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PT: Nutrition Exam 2 > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What is the excretory function?

A
  1. Elimination of a toxic and waste products (urea, etc.)
    Excretion = filtration + secretion - reabsorption
  2. Electrolyte, fluid, & Acid/Base Balance
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2
Q

What is the endocrine function (renal)?

A
  1. Erythropoietin

2. Renin

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3
Q

What is the renal metabolic function?

A
  1. Vitamin D activation
  2. Gluconeogenesis
  3. Insulin and Steroid metabolism
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4
Q

What circulatory aspects are part of the urinary system?

A
  1. Oxygenated: Aorta, renal arteries, afferent arterioles
  2. Glomerulus
  3. Deoxygenated: efferent arterioles, renal veins, inferior vena cava
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5
Q

What are the aspects of the urinary collecting system?

A

ureter, bladder, urethra

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6
Q

How many nephrons are in the kidney?

A
  1. 1 millon (2 million total)
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7
Q

What is the rate of blood flow into the kidney?

A

1 liter/minute
125 mL/min are filtered
0.8 mL/min are urine

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8
Q

What are the components of the nephron?

A
  1. Bowman’s capsule (Glomerulus–Filters size/charge)
  2. Proximal tubule (reabsorption)
  3. Loop of Henle (Na, water flux)
  4. Distal convoluted tubule (ALD)
  5. Collecting Duct (ADH)
  6. Ureter, Bladder, Urethra
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9
Q

What is the capacity of the bladder?

A

400 mL

@ 150 mL micturition sensation will occur

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10
Q

How long is the urethra in the male/female respectively?

A
  1. Male = 24 cm

2. Female = 4 cm

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11
Q

How can you assess how well the kidneys are working?

A
  1. Clinical S/S

2. Laboratory evidence (excretory, metabolic, endocrine)–Serum Creatinine

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12
Q

Why would you assess renal function?

A
  1. To dx renal disease
  2. To monitor disease progress
  3. To monitor response to treatment
  4. To find changes in function that may impact drug therapy
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13
Q

What GFR results in ‘kidney damage with normal or increased GFR’?

A

> 90 mL/min/1.73m2 (most prevalent)

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14
Q

What GFR results in ‘kidney damage with small decrease in GFR’?

A

60-89 mL/min/1.73m2 (2)

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15
Q

What GFR results in ‘kidney damage with moderate decrease in GFR’?

A

30-59 mL/min/1.73m2 (3)

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16
Q

What GFR results in ‘kidney damage with large decrease in GFR’?

A

15-29 mL/min/1.73m2 (4)

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17
Q

What GFR results in ‘kidney failure with need for dialysis’?

A

<15 mL/min/1.73m2 (5)

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18
Q

As creatinine clearance gets smaller what do you need to do to the dosage of drugs?

A

Decrease the dose or spread out the interval

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19
Q

How can you define renal function?

A
  1. GFR: the volume (mL) of plasma completely cleared of a substance per unit of time (min)
  2. Clearance
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20
Q

How many L of blood does that adult body filter per day?

A
  • 180 L*
  • 1.5 L are excreted
  • 99% reabsorbed
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21
Q

What different variables can affect ‘renal function’?

A
  1. Renal blood flow
  2. Hydrostatic/Oncotic pressures across the glomerulus
  3. Integrity of the glomerulus
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22
Q

When completing a physical exam what clinical evidence would support renal dysfunction?

A
  1. Edema, Skin turgor
  2. Fontanelle, membranes
  3. weight
  4. intake/output
  5. BP/Pulse
  6. Pulmonary auscultation
  7. JVD
  8. Bladder palpation
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23
Q

What patient complaints with warrant clinical evidence of renal dysfunction?

A
  1. Voiding habits
  2. Force of stream
  3. Pain
  4. SOB
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24
Q

What is an ‘ideal renal function test’?

A

Desired properties
1. Reflects glomerular filtration
(100% filtered, no secretion, no reabsorption)
2. Not influenced by other disease states
3. Easy to obtain

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25
Q

How can you quantify renal function?

A

Insulin, dyes, radio-labeled compounds

Accurate… but expensive, time consuming, and impractical (research only)

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26
Q

What is a BUN?

A

Blood urea nitrogen

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27
Q

What are the limits of BUN?

A
  1. Filtered then 50% reabsorbed
  2. Protein intake
  3. Liver function (AA to NH4+ to urea)
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28
Q

What is the normal SCr level of male/femal respectively?

A
  1. Adult Male: 0.9-1.3 mg/dL
  2. <19 y Male: 0.4-1.3 mg/dL
  3. Adult Female: 0.6-1.1 mg/dL
  4. <19 y Female: 0.4-1.3 mg/dL
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29
Q

Given ____, CrCl can be approximated.

A
  1. [SCl]
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30
Q

____ is a proxy for CFR

A

CrCl

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31
Q

What are the physiological limitations of SCr?

A
  1. Cr is 90% filtered and 10% secreted by tubules
  2. Variable muscle mass
    - Sex, Age, Health
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32
Q

What are other limitations of SCr?

A
  1. Changing renal function
  2. Diet (protein meal)
    - best in AM
  3. Concomitant drug therapy
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33
Q

How do the kidneys handle SCr?

A
  1. Tubular secretion– Min effect = 10% & increased proportion as filtration increases
  2. Drugs & Cr compete for secretion
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34
Q

What can effect Cr entry (Crin) physiologically?

A
  1. Sex, Age, Health, Habitus, Diet
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35
Q

What can effect CrCl physiologically?

A

Tubular secretion & medications

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36
Q

What are the limits to measured CrCl?

A
  1. Tubular Secretion
  2. Sample Loss
  3. Time (24 hours)
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37
Q

What is the Cockcroft & Gault equation for estimated CrCl?

A

(140 - age) x Weight / (SCr x 72) = mL/min

FOR ADULT WOMEN MULTIPLY RESULT BY 0.85

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38
Q

What are the limitations of the Cockcroft/Gault equation?

A
  1. Not for peds!
  2. Unreliable with rapidly changing renal function
  3. Muscle mass should be considered (Obesity over estimates, cachexia)
  4. Drugs may alter secretion
  5. Diminished MM with elderly and malnourished
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39
Q

How can you estimate CrCl in kids?

A
  1. Traub equation

2. Schwartz equation

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40
Q

What are the different renal function tests?

A
  1. Inulin (best accuracy)
  2. Iothalamate (better accuracy)
  3. 24-hour CrCl (good accuracy)
  4. SCr (with equations) (best-ish accuracy)
    Increasing Clinical Use
    Decreasing Cost
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41
Q

What conditions may yield a “falsely” low SCr, and thereby a falsely elevated calculated estimate of CrCl?

A

GFR appears better than it truly is

  1. Diminished muscle mass
  2. tubular secretion of Cr (@ low GFR)
42
Q

What are the advantages of a random urine collection?

A

collect anytime, convenient for patient & examiner

43
Q

What are the advantages of a first void urine collection?

A

best for chemical and microscopic examination

44
Q

What are the advantages of a 24-hour urine collection?

A

quantify urine substances

45
Q

What are the advantages of a fasting urine collection?

A

glucose metabolism

46
Q

What are the advantages of a post-prandial urine collection?

A

glucose metabolism

47
Q

What are the advantages of a post-void residual urine collection?

A

evaluated residual urine in bladder after voiding (work-up of obstruction/incontinence)

48
Q

What is the normal urine output of an adult?

A

1.2-1.5 L/day

49
Q

What constitutes polyuria? Why?

A
  1. > 2,000 mL/day

2. Water vs. solute

50
Q

What constitutes nocturia?

A

polyuria at night

51
Q

What constitutes oliguria? Why?

A
  1. < 400 mL/day (Peds <0.5 mL/kg/hr)

2. Pre-renal, intrinsic, post-renal

52
Q

What constitutes anuria?

A

complete absence of urine production

53
Q

Yellow urine

A

urochrome

54
Q

Green urine

A

infection/drug

55
Q

Pink/red urine

A

blood/drug

56
Q

orange urine

A

bili/drug

57
Q

foam urine

A

protein (albumin)

58
Q

faint odor urine

A

normal

59
Q

strong ammonia odor urine

A

bacteria convert to urea

UTI

60
Q

fruity odor urine

A

ketones (fat metabolism)

61
Q

What does a positive test for nitrates imply?

A

bacteria presence due to bacterial enzymes reducing nitrate to nitrite
false (-)/false (+) possible

62
Q

What is the normal pH of urine?

A

4.5-8 (help to confirm not dx)

63
Q

What does acidic urine imply?

A

metabolic acidosis, DM, dehydration, diarrhea, gout, respiratory acidosis, UTI

64
Q

what does alkaline urine imply?

A

metabolic alkalosis, respiratory alkalosis, UTI, acute/chronic renal failure, RTA, diuretics, alkaline drugs (bacteria produce NH4+ with increase pH)

65
Q

what are the normal protein-urine levels?

A
  1. < 150 mg/day

2. Albumin < 30 mg/day

66
Q

what would constitute microalbuminuria?

A

30 to 300 mg/day

consider albumin:creatinine ration in urine

67
Q

what would constitute albuminuria?

A

> 300 mg/24 hours

68
Q

what would constitute proteinuria?

A

> 500 mg/day

Ranges from trace to 4+

69
Q

What is the etiology of pre-renal proteinuria?

A

Overflow–increased plasma proteins

hemoglobinuria: hemolysis (casts)
myoglobinuria: myolysis (casts)

70
Q

What is the etiology of renal/glomerular proteinuria?

A

selective glomerular <1 gm/day

-membrane is intact but charge is lost

71
Q

What sorts of diseases can cause proteinuria?

A
  1. Autoimmune (glomerulonephritis)
  2. Systemic Disease (DM, Lupus)
  3. Drugs (Li)
72
Q

What happens in nonselective glomerular proteinuria?

A
  1. glomerular barrier seriously compromised
  2. massive amounts of protein (casts)
  3. lipid bodies may also pass into urine
  4. patient will have systemic complaints (edema, etc.)
  5. Disease states (glomerulonephritis)
73
Q

What is the etiology of renal/tubular proteinuria?

A
  • Tubular injury secondary to antibiotics
  • Loss of proteins normally filtered then reabsorbed
  • Disease states/Drugs
74
Q

What is the etiology of post- renal proteinuria?

A
  • Urinary tract proteins (<2g/day)

- Inflammation, malignancy, injury

75
Q

what is the etiology of non-pathological proteinuria?

A
  1. exercise
  2. pregnancy
  3. fever
    All usually < 2 gm/day
76
Q

What is pre-renal glucosuria?

A

elevated blood glucose

40 mg/min

77
Q

what is renal glucosuria?

A

defective renal absorption of glucose due to pregnancy or heavy metal poisoning
60 mg/min

78
Q

What can result in hyperglycemia without glycosuria?

A

Abnormal glucose filtration
-Poor renal perfusion, renal atherosclerosis
0 mg/min

79
Q

What is ketonuria?

A

Ketones present in the urine (absence = normal)

  • Acetone
  • Acetoacetic acid
  • betahydroxybutyric acid
  • metabolites of lipid catabolism
80
Q

What is the normal level of urobilinogen in the urine?

A

0.2-1 mg/dL

81
Q

What happens in the body with there is urobilinogen in the urine?

A
  • reduction of conjugated bilirubin by intestinal bacteria
  • reabsorption from gut, some renal excreted
  • False (+)/False (-
82
Q

What is bilirubin?

A

intermediated product of Hgb breakdown

–bound… NO renal elimination

83
Q

What can cause bilirubin to be in the urine?

A
  1. Cellular diseases

2. Obstructive diseases

84
Q

What is hematuria?

A

presence of blood in the urine

85
Q

what would cause blood to be present in the urine?

A

Source: kidney (glomerulus, tubules), urinary tract, or contaminant

86
Q

what are the two different aspects of hemoglobinuria?

A
  1. Isolates = hemolysis

2. RBCs + Hgb = lysed RBCs in urine

87
Q

What is the normal specific gravity of urine?

A

1.002-1.030

88
Q

What can cause high specific gravity in urine?

A

sugar, protein, contrast dye, dehydration

89
Q

What can cause low specific gravity in the urine?

A

DI, renal disease, dilute urine, inability to concentrate

90
Q

What is notable about leukocyte esterase’s?

A
  1. enzyme released by neutrophils
  2. pyuria = presence of pus in the urine
  3. good correlation with a UTI
91
Q

What are urine casts?

A
  1. precipitation of mucoproteins

2. shape indicates origin

92
Q

Where would you find squamous cells in the urinary tract?

A

lower 3rd of the urethra and vagina

93
Q

Where would you find transitional cells in the urinary tract?

A

present in the ureter and bladder

94
Q

Where would you find renal tubular cells in the urinary tract?

A

renal tubules

95
Q

Crystals in urine

A 
uric acid 
calcium oxalate 
sulfonamides
ampicillin
radiopaque dye
96
Q

Bacteria present in urine

A

> 100,000 colonies

only in 30-50% of cases

97
Q

When would you consider a contamination in urine sample with microorganisms?

A

no PMNs

>3 bacteria present

98
Q

yeast in urine sample

A

UTI vs contamination

99
Q

trichomonas vaginitis urine sample

A

vaginal contamination

100
Q

spermatozoa urine sample

A

male: normal
female: contaminant

101
Q

ova and parasites in urine

A

ova and parasites

fecal vs vaginal

PT: Nutrition Exam 2 (10 decks)

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