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Renal II Exam Three > Urinalysis CIS From Freemont-Smith > Flashcards

Urinalysis CIS From Freemont-Smith Flashcards

1
Q

If urine specific gravity is less than 1.005 then the patient is?

A

Hydrated

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2
Q

If the urine specific gravity is greater than 1.010 then the patient is?

A

Water conserving, up to 1.035

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3
Q

If a patients urine specific gravity is greater than 1.035 then the patient is?

A

In a non-physiologic state (possibly due to x-ray dyes or other)

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4
Q

In siadh will urine sg increase with H20 deprivation?

A

No

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5
Q

If the kidney has a problem reabsorbing bicarb, what type of RTA is likely?

A

RTA type 2

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6
Q

If a patient has problems excreting H+ ions into the collecting duct, then what type of RTA is likely?

A

Type I RTA

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7
Q

What is type IV RTA due to?

A

Insufficient aldosterone production or insufficient response in the tubules. (resistance)

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8
Q

+1 glucose equals roughly how much? What is normal?

A

• 1+ dipstick ≈ 250 mg/dL plasma glucose

(normal < 140 mg/dL)

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9
Q

What proteins are measured by the dipstick?

A

Albumin only

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10
Q

So can you detect multiple myeloma on dipstick?

A

No

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11
Q

What are the gold standard and routine standard practice for urinalysis?

A
  • gold standard is 24 hour urine protein
  • routine practice uses spot urine albumin to creatinine ratios
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12
Q

If protein loss is…

  • < 150 mg/day = ?
  • 150-300 mg/day = ?
  • 300mg- 3.5 gm/day = ?
  • > 3.5 gm/day = ?
A
  • < 150 mg/day = normal
  • 150-300 mg/day = microalbuminuria
  • 300mg- 3.5 gm/day = macroglobulinemia
  • > 3.5 gm/day = nephrotic syndrome
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13
Q

You should follow up the dipstick with complete renal function testing, what does this include?

A
  • urine sediment morphology (blood, casts)
  • Serum albumin (if low, then serious urine loss)
  • quantitative measure of urine protein loss
  • eGFR (corrects for age, sex and weight)
  • imaging
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14
Q

What are the steps in the investigation of proteinuria?

A
  1. Rule out transient proteinuria (fever/exercise)
  2. Rule out orthostatic proteinuria
  3. obtain urin sediment
    1. If normal, get quantitative urine protein
    1. < 150 mg/day reassure patient
    1. 150-300 mg/day microalbuminemia
    1. >300 mg/day macroalbuminemia
  1. If abnormal, determine primary vs. secondary glomerular disease
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15
Q

When do you ignore a dipstick test for a female?

A

Within 5 days of menstruation

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16
Q

What is the approach to the patient with red/brown urine?

A
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17
Q

Walk me through the algorithm for hematuria!

A
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18
Q

What are common mimics of primary hematuria?

A

menstruation

  • pigments (eg beets)
  • anticoagulation
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19
Q

The most reliable indicator of glomerular disease in hematuria without rbc casts is proteinuria. If…

  • < 2 gm /24 hr: ?
  • 2-4 gm/24 hr: ?
  • > 3.5 gm/24 hr: ?
A
  • < 2 gm /24 hr: tubulointerstitial
  • 2-4 gm/24 hr: glomerular
  • > 3.5 gm/24 hr: nephrotic
20
Q

dipstick bilirubin is positive when what kind of bilirubin is increased?

Negative when?

A

Direct (conjugated) bilirubin

negative in hemolysis

21
Q

Urobilinogen is a water-soluble metabolic product of bilirubin absorbed from gut and filtered. When is it increased?

Do you see this with obstructive jaundice (no bilirubin to gut)?

A

•Increased in hemolytic anemia (↑production) and liver disease ( ↓metabolism)

Not seen in obstructive jaundice

22
Q

Nitrites are specific for bacteria, but not sensitive. What sort of organisms is it good at detecting?

A

most gram (-) (E. coli, Klebsiella) and some gram (+) (Staph)

23
Q

What is leukocyte esterase (LE) sensitive for? Specific for?

A

Sensitive for infection

Specific for pyuria (does not equal infection… he seemed to really get off on this point. Watch for a TQ here)

24
Q

What does Dr. Freemont-smith consider the three key analytes in the dipstick test?

A
  1. Proteinuria: confirm with P/C ratio, sediment, eGFR
  2. Hematuria: R/O menses , urology versus nephrology
  3. Infection (LE/nitrite)
25
Q

A 26 year old newly married woman presents a 1 day history of burning on urination, urgency and frequency

  • Urine sediment: 12 pmn/hpf, 3 rbc/hpf
  • Urine dipstick:

Spec Gravity: 1.020

pH 6.4

Glucose neg

Protein 1+

Blood trace

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite 3+

Leuk Esterase 3+

Diagnosis? Organism?

A

Acute Cysticis - perhaps Staph. Saprophyticus

26
Q

A 32 year old single female presents with a 2 day history of burning on urination.

  • Urine sediment: 6 pmn/hpf
  • Urine dipstick:

Spec Gravity: 1.015

pH 6.4

Glucose neg

Protein 1+

Blood Neg

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase 3+

Diagnosis?

A

Pyuria & dysuria from urethritis (not UTI)…? Maybe bacteria that does not react and is nitrite neg

27
Q

A 24 year old afebrile female presents to your office with 3 day history of back pain after heavy lifting

  • Urine sediment: NDA
  • Urine dipstick:

Spec Gravity: 1.015

pH 6.4

Glucose Neg

Protein Neg

Blood Neg

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite 3+

Leuk Esterase Neg

Diagnosis?

A

Bactururia from poor transport (defective collection procedure)

28
Q

A 52 year old male presents with a 3 hour onset of severe colicky right-sided flank pain radiating into his groin

  • Urine sediment: 5 rbc/hpf
  • Urine dipstick:

Spec Gravity: 1.025

pH 6.4

Glucose Neg

Protein 1+

Blood 2+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase 1+

Diagnosis?

A

Calculus

29
Q

A 28 year old man has been in the ICU for 2 weeks following a motorcycle accident. He has had an indwelling bladder catheter for the 2 weeks. Repeated urine cultures have been negative

  • Urine sediment: 4 PMN/hpf, 3 rbc/hpf
  • Urine dipstick:

Spec Gravity: 1.015

pH 6.4

Glucose Neg

Protein 1+

Blood 1+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase 2+

Diagnosis?

A

Pyuria/hematuria from mechanical cause

30
Q

A 66 year old female with atrial fibrillation is seen in your office for routine follow-up of her Warfarin therapy (anti-coagulation). Prothrombin time = 68 sec (11-15) with INR 6X upper limit

  • Urine sediment: 6 rbc/hpf
  • Urine dipstick:

Spec Gravity: 1.020

pH 6.4

Glucose Neg

Protein 1+

Blood 3+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

Diagnosis?

A

Hematuria from coagulation defect

31
Q

A 54 year old asymptomatic male comes to your office after a dipstick for an insurance physical revealed blood.

  • Urine sediment: 5 rbc/hpf
  • Urine dipstick:

Spec Gravity: 1.020

pH 6.4

Glucose Neg

Protein Neg

Blood 2+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

Diagnosis?

A

Bladder Tumor

32
Q

A 6 year old boy presents with an acute onset of shaking and chills, with marked change in the color of his urine

•Urine sediment:

  • after centrifugation
  • no rbc’s seen on microscopy

•Urine dipstick:

Spec Gravity: 1.020

pH 7.4

Glucose Neg

Protein Neg

Blood 4+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

Diagnosis?

A

Intravascular hemolysis

33
Q

Which is hematuria and which is hemoglobinuria?

A

A: hematuria, as it centrifuges clear

B. Hemoglobinuria (intravascular hemolysis)

34
Q

An 18 year old high school athlete presents for evaluation for an endurance event. She is mid-cycle.

•Urine dipstick:

Spec Gravity: 1.020

pH 6.4

Glucose Neg

Protein Neg

Blood 1+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

• Urine sediment: 4 rbc/hpf (normal < 3 cells/hpf)

Diagnosis?

A

Thin basement membrane disease (apparently)

35
Q

A 32 year old, previously well male presents complaining of swelling of his face in the morning and swelling of his legs in the afternoon.

•Urine dipstick:

Spec Gravity: 1.030

pH 6.4

Glucose Neg

Protein 4+

Blood Neg

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

• Urine sediment: waxy casts, oval fat bodies

Diagnosis?

A

Minimal Change disease I believe. Can hit in middle age also.

36
Q

A 64 year old insulin-dependent diabetic is in for routine monitoring. He has had the disease for 2 decades

•Urine dipstick:

Spec Gravity: 1.005

pH 6.4

Glucose Neg

Protein trace

Blood Neg

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

• Urine sediment: waxy casts

Diagnosis?

A

Diabetic Nephropathy - urine is not concentrated (isothenuria)

37
Q

Albuminuria is present when? and is a marker for?

A

Albuminuria is present when UACR is greater than 30 mg/g and is a marker for CKD.

38
Q

What disease process caused this? Nephrotic or nephritic?

What will the basement membrane look like on EM?

A

Diabetes, these are kimmelsteil wilson nodules. Nephrotic.

Basement membrane will be thickened. (see attached image)

39
Q

A 24 year old male presents with gross hematuria 72 hours after the onset of acute pharyngitis

•Urine dipstick:

Spec Gravity: 1.025

pH 7.4

Glucose Neg

Protein 3+

Blood 4+

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

• Urine sediment: rbc: TNTC, rbc casts

Diagnosis?

A

Berger Disease

40
Q

Describe what you will see in IgA nephropathy on both light Microscopy and IF.

A

Light Microscopy: Mesangial proliferation

IF: Granular pattern of fluoresence

41
Q

What is the mesangium in direct contact with?

A

The plasma. He has this scattered through his ppt. about three or four times.

42
Q

Put the following in order from least to most common progression to ESRD by 10 years.

Membranous nephritis

Lupus Nephritis

IgA nephropathy

FSGS

Membranoproliferative

How can you slow this progression?

A
  • IgA nephropathy 10%
  • Lupus nephritis 20%
  • Membranous nephritis 25%
  • Membranoproliferative 40%
  • Focal and segmental 80%

Slow the process by use of ACE inhibitors

43
Q

A 76 year old female with known IgG kappa multiple myeloma presents with progressive renal failure

•Urine dipstick:

Spec Gravity: 1.035

pH 6.4

Glucose Neg

Protein Neg

Blood Neg

Bilirubin Neg

Ketones Neg

Urobilinogen Neg

Nitrite Neg

Leuk Esterase Neg

Urine sediment: waxy casts

Diagnosis?

A

Light chain nephropathy (amyloidosis)

44
Q

A 7 year old male with recurrent episodes of E. Coli cystitis presents with fever and right CVA pain

  • Urine sediment: 9 wbc/hpf,
  • Urine dipstick:

Spec Gravity: 1.025

pH 7.4

Glucose Neg

Protein 1+

Blood Neg

Bilirubin Neg

Ketones 1+

Urobilinogen Neg

Nitrite 2+

Leuk Esterase 2+

Diagnosis?

A

Acute pyelonephritis secondary to uretric reflux

45
Q

Autopsy of an eight year olds kidneys reveal the findings shown in the images. You determine that this child had a high anion gap metabolic acidosis.

What was the cause of the structures shown in the images?

A

Ethylene glycol poisoning (antifreeze/brake fluid)

( Pearl: Kids- tastes sweet-green)

Renal II Exam Three (13 decks)

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