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IPA > Renal Labs > Flashcards

Renal Labs Flashcards

1
Q

what are the 3 types of urinalysis

A
  1. dipstick = fast / cheap
  2. microscopic = evaluates sediment
  3. culture - tells us about infection
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2
Q

what are the indications for a urinalysis

A

desire to know something about urinary tract/ metabolic function

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3
Q

difference between clean catch and random sampling in UA

A

clean catch= steps to limit contamination by skin bacteria (cleansing area, collecting mid stream)

random is used more for drug screening, etc where bacteria will not matter

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4
Q

when might you use a catheter to obtain a UA

A

to avoid menstrual blood OR

in pt that is unable to perform a clean catch on own

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5
Q

how quickly do UA samples need to be evaluated

A

right away or refrigerate

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6
Q

things analyzed on a UA

A

this is the order of what comes fastest to slowest

glucose
bilirubin
ketone
blood
pH 
protein
urobilinogen 
nitrite
leukocyte
specific gravity

NOT CREATININE

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7
Q

how do you analyze urine with microscope

A

assess color, clarity and then spin sample

poor off most fluid, resuspend sediment and examine with scope

looking for cells, casts, crystals, microbes

HPF x 400

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8
Q

when might you run a urine culture

A

if you suspect infection of urinary tract

you usually request the test for sensitives as well

sensitivity= shows what antibodies that bacteria will be killed by

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9
Q

how would you collect urine for a urine culture

A

clean catch or catheter

organisms grow on media

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10
Q

when interpreting a urine culture, what does high numbers mean

A

likely cause of infection

few or no colonies= infection not likely

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11
Q

what does proteinuria indicate

A

if persistent: renal disease

if transient: febrile illness, CHF, exercise

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12
Q

what are methods to obtaining proteinuria

A

UA dipstick - rough estimate
24 hour urinary protein- gold standard
protein to creatine ratio
microalbuminuria

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13
Q

what is 24 hour urine collection

A

collecting each void within a 24 hour time frame, should be kept in refrigerator or with preservatives

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14
Q

what are blood tests that you may order (esp when concerned about renal function

A

creatinine

BUN

(usually both included on either a CMP or BMP) metabolic panels

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15
Q

what does creatinine measure

how to collect

A

it is used as the estimation for glomerular filtration rate

to collect you need nonfasting blood draw OR urine sample

it is a breakdown product of creatine phosphate

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16
Q

when would it be indicated to get a creatinine measure

A

blood test: to evaluate renal status (acute/chronic)

urine= estimating proteinuria or calculating creatinine clearance

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17
Q

what does a high serum creatinine indicate

A

impaired renal funciton

also large spread muscle injury (rhabdomyolysis)

increased muscle mass

18
Q

what does a low serum creatinine indicate

A

decrease in muscle mass

19
Q

what is the general rule in regards to creatinine

A

doubling of creatinine in serum indicates a 50% decline in GFR

20
Q

BUN

  • indications
  • collection
A

Blood urea Nitrogen
indication: renal status evaluation or liver function

collection: nonfasting blood specimen

21
Q

what does a decreased BUN indicate

A

low= less urea made (liver failure, malabsorption/malnutrition) OR urea diluted (pregnancy, fluid overload)

22
Q

what does an elevated BUN indicate

A

if it is pre-renal cause= increased BUN before kidney
-causes: shock, hypotension, dehydration, CHF

if it is postrenal= increase BUN after kidney
causes= urinary tract obstruction

kidney disease= increases BUN

23
Q

what is GFR estimates not helpful for

A

acute RF

may be normal values despite severe disease

24
Q

what are types of azotemia

A
  1. prereneal: increased BUN before reaches kidney: shock, hypotension, dehydration
  2. postrenal: increased BUN after leave kidney. Urinary tract obstruction
  3. renal/intrinsic: kidney disease
25
Q

what test is used to measure GFR

A

creatinine clearance- estimates

insulin is ONLY used in research - direct measure

26
Q

how do you measure creatinine clearance

A

collect urine X24 hours and one blood draw for serum creatinine then perform calculations

mL/min

27
Q

when is it indicated to get creatinine clearance

A

evaluation of kidneys filtering ability needed

28
Q

collection of creatinine clearance

A

24 hour collection PLUS single nonfasting blood specimen

29
Q

interpretation of creatinine clearance results

what does a high one mean

what does a low one mean

A

high= not commonly encountered- exercise, preg, increased CO syndromes

LOW!
- impaired renal function and or impaired flow to kidney
need to adjust meds, dialysis considerations

30
Q

what equation is used to calculate the CrCl

A

cockcroft gault formula

takes into account age, weight (based on ideal body weight) and gender

31
Q

what is the BUN : CrCl ratio

why is it important

A

both freely filtered by glomerulus
but BUN is reabsorbed in tubules to be regulated

creatinine remains the same throughout so can compare the funciton of nephron

32
Q

if BUN: CrCl ration is >20:1 what does that indicate

A

pre renal

BUN reabsorption is increased
BUN is disporportionaly elevated relative to creatinine in serum

remember BUN measured with blood

33
Q

If 10-20: 1 BUN: CrCl what does that mean

A

normal or post reanal

34
Q

<10:1 BUN:CrCL ratio what does that mean

A

intra renal

renal damage reduces absorption of BUN therefore lowering the BUN:Cr ratio

35
Q

what is the gold standard for imaging the kidney

A

CT

36
Q

when doing a CT of the kidney you should not use contrast, why

A

contrast can cause nephropathy

must check creatinine / BUN prior to contrast

37
Q

what percentage of cardiac output goes to kidneys

A

20-25%

38
Q

pt with left side and back pain with blood in urine (urine dipstick positive) also nauseated

what do you suspect

A

ureterolithiasis

39
Q

for ureterolithiasis (kidney stones) what do you order

what if pt pregnant

A

CT of KUB (kidneys, ureters’, bladder)

gold standard

if patient is pregnant - renal ultrasound better option (no radiation)

40
Q

post surgery checkup, diagnosed with benign prostatic hypertrophy - surgery 5 weeks ago

catheter removed 2 weeks ago
not feeling well past week, back/side/groin pain and increased urgency/burning with urination
vitals reveal fever and increased heart rate

A

pyelonephritis

order a UA/culture before antibiotics
and prescribe antibiotics

41
Q

pt with LLQ abd pain and fever getting CT scan with oral and IV contrast

history of DMII (type 2 diabetes) and milk HTN controlled with diet and lisinopril

what do we need to know about kidneys before she is given IV contrast

A

creatinine clearance - make sure working okay
and BUN ???
then use equation
keep in mind female, ideal weight, age

42
Q

what is the CrCl equation

A

(140-age) X (weight)
/
SCr ni mg/dL X 72

multiply final value by 0.85 because female

IPA (14 decks)

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