Lesson 2,3,4 Flashcards
Its function is to filter blood and crate urine as a waste by-product
Urinary system
Remove waste and extra water from the blood and help keep chemicals balanced in the body
Kidney
A tube that carries urine from the kidney to the urinary bladder
ureter
A sac that’s serves as a reservoir for urine
Urinary bladder
The tube that lets urine leave your bladder and your body
urethra
Size of urethra for female
3-4 cm
Size of urethra for male
20 cm
Is actually a fluid biopsy of the kidney
urine
Basic structural and functional unit of the kidney
Nephron
How many nephrons per kidney?
1 to 1.5 million
2 type of nephron
- Cortical nephrons
- Juxtamedulary nephrons
Are situated primarily in the cortex of the kidney, approximately 85% of nephrons
Cortical nephrons
Are responsible primarily for removal of waste products and reabsorption of nutrients
Cortical nephrons
Their primary function is concentration of the urine
Juxtamedulary nephron
Have a longer loop of Henle that extends deep into the medulla of the kidney
Juxtamedulary nephron
Detects low blood pressure and low blood volume which triggers RAAS
Juxtamedulary nephron
Order of urine formation
- Glomerulus
- Proximal convoluted tumble (PCT)
- Loof of Henle
- Distal Convoluted Tubule
- Collecting duct
- Calyx
- Renal pelvis
Responsible for selective reabsorption of blood and salt
Loop of henle
it is the major side of reabsorption
Proximal convoluted tubule
What are the 4 renal function?
- Renal blood flow
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion
The human kidneys receive approximately ____ of the blood pumped through the heart at all times
25%
What is the total renal blood flow?
1,200 mL/min
What is the total renal plasma flow?
600-700mL/min
What is the order of renal blood flow?
- Renal artery
- Afferent arteriole
- Glomerulus
- Efferent arteriole
- Peritubular capillaries
- Vasa recta
- Renal vein
It is the working portion of the kidney
glomerulus
A coil of approximately eight capillary lobes, located within the Bowman’ capsule
glomerulus
A nonselective filter of plasma substances with MW <70,000 dalton
Glomerulus
Glomerulus is a non selective filter of plasma substances with MW __________
<70,000 Dalton
It is a capillary endothelium with its large pores
Glomerular filtration barrier
It has trilayer basement membrane
Glomerular filtration barrier
What are the trilayer basement of the glomerular filtration barrier?
- Lamina rara interna
- Lamina densa
- Lamina rara externa
It is a filtration diaphragm found between the podocytes of Bowman’s space
Glomerular filtration barrier
What is the maximum of glomerular filtrate?
70,000
What is the maximum of albumin?
69,000
Glomerular filtrate has an S.G of _____ and ____ albumin
1.010
No
What are the glomerular filtrate that is usually filtered?
Salt
Water
Amino acid
Glucose
urea
If it were not for the __________________, all routine urine would have a positive readings on reagent strip for protein and albumin
Shield of negativity
1st function to be affected in renal disease
Tubular reabsorption
How many percent does tubular reabsorption has in renal function?
65%
It is responsible for when the filtrate concentration exceeds the maximal reabsorptive capacity (Tm) of the tubules, and the substance begins appearing in the urine.
Tubular reabsorption
It is the plasma concentration at which active transport stops
Renal threshold
What is the renal threshold for glucose?
160-180 mg/dL
It is the movement of substance across call membrane into the bloodstream by electrochemical energy
Active transport
It is the movement of substance across a membrane by diffusion because of physical gradient
Passive transport
Patient with Normal blood glucose level + glucose in urine = _____________
Tubular damage
It involves the passage of substances from the blood in peritubular capillaries to the tubular fitrate
Tubular secretion
2 major functions of tubular secretion
- Regulation of the acid-base balance in the body through secretion of hydrogen ions
- Elimination of waste products not filtered by the glomerulus
It is the major site for removal of nonfiltered substances
Proximal convoluted tubule
It is when the urine is alkaline
Renal tubular acidosis (RTA)
Failure to produce an acid urine due to inability to secrete hydrogen ions
Renal tubular acidosis (RTA)
It regulate water reabsorption in the DCT and CD
Anti-diuretic hormone
It is also known as anti-diuretic hormone
vasopressin
Responsible for controlling the urination
Anti-diuretic hormone
It is the ADH deficiency which leads to polyuria
Diabetes insipidus (DI)
It is when there is excess ADH which leads to oliguria
Syndrome of inappropriate ADH secretion
It is when there is excess ADH which leads to oliguria
Syndrome of inappropriate ADH secretion
It is responsible for the salt concentration
Aldosterone
It regulates salt reabsorption in the DCT
aldosterone
It regulates the flow of blood to and within the glomerulus
Renin-angiotensin-aldosterone system (RAAS)
It responds to changes in blood pressure and plasma sodium content that are monitored by the juxtaglomerular apparatus
Renin-Angiotensin-Aldosterone System
It is used to evaluate glomerular filtartion
Clearance test
It measures the rate at which the kidneys are able to remove a filterable substance from the blood
Clearance test
It is obsolete in the clearance test
Urea
It is the most common in the clearance test
Creatinine
It is the gold standard or the reference method in the clearance tests
Insulin with MW of 5,200 Dalton
It is the better marker of renal tubular function in the clearance test
Beta 2-microglobulin with MW of 11,800 Dalton
It is a measure of the completeness of a 24-hour urine collection
Creatinine clearance
By far the greatest source or error in any clearance procedure utilizing urine is the ___________________
Use of improperly timed urine specimens
Around_______ of creatinine is secreted by the renal tubules
7-10%
It is used to evaluate tubular reabsorption
Concentration test
What are the 2 obsolete concentration test
- Fishborg test
- Mosenthal
What test is done when Patient is deprived of fluid up to 24 hours
Fishborg test
In what test does a patient maintain normal diet and fluid intake, where the day and night urine are compared in terms of volume and S.G?
Mosenthal
It is a test influenced by the number and density of particles in a solutuon
Specific gravity
It is more precise than osmolarity because it does not vary with temperature. It is also influenced by the number and density of particles in a solution
Osmolality
What are the tests for tubular secretion and renal blood flow
- p-aminohippuric acid (PAH) Test
- Phenolsulfonphthalein (PSP) Test
- Urine pH, titratable acidity, urinary ammonia
who inferred diagnoses from urine evaluation?
Hippocrates
Aristotle
ancient Egyptians
It was until when that uroscopy reached diagnostic dominance?
middle ages
the publication of _________ is a major reason for the rise to prominence of uroscopy
Johannes de Ketham’s Fasciculus Medicinae in 1491
It is the first illustrated medical book printed and it depicted the urine wheel
Johannes de Ketham’s Fasciculus Medicinae in 1491
it is a large circle surrounded by thin-necked, urine flasks. this shows how the color and consistency of the urine could be matched to a diagnosis
urine wheel
What are the 4 humours?
Sanguineous = blood
choleric = yellow bile
phlegmatic = phlegm
melancholic = black bile
he first documented the importance of sputum examination; uroscopy
hippocrates
he discovered albuminuria by boiling urine
Frederik Dekkers
who wrote a book about “pisse prophets”
Thomas Bryant
he contributed the examination of urine sediment
Thomas Addis
He introduced urinalysis as part of doctor’s routine patient examination
Richard Bright
he coined urochrome
Ludwig Thudichum
it is the pigment of urine (yellow)
urochrome
he discovered cerebrospinal fluid
Domenico Cotugno
he termed Phenylketonuria
Ivan Falling
he termed Alkaptonuria
Archibald Garrod
he discovered Orthostatic or cyclic proteinuria
Frederick William Pavy
cystine calculi
William Wollaston
Benedict’s reagent
Stanley Benedict
they used to detect diabetes by using the “taste test”
babylonians and egyptians
they noticed that “honey urine” attracted ants
hindu physicians
what is the water and solute composoition of urine?
95-97% water
3-5% solute
it is the major organic substance
urea
it is the major inorganic substance
chloride
it is the principal salt
NaCl
it is clean, dry, leaked-proof __________, with a wide base and an opening of at least 4cm
container
the container should be made of _____ to allow for determination of color and clarity
clear material
the recommended capacity of the container is ____ which allows ___ of specimen needed for microscopic analysis
50 mL
12 mL
proper labeling of the specimen includes:
- patient’s last and first name
- identification number
- date and time of collection
- patient’s age
- location
- healthcare provider’s name
- preservative used if any
- patient’s sex
it must be attached to the container, not to the lid, and should not be detached
label
this must accompany specimens delivered to the laboratory, its information should match the information on the specimen label
requisition form
routine screening
can be collected anytime
ideal for cytology studies
random/occasional/single
random urine specimen is ideal for cytology studies only if with prior ____________ and __________ 5 mins before collection
exercise and hydration
ideal for routine analysis
essential for preventing false-negative pregnancy tests
most acidic and most concentrated
for evaluating orthostatic proteinuria
first morning
2nd voided urine after a period of fasting
for glucose determination
second morning/fasting
for diabetic screening and monitoring
preferred for testing glucose
2-hour post-prandial
optional with blood samples in glucose tolerance
glucose tolerance
at least 2 voided collection
used in diagnosis of diabetes
fractional specimen
for routine screening and bacterial culture
midstream clean-catch
for bacterial culture
may be urethral or ureteral
catherized
bladder urine for anaerobic bacterial culture and urine cytology
suprapubic aspiration
use soft, clear plastic bag with adhesive
pediatric specimen
for prostatic infection
three-glass technique
three-glass technique normal result
slight contam
sterile
sterile
three-glass technique for prostatitis
slight contam
sterile
incresed wbc +bacteria
three-glass technique for UTI
contam
contam
invalid
it has VB1, VB2, EPS, VB3
Stamey-Mears test for prostatitis
for quantitative testing:
24 hr =
12 hr =
4 hr (first morning) =
afternoon (2-4pm) =
timed specimen
requires preservatives
for addis count
for nitrite determination
for urobilinogen determination
it is the process providing documentation of proper sample ID from the time of collection to the receipt of laboratory result
chain of reaction
required urine volume for drug testing
30-40 ml
container capacity for drug testing
60 ml
temperature within 4 mins.
32.5-37.7 C
it is added to toilet water reservoir during drug testing
bluing agent
