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3/ REN > Urine as an Indicator of Disease > Flashcards

Urine as an Indicator of Disease Flashcards

1
Q

What are the 3 aspects of urine that you can investigate?

A

gross appearance
microscopy
biochemistry

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2
Q

What are the advantages of urine analysis?

A
  • non-invasive diagnosis
  • easily obtained - feasible in local GP practice
  • normal composition normally know
  • for pre-renal or renal disease
  • changes in levels of what should be present or appearance of material that should be ‘absent’
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3
Q

What are the normal levels of the following substances in the urine?

  • uric acid
  • bicarbonate ions
  • creatinine
  • potassium ions
  • sodium ions
  • chloride ions
  • ureas
A
  • uric acid = 0.6g
  • bicarbonate ions = 1.2g
  • creatinine = 3.2g
  • potassium ions = 3.2g
  • sodium ions = 4.1g
  • chloride ions = 6.6g
  • ureas = 25g
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4
Q

Why is a 24h urine sample the most useful?

A

most representative as levels of substances change over the course of a day

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5
Q

Describe appropriate collection of urine

A
  • clean/sterile container
  • random samples, clean catch midstream specimen
  • timing depends on test required
  • test as soon as possible
  • 24 hour specimen, with empty bladder at hour 0
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6
Q

What is a typical volume of urine in 24 hours?

A

0.8-2L

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7
Q

What should the gross appearance of urine be?

A
  • pale yellow and clear
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8
Q

Blood in different sections of urine indication blood from where

A 
early = urethra
throughout = bladder
end = prostate
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9
Q

What is pseudohaematuria caused by?

A
  • free Hb, myoglobin, porphoryins, drugs
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10
Q

What does red/brown urine indicate?

A
  • conjugated bilrubin
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11
Q

What does black urine indicate?

A
  • melanin e..g in disseminated melanoma
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12
Q

What does foamy urine indicate?

A

proteinuria

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13
Q

What does cloudy urine indicate?

A
  • protein, oxalates, cells, phosphates, platelets
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14
Q

Why does normal urine darken on standing?

A

completion of oxidation

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15
Q

What does dramatic darkening on standing indicate?

A
  • haematuria in case of sever P.falciparum malaria
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16
Q

What four things can be found on microscopic examination and how?

A

Centifuge urine sampel, examine sediment for:

  1. bacteria
  2. cells
  3. casts
  4. crystals
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17
Q

How many RBC’s and WBC’s are normal in the urine?

A

RBC >1 is abnormal

WBC >10 is abnormal

18
Q

What do casts indicate?

What do redcell casts indicate?

A

Casts e.g. hyaline. composed for primary mucoprotein secreted by tubules or fine granular

  • normal finding post exercise
  • larger coarse casts are abnormal
  • red cell cast = kidney damage
19
Q

What 4 kinds of crystals can be present in urine?

A
  • oxalate crustals
  • crusting
  • triple phosphate
  • amorphous crystals
20
Q

What is a normal pH range for urine?

A

4.5-8

21
Q

What factors in diet lead to acidic urine?

What factors in diet lead to alkaline urine?

A 
acidic = meat 
alkaline = citrus fruit and veg
22
Q

What diseases cause extremely acidic urine?

A
  • uncontrolled diabetes, starvation, respiratory disorders
23
Q

What diseases cause extremely alkaline urine?

A
  • UT obstruciton, some repistoraty disorders e.g. alkalosis
24
Q

What can cause variation in excreted creatinine?

A
  • increased = excessive meat diet

- decrease = wasting disease, malnutrition, poor renal blood blood or function

25
Q

Which two kinds of disorder cause abnormal solute excretion?

A

pre-renal and renal

26
Q

Describe pre-renal cause of abnormally high/low solute excretion

A
  • kidney function is normal
    Overspill:
  • increased solute filtration –> increased production in body
  • abnormal metabolite so no suitable transporter for reabsorption
    Decreased solute filtration
  • decreased production in body
  • decreased delivery e.g. cardiac failure, haemorrhage, burns
27
Q

Describe renal causes of abnormal solute excretion

A
  • kidney is abnormal
    Glomerular malfunction
  • infection, autoimmune disease, inflammation –> leakage
    Tubular malfunction
  • infection, autoimmune disease, inflammation, necrosis, drugs, toxins
  • defective reabsorption e.g. glucose
  • defective secretion e.g. H+
28
Q

What is urea?

A

the non-toxic end-product of nitrogen metabolism

29
Q

What factors increase urea excretion?

A
  • excess protein intake
  • protein energy malnutrition
  • uncontrolled DM1
  • infections, burns, wasting diseases, trauma
30
Q

What factors decrease urea excretion?

A
  • low protein diet, severe liver disease/genetic defects
  • glomerular nephritis, acute tubular necrosis
  • poor renal bloody supply or renal obstruction
31
Q

What are the outcomes of decreased urea excretion?

A
  • hyperammonaemia, NH4+ crosses BBB –> lethargy, irratibilty, finally coma
32
Q

What are the casues of glycosuria? x3 categories

A 
Metabolic hyperglycaemia 
- diabetes mellitus type 1
- anxiety, stress
- phaechromocytoma 
Reduced renal threshold 
- pregnancy or renal glycosuria (genetic) 
Tubular malfunction 
- generalised tubular damage secondary to other damage 
- fanconi syndrome
33
Q 
What are the characteristics of pheochromocytoma?
What is it?
What are the symptoms?
How is it diagnosed?
What is the treatment?
A
  • a pre renal disorder –> increased end-product excretion
  • secreting adrenal medullary tumour
  • ocassinoaly ectopic
  • excessive secretion of adrenaline causes hypertension, headaches, sweating, anxiety, palpitation, tachycardia, anorexia, hyperglycaemia, high plasma FFAs
  • diagnosed by excessive adrenaline breakdown products in ruine - metaneprhones and VMA
  • therapy by surgery and blockers
34
Q

What sugars are abnormally excreted in urine?

When might they be present?

A
  • galactose = enzyme deficieny
  • fructose = fructose intolerance, essential fructosuria
  • lactose = lactation, lactase deficient, coeliac
  • pentoses = essential pentosuria
35
Q

When may ketones be present in the urine?

A
  • unctornled type 1 diabetes

- starvation

36
Q

When might amino acids be present in the urine?

A
  • generalised tubular damage
  • specific transporter defects (e.g. cystinuria and Hartnup’s)
  • raised plasma AA’s e.g. PKU, cystinosis
37
Q

When might conjugated bilibruin be present in the urine?

A
  • liver damage

- obstructed bile ducts

38
Q

What is the definiciton of proteinuria?

What does it indicate?

A
  • > 200mg/24h of proteins

- nephrotic syndrome

39
Q

What is orthostatic proteinuria?

A
  • usualyl a benign condition affecting children
  • protein isnot detectable in morning
  • delvops only after standing uprights
  • insignificant if proteinuria is detected only in somme of the urine samples
40
Q

What are the mechanisms of proteinuria?

A

Pre renal problem (overflow) e.g. Bence Jones proteins
Renal problem
- glomerular e.g increased permeability to albumin
- tubular e.g. impaired of saturated respiration
- secreted e.g. due to secretion by kidneys or epithelium of urinary tract

41
Q

Protein size indicates pre-renal vs renal problem.

Explain

A

Low MWt –> kidney is topically normal e.g. myoglobin

High MWt –> damaged kidney e.g. albumin

42
Q

What is the deficiency in PKU?
What does it lead to in the urine?
What are the consequences

A
  • genetic deficieny of Phe hydroxylase
  • excess excretion of phenylpyruvate
  • accumulation of hydrophobic Phe which affects the brain
  • build up of transmission byproducts

3/ REN (19 decks)

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