
Q

What material is needed for cast formation in urine?

A

proteins

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20
Q

Where does cast formation typically occur? What do they indicate?

A

distal convoluted tubule and collecting tubule where urine concentration is greatest

casts prove renal origin; kidney disease

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21
Q

What do RBC casts indicate?

A

blood leaking through basement membrane or direct nephron bleeding (GN, urinary stasis)

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22
Q

What to WBC casts indicate?

A

tubulointerstitial disease (pyelonephritis, interstitial nephritis)

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23
Q

How do granular casts form?

A

casts degraded as they travel through nephron making them unrecognizable

24
Q

What is the significance of waxy cast in urine?

A
  • cast has taken longer to migrate through nephron

- indicates severe renal tubular stasis and nephron injury associated with CKD and renal amyloidosis

25
Q

What are fatty casts and how do they form?

A

casts that contain fat globules and indicate renal tubule damage with fatty degradation of tubular epithelial cells

26
Q

Disorders with fatty casts and/or oval fat bodies in urine?

A

subacute or chronic GN, SLE, amyloidosis, toxic poisoning

27
Q

Under what circumstances would you see broad casts in urine?

A

severe localized renal tubule damage from severe stasis

28
Q

How long to get results of urine culture?

A

48 hours

29
Q

What is the purpose of FISH?

A

“fluorescent in situ hybridization”

can detect cancer cells from genetic material in urine

30
Q

Define azotemia

A

elevated BUN

31
Q

What can cause elevated BUN?

A

excessive urea presented to kidneys
decreased renal blood flow (lowers GFR)
intrinsic renal disease
urinary obstruction

32
Q

What is a normal BUN range? renal impairment?

A

normal 8-20 mg/dl
mild azotemia 20-50
severe azotemia > 50

33
Q

Possible causes of elevated Creatinine

A

renal failure, acromegaly, giantism, muscle necrosis, hypovolemia, high protein diet

34
Q

Timing of creatinine highs/lows

A

lowest at 7 AM

highest at 7 PM

35
Q

Which serum marker is best indicator for chronic renal disease?

A

creatinine (takes longer to rise than BUN)

36
Q

What is normal Cr:BUN ratio?

A

10:1

37
Q

Why is Cr:BUN useful in work up of renal disease?

A

helps differentiate pre and post-renal azotemia (>20:1) from intrinsic (<20:1)

38
Q

Casts in urine indicate damage is where?

A

within kidney NOT lower urinary tract

39
Q

How is GFR determined?

A

clearance of creatinine from kidneys (ml/min)

40
Q

What is considered the most reliable test for renal function?

A

serial measurement of creatinine clearance

41
Q

What is normal range of Cr clearance?

A

80-120 ml/min/1.73m^2

42
Q

What is the major diagnostic utility of measuring urine Na+?

A

determines integrity of nephron tubule for reabsorption

HIGH urine Na+ (>20) = low reabsorption; ATN?
LOW urine Na+ (<20) = prerenal azotemia, acute GN

43
Q

What advantage does Doppler US have over conventional US?

A

Doppler can appreciate blood flow direction and magnitude of velocity

44
Q

In which patients would VCUG be of utility in work up?

A

dysuria, UTI in infants and children, cystitis, urinary incontinence, vesicoureteral reflux

45
Q

A RUG is ordered to assess what?

A

structural abnormalities of urethra with XR and contrast

46
Q

Why is a CT angiogram useful in evaluating renal disease?

A

assess renal arteries for atherosclerosis, renal blood flow for renal transplant, retroperitoneal hemorrhage

47
Q

Eosinophils in urine strongly suggests dx of _______.

A

AIN

48
Q

Test of choice for evaluating suspected nephrolithiasis

A

non-contrast helical CT

49
Q

What labs are used to help diagnose AKI?

A

increase in serum Cr >0.5
increase in serum Cr >20%
decline in GFR >50%

50
Q

most reliable urine sample? 2nd and 3rd most reliable?

A

1st suprapubic bladder tap
2nd catheterization
3rd clean catch urine sample

51
Q

Possible causes of hematuria

A

renal disease, bladder cancer, hemoglobinuria

52
Q

Fractional excretion of Na+ (FE Na+) of patients with ______ is decreased and with _______ is increased.

A

low (2) = intrinsic/ATN

53
Q

CrCl 10-20 ml/min/1.73 m^2 indicates what?

A

severe renal failure -> dialysis

54
Q

Gold standard for detecting renal artery stenosis

A

renal angiogram

55
Q

_______ should ALWAYS be performed prior to transurethral catheterization in patient with suspected urethral injury.

A

RUG

Nephro Module (3 decks)

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