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Body Fluids > Urine > Flashcards

Urine Flashcards

1
Q

Principal means of waste product excretion in man

A

urination

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2
Q

principal constituents of urine (4)

A

water
urea
uric acid
creatinine

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3
Q

other urine constituents (5)

A 
hormones and their metabolites
sodium
potassium
chloride
ammonia
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4
Q

functions of the kidney (4)

A
  • regulation of water and inorganic ion balance
  • removal of metabolic waste products and foreign chemicals from the blood and their excretion in the urine
  • secretion of hormones (EPO, Renin, 1,25-Dihydroxyvitamin D)
  • Gluconeogenesis
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5
Q

Hormone that controls rbc production

A

Erythropoietin

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6
Q

Hormone that controls formation of angiotensin

A

Renin

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7
Q

Hormone that influences blood pressure and sodium balance

A

Angiotensin

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8
Q

Hormone that influences calcium balance

A

1,25-Dihydroxy Vitamin D3

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9
Q

Arteriole that carries blood to the nephron

A

afferent arteriole

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10
Q

Arteriole that carries blood away from the nephron

A

efferent arteriole

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11
Q

Functional unit of the kidney

A

nephron

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12
Q

capillary network of the nephron

A

glomerulus

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13
Q

blood pressure inside the glomerulus (

A
  • is 3x greater than the pressure in other capillaries

- forces the water and small molecules through the capillary membrane and into the Bowman’s capsule.

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14
Q

Glomerular filtrate is basically

A

-plasma without the proteins (cells and the large molecular size plasma proteins are unable to pass through the semipermeable membrane)

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15
Q

the pH, specific gravity, and osmolality of normal urine =

A
  • 7.4
  • 1.010
  • 285
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16
Q

In the average healthy person, >_______ Liters of filtrate are formed each day.
Normal urine output ~_______mLs = only ___% of the amount of filtrate formed; the rest is reabsorbed.

A

180
1500 (1.5 Liters)
1%

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17
Q

Course of urine through the nephron

A

afferent arteriole –> glomerulus –> Bowman’s capsule –> PCT (80% of fluid and electrolytes reabsorbed) –> Loop of Henle –> DCT (final reabsorption of sodium, removal of excess acid) –> collecting ducts –> ureters –> bladder

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18
Q

Sodium-Potassium pump is under the control of

A

aldosterone (released by the adrenal medulla in response to 1) hypotension or 2) low plasma sodium)

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19
Q

Main functions of the nephron at the distal tubule (2)

A

1) final reabsorption of sodium - water/electrolyte balance (=regulated by ADH (secreted by the pituitary)- higher ADH=more water reabsorption, etc..)
2) removal of excess of acid from the body - acid/base balance

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20
Q

Descending portion of the Loop of Henle

A

concentrating portion = more permeable to water, water is reabsorbed.

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21
Q

Ascending portion of the Loop of Henle

A

= diluting portion - removal of salt with little water lowers salt and osmotic concentration = dilutes the tubular fluid.
-active reabsorption of Na, Cl, Mg, Ca.

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22
Q

Diseases of the kidney - 4 main types based on the 4 basic morphologic components initially affected:

A
  • glomeruli
  • tubules
  • interstitium
  • blood vessels
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23
Q

Glomerular diseases are most often _______________ mediated, but may also result from _________ and __________ disorders.

A

immunologically
metabolic
hereditary

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24
Q

Acute inflammation of the glomeruli

A

Acute glomerulonephritis

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25
Q

Acute glomerulonephritis may be caused by (4)

A
  • immune complex diseases (=Beta strep A sequelae)
  • metabolic/vascular disorders
  • toxins
  • heredity
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26
Q

Symptoms of Acute Glomerulonephritis (8)

assoc. primarily with _____ casts.

A
  • oliguria, hematuria, proteinuria, decreased GFR, increased BUN and serum creatinine levels, anemia, edema, hypertension
  • *RBC casts
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27
Q

Nephrotic Syndrome is characterized by

A

increased glomerular permeability - results in massive proteinuria and excretion of fat bodies

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28
Q

causes of Nephrotic Syndrome

A
  • associated with glomerulonephritis
  • associated with generalized disease processes (= cancer and lupus)
  • associated with circulatory disorders (like those caused by renal vein thrombosis, infections, toxins, preeclampsia, transplant rejection)
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29
Q

symptoms of nephrotic syndrome (5)

(2) may be present

A
  • massive proteinuria (albumin ~ 2-3 g/day) in the absence of depressed GFR, hypoalbuminemia with plasma albumin levels
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30
Q

disorders of the kidney most likely due to presence of toxins or infectious agents (2)

A

tubular and interstitial disorders

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31
Q

Renal Tubular Acidosis (RTA) =

two types =

A

defective secretion of hydrogen ions by renal tubules in the presence of a normal/nearly normal GFR

  • Type I - Distal
  • Type II - Proximal
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32
Q

Type I / Distal RTA

A

problem is in the collecting ducts - impaired excretion of hydrogen ions, calcium carbonate is drawn from the bones to act as a buffer.
Results in osteomalacia (bone softening), hypercalcemia, nephrocalcinosis (ppt of ca phos in the tubules resulting in renal insufficiency), and hypokalemia.
-secondary causes = cirrhosis, drugs (ampho B), lithium, kidney transplant rejection, hypergammaglobulinemia.

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33
Q

Type II / Proximal RTA

A

=reduced bicarbonate reabsorption in the proximal tubules, depletes the bicarb content of blood and tissues - results in a more generalized dysfxn that type I RTA.

  • will see osteomalacia, but not the nephrocalcinosis and hypokalemia
  • secondary causes = mm, transplant rejection, inborn errors of metabolism, drugs and toxins.
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34
Q

Type III RTA

A

combination of I and II

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35
Q

Type IV RTA

A

characterized by mild-moderate insufficiency, hyperchloremic acidosis and hyperkalemia

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36
Q

Inherited real diseases characterized by increased urinary excretion of phosphate, glucose, amino acids, low serum phosphorus, systemic acidosis

A

Fanconi syndrome

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37
Q

renal disorder that affects the tubules, interstitium, and renal pelvis

A

Pyelonephritis

may be acute or chronic

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37
Q

Acute Pyelonephritis:
Definition
Clinical presentation (4)
Lab findings (3)

A

=Acute bacterial infection of the kidney (ascending/descending)

  • Sudden onset with 1) flank pain 2) fever 3) malaise
  • Pyuria (many wbcs), bacteria, WBC casts
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38
Q

Chronic Pyelonephritis symptoms

A

pyuria
bacteriuria
development of hypertension
decreased GFR

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39
Q

Infection of the bladder =

A

Cystitis

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40
Q

WBC casts in urine

A

pyelonephritis

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41
Q

Passage of kidney stones down the ureter produces _____ _____
and _________.

A
  • Renal colic = sever pain in the back radiating to the groin
  • Hematuria
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42
Q

Clot formation in the renal veins will result in (2)

A
  • massive proteinuria

- nephrotic syndrome

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43
Q

if stones obstruct the renal pelvis or ureter, ___ may develop

A

UTI

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44
Q

Stones may form (2)

A
  • after recurrent uti with urease-producing organisms (=Proteus)
  • when the urine is supersaturated with large quantities of calcium, uric acid, cystine, or xanthine.***Calcium Oxalate = most common constituent of urinary calculi.
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45
Q

most common constituent of urinary calculi =

A

Calcium oxalate

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46
Q

Acute renal failure is usually accompanied by

A
  • Oliguria

- Anuria

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47
Q

Renal failure occurring before blood reaches the kidney as in hypovolemia or cardiovascular failure =

A

Prerenal

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48
Q

Renal failure occurring within the kidney

A

Renal

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49
Q

Most common cause of Renal failure =

Also caused by (2)

A

Acute tubular necrosis

Glomerulonephritis and vascular obstruction

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50
Q

Renal failure occurring after the urine leaves the kidney and is usually caused by obstruction

A

Postrenal

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51
Q

Stage of chronic renal failure:

Diminished renal function with normal serum creatinine and BUN levels.

A

Stage I

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52
Q

Stage of chronic renal failure

Mild renal insufficiency

A

Stage II

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53
Q

Stage of chronic renal failure

frank renal failure with advancing anemia and acidosis

A

Stage III

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54
Q

Stage of Chronic renal failure

uremia, manifested as increased BUN and serum creatinine with an acid-base and electrolyte imbalance

A

Stage IV -

55
Q

Glomerular function is most conveniently measured by the =

A

Creatinine clearance test on a 24 hr urine specimen

56
Q

Advantages of Creatinine Clearance test (3)

A
  • Amount of creatinine produced endogenously from protein metabolism is relatively constant, and is directly proportional to body SA
  • Amount of creatinine in urine is dependent on renal function
  • Creatinine is freely filtered at the glomerulus and isn’t reabsorbed by the tubules
57
Q

Disadvantages of Creatinine Clearance

A

-It usually parallels the GFR, but at lower filtration rates it becomes increasingly inacurrate

58
Q

The method of choice to obtain a precise GFR =
Advantages (2)
Disadvantages (2)

A

=Inulin clearance method

  • Glomerular capillary wall is freely permeable to inulin, inulin isn’t reabsorbed/secreted/metabolically altered by the renal tubule
  • Requires a continuous IV in fusion throughout the duration of the test to maintain a constant plasma level, inulin is technically difficult to measure.
59
Q

The assessment of the concentrating and diluting ability of the renal tubules is accomplished through measuring urine (2)

A

specific gravity and osmolality

60
Q

The ratio of the mass of a solution compared with the mass of an equal volume of pure water =

A

specific gravity

61
Q

the number of dissolved particles in a solution is determined by

A

osmolality

62
Q

Secretory function of the renal tubules is evaluated by

A

injecting exogenous organic anions/cations into the circulation and determining their clearance values.

  • Paraaminohippruate (PAH) (organic anion) - normally used.
  • normal PAH clearance = 600-700 mL/min
63
Q

24 hour urine for protein and creatinine

A

protein or creatinine result X 24hr urine volume (ml/min) / 100

64
Q

Least invasive specimen acceptable for urine culture =

A

midstream urine collection

65
Q

Physical characteristics of urine for routine UA (4)

A
  • color
  • appearance
  • specific gravity
  • volume and/or odor
66
Q

chief pigment of urine =

other pigments in lesser concentration = (2)

A

urochrome

-uroerythrin and urobilin

67
Q

Specific gravity <1.007 is termed what and is caused by

A

=hyposthenuric

-Excessive fluids/diuretics, DI, renal disease where conc. ability is lost.

68
Q

Specific gravity fixed @ 1.010 =

A

Isosthenuric

-Chronic renal disease where conc. and diluting ability lost — SG = same as glomerular filtrate.

69
Q

Specific Gravity > 1.020 =

A

Hypersthenuric

-proteinuria, glycosuria, dehydration, radiographic dyes

70
Q

Urinometer must be corrected for presence of glucose and protein by

A

For every gram/dL of protein or glucose, subtract .003 from the urinometer value.

71
Q

Urine test strip method

A

contains a pretreated electrolyte that elicits a pH change.
This method is based on the ionic concentration of urine
-not affected by glucose, protein or radiographic dyes

72
Q

Refractometer method

A

=based on the principle of the refractive index

  • as # of diss. particles in soln. increases, so does the refractive index.
  • its corrected for temperature from 15 to 37 degrees
73
Q

Odor:
Ammonia =
Sweet, fruity =
Maple syrup =

A
  • can indicate bacterial growth
  • can indicate the presence of ketones
  • can indicate MSUD (aminoacidopathy)
74
Q

Volume:
Anuria =
Oliguria =
Polyuria =

A
  • absence of urine - acute renal failure, urinary tract obstruction, major transfusion reaction (free Hgb clogs tubules)
  • <500 ml/day - poor blood supply (shock/dehydration), fluid shift (edema), urinary tract obstruction, poor kidney function (acute/end stage)
  • > 2000 ml/day - increased fluid intake, DM/DI, renal disease affecting concentrating ability
75
Q

Dysuria =

A

any increase in urine volume

76
Q

pH of urine reflects the ability of the kidney to maintain normal __ concentration in ______ and _____________ _____.

A

H+
plasma
extracellular fluid

77
Q

Average pH of urine =

A

6

78
Q

pH methodology

A

urine test strip contains indicators methyl red and bromthymol blue - gives a range of color change from orange - green - blue as pH rises.

79
Q

Sources of error for urine pH

A
  • Runover phenomenon = too much urine on dipstick/ urine allowed to stand too long before testing = falsely elevated pH = alkaline
  • Acid urine = starvation diets, proteinuria, diarrhea, DM
  • Alkaline = RTA, renal failure, UTI, vomiting, diet high in fruits/veggies
80
Q

Leukocyte esterase - purpose

methodology

A

= detects the presence of pyuria (wbcs in urine)
-Neutrophils contain esterases, catalyze the production of indoxyl from an indoxyl carbonic acid ester. The indoxyl reacts with diazonium to produce a purple color.

81
Q

Leukocyte Esterase - sources of error

A

false + = with formaldehyde and oxidizing agents

false - = high protein, glucose, SG, high doses of cephalexin, gentamycin, ascorbic acid.

82
Q

Nitrite - used to detect the presence of certain ________ in urine
methodology =

A

bacteria

  • based on the Griess test; test strip depends on reduction of nitrates to nitrites by enzymatic action of certain bacteria.
  • in acid pH, nitrite reacts with aromatic amine to produce a pink color
83
Q

Nitrite - sources of error

A

false + = bacterial contamination of improperly collected or stored specimen
false - = high ascorbic acid, extremely high bacterial count, antibiotic therapy, UTI caused by non nitrite-reducing bacteria, urine not in bladder for > 4hrs

84
Q

majority of ketone composition =

A

B-hydroxybutyric acid

85
Q

Presence of ketones in the urine is due to

A

=the incomplete metabolism of fats for energy

86
Q

Ketones - methodology

A

reagent strip test is based on modified tube test
-detects acetoacetic acid and acetone - they react with sodium nitroprusside and glycine in alkaline medium to produce a purple colorj

87
Q

Ketones- sources of error

A

falsely decreased - early stages of DKA - beta levels are increased but acetoacetate is still normal - blood gases and glucose levels are more useful in this case
false + = large doses of levodopa
false - = improperly stored specimen (=conversion of acetoacetic acid to acetone with subsequent evaporation)

88
Q

Glucose is present in urine only when plasma glucose levels

A

exceed the renal threshold (160-180 mg/dL)

89
Q

Glucose - methodology

A

Test strip is based on the glucose-oxidase/peroxidase reaction = specific for glucose

  • Gluc reacts with glucose oxidase to form gluconic acid and H2O2 - H2O2 reacts with peroxidase to oxidize the chromogen / indicator which produces color
  • -Ortho-toluidine =blue, iodine = brown, tetramethylbenzidine = green
90
Q

Glucose - sources of error

A

false + = strong oxidizing agents

false - = levodopa metabolites and ascorbic acid, increased ketones, too cold due to refrigeration.

91
Q

Methodology for reducing substances

A

Copper reduction tests - will react with sufficient quantities of any reducing substance in the urine (lactose, fructose, galactose, maltose, pentoses)(found in the urine of people with inherited metabolic disorders) - if that is suspected ,sugar can by identified using thin layer chromatography

92
Q

Clinitest - sources of error

A

false + = HGA, drugs and their metabolites (ascorbic acid/salicylates), preservatives (formalin)
false - = if clinitest tube is mixed before 15 seconds, presence of radiographic contrast media
Passthrough rxn = high levels, starts positive, then passes through all colors, then ends on greenish brown which corresponds with a lower concentration than orange - should be reported as > 4+

93
Q

Test for Lactose

A

Rubner’s qualitative test - uses lead acetate, forms a brick red solution, then a red ppt with a clear supernatant
Glucose = yellow ppt with yellow soln.

94
Q

Test for Fructose

A

Resorcinol + acidified urine, fructose will cause formation of a heavy red ppt = soluble in ETOH - urine must be fresh when testing (will form glucose in alkaline urine)

95
Q

Test for deficiency in galactose 1-Phosphate uridyl transferase in

A

newborns
test is based on measuring transferase activity in red cells - wb is added to rxn mixture, which fluoresces if enzyme is present

96
Q

Test for Pentose

A

Bial-orcinol test - pentose produces olive green compound (soluble in amyl alcohol)

97
Q

Pentose is found in urine (2)

A
  • after ingestion of large amounts of fruit

- in idiopathic pentosuria

98
Q

Test for Sucrose

A

detected in thin layer chromatography, but stained by a substance no dependent on reducing properties.

99
Q

presence of porphyrins in urine =

A

red wine color

100
Q

presence of melanin/melanogen =

A

urine darkens on standing and reacts with nitroprusside and ferric chloride

101
Q

Of the normal protein excreted, 1/3 = ____ _________ glycoprotein, 1/3 = _______, and the rest is small globulins

A 
Tamm Horsfall (=uromodulin)
albumin
102
Q

Protein - methodology

A

Reagent strip = sensitive only to Albumin

-based on the principle of protein-error of pH indicators

103
Q

Protein - sources of error

A

false + = alkaline urines, excessive wetting of test strip, presence of ammonium compounds used to clean the skin
false - = proteins other than albumin are present

104
Q

Protein - confirmatory tests

A

= semi-quantitative method

  • sulfosalicylic acid test
  • heat and acetic acid test
105
Q

Bence Jones proteinuria associated with (3)

A

multiple myeloma
macroglobulinemia
malignant lymphomas

106
Q

as larger proteins appear, the prognosis

A

worsens

107
Q

tubular disease is associated with the loss of

A

very small proteins

108
Q

glomerular disease allows escape of

A

intermediate sized protein molecules

109
Q

Heavy proteinuria

A

=3-4 G/day - nephrotic syndrome

110
Q

Moderate proteinuria

A

1-3 g/day - glomerular diseases and multiple myeloma

111
Q

Minimal proteinuria

A

<1 G/day - chronic pyelonephritis, ~inactive Glomerular disease, tubular disease, postrenal proteinuria

112
Q

presence of abnormal rbcs in urine

A

hematuria

113
Q

presence of free hgb in urine

A

hemoglobinuria

114
Q

myoglobinuria

A

acute destruction of muscle fibers = rhabdomyolysis

  • if large amounts are present, anuria may result
  • seen in skeletal muscle diseases, trauma, infections, influenza, herpes, EBV, Legionella, toxic substances, a variety of congenital disorders
115
Q

Blood - methodology

A

based on the liberation of O2 from peroxide in the test strip by the peroxidase-like activity of heme

116
Q

Blood- Sources of Error

A

false - = really high nitrite/ really high ascorbic acid, falsely decreased due to poor mixture of specimen prior to testing.
false + = oxidizing contaminants or microbial peroxidse

117
Q

Test for bilirubin detects what form of bilirubin?

A

Conjugated (water-soluble)

118
Q

Bilirubin - methodology

A

test strip is based on the diazo reaction = utilizes coupling reaction of a diazonium salt with bilirubin in an acid medium to produce a red violet azo dye.
-Both neg results on suspicious urines and pos results on test strip should be confirmed using Ictotest (=uses same rxn)

119
Q

Bilirubin - Sources of Error

A

false - = large amounts of ascorbic acid, prolonged specimen storage (bilirubin broken down by light exposure)
false + = drugs

120
Q

Substance formed in the intestine by the bacterial breakdown of conjugated bilirubin

A

urobilinogen

121
Q

Urobilinogen - methodology

A

based on Ehrlish aldehyde reaction - based on the formation of a red azo dye from the coupling of urobilinogen with a diazonium compound in an acid medium

122
Q

Urobilinogen - Sources of Error

A

False - = formalin or prolonged standing

False + = drugs

123
Q

Increased urobilinogen

normal bilirubin

A

Hemolytic Jaundice

124
Q

Increased urobilinogen and bilirubin

A

Hepatocellular Jaundice

125
Q

Decreased Urobilinogen

Increased Bilirubin

A

Obstructive Jaundice

126
Q

presence of Indican in urine ~ with

color =

A

small bowel bacterial contamination and GI abnormalities

green-blue

127
Q

Excess of one or more amino acids in the urine

A

Aminoaciduria

  • overflow (4)
  • transport (2)
128
Q

Overflow Aminoacidurias (4)

A

Phenylketonuria - phenylalanine hydroxylase deficiency - Guthrie test

  • Alkaptonuria - Homogentisic acid oxidase deficiency (=accum. of HGA) - causes urine to turn brown-black upon standing - accumulates in cartilage tissue.
  • MSUD - Elevated Leu, Ile, Val and excretion of their corresponding ketoacids.
  • Tyrosinosis = fumarylacetoacetate deficiency = kidney damage leads to Fanconi’s with VD-resistant ricketts -Tyr and Leu crystals present
129
Q

Renal Transport Aminoaciduria (RTA)-C

A
  • Cystinuria - one renal tubular abs mechanism for lysine, arginine, ornithine, cystine - cystine = only one that crystallizes
  • —cyanide nitroprusside test = +
  • Fanconi Syndrome
130
Q

Lipiduria is most often seen in _________ ________

Oval Fat Bodies =

A

nephrotic syndrome

RT cells / macrophages in which globules of fat have accumulated.

131
Q

Urine containing lymph =

A

chyluria

132
Q

Clinical manifestation of chyluria

A

+ protein, wbcs and rbcs present, milky/opalescent urine

133
Q

screening test for porphyrins =

confirmatory test for porphyrins =

A
  • Watson-Schwartz test = uses Ehrlich’s reagent

- Hoesch test

134
Q

Increased plasma calcium ~ with

A

HyperPTH and vice versa

135
Q

Two methods of measuring calcium =

A

EDTA titration
Sulkowitch test
-Ca++ is ppt’d out as Calcium Oxalate - degree of ppt is noted visually.

Body Fluids (2 decks)

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