Part1 Flashcards
Where are casts formed?
Renal tubules
The body excretes how may grams of substrate a day? Half is what?
60 grams, 50% is urea
Most kidney stones are made with what kind of crystals?
Calcium oxalate (75%)
What is the initial and most common follow up for gallstones?
Expectant management
Cholesterol plates in the urine are usually indicative of what condition?
Hyperlipidemia
Which physical exam test would be positive with a patient with WBC casts in the urine?
Punch test (kidneys –> pyelonephritis
What could be the cause of post-hepative liver disease
Biliary tree obstruction
What is the normal color range for unwind?
Straw to amber (light yellow to dark yellow)
What does ketonuria indicate in non diabetic patients?
- Reduced carbohydrate metabolism and excessive fat metabolism
What are the steps when suspecting lytic metastasis as a cause for a pathological fracture due to findings on X-ray?
- Bone scan —> MRI —> Biopsy
Frothy urine due to
Proteins
Milky urine is associated with what?
Hyperlipidemia (risk factor for heart disease)
Urine may appear _______in nephrotic syndrome?
Frothy
Acidic urine is associated with what kinds of stones?
Xanthine, cysteine, Uric acid
What would conjugated bilirubin in the urine indicate?
Obstruction to flow of bile from liver (possible gall stones, tumor, pancreatic cancer, liver inflammation/infection)
What are the steps when suspecting MM as a cause for a pathological fracture due to findings on X-ray?
- PEP —> Skeletal Survey —> MRI —> Biopsy
Which form of bilirubin is pre hepatic?
Unconjugated
Orthostatic proteinuria is associated with what spinal change?
Exaggerated lumbar lordosis
What is the diagnosis for red, pink, smokey colored urine with increased RBC count?
Hematuria
What screening test is used to detect WBCs in urine?
Leukocyte esterase
Excess of what vitamin can cause bright yellow urine?
B vit
What are the federal regulatory standards that apply to all clinical lab testing performed on humans in the us? Except clinical trials and basic research?
CLIA
Diets high in citrus fruits and vegs are usually what (pH)?
Alkaline
What kind of UTI has a pH that you’d want to drink cranberry juice?
Alkaline (>7)
A feces odor of urine usually indicates what?
Enterobladderfistula or asparagus
Acidic pH is assocaited with what?
Respiratory acidosis (emphysema)
What is the primary indication of renal disease?
Proteinuria
Which are acid urine crystals?
Calcium oxalate, uric acid
What is the procedure used to measure the exact amount of Bence Jones proteins?
Immunoelectrophoresis
Why is it important to always analyze for proteinuria?
Primary indicator for renal disease
What is the term for when a patient presents with normal urine when supine and displays proteinuria when standing
Orthostatic proteinuria
What is the normal rage or urine a day?
600-2000ml/day
What is the function/purpose of specific gravity ?
To evaluate the kidneys ability to concentrate urine
What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, and no CRAB signs and symptoms?
Smoldering MM
What technically is SpG?
Weight of urine compared to distilled water
What is the Normal rage of specific gravity for urine in an adult?
1.015-1.035
What color froth is assoacited with proteins?
White
Milky urine is associated with what?
Hyperlipidema
If a patient presents with yellow and clear urine with moderate occult blood but WBC and RBC counts are normal, what is the issue?
Either microhemo- or micromyoglobinuria (due to no RBC elevation but present occult blood)
What condition is present with a serum M protein level less than 3g/dL,
- Monoclonal gammopathy of undetermined significance (MGUS)
How does liver/biliary tract disease affect liver enzyme amounts?
Increase
Hazy or cloudy Urine is due to/?
Infection
hat is the possible diagnosis of yellow colored urine and occult blood with normal RBC?
Micromyo- or micro-hemoglobinuria
What does a positive leukocyte esterase test indicate?
UTI
The functional unit of the kidney is?
Nephron
What binds to bilirubin to transport it to the liver to be conjugated
Albumin
What can cause black urine?
Alkaptonuria, melanin probs like malignant melanoma
Which crystals are seen in kidney stones with gout patients?
Uric acid
Occult blood in the urine with no elevation of RBCs following a heart attack would indicate what diagnosis?
Myoglobinuria
What color is urine when they are dehydrated from fever, vomiting and food like rhubarb?
Orange
More alkaline pH (>7) is associated with what?
Respiratory alkalosis
(Hyperventilation ) , UTI
What amount of sugar and ketones are normal in unkind?
None
Brownish yellow/green urine is associated with what?
Liver prob, check bilirubin and urobiliogen
What would cause brownish yellow green urine?
Liver probs so check biliburin and urobilinogen
What happens to turbidity and ph of urine that is unpreserved?
Increases
What percent of cardiac output perfuse the kidneys each min?
25%
Alkaline urine is associated with what kind of stones?
Calcium, carbonate, calcium carbonate, and magnesium phosphate stones
What do waxy, broad, and fatty casts indicate?
Chronic renal failure (NOT GOOD)
What is the diagnosis for red, pink, smokey colored urine with normal RBC count?
Myo- or hemoglobinuria
What is the test used for finding a monoclonal immunoglobulin in urine (aka looking for Bence-Jones proteins for a patient with suspected MM)?
- Protein electrophoresis (urine immunofixation
If a chiropractor chooses to do his lab work in his office what standards must be met for legalities?
CLIA AND OSA
Normal amounts of bilirubin and urobil in urine?
None and less than 1
What does a positive dipstick for proteinuria need to be confirmed with?
- Sulfosalicylic Acid Precipitation Test (SSA)
Pylonephritis is an infection of what park of the kidney?
Interstitum
a diagnosis of hematuria, which substance must be elevated in the blood?
RBCs (if not, then look to hemoglobinuria or myoglobinuria)
What is normal ph?
4.5-7.5
What type of UTI is usually self-limiting: lower or upper?
Low
Colorless urine is associated with what?
Diabetes insipidus or over hydration
If the history doesn’t indicate protein what does this tell us about a UTI?
It’s lower
What color froth is assocaited with levels of bilirubin ?
Yellow
RBC cast?
Glomerulonephritis
What is the term for neutrophils seen in the urine (WBCs undergoing phagocytosis), and what does it indicate?
Glitter cells; indicates UTI
What is the pain location for upper vs lower UTIs?
Upper = flank pain; Lower = lower back and pubic pain
What is the most common cause of hematuria due to glomerulonephritis?
Mismanaged strep
What is the oldest clinical lab procedure?
Urinalysis
What does red, pink or smoky tell us/
It’s not micro
What is the classic condition that causes hyperglycemia and glucosuria?
Diabetes mellitus
What time of day makes for the best urine sample?
Early morning
What does a positive nitrite test indicate with urine?
Bacteria present (enough gram negative bacteria to convert or reduce nitrates to nitrites)
What us the name for urine output over 2000 ml a day?
Polyuria
What kind of sickness is a common complication in patients with MM?
Respiratory inf
Where would kidney stones appear on a lateral X-ray?
Either overly vertebral bodies or be slightly anterior (because they’re retroperitoneal)
WBC cast?
Pyleonephritis
What would be the diagnosis with increased RBCs although there is no change in urine color (yellow)?
Microhematuria
What percent of urine is water?
95%
Where would gallstones be on an AP X-ray?
Right UPPER abdominal quadrant
Bilateral sacroilitis would be indicative of which group of pathologies?
Seronegative spondyloarthropathies like reactive/Reiter’s arthritis, enteropathic, and psoriatic
A fruity or sweet urine smell usually indicates what?
Diabetes mellitus or ketosis
Decreased SpG indicates what?
Glomerulonephritis (hematuria, blood casts), renal failure
What type of UTI (upper or lower) needs a consult right away?
Up
What is the “CRAB” mnemonic to remember signs and symptoms associated with MM?
Calcium (elevated), Renal failure/dysfunction, Anemia, Bone lesions
What is the term for urine output less than 500ml a day?
Oliguria
What are the 2 lower UTIs discussed?
Cystitis and urethritis
What does ketonuria indicate in diabetic patients?
Uncontrolled disease
Most amino acids are usually insignificant except for which 3, and what do they possible indicate?
Tyrosine, leucine, cysteine; indicative of severe liver disease
Nephrotic syndrome has what protein?
+4
WHAT 3 properties make up a routine UA?
Physical, chemical microscopic
High levels of what tell us its prostate cancer
?
Alkaline phosphatase
Feces order urine?
Enterobladder fistula
Proteinuria because of kidney disease usually indicates what?
Upper UTI
Why don’t bone scans contribute to a MM diagnosis
- Lack of osteoblastic activity
Which will detect Bence Jones proteins: routine UA or PEP?
Pep dumbass
what does yellow urine and occult blood tell us?
Either hemoglobinuria or myoglobinuria
What does isothenuria indicate?
Protein free plasma and end stage renal failure
What are the 3 probable causes of pathological fracture in order from most common to least common?
1: osteoporosis 2: lytic metastasis 3: multiple myeloma
Diet high in animal is usually more what (ph)?
Acidic
When acted on by bacteria, what is the byproduct of bilirubin
Urobilinogen
What is fixed SpG at 1.010?
Isosthenuria
What is the normal range for daily volume of urine?
600-2000 ml a day with an average of 1200-1500
Fruity, sweet urine is indicative of
?
Diabetes mellitus/ketosis
What bacteria is usually to blame for positive nitrates seen in urine?
E. coli (normal flora in the GI tract that becomes pathological elsewhere)
Which are alkaline urine crystals?
Amorphous phosphates, calcium carbonate, triple phosphate
What extra test should be run on all patients with a 4+ protein level?
- Bence Jones test (PEP
What color urine is found with dehydration from fever, vomiting, certain foods, and meds?
Orange
Is clear urine normal?
Yes
Is cystitis upper or lower urinary tract infection?
Lower
What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, AND CRAB signs and symptoms?
Tru emm
What happens do nitrites in underserved urine?
Increase
Does a negative nitrite test mean there’s absence of bacteria?
Not necessarily (sometimes UTIs can be caused by infections that don’t convert nitrate to nitrite and therefore aren’t detected on this test…examples = staph and strep)
When does filtrate become urine/
Distal convoluted tubule
What is the term for fixed SpG of urine at 1.010?? `
Isothenuria
