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CC1 continuation > NPN > Flashcards

NPN Flashcards

1
Q

Which is true regarding NPN?
A. Compounds arise from the catabolism of proteins and nucleic acids
B. Majority are excreted in the kidneys
C. The term nonprotein nitrogen (NPN) originated in the early days of biochemistry
D. A and B

A

D

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2
Q

NPN of highest concentration in the blood and end product of protein catabolism state of hydration

A

Urea

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3
Q

First metabolite to increase in kidney diseases and part of the B:C Ratio (normal B:C ratio is 10:1-20:1)

A

Urea

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4
Q

increased BUN

a. poor nutrition
b. high fluid intake
c. azotemia
d. over hydration
e. pregnancy
f. severe liver disease

A

C

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5
Q

decreased BUN:

a. stress
b. burns
c. high protein diet
d. dehydration
e. severe liver disease (hormones)
f. azotemia

A

E

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6
Q 
Clinical application of Urea
A. Evaluation of renal function
B. Assess hydration status
C. Determine nitrogen balance
D. Aid in the diagnosis of renal disease
E. Verify adequacy of dialysis
F. All of the above
A

F

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7
Q

are used most frequently in clinical laboratories for Urea

A

Enzymatic method

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8
Q

The most common method couples the urease reaction with ____________

A

glutamate dehydrogenase

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9
Q

An increase in pH due to the production of ammonia color results in urase (6.8)

A

Yellow

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10
Q

An increase in pH due to the production of ammonia color results in urase (pH 8.2)

A

bright pink

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11
Q

End product of muscle metabolism derived from

A

creatinine

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12
Q

Urea in PFF, the presence of buffer and heat-forming ammonium carbonate which is then reacted with _____ to form a ______

A

Nessler’s reagent, yellow dimercuric ammonium iodide

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13
Q

The Oldest method in Urase

A

Micro-Kjeldahl Nessler

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14
Q

Mixture of sulfuric acid and phosphoric acid

A

Kjeldahl process

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15
Q

Coupled Urease

A

Glutamate Dehydrogenase Method

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16
Q

Commonly and Routinely done. Urease is prepared from jack beans. Ammonia treating with Berthelot reagents.

A

Hydrolysis of Urea by Urease

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17
Q

DIRECT MEASUREMENT OF UREA

A

Diacetyl Monoxime Method (DAM)

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18
Q

Diacetyl Monoxime Method (DAM) produces what color

A

Yellow

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19
Q

Principle of Diacetyl Monoxime Method

A

Faeron Reaction

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20
Q
  1. _____ will inhibit urase, it should be avoided. 2._______ are added to enhance color development.
A
  1. Fluoride and Citrate

2. Thiosemicarbazide and ferric ions

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21
Q

Urea nitrogen concentration expressed in

A

mg/dL

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22
Q

Urea nitrogen concentration converted to urea concentration in ____

A

mmol/L

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23
Q

Specimen used in Urea

A

plasma, serum, urine, non-hemolyzed

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24
Q

Fasting is usually required in Urea and Creatinine. TRUE OR FALSE.

A

False (not)

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25
Q

elevated level of nitrogenous substances like urea and creatinine in the blood

A

Azotemia

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26
Q

very high plasma urea concentration accompanied by renal failure

A

Uremia

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27
Q

conditions in which circulation through the kidneys is less efficient than usual

A

Pre-renal

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28
Q

characterized by the presence of lesions on

the parenchyma itself (tubular injury)

A

Renal causes

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29
Q

due to the obstruction in the-urinary tract due to

A

Post-renal causes

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30
Q 
What classification:
Hemorrhage (blood loss)
Cardiac decompression
Increased protein catabolism
Heatstroke (Dehydration)
Burns (Fluid loss)
A

Pre-renal

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31
Q 
What classification:
Chronic nephritis
Acute glomerulonephritis (AGN)
Polycystic kidney
Nephrosclerosis
Tubular necrosis
A

Renal causes

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32
Q

What classification:
Stones
Prostatic enlargement
Tumors

A

Post-renal causes

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33
Q 
What creatinine ratio?
Low protein diet
Acute tubular necrosis
Repeated dialysis
Hepatic disease
A

Low Ratio <10:1

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34
Q 
What creatinine ratio?
Pre-renal azotemia
-Dehydration
-Catabolic states
-GI bleeding
-High protein diet
A

High ratio = >20:1 (with normal creatinine)

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35
Q

Post-renal azotemia

A

High ratio = >20:1 (with elevated creatinine)

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36
Q

______ is inversely related to glomerular filtration rate (GFR)

A

Plasma creatinine

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37
Q

Not affected by protein diet and not reused in the body’s metabolism. Also used to evaluate fetal kidney maturity (2 mg/dL).

A

Creatinine

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38
Q

Most commonly used to monitor renal function, an index of overall renal function. Solely a waste product & not easily removed by dialysis.

A

Creatinine

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39
Q

Creatinine is decreased creatinine during decreased GFR. TRUE OR FALSE.

A

True

40
Q

Creatine is synthesized in the liver from ____

A

arginine, glycine and methionine

41
Q

Creatine is transported to tissues and converted to ____

A

Creatinine phosphate

42
Q

Creatinine is released into the circulation at a relatively constant rate. TRUE OR FALSE.

A

True

43
Q

Clinical application of Creatinine except:

a. used to determine sufficiency of kidney function and the severity of kidney damage
b. To monitor the progression of kidney disease
c. Urinary creatinine excretion has been used as a measure of the completeness of mid-catch stream urine collections in a given individual

A

C (24 hour urine)

44
Q

a measure of the amount of creatinine eliminated from the blood by the kidneys, and GFR are used to gauge renal function

A

Creatinine clearance

45
Q

The methods most frequently used to measure creatinine are based on the ______

A

Jaffe reaction

46
Q

Creatinine reacts with ____ in _____ solution to form a ____ chromogen

A

picric acid, alkaline, red-orange

47
Q

Reference method for Jaffe reaction

A

Isotope Dilution Mass Spectrometry

48
Q

Jaffe reagent ___ and ____

A

saturated picric acid and 10% NaOH

49
Q

Interferences in creatinine are Folin-Wu & Lloyd or Fuller’s earth method. TRUE OR FALSE

A

true

50
Q

Which is correctly matched?
A. Lloyds reagent & (Sodium Aluminum Silicate)
b. Fuller’s earth reagent (Aluminum Magnesium Silicate)
c. Both A and B
d. Neither

A

C

51
Q

In Enzymatic Method of creatinine, it uses ____.

A

Creatinine Amidohydrolase Method & Creatinase-Hydrogen Peroxide Method

52
Q

Specimen used in creatinine

A

plasma, serum, urine,

53
Q

_____ samples should be avoided in creatinine test

A

Hemolyzed and icteric

54
Q 
Increase Creatinine Except:
A Impaired Renal function
b Chronic nephritis
c Muscular diseases
d CHF
e Decreased muscle mass
A

E

55
Q 
Decrease Creatinine Except:
a Decreased muscle mass
b Advanced and severe liver disease
c Chronic nephritis
d pregnancy 
e inadequate dietary protein
A

C

56
Q

The product of catabolism of the purine (Adenine and Guanine) nucleic acid, relatively insoluble in plasma and can be deposited in the joints and tissue.

A

Uric Acid

57
Q

Most uric acid is reabsorbed in the ____ and reused

A

PCT

58
Q

Final breakdown of nucleic acids catabolism in humans

A

Uric acid

59
Q

Plasma: 95% exists as _____ urate (Uric Acid)

A

monosodium

60
Q

Clinical Application of Uric acid EXCEPT:
A. To confirm diagnosis and monitor treatment of gout
B. To assist in the diagnosis of renal calculi
C. To prevent nephropathy during chemotherapeutic treatment
D. To assess inherited disorders of cystine metabolism

A

D

61
Q

involves the chemical reaction of uric acid with alkaline phosphotungstate in a protein-free solution with tungsten blue as the end product

A

Caraway Method

62
Q

simplest and most specific method, uses uricase to convert uric acid into allantoin; can be measured
spectrophotometrically at ___ nm or coupled with catalase or peroxidase

A

Uricase Method, 293

63
Q

Negative Interference of Uricase

A

Hemoglobin and Xanthine

64
Q

measure the hydrogen peroxide produced as uric acid is converted to allantoin

A

Coupled enzyme methods

65
Q

used to catalyze a chemical indicator reaction

Interference of coupled enzyme methods in uric acid is ____ and _____

A

Peroxidase or Catalase

Bilirubin & ascorbic acid

66
Q

Principle in chemical methods of uric acid

A

Reduction-Oxidation

67
Q

Sodium cyanide in Reduction-Oxidation

A

Folin, Brown, Newton, Benedict

68
Q

Sodium carbonate in Reduction-Oxidation

A

Archibald, Caraway, Henry

69
Q

Incubation period after the addition of an alkali to inactivate non-uric acid reactants

A

Lag phase

70
Q

Specimen used in Uric Acid 1.____ and 2.____ should be avoided

A

1 heparinized plasma, serum, urine

2 Gross lipemia

71
Q

may falsely decrease results in Uric Acid

A

High bilirubin concentration

72
Q

Significant hemolysis results in low values and salicylates and Thiazides increases values in Uric Acid. TRUE OR FALSE.

A

True

73
Q

EDTA or fluoride additives are NOT used in uric acid. TRUE OR FALSE.

A

True

74
Q

Urine specimens must be acidic in uric acid (pH5.5). TRUE OR FALSE.

A

False (alkaline, pH8)

75
Q

deficiency of hypoxanthine-guanine phosphoribosyl transferase (HGPRT); neurologic symptoms, mental retardation, and self-mutilation

A

Lesch-Nyhan syndrome

76
Q

first diagnosed between 3rd and 5th decade of life; pain and inflammation of the joints

A

Gout

77
Q

seen in leukemia, lymphoma, multiple myeloma or polycythemia. Treatment is allopurinol.

A

Increased nuclear metabolism

78
Q

due to decreased glomerular filtration rate and tubular secretion; >10mg/dL plasma UA which can cause urinary tract calculi

A

Chronic renal disease

79
Q 
TRUE OR FALSE.
HYPOURICEMIA: 
Hemolytic or megaloblastic anemia
Secondary to glycogen storage diseases
Toxemia of pregnancy and lactic acidosis
Increased dietary intake
Ethanol consumption
A

False (Hyperuricemia)

80
Q 
TRUE OR FALSE.
HYPERURICEMIA: 
Fanconi’s syndrome
Wilson’s disease
Hodgkin’s disease
A

False (Hypouricemia)

81
Q

Formed in the deamination of amino acids during protein metabolism and not useful for renal studies but for liver function

A

Ammonia

82
Q

Removed from the circulation and converted to urea in the liver and has its significance in impending hepatic coma and terminal stages of hepatic cirrhosis

A

Ammonia

83
Q

Free ammonia is nontoxic. TRUE OR FALSE

A

False (toxic)

84
Q

May result from anaerobic metabolic reactions that occur in skeletal muscle during exercise

A

Ammonia

85
Q 
Increase ammonia EXCEPT:
A Reye’s Syndrome
B Kidney failure
C cirrhosis
D hepatic coma
E acetaminophen poisoning
A

B

86
Q

monitor hyperalimentation therapy

A

Blood ammonia

87
Q

used to confirm the ability of the kidneys to produce ammonia

A

Urinary ammonia

88
Q

ammonia is isolated from the sample and then assayed

A

Two-step approach

89
Q

Specimen used in ammonia

A

Whole blood ammonia concentration

90
Q

Venous blood is placed on ice immediately. Samples should be centrifuged at 0°C to 4°C within 20 minutes of collection. Cigarette smoking is a significant source of ammonia contamination. Hemolysis should be avoided. TRUE OR FALSE. (AMMONIA)

A

True

91
Q

Anticoagulants used in ammonia

A

Heparin and EDTA

92
Q

The ammonia formed reacts with phenol and alkaline hypochlorite using sodium nitroprusside as catalyst to form indophenol blue (ammonia)

A

BERTHELOT’S REACTION

93
Q

ammonia formed when it reacts with the Nessler’s reagent in the presence of a colloidal stabilizer forms a colloidal suspension of dimercuric ammonium iodide (ammonia)

A

NESSLERIZATION
Yellow - low to moderate
orange brown - high

94
Q

Ammonium salts, asparaginase, barbiturates, diuretics, ethanol, hyperalimentation, narcotic analgesics

A

Increased plasma ammonia

95
Q

Diphenhydramine, Lactobacillus acidophilus, lactulose, levodopa, and several antibiotics

A

Decreased plasma ammonia

96
Q

Glucose at concentrations greater than __ mg/dL interferes in dry slide methods

A

600

97
Q

is a source of contamination leading to elevated levels

A

Smoking & Prolong standing

CC1 continuation (4 decks)

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