Quizzes Flashcards
When should you perform a UA dip, what four things would make you perform a complete UA?
dip - with presenting urinary sx complete UA - if DIP has: positive: - protein - heme - LE or - nitrate
Early AM voids are best for (4)?
spec gravity
protein
TB
urine cytology
A random SG of greater than 1.020 is a good indication of what? if it’s less than 1.003, what should be suspect?
NO intrinsic KI dz
less than 1.003
KI dz
sickle cell dz
diabetes insipidis
What is optimal urine pH?
- 5
- alkaline urine can indicate renal failure*
what is the only reliable way to quantify proteinuria? what are other methods unreliable?
24 hour urine collection
IF protein loss is greater than 3.5 - nephrotic syndrome, GBM damage
- dip-sticks pick up albumin, not globulin, therefore globulins of Bence-Jones proteins (multiple myeloma pathognomonic) are missed
blood levels have to be greater than what for a dip to respond positive for glucose? what could lead to positive false readings?
170 mg/dl
- glucose will take Na and H2O with it, therefore causing:
polyuria
polydipsia - false positive due to: aspirin, nitrite, XS protein, oxidizing agents
this is useful in detection of asymptomatic urinary tract infections, and may be the only sign of pyelonephritis in women (esp when pregnant), elderly and kiddos. What is it? What is it picking up? And what can create a false positive?
Nitrite
picks up - conversion of nitrate to nitrite via coagulase splitting bacteria (MC e.coli)
false positive
- ascorbic acid
This urinary test is often the first indication of viral hepatitis - what is it/
Urobilinogen
This is seen in:
- increased fat metab with decrease CHO intake
- loss of CHO (vomit, diarrhea)
- inadequate CHO (starvation)
- increased metab (hyperthyroidism, fever)
Ketouria
- ketones are often useful in monitoring diabetics (proper insulin dose)
how do we define, pyuria?
pus in the urine
greater than 5 WBCs/hpf
- if EOS, think drug-induced interstitial nephritis
- TB causes sterile pyuria
When these are present, a specific type can indicate renal tubular damage - what are these, and what are the types (3)?
epithelial cells
- squamous - urethra, vaginal, clue cells*
- renal tubular epithelial - renal tubule, damage!
- transitional - considered normal, unless morphology is odd - cytology if so.
These are hallmark signs of nephrotic syndrome - what are they?
broad, waxy casts
- renal failure casts
These are pathognomonic of acute GN -or vasculitis - what are they?
RBC casts
What is the gold standard for measuring GFR?
inulin infusion
*GFR declines 13 ml/min/decade after the age of 45
This is an accurate and reliable measure of renal function WITHOUT the need for infusion, what is it?
endogenous creatinine clearance
- 24hr urine and serum samples
which test indicates GFR, but can also be useful in identifying GI bleeds?
BUN - blood urea nitrogen
BUN:creatinine can tell us some shit, what does it mean when it’s greater than 20:1, and what does it mean when it’s less than 10:1?
greater than 20:1
- PRERENAL ARF
less than 10:1
- RENAL damage
an increase of this electrolyte is indicative of renal cell carcinoma, which is it?
serum calcium
- also increases in those with renal stones
what imaging is the test of choice when suspicious of renal stones?
plain film of the abdomen
- poor soft-tissue contrast
This supplement can be protective of the KI when exposed to radiocontrast agents (which are associated with 0.5-1% ARF)
NAC
Doing this simple thing helps to decrease stone formation, decrease contact time for mutagens/carcinogens, and allow for increased flushing of pathogens - what is it?
regular water intake
- normal urination freq q1-2 hours (awake)
- optimal urine volume 2500ml/day
what two symptoms are related to micturation (the act of urination)
- irritative (urgency, frequency, dysuria, nocturia)
- obstructive (hesitancy, decreased force of stream, dribbling)
when there is dysuria, with fever, what should you have topping your DDX?
pyelonephritis
- generally painless unless CONCURRENT cystitis
- urethritis, cystitis and chronic prostatitis do NOT have fever
If you see this - you may be looking at ARF, fluid-ion imbalance OR BL urethral obstruction - what is this?
Oliguria (less than 500 ml/day) and/or
Anuria (less than 100 ml/day)
- REFER for immediate TX
This, in adults, is considered a sign of cancer until proven otherwise, what is it?
gross hematuria
- the degree of hematuria does NOT relate to severity - ANY RBC presence should be investigated.
- presence of gross, painless hematuria, often first manifestation of urothelial tumor
What is the bladder capacity for an adult? A child?
adult - 350-450ml
child: 1oz/yr of age, up to 5
If you palpate an enlgarged lymph node in the left supraclavicular region - what could this be indicative of?
tumor of testis/prostate
- further investigation NEEDED
a male 18-35 ptc with spontaneous swelling of the testis - what needs to be ruled out?
tumor
When you see edema with added urine findings of hematuria, RBC casts, lipiduria - where may this be coming from?
think glomerular disease
- nephrotic
- nephritic
Nephritic vs Nephrotic disease
Nephritic - PHAROH inflammatory process causing dysfunction - proteinuria - hematuria - azotemia - RBC casts - oliguria - HTN
Nephrotic
damage to BM as end result of various dz
KEY: SEVERE PROTEINURIA ( greater than 3.5g/24hr) leads to systematic edema*
- foamy urine
What are the 3 classifications for nephritic syndrome?
- Post-infectious (MC group A beta hemolytic strep) PSGN “nephrotoxic strep”
- autoimune (SLE, goodpasture’s, amyloid)
- Primary KI dz - IgA nephropathy
What color urine would you expect to see in glomerular disorders?
- dark red, brown, cola-colored
proteinuria, edema, HTN, URI hx, fever, rash, reduced renal fxn
