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191 Cards in this Set
- Front
- Back
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most accurate way of assessing renal failure when a pt is oliguric (<400ml/day)
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fractional excretion of sodium (FENa)
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the calculation of the FENa is based on what?
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The concentrations of Na in the blood and urine
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This gives us clues about the renal parenchyma
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Urine sediment for microscopy view
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How long can you let a urine sample sit before it is too late to be tested?
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1 hour or refrigerate
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Urinalysis result that is suggestive of bacteria?
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Leukocyte Esterase (produced by neutrophils)
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Urinalysis result that is suggestive of gram negative bacteria
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Nitrites (reduced from Nitrates by gram neg bacteria)
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If Nitrites are not present, can you rule out bacturia?
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No
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What is the first indication of renal dz?
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Proteinuria (4+ and above)
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This is useful for diagnosing UTI's, Urinary stone dz, and renal tubular acidosis.
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Urinary pH
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Normal range of urinary pH?
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5.0-8.0
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This can give you a false positive result of blood detected by urinalysis dipstick
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(aside from menses and concentrated urine), ingestion of excessive ascorbic acid (Vit C)
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correlates with urine osmolality, and gives important insight into hydration status
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specific gravity
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normal range of specific gravity
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1.003 - 1.030
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specific gravity is normally not elevated. If it is, what should you suspect?
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contamination
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conditions that can give a false positive of Ketones in the urine
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pregnant, post exercise, a carb free diet. Taking levadopa or captopril
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urinalysis result suggesting hepatic dz or hemalytic processes
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urobillinogen above 4 mg/day
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What does the presence of 3 RBC's on a high power view mean?
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The presence of blood in the urine and warrants further work up
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Dysmorphic RBC's on a smear indicate what type of disorder?
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nephritic
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how many WBC must be seen on a high power view for it to be classified as pyuria?
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5
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When is sterile pyuria seen?
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GU TB and analgesic neuropathy
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What is the most common protein excreted in the urine?
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TAMM Horsefall muco protein
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These casts are seen in febrile dz, following strenuous exercise, and during a short diuretic therapy, but do not necessarily suggest renal pathology
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Hyaline Casts
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These casts are a result of renal parenchymal bleeding; a hallmark of nephritic syndrome
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RBC Casts
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These casts indicate pyelonephritis (a distinguisher from upper and lower UTI infections
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White Cell Casts
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sloughed tubuler cells that form tubuler cell casts are characteristic of…
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acute tubuler necrosis
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Muddy Brown granuler cells are an indicator of…
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acute tubuler necrosis
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Broad, Waxy casts are an indicator of…
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parenchymal dz… an indicator of stasis (they are broad because tubules become dialated). It is an indicator of Chronic Kidney Dz
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Renal pain may radiate to?
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umbilicus….may be referred to?
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|
|
Renal pain is usually constant if..
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infection
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renal pain may come and go if…
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obstruction…
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Patients with intraperitoneal disease typically…
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lie motionless
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If upper uretal obstruction, pain is referred to
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scrotum or labia
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suprapupic discomfort is associated with
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acute urinary retention
|
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Is there pain with chronic retention?
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no
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Where is the pain usually referred to in acute cystitis?
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distal urethra and it is associated with micturation
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|
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"This may result in scrotal ""heaviness""
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varicocele or hydrocele
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Do you refer a patient with hematospermia?
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depends…if young and healthy male, may be transient…results from inflammation of prostate or seminal vesicles….however, if painful, refer
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|
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Presence of gas in the urine is called
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pneumaturia…
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When do you seen pneumaturia?
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diverticulitis is most common cause; also seen with colon cancer and IBD
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What must you do if elderly patient has bloody urethral discharge?
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rule out urethral carcinoma
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What is a way to differentiate between pyelonephritis and acute cystitis?
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Fever occurs with pyelonephrites, but not acute cystits (usually)
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|
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In men, a fever may be associated with?
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acute prostatitis or acute epidiymitis
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|
|
Renal pain may radiate to?
|
umbilicus….may be referred to?
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|
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Renal pain may radiate to?
|
umbilicus….may be referred to?
|
|
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Renal pain may radiate to?
|
umbilicus….may be referred to?
|
|
|
Renal pain is usually constant if..
|
infection
|
|
|
Renal pain is usually constant if..
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infection
|
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**This is a late finding in cancer!**
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FEVER!!
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|
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Renal pain is usually constant if..
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infection
|
|
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renal pain may come and go if…
|
obstruction…
|
|
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renal pain may come and go if…
|
obstruction…
|
|
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The principal end product of protein catabolism and constitutes one half of total urinary solids. It is synthesized in the liver.
|
UREA
|
|
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renal pain may come and go if…
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obstruction…
|
|
|
Patients with intraperitoneal disease typically…
|
lie motionless
|
|
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Patients with intraperitoneal disease typically…
|
lie motionless
|
|
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Patients with intraperitoneal disease typically…
|
lie motionless
|
|
|
If upper uretal obstruction, pain is referred to
|
scrotum or labia
|
|
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If upper uretal obstruction, pain is referred to
|
scrotum or labia
|
|
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What will the BUN look like in SIADH?
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decreased
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suprapupic discomfort is associated with
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acute urinary retention
|
|
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If upper uretal obstruction, pain is referred to
|
scrotum or labia
|
|
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suprapupic discomfort is associated with
|
acute urinary retention
|
|
|
Normal values for serum creatinine
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0.6-1.2
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|
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Is there pain with chronic retention?
|
no
|
|
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product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion
|
serum creatinine
|
|
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suprapupic discomfort is associated with
|
acute urinary retention
|
|
|
Is there pain with chronic retention?
|
no
|
|
|
Where is the pain usually referred to in acute cystitis?
|
distal urethra and it is associated with micturation
|
|
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When may you see an increased Serum Creatinine?
|
renal failure and urinary tract obstruction, increased cooked meat intake, increased muscle mass, meds
|
|
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Is there pain with chronic retention?
|
no
|
|
|
Where is the pain usually referred to in acute cystitis?
|
distal urethra and it is associated with micturation
|
|
|
"This may result in scrotal ""heaviness""
|
varicocele or hydrocele
|
|
|
Where is the pain usually referred to in acute cystitis?
|
distal urethra and it is associated with micturation
|
|
|
Normal values for GFR?
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100-120 ml/min
|
|
|
"This may result in scrotal ""heaviness""
|
varicocele or hydrocele
|
|
|
"This may result in scrotal ""heaviness""
|
varicocele or hydrocele
|
|
|
Do you refer a patient with hematospermia?
|
depends…if young and healthy male, may be transient…results from inflammation of prostate or seminal vesicles….however, if painful, refer
|
|
|
Do you refer a patient with hematospermia?
|
depends…if young and healthy male, may be transient…results from inflammation of prostate or seminal vesicles….however, if painful, refer
|
|
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What is the gold standard for GFR?
|
inject with inulin and measure the clearance…not practical, so we use creatinine clearance
|
|
|
Do you refer a patient with hematospermia?
|
depends…if young and healthy male, may be transient…results from inflammation of prostate or seminal vesicles….however, if painful, refer
|
|
|
Presence of gas in the urine is called
|
pneumaturia…
|
|
|
What test do you use when you suspect acute renal failure? It is most accurate when patient is oliguric.
|
fractional excretion of sodium
|
|
|
Presence of gas in the urine is called
|
pneumaturia…
|
|
|
Presence of gas in the urine is called
|
pneumaturia…
|
|
|
When do you seen pneumaturia?
|
diverticulitis is most common cause; also seen with colon cancer and IBD
|
|
|
When do you seen pneumaturia?
|
diverticulitis is most common cause; also seen with colon cancer and IBD
|
|
|
normal range for urinary pH
|
5.0-8.0
|
|
|
What must you do if elderly patient has bloody urethral discharge?
|
rule out urethral carcinoma
|
|
|
When do you seen pneumaturia?
|
diverticulitis is most common cause; also seen with colon cancer and IBD
|
|
|
What is a way to differentiate between pyelonephritis and acute cystitis?
|
Fever occurs with pyelonephrites, but not acute cystits (usually)
|
|
|
What could cause a false negative blood result in urine?
|
high ascorbic acid intake
|
|
|
What must you do if elderly patient has bloody urethral discharge?
|
rule out urethral carcinoma
|
|
|
What must you do if elderly patient has bloody urethral discharge?
|
rule out urethral carcinoma
|
|
|
What is a way to differentiate between pyelonephritis and acute cystitis?
|
Fever occurs with pyelonephrites, but not acute cystits (usually)
|
|
|
In men, a fever may be associated with?
|
acute prostatitis or acute epidiymitis
|
|
|
Normal range for specific gravity
|
1.003 to 1.030
|
|
|
What is a way to differentiate between pyelonephritis and acute cystitis?
|
Fever occurs with pyelonephrites, but not acute cystits (usually)
|
|
|
**This is a late finding in cancer!**
|
FEVER!!
|
|
|
In men, a fever may be associated with?
|
acute prostatitis or acute epidiymitis
|
|
|
When will high specific values be present in urine?
|
dehydration and shock….decreased levels are seen in overhydration or an impaired ability to concentrate the urine
|
|
|
In men, a fever may be associated with?
|
acute prostatitis or acute epidiymitis
|
|
|
The principal end product of protein catabolism and constitutes one half of total urinary solids. It is synthesized in the liver.
|
UREA
|
|
|
**This is a late finding in cancer!**
|
FEVER!!
|
|
|
dysmorphic RBC in urine indicates
|
nephritic syndrome
|
|
|
**This is a late finding in cancer!**
|
FEVER!!
|
|
|
If the RBC in the urine is round/normal shaped, then
|
disease along epithelial lining of tract
|
|
|
The principal end product of protein catabolism and constitutes one half of total urinary solids. It is synthesized in the liver.
|
UREA
|
|
|
The principal end product of protein catabolism and constitutes one half of total urinary solids. It is synthesized in the liver.
|
UREA
|
|
|
What will the BUN look like in SIADH?
|
decreased
|
|
|
What could cause sterile pyuria?
|
GU Tb and analgesic nephropathy
|
|
|
What will the BUN look like in SIADH?
|
decreased
|
|
|
What will the BUN look like in SIADH?
|
decreased
|
|
|
Normal values for serum creatinine
|
0.6-1.2
|
|
|
Red cell casts are hallmark for
|
nephritic syndrome; indicates intraparenchymal bleeding
|
|
|
Normal values for serum creatinine
|
0.6-1.2
|
|
|
product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion
|
serum creatinine
|
|
|
Normal values for serum creatinine
|
0.6-1.2
|
|
|
White cell casts are characteristic of
|
pyelonephritis and acute interswtitial nephritis
|
|
|
product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion
|
serum creatinine
|
|
|
product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion
|
serum creatinine
|
|
|
When may you see an increased Serum Creatinine?
|
renal failure and urinary tract obstruction, increased cooked meat intake, increased muscle mass, meds
|
|
|
Normal values for GFR?
|
100-120 ml/min
|
|
|
Tubular casts are seen in
|
acute tubular necrosis
|
|
|
When may you see an increased Serum Creatinine?
|
renal failure and urinary tract obstruction, increased cooked meat intake, increased muscle mass, meds
|
|
|
When may you see an increased Serum Creatinine?
|
renal failure and urinary tract obstruction, increased cooked meat intake, increased muscle mass, meds
|
|
|
Granular casts are seen in
|
acute tubular necrosis
|
|
|
What is the gold standard for GFR?
|
inject with inulin and measure the clearance…not practical, so we use creatinine clearance
|
|
|
Normal values for GFR?
|
100-120 ml/min
|
|
|
Normal values for GFR?
|
100-120 ml/min
|
|
|
These casts are seen in chronic kidney disease. They are indicative of stasis and tubules that have become dilated and atrophic due to chronic parenchymal disease.
|
broad, waxy casts
|
|
|
What test do you use when you suspect acute renal failure? It is most accurate when patient is oliguric.
|
fractional excretion of sodium
|
|
|
What is the gold standard for GFR?
|
inject with inulin and measure the clearance…not practical, so we use creatinine clearance
|
|
|
What is the gold standard for GFR?
|
inject with inulin and measure the clearance…not practical, so we use creatinine clearance
|
|
|
This is important to screen diabetics for because it highly correlates with diabetic nephropathy.
|
microalbumineria
|
|
|
What test do you use when you suspect acute renal failure? It is most accurate when patient is oliguric.
|
fractional excretion of sodium
|
|
|
normal range for urinary pH
|
5.0-8.0
|
|
|
What test do you use when you suspect acute renal failure? It is most accurate when patient is oliguric.
|
fractional excretion of sodium
|
|
|
protein range in urine > 3.5g/day =
|
nephrotic range proteinuria
|
|
|
What could cause a false negative blood result in urine?
|
high ascorbic acid intake
|
|
|
normal range for urinary pH
|
5.0-8.0
|
|
|
normal range for urinary pH
|
5.0-8.0
|
|
|
gold standard for quantifying the level of protein excretion
|
24 hour urine collection
|
|
|
What could cause a false negative blood result in urine?
|
high ascorbic acid intake
|
|
|
What could cause a false negative blood result in urine?
|
high ascorbic acid intake
|
|
|
Normal range for specific gravity
|
1.003 to 1.030
|
|
|
How do you treat proteinuria?
|
ACE or ARB….goal is to lower proteinuria to <0.5 grams per day
|
|
|
Normal range for specific gravity
|
1.003 to 1.030
|
|
|
Normal range for specific gravity
|
1.003 to 1.030
|
|
|
When will high specific values be present in urine?
|
dehydration and shock….decreased levels are seen in overhydration or an impaired ability to concentrate the urine
|
|
|
When will high specific values be present in urine?
|
dehydration and shock….decreased levels are seen in overhydration or an impaired ability to concentrate the urine
|
|
|
dysmorphic RBC in urine indicates
|
nephritic syndrome
|
|
|
What levels may go up with ACE-I?
|
potassium and creatinine
|
|
|
When will high specific values be present in urine?
|
dehydration and shock….decreased levels are seen in overhydration or an impaired ability to concentrate the urine
|
|
|
dysmorphic RBC in urine indicates
|
nephritic syndrome
|
|
|
dysmorphic RBC in urine indicates
|
nephritic syndrome
|
|
|
If the RBC in the urine is round/normal shaped, then
|
disease along epithelial lining of tract
|
|
|
If the RBC in the urine is round/normal shaped, then
|
disease along epithelial lining of tract
|
|
|
What could cause sterile pyuria?
|
GU Tb and analgesic nephropathy
|
|
|
If the RBC in the urine is round/normal shaped, then
|
disease along epithelial lining of tract
|
|
|
What could cause sterile pyuria?
|
GU Tb and analgesic nephropathy
|
|
|
Red cell casts are hallmark for
|
nephritic syndrome; indicates intraparenchymal bleeding
|
|
|
What could cause sterile pyuria?
|
GU Tb and analgesic nephropathy
|
|
|
White cell casts are characteristic of
|
pyelonephritis and acute interswtitial nephritis
|
|
|
Red cell casts are hallmark for
|
nephritic syndrome; indicates intraparenchymal bleeding
|
|
|
Tubular casts are seen in
|
acute tubular necrosis
|
|
|
Red cell casts are hallmark for
|
nephritic syndrome; indicates intraparenchymal bleeding
|
|
|
White cell casts are characteristic of
|
pyelonephritis and acute interswtitial nephritis
|
|
|
Tubular casts are seen in
|
acute tubular necrosis
|
|
|
White cell casts are characteristic of
|
pyelonephritis and acute interswtitial nephritis
|
|
|
Granular casts are seen in
|
acute tubular necrosis
|
|
|
Granular casts are seen in
|
acute tubular necrosis
|
|
|
Tubular casts are seen in
|
acute tubular necrosis
|
|
|
These casts are seen in chronic kidney disease. They are indicative of stasis and tubules that have become dilated and atrophic due to chronic parenchymal disease.
|
broad, waxy casts
|
|
|
Granular casts are seen in
|
acute tubular necrosis
|
|
|
These casts are seen in chronic kidney disease. They are indicative of stasis and tubules that have become dilated and atrophic due to chronic parenchymal disease.
|
broad, waxy casts
|
|
|
This is important to screen diabetics for because it highly correlates with diabetic nephropathy.
|
microalbumineria
|
|
|
This is important to screen diabetics for because it highly correlates with diabetic nephropathy.
|
microalbumineria
|
|
|
These casts are seen in chronic kidney disease. They are indicative of stasis and tubules that have become dilated and atrophic due to chronic parenchymal disease.
|
broad, waxy casts
|
|
|
protein range in urine > 3.5g/day =
|
nephrotic range proteinuria
|
|
|
protein range in urine > 3.5g/day =
|
nephrotic range proteinuria
|
|
|
This is important to screen diabetics for because it highly correlates with diabetic nephropathy.
|
microalbumineria
|
|
|
gold standard for quantifying the level of protein excretion
|
24 hour urine collection
|
|
|
How do you treat proteinuria?
|
ACE or ARB….goal is to lower proteinuria to <0.5 grams per day
|
|
|
gold standard for quantifying the level of protein excretion
|
24 hour urine collection
|
|
|
protein range in urine > 3.5g/day =
|
nephrotic range proteinuria
|
|
|
What levels may go up with ACE-I?
|
potassium and creatinine
|
|
|
How do you treat proteinuria?
|
ACE or ARB….goal is to lower proteinuria to <0.5 grams per day
|
|
|
gold standard for quantifying the level of protein excretion
|
24 hour urine collection
|
|
|
How do you treat proteinuria?
|
ACE or ARB….goal is to lower proteinuria to <0.5 grams per day
|
|
|
What levels may go up with ACE-I?
|
potassium and creatinine
|
|
|
What levels may go up with ACE-I?
|
potassium and creatinine
|
