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Clinical Laboratory Medicine > Quiz #2 > Flashcards

Quiz #2 Flashcards

1
Q

Erythropoietin

A

Hormone released in response to hypoxia in renal circulation and stimulates erythropoiesis in the bone marrow

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2
Q

Renin

A

Enzyme that breaks down angiotensinogen to

angiotensin I

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3
Q

Calcitriol

A

Increases blood calcium by promoting intestinal absorption of calcium and increasing renal tubular reabsorption of calcium

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4
Q

Renal disease lab findings:

A

Increased serum blood urea nitrogen (BUN) and
serum creatinine

Decreased creatinine clearance

Oliguria (

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5
Q

Blood Urea Nitrogen:

A

Measures the amount of urea nitrogen in the blood

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6
Q

BUN depends on:

A

GFR
Diet protein intake
Tissue metabolism
Proximal tube reabsorption

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7
Q

Increased BUN cause:

A 
CHF
Renal Failure
Shock, burns, etc.
Excessive protein intake
GI Bleeding
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8
Q

Decreased BUN cause:

A

Malnutrition
Liver failure
Pregnancy, SIADH

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9
Q

Azotemia:

A

Nitrogen retention seen with elevated BUN

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10
Q

Chronic Renal Failure (CRF):

A

> 3 months deterioration in renal failure

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11
Q

Uremia:

A

end-stage renal failure

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12
Q

Serum Creatinine:

A

Waste product in the blood that comes from muscle activity

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13
Q

Acute Kidney Injury:

A

Azotemia (elevated BUN and creatinine)

Either pre renal, renal, or post renal

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14
Q

BUN/Cr ratio:

A

Prerenal (>20:1)

Renal (

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15
Q

AKI biomarkers:

A

Serum and urine cystatin C
Neutrophil gelatinase-associated lipocalin
(NGAL)
Kidney injury molecule 1 (KIM-1)
Interleukin 19 (IL-18)
N-acetyl-glucosaminidase
Liver fatty acid-binding protein (L-FABP)

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16
Q

Serum Cr:

A

Increased: Renal disease, hypovolemia & tissue necrosis

Decreased: Debilitation, decreased muscle mass, Pregnancy, SIADH

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17
Q

Creatinine Clearance (CCr):

A

Volume of blood plasma that is cleared of creatinine per unit of time and is a useful measure for approximating the GFR

Cockcroft-Gault formula

Detects renal dysfunction

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18
Q

GFR:

A

Volume filtered from the kidney glomerular capillaries into the Bowman’s capsule per unit of time

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19
Q

Relationship between GFR and Creatine:

A

Inverse

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20
Q

Urine Osmolality (Uosm):

A

Evaluates the concentrating ability of kidney

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21
Q

Urine Osmolality (Uosm):

A

Increased: SIADH, Dehydration

Decreased: Diabetes Insipidus (diuretic effect), Excessive hydration

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22
Q

Urinalysis components:

A 
1. Physical examination 
• Color
• Clarity
• Specific gravity 
• Volume
• Odor
2. Chemical examination (Reagent strip) 
3. Microscopic examination
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23
Q

Urine color:

A
  • Normal – yellow or amber
  • Dark yellow – ? Dehydration
  • Colorless - ? dilute urine or polyuria
  • Red or red-brown – blood or hemoglobin
  • Dark brown or black – alkaptonuria or malignant melanoma
  • Yellow-brown to yellow-green -Bilirubin or bile pigments
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24
Q

Urine clarity:

A

Normal – clear or transparent

Cloudy/Turbid – possible bacteria or alkalinity

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25
Q

Urine odor:

A

Fruity or sweet odor – diabetic ketoacidosis

Ammoniacal odor – long standing urine

Pungent odor – urinary tract infections

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26
Q

Urine volume:

A

-Oliguria – decrease in normal daily urine output
-Dehydration, burns, diarrhea, vomiting
-Anuria – cessation of urine flow
-Serious damage to the kidney
-Nocturia – increase in the nocturnal excretion of
urine
-Polyuria – increase in the daily urine output ▪ Diuretics, Diabetes mellitus, diabetes insipidus

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27
Q

Urine Specific Gravity:

A

Measure of the weight of solutes in water in the urine

Gives insight into hydration

High: glycosuria, SIADH

Low: Diuretic use, decreased ADH

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28
Q

Specific gravity ranges:

A

Desirable Range: 1.010-1.025

Normal Range: 1.005 to 1.030

1.020 indicates relative dehydration

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29
Q

How to measure specific gravity:

A

Urinometer: weighted with mercury

Refractometer: handheld; measures refractive index

Reagent dipstick: Measures the concentration of ions and gives an indirect measure of specific gravity

30
Q

Urine collection time:

A

Morning: urine is concentrated

Midstream is preferred

Should be examined within 1 hour; refrigerate it cannot

31
Q

Urine osmolality ranges:

A

> 850 mOsm/kg (with 12-14 hr fluid restriction)

50-1200 mOsm/kg (random, depending on fluid intake)

32
Q

Reagent Strip is used to determine:

A
  • pH
  • Specific Gravity
  • Protein
  • Glucose
  • Ketones
  • Bilirubin
  • Nitrites
  • Leukocyte Esterase
33
Q

Urine pH:

A

Measure of the kidney’s ability to preserve normal hydrogen ion concentration in maintenance of acid-base balance

34
Q

Normal urine pH:

A

Desirable Range: 6-6.5
Normal Range: 4.5-8

More acidic: cranberries, high protein

More alkaline: citrate, vegetables, dairy products

35
Q

Persistant urine alkaline urine pH suggests:

A

UTI (pH 7-8)

36
Q

Persistent acidic urine (pH 5-6) suggests:

A 
Acidosis
Diabetes Mellitus
Starvation
Diarrhea
Uric acid calculi
Drugs (ammonium chloride)
37
Q

Urine protein:

A

Sensitive indicator of glomerular and tubular renal function

Normally,

38
Q

Microalbuminuria:

A

excretion of 30-150 mg of protein daily

39
Q

Proteinuria:

A

excretion of > 150 mg of protein daily (10-20 mg/dL)

40
Q

Urine protein ranges:

A

Normal = trace

Abnormal = 
1+: 30 mg of protein per dL  
2+: 100 mg/dL
3+: 300 mg/dL
4+: 1,000 mg/dL
41
Q

Urine protein causes:

A

Transient proteinuria - CHF, stress, exercise

Persistent proteinuria - Diabetes, drugs, malignancies (multiple myeloma = Bence-Jones protein)

42
Q

Urine ketones (ketone urea):

A

Ketones are the products of fat metabolism

Causes: Diabetic ketoacidosis, fasting/starvation, carbohydrate-free diets (Atkins), pregnancy

43
Q

Urine blood (hematuria):

A

Either lysed or intact RBC

Normal = negative

  • Menses, vigorous exercise, anticoagulation therapy
  • Myoglobinuria – rhabdomyolysis, myocardial infarction
  • Hemolytic anemia, infections, calculi, tumors
44
Q

Bilirubinuria:

A

Normal = negative

  • Liver disease (hepatitis, cirrhosis)
  • Obstructive biliary tract disease
45
Q

Urine urobilinogen:

A

normal = negative or trace

Conjugated bilirubin in the intestinal tract is converted by bacterial action to urobilinogen

46
Q

Increased urine urobilinogen causes:

A

Any condition that causes an increase in the
production in bilirubin (ie. hemolytic anemia)

Any disease that prevents the liver from normally removing the reabsorbed urobilinogen from the portal circulation (i.e.. CHF, infectious or toxic hepatitis)

47
Q

Decreased urine urobilinogen causes:

A

Any process that decreases bilirubin in the stool

Diminishing liver function

Obstruction of the bile ducts (cholelithiasis)

Antibiotics - decreased intestinal flora

48
Q

Urine nitrites:

A

Rapid screen for the detection of bacteria that are capable of reducing nitrates to nitrites (E. coli)

Positive = >10,000/mL

49
Q

Urine nitrite tests:

A

Test is highly specific but not highly sensitive

50
Q

Urine Leukocyte Esterase:

A

Test that indicates whether white blood cells are present in the urine

Cystitis, Pyelonephritis, Urethritis (STI)

Normal = negative

51
Q

Tests to confirm:

A

Ictotest – bilirubin (purple)
Clinitest – glucose
Sulfosalicylic acid – protein (hazy)
Acetest – Ketones (purple)

52
Q

Urine microscopy viewing:

A

Scanning lens 10x X 4x = 40x Low power 10x X 10x = 100x High power 10x X 40x = 400x

53
Q

Urine microscopy findings:

A

Cells & Cellular Elements Crystals
Casts
Bacteria

54
Q

Urine microscopy specimens:

A

Fresh sample of 10-15 mL of urine is centrifuged
at 1,500-3,000 rpm for 5 minutes

Take out supernatant

Use single drop

55
Q

Urine microscopy staining:

A 
-Sternheimer-Malbin stain
     Cells and casts 
-Toluidine blue
     Differentially stains various    cell components 
-Sudan III or oil red O stain
     Stains lipids
-Prussian blue stain
     Hemosiderin (iron)
56
Q

Cellular findings:

A

Squamous epithelial cells - not a clean catch

Clue cells - Squamous epithelial cells covered with bacteria Gardenerella vaginalis

Trichomonas vaginalis - Sexually transmitted
urogenital parasite (1 to 2 times larger that WBC, rapid erratic movement)

Fungus - Vaginal candidiasis

Bacteria

57
Q

Urine Crystals:

A

Commonly found in urine sediment

Rarely clinically significant

Reported as few, moderate, many, or too numerous to count (TNTC)

58
Q

Normal crystals in acidic urine (urates):

A

Uric acid crystals
Amorphous urates
Calcium oxalate crystals

59
Q

Urine crystals, amorphous:

A

Yellow-brown granules

Often found in clumps

60
Q

Urine crystals, Calcium oxalate:

A

Common cause
of urolithiasis

One of the toxic effects in ethylene glycol poisoning

61
Q

Urine crystals, uric acid:

A

Yellow to red to orange in color

Appear in many shapes

62
Q

Normal alkaline urine crystals:

A

Triple phosphate - Coffin lid appearance

Calcium phosphate - Large flat-shaped plates or wedge shaped prisms, rosettes

Ammonium bitrate crystals - “Thorn apple” shape, yellow-brown

Calcium carbonate crystals - Small colorless granules
or dumbbells

63
Q

Abnormal crystals in acidic or neutral urine:

A 
Cystine crystals
Cholesterol crystals 
Leucine crystals
Tyrosine crystals
Bilirubin
64
Q

Urinary Casts:

A

Formed in distal and collecting tubules

Only a few hyaline or granular casts are normal

65
Q

Normal urinary casts:

A

Hyaline casts

Granular casts

66
Q

Abnormal urinary casts:

A

Cellular casts:
-Red blood cell casts
Signify glomerular disease
-White blood cell casts
Associated with pyelonephritis and infection
-Renal tubular epithelial cell casts
Tubular diseases like tubular necrosis or drug toxicity

Acellular cast:
-Waxy cast
Seen in severe renal failure

67
Q

Urine Hemosiderin:

A

Protein that stores iron

Normal result: negative

Appears as a dark yellow-brown pigment

Positive:
Hemochromatosis
Chronic hemolytic anemia
Paroxysmal nocturnal hemoglobinemia

68
Q

Urinary Pregnancy Tests:

A

Human chorionic gonadotropin (hCG)

Tests look for beta subunit or hCG in blood or urine

69
Q

Urine pregnancy test results:

A

Negative: 25 IU/L

Home pregnancy test, should be done first thing in the morning

70
Q

Urine pregnancy test results:

A

False negative:

  • Testing done too early
  • Test has too high hCG detection threshold
  • Medications: diuretics and promethazine

False positive:

  • Medications containing the hCG molecule
  • Non-pregnant production of the hCG molecule
  • Medications (chlorpromazine, phenothiazines, methadone)
  • Tests read after the suggested reaction time
71
Q

Urine pregnancy tests, conditions that may produce elevated hCG:

A
  • Testicular tumors
  • Ovarian germ cell tumors
  • Choricocarcinoma
  • Gestational trophoblastic disease
72
Q

hCG Blood tests:

A

Qualitative:
Urine: 20-50
Blood: 5-10

Quantitative:
Can detect as low as 1 IU/L

Clinical Laboratory Medicine (4 decks)

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