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72 Cards in this Set

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Diabetes mellitus in polyuria
excess glucose in blood leads to high concentration of glucose in filtrate exceeding the renal threshold. urine looks dilute but has a high osmolality
Average adult daily output volume
1200-1500 mL
commonly see in states of dehydration resulting from water loss due to excessive vomiting, diarrhea, perspiration, or from severe burns
Oliguria, this may lead to anuria a complete cessation of urine flow.
What causes auria
any serious damage to the kidneys or a decrease in blood flow to the kidneys
Decreased production or function of ADH affecting the nephron's ability to concentrate urine through water reabsorption
Diabetes insipidus: urine is dilute with a low osmolality
Why would the urine be an amber beer brown
due to the presence of conjugated bilirubin
Why would the urine be red or pink and clear
hemoglobin or myoglobin or porphyrins
Your patients urine is cloudy in appearance, what is the problem?
Intact red blood cells
Your patients urine is pink and clear what is the problem
it has hemoglobin, myoglobin or porphyrins present in the urine
What color does methemoglobin turn urine to?
Brown, black. Upon standing, hemoglobin iron in acidic urine will be oxidized to methemoglobin, which turns the urine brown
What color does homogentisic acid turn the urine
brown/black upon standing alkaline urine will turn brown if homogentisic acid is present in the urine sample
Alkaptonuria
a metabolic defect. increased excretion in occurs in the disease
What color does melanin turn the urine
Upon standing, neutral pH urine will turn black if melanin is present in the urine sample
Why will melanin appear in the urine
the patient has metastatic malignant melanoma (an aggressive form of skin cancer)
What color does Pyridium (phenazopyriding) turn the urine?
dark orange. antibiotic rifampicin
How does normal urine look
clear or hazy
How does amorphous crystal make the urine look
a normal clear or hazy
How does squamous epithelial cells make the urine look?
a normal clear or hazy
How does seminal fluid make the urine look
a normal clear or hazy
how does fecal contamination make the urine look
a normal clear or hazy
What color does homogentisic acid turn the urine
brown/black upon standing alkaline urine will turn brown if homogentisic acid is present in the urine sample
Alkaptonuria
a metabolic defect. increased excretion in occurs in the disease
What color does melanin turn the urine
Upon standing, neutral pH urine will turn black if melanin is present in the urine sample
Why will melanin appear in the urine
the patient has metastatic malignant melanoma (an aggressive form of skin cancer)
What color does Pyridium (phenazopyriding) turn the urine?
dark orange. antibiotic rifampicin
How does normal urine look
clear or hazy
How does amorphous crystal make the urine look
a normal clear or hazy
How does squamous epithelial cells make the urine look?
a normal clear or hazy
How does seminal fluid make the urine look
a normal clear or hazy
how does fecal contamination make the urine look
a normal clear or hazy
how does mucus make the urine look
a normal clear or hazy
What causes the urine to have WBC, RBC, and bacteria
Pathologic etiologies
When the urine is cloudy or turbid, is this normal
No, this is caused by a pathologic etiologies
How does normal freshly voided urine smell
pungent odor of volatile aromatic acids
What does bacterial infections, elevated ketones, maple syrup urine disease, and asparagus have in common?
They all make unusual odors in the urine
How is the chemical analysis of urine accomplished?
Utilization of a urine chemstrip or dipstick
What is the normal value of protein in the urine
Negative, Trace or trace dipstick reading (<= 150mg/day)
What is the significance of urine pH?
Aids in identifying acid base disorders
When is acidic urine produced
Respiratory or metabolic acidosis - not related to renal function disorders
When is alkaline urine produced
Respiratory or metabolic alkalosis
How are abnormally high protein values reported
3+, 4+
How much proteins are reabsorbed by the tubules?
95-99%. Only the smallest proteins are filtered from the plasma into the urine
What are Tamm-Horsfall protein
muco protein synthesized by the distal tubular cells and involved in cast formation
What is the chemstrip most sensitive to
the presence of albumin-although globulin are the major protein fraction found in urine
What is sulfosalicylic Acid (SSA)
Confirmatory test, used to retest all specimens with positive chemstrip results (1+ to 4+)
When the SSA test confirms the presence of protein what should you order
24 hour urine protein
What does the 24hr urine provide
quantify the amount of protein that is being secreted per day. It averages out normal variations in urine concentration
What do you order if the 24hr urine is > 150 mg/day
a urine protein electrophoresis procedure is performed to identify proportions of albumin and other proteins
Why would a 24hr urine protein be ordered for patients with diabetes melitus and hypertension
to screen for nephropathy
What is most commonly performed on a spot urine specimen from a diabetic patient
albumin to creatinine ratio
What is the most common screening test for the presence of microalbumin in the urine
Spot Method
What test is used to diagnose diabetic nephropathy and to follow the disease
Spot Method
Can you find the presence of microalbumin in a routine chemstrip testing
no, you must use the spot method
Why is a random urine sample done in the spot method
Tested for the amount of albumin and cratinine present. The amount of albumin present (abnormal) is compared to the amount of creatinine (assumed normal)
What items are checked in a "spot Method"
1. an albumin to creatinine ration
2. presence of microalbumin
3. a random urine sample is tested for the amount of albumin and creatinine present
4. the amount of albumin present is compared to the amount of creatine present
Significance of abnormal protein results
1. increased is pathologic when the level exceeds 150mg/day
2. a level of over 3.5 g/day is defined as massive proteinuria
What are the functional causes proteinuria
1. r/t changes in glomerular blood flow
2. enhanced glomerular permeability
3. no discernible systemic or renal disease or damage
4. severe muscular exertion within 24hrs
5. pregnancy
6. orthostatic proteinuria
These causes of protein urina are usually transient and resolve with time
proteinuria r/t changes in glomerular blood flow or enhanced glomerular permeability
Is the proteinuria with pregnancy usually benign
yes
when is protein uria with pregnancy significant?
with it is in conjunction with hypertension and edema. could be pre-eclampsia
What is orthostatic proteinuria
a benign proteinuria associated with the upright position
What are the organic causes for proteinura
1. prerenal proteinuria: associated with non-renal diseases
2. kidney diseases
name some diseases associated with prerenal proteinuria with non renal diseases
1. multiple myeloma
2. bence jones proteins of low molecular weight
3. CHF
4. Renal hypoxia due to renal artery stenosis
5. hypertension
6. fever
Define multiple myeloma
malignancy of plasma cells causing production of excess immunoglobulin (Ig) light chains
Causes of renal protein uria
caused by kidney diseases, primary or induced glomerular proteinuria: protein leaks through gomerulus
Renal proteinuria: primary
Glomerulonephritis, nephrotic syndrome
Renal proteinuria: induced
Drugs or toxins, systemic disease, diabetes mellitus or pre-eclampsia
Defective tubular reabsorption characterized by increased levels of low molecular weight proteins
Tubular proteinuria
Examples of tubular proteinuria
1. acute or chronic pylelonephritis
2. Drugs or toxins
Postrenal Proteinuria
Protein from the urinary tract below the level of the kidney parenchyma
Examples of postrenal proteinuria
1. inflammation within the urinary tract
2. contamination with vaginal secretions
Example of Inflammation within the urinary tract
1. renal pelvis-pyelonephritis
2. bladder-cystitis
3. urethral-urethritis
4. prostate gland-prostatitis