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126 Cards in this Set
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Total renal blood flow |
~1200 mL/minute |
formed elements + plasma |
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Total renal plasma flow |
600-700 mL/minute |
no formed elements |
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Where final urine concentration takes place through water reabsorption |
Collecting duct |
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Renal blood flow: |
Afferent arteriole > glomerulus > efferent arteriole > peritubular capillaries > vasa recta > renal vein |
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Immediate reabsorption of essential substances |
Proximal convoluted tubule |
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Where final adjustment of urine composition happens |
Distal convoluted tubule |
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Functions as a sieve or filter |
Glomerulus |
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Molecular weight of substances allowed to be filtered in the glomerulus |
MW <70,000 daltons |
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Cannot freely pass to the glumerulus |
Albumin, proteins |
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What will happen if the capillary walls and Bowman's capsule are damaged? |
There will be a passage of blood cells and proteins |
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Water outside |
Hydrostatic pressure |
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Retains water inside |
Osmotic pressure |
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Regulates the flow of blood to and within the glomerulus |
RAAS |
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Dilates the afferent arteriole and constricts the efferent arteriole (high BP) |
Angiotensin II |
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Responds to changes in blood pressure and sodium content that are monitored by the juxtaglomerular apparatus |
RAAS |
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Stimulates sodium reabsorption in the proximal convoluted tubule |
Angiotensin II |
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Triggers the adrenal cortex to release sodium-retaining hormone aldosterone |
Angiotensin II |
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Triggers ADH release by the hypothalamus to stimulate water reabsorption in the collecting duct |
Angiotensin II |
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Sodium-retaining hormone |
Aldosterone |
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ADH/Vasopressin is produced by: |
Hypothalamus |
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Hormones stored in posterior pituitary gland |
ADH and Oxytocin |
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Levels of ADH secretion and urine volume in increased body hydration |
Decreased, Increased |
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Levels of ADH secretion and urine volume in decreased body hydration |
Increased, decreased |
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When the plasma ultrafiltrate enters the proximal convoluted tubule, the nephrons, through cellular transport mechanisms, begin reabsorbing the essential substances and water |
Tubular reabsorption |
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Two types of nephrons: |
Cortical nephrons Juxtamedullary nephrons |
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Movement of a substance across cell membranes into the bloodstream by electrochemical energy (ATP) |
Active transport |
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Movement of molecules across a membrane by diffusion because of physical gradient |
Passive transport |
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Substances in active transport |
Glucose Amino acid Chloride Sodium |
GACS |
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Substances in passive transport |
Water Urea Sodium |
WUS |
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Active transport: Glucose and amino acid location of reabsorption |
Proximal convoluted tubule |
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Active transport: Chloride location of reabsorption |
Ascending loop of Henle |
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Active transport:Sodium location of reabsorption |
Proximal and distal convoluted tubules |
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Passive transport:Water location of reabsorption |
Proximal convoluted tubule Descending loop of Henle Collecting duct |
CPD |
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Passive transport: Urea location of reabsorption |
Proximal convoluted tubule Ascending loop of Henle |
UPA |
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Passive transport: Sodium location of reabsorption |
Ascending loop of Henle |
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Impermeable to water (no transport of water) |
Ascending loop of Henle |
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Plasma concentration at which active transport stops |
Renal threshold |
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Renal threshold of glucose: |
160-180 mg/dL |
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The passage of substances from the blood in the peritubular capillaries to the tubular filtrate |
Tubular secretion |
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Eliminates water products not filtered by the glomerulus |
Tubular secretion |
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Regulates the acid-base balance in the body through the secretion of hydrogen ions |
Tubular secretion |
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Original GF volume |
180 L in 24 hours |
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180 L is reduced to about: |
1-2 L |
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Clearance tests: |
Creatinine B2-microglobulin Cystatin C Radioisotopes |
RCBC |
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Measures the rate at which the kidneys are able to remove a filterable substance from the blood |
Clearance test |
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Original reference method for GFR |
Inulin |
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Earliest GF test measures: |
Urea |
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Greatest source of error in any clearance test |
Improperly timed urine specimens |
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How to ensure that the GF is being measured accurately? |
The substance analyzed must be one that is neither reabsorbed nor secreted by the tubules |
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24 hr urine collection: Day 1 (7 AM) |
Px voids and discards the specimen; collect all urine for the next 24 hours |
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24 hr urine collection:Day 2 (7 AM) |
Px voids and adds the urine to previously collected urine |
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After 24 hr urine is collected, the first thing to do is: |
Measure the volume |
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Single marker that denotes renal failure |
Creatinine |
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Marker of renal tubular integrity |
Microglobulin |
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Polymer of fructose; extremely stable substance that is not reabsorbed nor secreted by the tubules |
Inulin |
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Not a normal body constituent; infused by IV throughout the testing period |
Inulin |
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Small protein produced at a constant rate by all nucleated cells |
Cystatin C |
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Readily filtered by the glomerulus and reabsorbed and broken down by the renal tubular cells; not secreted in the tubules; serum concentration can be directly related to the GFR |
Cystatin C |
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Dissociates from HLA at a constant rate; rapidly removed from the plasma |
Beta 2-microglobulin |
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Decreased GFR and increased plasma levels of analyte (accumulation) |
Kidney disease |
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Injecting radionucleotides; enables visualization of the filtration in one or both kidneys; measure the viability of a transplanted kidney |
Radioisotopes |
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Waste product of muscle metabolism that is produced enzymatically by creatine phosphokinase from creatine; endogenous substance |
Creatinine |
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Creatinine clearance formula/s: |
A. U/P B. UV/P x 1.73/A |
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Normal creatinine clearance value |
Approaches 120 mL/min |
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Creatinine clearance NV in men |
107-139 mL/min |
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Creatinine clearance NV in women |
87-107 mL/min |
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Estimated GFR |
Cockcroft - Gault Formula Modification of Diet in Renal Disease Formula |
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Predicts creatinine clearance and the results are not corrected for body surface area |
Cockcroft - Gault Formula |
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Cockcroft - Gault Formula Parameters |
Body weight (kg) Age Gender/sex Serum creatinine |
BAGS |
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MDRD formula parameters: |
Race Age Gender/sex Serum creatinine * Variables include ethnicity, BUN, and serum albumin |
RAGS |
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Factors needed in the computation using Cockroft-Gault formula, except: A. Age B. Plasma creatinine C. 24-hr urine volume D. Body weight |
C. 24-hr urine volume |
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First function to be affected in renal disease |
Tubular reabsorption |
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Concentration tests |
Specific gravity Osmometry |
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Screening procedure; quantitative; influenced by the number and density (MW) of the particles |
Specific gravity |
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Patients were deprived of fluids for 24 hours before measuring SG |
Fishberg test |
>1.026 (normal) |
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Volume and SG of day and night urine samples are compared to evaluate concentrating ability |
Mosenthal test |
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More accurate than SG; quantitative of renal concentrating ability; only the number of particles in a solution |
Osmometry |
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Measurement of freezing point depression was the first principle incorporated into clinical osmometers; 1 mol of nonionizing substance dissolved in 1 kg of water lowers the freezing point to 1.86°C |
Freezing point osmometer |
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Radiographic contrast media >1.040 |
Increased MW substances |
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Tests to measure tubular secretion of nonfiltered substances and renal blood flow are closely related in that total renal blood flow through the nephron |
PSP test (historically) PAH test (most commonly associated) |
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Excreted acid in a normal person: |
70 mEq/day (in a form of H+, H2PO4-, NH4+) |
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The inability to produce an acidic urine in the presence of metabolic acidosis; can be caused by impaired tubular secretion of hydrogen ions or ammonia |
Renal Tubular Acidosis |
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Renal Tubular Acidosis urine pH: |
Alkaline |
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Renal Tubular Acidosis additional tests: |
Urine pH Titratable acidity Urinary ammonia measurement |
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Urine composition: |
95% water 5% solutes |
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Total dissolved solids in 24 hours |
60 grams |
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Organic substances in urine |
35 grams (urea, creatinine, uric acid) |
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Inorganic substances in urine |
25 grams (chloride, sodium, potassium) |
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Major metabolic waste product produced in the liver from the breakdown of protein and amino acids |
Urea |
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Major inorganic solid dissolved in urine |
Chloride |
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Urine specimen must be: |
Collected in clean, dry, leak-proof containers that must be clear to determine the color and clarity of urine; labels should be attached to the container and not to the lid |
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Recommended capacity of the urine container |
50 mL |
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Volume of urine needed for microscopic analysis: |
12 mL |
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No mixing of urine can cause: |
False negative |
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Methods of urine collection: |
Midstream Cathetherized Suprapubic aspiration Glass technique Pediatric specimen Drug specimen collection |
MSG CPD |
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Routine screening, bacterial culture |
Midstream |
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Cathetherized |
Bacterial culture |
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Bladder urine for bacterial culture, cytology |
Suprapubic aspiration |
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Prostatic infection |
Three-glass technique |
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Three-glass technique: |
1st - first voided 2nd - midstream 3rd - post-massage spx |
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Use of soft, clear plastic bag with adhesive; sterile spx obtained through cathetherization and suprapubic aspiration |
Pediatric specimen |
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Drug specimen collection |
30-45 mL urine in a 60 mL container Temperature should be 32.5-37.7 °C (measured within 4 mins after collection) Validity is 1 year |
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Types of urine specimens |
Occasional/single/random Timed First morning Fasting/second morning |
TOFF |
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Fasting/second morning |
Glucose determination |
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First morning |
Routine testing, pregnancy, evaluation of orthostatic proteinuria |
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Timed urine |
Quantitative chemical tests |
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24 hour; |
Creatinine clearance |
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12 hours: |
Addis count |
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Afternoon specimen (2-4PM); collected using amber bottle |
Urobilinogen determination |
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Collected after 4 hours to allow contact of bacteria and urinary nitrate (nitrate to nitrite) |
Nitrite determination |
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Occasional/single/random |
Routine screening |
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Increased in unpreserved urine: |
pH Odor Nitrite Bacteria |
PONB |
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Least affected in unpreserved urine: |
Protein |
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Color of unpreserved urine: |
Modified or darkened |
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Decreased in unpreserved urine: |
Clarity Glucose Ketones Bilirubin Urobilinogen WBC/RBC |
KRUB GCW |
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Urine specimen must be measured within: |
2 hours *If not, it must be refrigerated or added with a preservative |
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Preservation, physical: |
Refrigeration Freezing/ice |
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Chemical preservatives |
Formalin Thymol Boric acid Toluene Sodium fluoride Phenol HCl H2SO4- Saccamano's fixative |
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Saccamano's fixative |
Cytology |
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Formalin |
Addis count |
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Boric acid |
Bacterial culture Albumin |
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HCl |
Catecholamines |
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Preserves glucose and sediments well but interferes with acid precipitation tests for protein |
Thymol |
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Doesn't interfere but floats on surface of specimens and clings to pipettes and testing materials; preserves ketones and proteins but is not effective against bacteria |
Toluene |
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Indicates the degree of hydration and should correlate with urine SG |
Color |
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Color in high SG |
Darker |
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