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BiB Midterm 3 & Final > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What does bubbly/foamy urine indicate?

A

Proteinuria

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2
Q

What does red/brown/black urine indicate?

A

RBC or heme products in the urine.

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3
Q

What is a urine dipstick?

A

A strip with multiple “squares” that is dipped into the urine. After removing the squares may change colors which can be used to determine kidney function.

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4
Q

What does the specific gravity of urine tell you?

A

The ratio of the urine weight to the weight of distilled water. Provides an estimate of urine osmolality.

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5
Q

What do the following specific gravities tell you about the urine osmolality?:
<1.003
>1.018

A

<1.003: Low urine osmolality (maximally diluted, <100)

>1.018: High urine osmolality (>600)

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6
Q

Define isostheuria. What would the urine specific gravity be in this case?

A

The Kidney loses its ability to concentrate or dilute the urine, so the urine osmolality will be the same as the plasma osmolality (285-295).

Specific gravity = 1.010

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7
Q

Describe case(s) where there is high urine osmolality that does not suggest an increased urine concentration (osmolality).

A

large molecules are in the urine (proteinuria, glucosuria, radiocontrast media)

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8
Q

What is the normal urine pH range?

A

4.5-8

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9
Q

If the urine is positive for Heme what does this indicate?

A

There may be RBC or myoglobin in the urine.

You have to use a microscope to confirm the presence of RBCs

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10
Q

What does it mean if the urine dipstick is positive for Ketones?

What can this NOT detect?

A

Diabetic Ketoacidosis (DKA) or Starvation.

This cannot detect beta hydroxybutyrate. (A major breakdown product of alcohol)

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11
Q

What is leukocyte esterase? What does it mean if it is positive in the urine dipstick?

A

Leukocyte esterase - an enzyme released by lysed neutrophils.

This can indicate a UTI or inflammation of the kidney (interstitial nephritis)

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12
Q

What does it mean if the urine dipstick is positive for nitrite?

A

Indicates presence of bacteria (Bacteriuria) (enterobacteriaceae) that produce nitrate reductase

UTI

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13
Q

What is the most effective way (gold standard) to measure urine protein levels? What is the best time to use this?

A

24 hour urine protein.

Most appropriate to use when monitoring the treatment of glomerular disease.

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14
Q

How can you estimate the 24 hour urine PROTEIN without using the 24 hour method?

A

UPC - Urine protein:creatinine ratio.

Divide the urine protein amount by the urine creatinine amount which gives you a rough estimate of 24 hour urine protein.

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15
Q

How can you estimate the 24 hour urine ALMBUMIN without the 24 hour method?

A

ACR - Urine Albumin:Creatine ratio

Urine albumin x100) / (Urine creatinine

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16
Q

What are the ranges (mg/g) for each grade of albuminuria?

Normal-Mild
Moderate
Severe

A

Normal/Mild - <30mg/g

Moderate - 30mg/g - 300mg/g

Severe - >300mg/g

17
Q

Albuminuria is an indicator of ______ morbidity and mortalilty

A

cardiovascular

18
Q 
On a Renal Biopsy what do the following stains allow you to see?
PAS stain
Trichrome stain
Silver stain
H &amp; E stain
A

PAS: GBM & mesangial matrix (Magenta/Pink Orchard)
Trichrome: Collagen deposition (light blue); indicating scarring and fibrosis
Silver: GBM & Tubular Basement Membrane (TBM) (Black)
H & E: General structure, cellularity, etc

19
Q

What abnormalities are we looking for when we take a renal biopsy?

A

Inflammation/proliferation
Capillary wall abnormalities
Abnormal protein accumulation
scarring/sclerosis/fibrosis

20
Q 
Define the Following:
Focal Lesion
Diffuse Lesion
Segmental Lesion
Global Lesion
A

Focal: x < 50% of the glomeruli are affected
Diffuse: x > 50% of the glomeruli are affected

Segmental: Only a portion of the glomerular tuft is affected
Global: The whole glomerular tuft is affected

21
Q

What are the two mechanisms of glomerular injury? Give the subtypes of each.

A
  1. Non-immunologic (ischemia, endothelial damage, (toxin, sepsis) deposition of proteins (amyloids))
  2. Immunologic (nephritis; inflammation & nephrotic; non-inflammatory)
22
Q

What is the progression of ischemia of glomeruli?

A

ischemia –> fibrosis –> sclerosis –> non-functional glomeruli

23
Q

What are the 3 ways in which immunologic glomerular injury occurs?

A
  1. Antibody-Antigen Interactions
  2. Immune Cells
  3. Alternative activation of complement system
24
Q

Antibody-Antigen Interactions include the following

A
  1. Intrinsic antigens (Antigens native to the kidney are bound by antibodies)
  2. Planted Antigen (Antigen is planted from the outside and antibodies later bind them )
  3. Circulating Immune complexes (Deposit into glomerulus)

BiB Midterm 3 & Final (10 decks)

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