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52 Cards in this Set

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  • Back
Kidney misc.

When is edema clinically evident?
Not until 2.5-3 L are retained
Kidney misc.

What determines the location of edema?
Location of edema is determined by gravity or by local changes in capillary pressure or permeability.
Kidney misc.

Four causes of edema formation?
Causes of edema formation:
1. increased capillary hydraulic pressure
2. decrease plasma oncotic pressure
3. increased capillary permeability
4. venous or lymphatic obstruction
Kidney misc.

When volume is lost via internal sequestration (third spacing) what does that mean has happened? Give five examples of when this is the case.
Internal sequestration: plasma volume is decreased but interstital volume is not

Five examples are: crush injury, burns, surgery, infection, internal hemorrhage.

This happens from:
1. crush injury
2. burns
3. infection
4. internal hemorrhage
5. surgery
Kidney misc:

Define total body water:
TBW = ICF (2/3) + ECF (1/3)

ECF is further divided into interstitial fluid (3/4 of ECF) and plasma volume (1/4 ECF)
Kidney misc:

What is responsible for the net oncotic pressure in the plamsa volume?
Proteins (colloids) contained inside the plasma compartment kept inside capillaries because of the capillaries poor permeability to proteins.
Kidney misc:

Under normal circumstances where is the hydrostatic pressure greater than the oncotic pressure in the interstitium
The hydrostatic pressure is greater than the oncotic pressure at the arteriolar end causing ultrafiltration of fluit into the interstitium.
Kidney misc:

How is ECF osmolality regulated?
ECF osmolality is regulated with great precision by altering the state of H2O balence. This in effect regulates the plasma sodium concentration, as Na and other ions make up almost all of the ECF. Regulation of ECF osmolality (na conc) in effect regulates the ICF volume.
Kidney misc:

Since ECF volume is maintained relatively constant in the body, does this mean that Na is also maintained constant?
Kidney misc:

What determines renal blood flow?
The sum of the individual resistances of the efferent and afferent arteriole => this determines RBF for any give arterial pressure.
Patient with Hematuria:

What is the definition of hematuria?
> 5 RBC's in a high power field
Patient with Hematuria:

What is pseudohematuria from urinary pigments and what specifically is it caused by?
Urinary pigments creating a pink/red color in the urine. And your urine dipstick would be negative.

This is caused by:
1. anthocyanin (beets)
2. phenotpthalein (laxatives)
3. urates in high concentration (infants)
4. phenazopyridine (pyridium)
5. seratia marcenses infection (infants)
Patient with Hematuria:

What is myoglobinuria?
Another psuedohematuria that causes the formation of red urine, dipstick is positive, sediment shows no RBCs.
Patient with Hematuria:

A positive dipstick and a negative microscopic examination is usually myoglobinuria but what else can it be?
Can also be microhematuria masked by hemolysis (caused by dilute urine, warmth, or alkalinity)
Patient with Hematuria:

What does gross hematuria most commonly signify?

What does microhematuria?
Gross: urologic origin

Micro: nephrologic disease (often accompanied by casts and proteinuria)
Patient with Hematuria:

What does the timing of the hematuria tell you about the origin of blood?
Initial: uretral diseaes (anterior)
Terminal: near the bladder neck or prostatic urethra

Total: disease in bladder, ureter, or kidneys

Blood between voiding (on clothing) but with clear urine: urethral meatus
Patient with Hematuria:

What is silent hematuria? And what is it considered to be?
Silent hematuria is PAINLESS (90%) and often intermittent.

A tumor until proven otherwise
Patient with Hematuria:

What are the for most common reasons for hematuria in adults?
1. tumor
2. stones
3. infection
4. BPH
Patient with Hematuria:

What type of CA are a majority of bladder CA's?
Transitional cell CA (95%)
Patient with Hematuria:

Where to bladder CA's most likely reoccur?
In the urinary tract
Patient with Hematuria:

What is the fourth most common CA in men (and ninth in women)?
transitonal cell CA of bladder
Patient with Hematuria:

What kind of CA can schistosomiasis cause?
Squamous cell CA
Patient with Hematuria:

Can hematuria be caused by anticoagulants?
It could however hematuria DOES NOT RELATE DIRECTLY TO THE PROTHROMBIN TIME and in 80% of cases an actual abnormality is identified.
Patient with Hematuria:

What percentage of joggers will have hematuria and how long before it resolves?
20% of joggers

It clears within 48-72 hrs.
Patient with Hematuria:

How often is hematuria present in a patient with renal cell CA?
40% of the time
Patient with Hematuria:

What is hemorrhagic cystitis?
Hematuria caused by chemotherapeutic agents (most common cyclophosphamide and ifosfamide) as well as bacteria.
Patient with Hematuria:

When you see WBC's in the urine do you now know it must be an infection?
It probably is but you still can rule out other causes so always do a culture.
Patient with Hematuria:

What is the most common cause of hematuria in a patient > 50yo?
Bladder CA
Patient with Hematuria:

What is the likehood ratio of gross vs microhematuria being associated with a life-threatening condition?
Gross hematuria has a 5 time greater likelihood of being associated with something life-threatening
Patient with Hematuria:

Basic evaluation in adults with hematuria includes: (5)
1. History
2. PE
3. Labs (UA +- culture)
4. CT urogram
5. cystoscopy +/- cytology
Urine lab evaluation

What compounds are in urine when urine odor is:
1. normal
2. ammonical odor
3. sweet fruity
4. foul smell
5. stale water smell
1. normal: aromatic compounds
2. ammonical odor: after prolonged standing urea is decomposed by bacteria to NH3
3. sweet: acetone
4. foul smell: UTI with coliform organisms
5. stale water: acute tubular necrosis (no urea to smell because there is no necrosis)
Urine lab evaluation

Three things that could be in urine if urine is foamy?
1. protein
2. bile salts
3. PHENAZOPYRIDINE: analgesic for UTI's
Urine lab evaluation

What two things can increase the osmolarity of urine?
1. contrast media
2. glucose
Urine lab evaluation

Why when testing the pH of urine must the urine be fresh?
Because older urine will have converted the urea to ammonia --> increase in pH
Urine lab evaluation

What two things happen because of alkaline urine?
1. salicylate excretion is enhanced by alkaline urine

2. phosphate and ca carbonate stones form in alkaline urine
Urine lab evaluation

What two things happen in/or signify from acidic urine?
1. cystine and uric acid stones form in acid urine (ur a cysie -- you're a sissy)

2. in diagnosis of acute tubular acidiosis the urine pH remains >5.5
Urine lab evaluation

Does a urine dipstick test for light chains? What color does it give?

Gives a green color (but not for light chains since it doesn't test for light chains)
Urine lab evaluation

Why is urine creatinine excretion used to evaluate if we really obtained a 24 hr urine?

How can it be used to diagnose nephrotic proteinuria?
Used to measure whether or not we have a 24 hr urine because:

Spot urine protein and creatinine ratio (creatinine should be 1500 and protein should be 15)) --> if <0.1 = nL; if >3=nephrotic syndrome
Urine lab evaluation

How do we use creatinine to detect if we have microalbuminemia?
A normal daily albumin excretion is <30mg and nL creatinine is around 1000.

If the ratio of albumin to creatine is >30 = microalbuminemia.
Urine lab evaluation

To measure urinary ketones that could be formed by diabetic ketoacidosis, starvation, alcoholic ketosis we can look for the presence of acetoacetic acid, acetone, and beta hydroxybutyric acid.

Which one of these will not be picked up by dip-stick (reagent impregnated paper strip)?
Beta-hydroxybutyric acid

Urine lab evaluation

In a urinanalysis, if you see WBC's in clumps what is it always?
Urine lab evaluation

What are these findings indicative of:
1. hyaline cast
2. waxy cast
3. fatty cast
4. RBC cast
1. hyaline: dehydration, fasting, CHF (low significance)
2. renal failure (will see sharp borders)
3. nephrotic
4. acute glomerular nephritis
Urine lab evaluation

What is a "dirty brown sediment" in urine indicitive of?
Acute tubular necrosis
Urine lab evaluation

Can uric acid crystals normally be present in the urine?
Yep (cystine are never nL)
Urine lab evaluation

What does it mean to have the presence of triple-phosphate crystals in the urine (coffin-lid)?
This always signifies an infection with a urea splitting organism.

Will form staghorn canaliculi
Urine lab evaluation

Is creatinine freely filtered AND reabsorbed by the glomeruli?
Creatinine is freely filtered but NOT reasborbed!
Urine lab evaluation

If the BUN/Creatinine ratio is 10:1 what two things could this signfy?
either a normal kidney or chronic renal failure
Urine lab evaluation

What if the BUN: Creatinine is >10:1?
This signifies (an increased in urea reabsorption)either
1. decreasd perfusion (hypovolemia and CHF)


2. Increased urea load: (GI bleed from break down of blood products, glucocorticoid break down in tissue, high protein diet, hyper catabolic state, tetracycline)
Urine lab evaluation

What three conditions can cause an BUN/Creatinine > 10:1?
1. Obstructive uropathy
2. uretero-enterstomy (from bladder CA)
3. decreased m. mass
Urine lab evaluation
What three drugs can inhibit the creatinine secretion?
1. cimetidine
2. trimethoprim
3. probenecid
(cause a < 10:1 BUN: creatinine ratio.
Urine lab evaluation

How much does GFR decline per year after age 40?
1mL/min/year after 40
Urine lab evaluation

What is the formula to calculate creatinine clearance?
= (140-age) x wt(kg)

72 x serum creatinine

then multiply by 0.85 for females