Renal System Part 1

Question 1

The functional unit of the kidney is the _____

Answer 1

nephron

Question 2

How many nephrons per kidney?

Answer 2

1 million

Question 3

A nephron is composed of:

Answer 3

Glomerulus
Proximal Tubule
Loop of Henle
Distal tubule
Collecting duct

Question 4

The proximal tubule absorbs large amount of?

Answer 4

H2O, Glucose, uric acid, Na, Cl, HCO3

Question 5

Loop of Henle absorbs?

Answer 5

Na, Cl, H2O

Question 6

Distal tubule controls excretion of?

Answer 6

Na, K, HCO3, H

Question 7

Collecting duct regulates?

Answer 7

Amount of water in urine

Question 8

What 3 labs are tests of renal function?

Answer 8

BUN
Creatinine
Urinalysis

Question 9

What is BUN?

What is its normal range?

Answer 9

Blood urea nitrogen

8-20mg/dl

Question 10

BUN is a marker of?

Answer 10

Protein metabolism

Question 11

Creatinine is a product of?

Answer 11

Skeletal muscle contraction

Question 12

Daily production of Cr depends on?

Answer 12

Muscle mass

Question 13

Normal range for Cr?

Answer 13

0.5-1.1

Question 14

A doubling of Cr corresponds to a ___ decrease in renal function

Answer 14

50%

Question 15

What two groups would you expect to see lower creatinine levels assuming no renal disease?

Answer 15

Females

Spinal cord injuries

Question 16

What is the most accurate test of glomerular filtration rate?

Answer 16

Insulin filtration rate

Question 17

What test is ordered most often to for glomerular filtration rate?

Answer 17

CrCl (creatinine clearance)

Question 18

Normal CrCl?

Answer 18

90-140ml/min

Question 19

What tests are required to detect CrCl?

Answer 19

24 hour urine and serum creatinine drawn within 24 hours of urine collection

Question 20

If your patient refuses a 24 hour urine, what can you use to estimate a CrCl?

Answer 20

Cockroft-Gault or MDRD equations

Question 21

To calculate a Cockroft-Gault, what measurements do you need?

Answer 21

Age, weight, and serum Cl

Question 22

To calculate an MDRD, what measurements are neccessary?

Answer 22

Age, sex, ethnicity, plasma Cr (PCr)

Question 23

What is measured in a unrinalysis?

Answer 23

Specific gravity, pH, glucose, protein, ketones, blood, bilirubin, nitrite, and leukocyte esterase

Question 24

Normal urine pH?

Answer 24

4.5-8

Question 25

Alkalinic urine can be a sign of?

Answer 25

UTI or renal tubular defects

Question 26

Normal specific gravity?

Answer 26

1.010-1.025

Question 27

A high specific gravity can indicate _____, while a low specific gravity can indicate _____.

Answer 27

Concentrated (dehydration) | Dilute (renal failure, over hydration)

Question 28

What ion is the main contributor to specific gravity?

Answer 28

Na

Question 29

Normal urine ketones measure as _____

Answer 29

negative

Question 30

Name a few populations that may have ketonuria?

Answer 30

Uncontrolled diabetics Ketoacidosis patients High protein diets Patients with excessive vomiting and dehydration

Question 31

Urine glucose is normally negative unless plasma glucose is above ____

Answer 31

250-300

Question 32

Suspect ______ ______ in a patient with proteinuria and edema

Answer 32

Nephrotic syndrome

Question 33

Bilirubin and urobilinogen would be elevated in what conditions?

Answer 33

Liver damage | Obstruction of bile duct

Question 34

Causes of false negatives for blood in the urine?

Answer 34

Myoglobin | High doses of Vit C

Question 35

What S/S should make you think of bladder carcinoma?

Answer 35

Painless hematuria with history of smoking

Question 36

When suspicious of a UTI, what value will likely detect presence of WBCs?

Answer 36

Leukocyte esterase

Question 37

How does urine nitrate help in diagnosis of UTIs?

Answer 37

Bacteria produce nitrate reductase, which converts nitrate to nitrite.

Question 38

What type of bacteria commonly produce reductase?

Answer 38

Gram negative organisms

Question 39

A patient taking pyrimidine presents for UTI symptoms. Her UA is + for nitrite. Is this enough to diagnose a UTI?

Answer 39

No, the color of urine interferes with the nitrite test. Pyrimidine (Azo) is a drug that interferes with urine color.

Question 40

Sterile pyruia should make you think of?

Answer 40

TB

Question 41

UA with RBCs should make you think of?

Answer 41

Infection, renal calculi

Question 42

UA with eosinophils should make you think of?

Answer 42

interstitial nephritis.

Question 43

Urinary casts are formed in the _____

Answer 43

Distal and collecting tubules

Question 44

Casts present after exercise or chronic renal failure?

Answer 44

Hyaline

Question 45

Casts present during glomerulonephritis or SBE(subacute bacterial endocarditis??)?

Answer 45

Red cell casts

Question 46

What casts would you expect to be present during pyelonephritis?

Answer 46

White cell casts

Question 47

What cell casts would you expect to be present during tubular necrosis?

Answer 47

Epithelial cell casts

Question 48

What cell casts would you expect to be present during nephrotic syndrome, lead toxicity, or glomerulonephritis?

Answer 48

Granular cell casts

Question 49

What cell casts would you expect to be present during renal failure/acute tubular necrosis?

Answer 49

Waxy cell casts

Question 50

Crystal in urine should make you suspicious for?

Answer 50

Stones