Urinalysis

Question 0

Joanne has chronic kidney disease with a GFR of about 20 ml/min. What is the specific gravity of her urine?

a. 1.010
b. 1.035
c. 1.005
d. 1.020

Answer 0

a. 1.010

Question 1

in the urine dipstick, ___ is isoosmolar

less is ___ and more is ___

Answer 1

1.010
hypotonic
hypertonic

Question 2

what happens in renal tubular acidosis with a LOW pH?

Answer 2

• loss of proximal tubule HCO3 reabsorption

- collecting duct can still acidify/secrete

Question 3

what happens in renal tubular acidosis with a HIGH pH?

Answer 3

-the collecting duct is unable to secrete acid/generate an H-gradient

Question 4

the filtration barrier of the kidney usually filters out things that are bigger than ___ kDa

Answer 4

40

Question 5

where are proteins reabsorbed?

Answer 5

the proximal tubule

Question 6

how much glucose can the kidney reabsorb?

Answer 6

about 180

Question 7

how does the dipstick measure cells?

Answer 7

only by measuring cell products like leuk esterase and hemoglobin

Question 8

how many RBCs are in a normal urine sample?

Answer 8

0-3

Question 9

how many WBCs are in a normal urine sample?

Answer 9

0-5

Question 10

if you see…

• a dipstick hemoglobin positive but no RBCs
• or many bacteria but no WBCs
• or many amorphous crystals
• -what is going on?

Answer 10

old urine specimen

Question 11

what does it mean if there are dysmorphic RBCs in the urine?

Answer 11

there is a glomerular problem (they are getting injured as they squeeze through)

Question 12

hyaline casts

Answer 12

non-pathogenic, clear

Question 13

granular casts

Answer 13

non-specific, if there are a lot it can mean there is acute tubular necrosis/acute kidney injury

Question 14

WBC casts

Answer 14

• pyelonephritis

- interstitial nephritis

Question 15

epithelial cell cast

Answer 15

-seen in acute kidney injury

Question 16

active sediment

Answer 16

RBCs and WBCs in the urine, signifies acute glomerular nephritis

Question 17

what does bacteriuria with a big squamous cell suggest?

Answer 17

contamination (not concerned about UTI unless there are symptoms)

Question 18

what do triple phosphate (struvite) crystals look like?

Answer 18

coffin lid

Question 19

what do urate crystals look like?

Answer 19

• birefringent

- rhomboid or rosettes

Question 20

what do cystinuria crystals look like?

Answer 20

hexagonal

Question 21

what do indinavir crystals look like?

Answer 21

brushy

Question 22

what do calcium crystals look like?

Answer 22

envelope, dumbell shape

Question 23

what measurement is used to stage diabetic nephropathy and predict CV risk?

Answer 23

albumin

Question 24

what do we measure to predict stone risk?

Answer 24

calcium salts, urate, citrate

Question 25

what does a low fractional excretion of Na mean?

Answer 25

-you are reabsorbing sodium because you are dehydrated

Question 26

what is urine sodium if you have a pre-renal problem? what about acute kidney injury?

Answer 26

<20, >40 mEq/L

Question 27

FE Na in pre-renal problem? what about acute kidney injury?

Answer 27

<1%, > or = 1%

Question 28

FE Urea in pre-renal problem? what about acute kidney injury?

Answer 28

<35%, >50%

Question 29

UrineCr/PlasmaCr in pre-renal problem? what about acute kidney injury?

Answer 29

> 40, <20

Question 30

what is the normal protein/Cr ratio?

Answer 30

< 150 mg/g

Question 31

what is a normal albumin/Cr clearance?

Answer 31

<30 mg/day

Question 32

what is microalbuminuria?

Answer 32

albumin/Cr clearance of 30-299

Question 33

what is macroalbuminuria?

Answer 33

albumin/Cr clearance of >300

Question 34

what is the recommended daily intake of sodium? how much comes out in the urine?

Answer 34

2300 mg, pretty much all of it

Question 35

what is a normal protein /day?

Answer 35

<300 mga

Question 36

what is a normal creatine clearance?

Answer 36

90-130 ml/min

Question 37

NGAL (neutrophil gelatinase associated lipocalin)

Answer 37

a marker that can demonstrate acute kidney injury earlier than creatinine
-not certain clinical application