M2-C6-L15A --> Renal Function Tests

Front 1

URINALYSIS : COLOR

- Urine being colorless to a deep yellow is associated with?

Back 1

- Urochromes

Front 2

URINALYSIS : COLOR

- Urine being red is associated with? x3

Back 2

- Red cells
- Hemoglobin
- Myoglobin

Front 3

URINALYSIS : COLOR

- Urine being cloudy is associated with? x2

Back 3

- WBC (pyuria)

- Amorphous phosphates

Front 4

URINALYSIS : COLOR

- Urine being Orange or Green is associated with? x2

Back 4

- Bile pigments

- Drugs

Front 5

URINALYSIS : COLOR

- what drug can turn the urine orange?

Back 5

- Rifampin

Front 6

URINALYSIS : DIPSTICK

- measures what? x8

Back 6

(SPPG BLiNK)

- Specific gravity
- pH
- Proteins
- Glucose

- Blood
- Leukocyte esterase
- Nitrites
- Ketones

Front 7

URINALYSIS : DIPSTICK

- Specific gravity normal values

- Specific gravity reflects what? x2

Back 7

1.005 - 1.030

- Concentration of Solutes
- Presence of Heavy Solutes

Front 8

URINALYSIS : DIPSTICK

- Protein findings are associated with?

Back 8

- Albumin

(not immunoglobulins nor mucoproteins)

Front 9

URINALYSIS : DIPSTICK

- Glucose findings may be indicative of? x2

Back 9

- DM

- Glucosuria

Front 10

URINALYSIS : DIPSTICK

- blood in the urine is associated with? x3

Back 10

- RBCs

- Hemoglobin

- Myoglobin

Front 11

URINALYSIS : DIPSTICK

- Leukocyte esterase is released from where?

Back 11

- WBC's

Front 12

URINALYSIS : DIPSTICK

- Nitrite findings are indicative of what?

- what causes this?

Back 12

- infection

- presence of Gram Negative bacteria

(GNB converts Nitrates to Nitrites)

Front 13

URINALYSIS : DIPSTICK

- Ketone findings are indicative of what? x3

Back 13

- DKA

- Alcohol

- Starvation

Front 14

URINALYSIS : DIPSTICK

- pH normal values in urine

- pH becomes more alkaline with what conditions? x2

Back 14

4.0 - 8.0

- After Meals
- After Standing for a while

Front 15

URINALYSIS : CELLS

- RBCs in the UA due to what possible conditions? x2

- criteria for Hematuria

Back 15

- UTI
- Urinary Tract Inflammation

- Hematuria > 2 RBC/HPF

Front 16

URINALYSIS : CELLS

- WBCs in the UA associated with what conditions? x2

- criteria for Pyuria?

Back 16

- UTI
- Urinary Tract Inflammation

- Pyuria > 4 WBC/HPF

Front 17

URINALYSIS : CELLS

- Sterile Pyruia of the UA is indicative of what 4 conditions?

Back 17

(PCR-In)

- Prostatitis
- Chronic Urethritis
- Renal TB

- Interstitial Nephritis

Front 18

URINALYSIS : CELLS

- Interstitial Nephritis seen in Sterile Pyuria is associated with what type of WBCs?

- what stain do you use for this?

Back 18

- Eosinophils

- Wright's stain

Front 19

URINALYSIS : CELLS

- which cells in the UA are just considered contaminants?

Back 19

- Vaginal Squamous Epithelial cells

Front 20

URINALYSIS : CELLS

- Oval Fat Bodies in the UA are associated with what syndrome?

- describe how Oval Fat Bodies are made

Back 20

- nephrOtic syndrOme

- Lipid Uptake by Tubular cells forms the oval fat bodies and fat droplets

Front 21

URINALYSIS : CELLS

- Nephrotic Syndrome shows what cells in the UA?

- what else in the UA?

- what about in the blood?

Back 21

- Oval Fat bodies

- Lipiduria

- HyperLipidemia

Front 22

URINALYSIS : CELLS

- Oval Fat bodies and Lipid droplets can be visualized microscopically with?

- what structure is seen?

Back 22

- Polarized light

- "Maltese Crosses"

Front 23

URINALYSIS : CASTS

- Hyaline Casts seen in?

- Hyaline Casts derived from?

Back 23

- Normal Concentrated Urine

- Tamm-Horsfall Mucoprotein

Front 24

URINALYSIS : CASTS

- Tubular Epithelial Casts are indicative of what condition?

Back 24

- Renal Tubular Injury

Front 25

URINALYSIS : CASTS

- Waxy, broad casts are indicative of what?

Back 25

- Chronic Renal Failure

Front 26

URINALYSIS : CASTS

- RBC casts are indicative of what conditions? x2

Back 26

- Glomerulonephritis

- Vasculitis

Front 27

URINALYSIS : CASTS

- WBC casts are associated with what 2 conditions?

Back 27

- Pyelonephritis
(in the presence of infection)

- Interstitial Nephritis

Front 28

URINALYSIS : CASTS

- Dirty Brown Coarse Granular Casts ("Muddy Brown Casts") are indicative of what conditions?

Back 28

- Acute Tubular Necrosis (ATN)

Front 29

URINALYSIS : CRYSTALS

- Calcium Oxalate crystals look like what under microscopy?

- Calcium Oxalate crystals are indicative of what conditions? x3

Back 29

- Envelop

- Normal Acid Urine
- HyperOxaluria
- Ethylene glycol poisoning

Front 30

URINALYSIS : CRYSTALS

- Triple Phosphate crystals composed of what? x4

- look like what or aka?

Back 30

- Calcium
- Ammonia
- Magnesium
- Phosphate

(coFFFin lids for triple FFFosphate)
- "Coffin-Lid"

Front 31

URINALYSIS : CRYSTALS

- Triple Phosphate crystals (or Coffin lids) in urine suggests what?

- 2 examples of organisms
responsible?

- what would you expect the urine pH to be?

Back 31

- infection by Urea Splitting Organisms

- E.coli
- Klebsiella

- Alkaline

Front 32

URINALYSIS : CRYSTALS

- Cystine crystals look like what? x2

- Cystine crystals indicative of what conditions?

Back 32

(CBS)
- Benzene
- Stop sign

- Cystinuria

Front 33

URINALYSIS : CRYSTALS

- Uric Acid crystals look like what? x2

- Uric Acid crystals are indicative of what? x3

Back 33

(URA = Urates Rhomboid & Amorphous)

- Rhomboid shaped
- Amorphous urates

- Normal Acid urine
- Uric Acid Nephropathy
- Hyperuricosuria

Front 34

RENAL FUNCTION TEST OVERVIEW

- tests what 3 things?

Back 34

(GTP)

- Glomerular Filtration
- Tubular function
- Protein Excretion

Front 35

RENAL FUNCTION TEST OVERVIEW

- Renal Function Test for Glomerular Filtration measures what 3 things?

Back 35

(GF in CBS)

- Creatinine clearance
- BUN in serum
- Creatinine in serum

Front 36

RENAL FUNCTION TEST OVERVIEW

- Renal Function Test for Tubular Function measures what 3 things?

Back 36

(Tubular FAM)

- Fractional Excretion of Solutes (FENa)

- Acidification of urine

- Maximal Urine concentration ability

Front 37

RENAL FUNCTION TEST OVERVIEW

- Renal Function Test for Protein Excretion measures what 2 things?

Back 37

(PE = 24 hour PCR)

- 24 hour Protein

- Protein:Creatinine ratio

Front 38

RENAL FUNCTION TEST OVERVIEW

- what are 2 independent risk factors for Cardiovascular Dz?

Back 38

- Microalbuminuria

- CKD

Front 39

SERUM UREA NITROGEN (BUN)

- Urea is made and secreted from where?

- Daily Urea generation is variable or constant?

- why or why not?

Back 39

- Liver

- Variable

Variable b/c Dependent on
- Protein Intake
- Catabolic rates
(also Liver function)

Front 40

SERUM UREA NITROGEN (BUN)

- Urea generation is dependent on what 3 things?

Back 40

(LPC)

- Liver function

- Protein intake

- Catabolic rates

Front 41

SERUM UREA NITROGEN (BUN)

- Urea is filtered where?

- Urea reabsorption where? x3

Back 41

- Glomerulus

- Proximal Tubules
- Distal Tubules
- Collecting Tubules

Front 42

SERUM UREA NITROGEN (BUN)

- describe the GFR estimation with Urea Clearance

- why so?

Back 42

- "U"rea is "U"nderestimation

- In volume depletion, Urea reabsorption is increased while Creatinine is not.

Front 43

SERUM UREA NITROGEN (BUN)

- normal BUN:Cr ratio

- Urea MW

Back 43

10 to 1

60 Daltons

Front 44

SERUM UREA NITROGEN (BUN)

- Urea reabsorption increases with what volume change?

- how does above volume change affect creatinine?

- thus what can be said?

Back 44

- Volume depletion (pre-renal states)

- Creatinine reabsorption does NOT change

- Urea clearance is an UNDERestimation of GFR

Front 45

BUN : CREATININE RATIO

- Pre-Renal Azotemia involves what type of BUN:Cr ratio change?

Back 45

- Increased

Front 46

BUN : CREATININE RATIO

- what conditions would increase the BUN:Cr ratio? x4

- what diets would increase the BUN:Cr ratio?

- what drugs would increase the BUN:Cr ratio? x2

Back 46

(VC OG gets more ass)
- Volume depletion
- CHF
- Obstructive uropathy
- GI Hemorrhage

- High Protein diet

- Corticosteroids
- Tetracycline

Front 47

BUN : CREATININE RATIO

- what conditions would decrease the BUN:Cr ratio? x2

Back 47

- Liver disease

- Low Protein diet

Front 48

SERUM CREATININE

- Creatinine is made and secreted from where?

- Daily Creatinine generation is variable or constant?

- why or why not?

Back 48

- made by the breakdown of creatinine phosphate in the Muscles

- Constant

- b/c determined by Muscle mass

Front 49

SERUM CREATININE

- Creatinine generation in males?

- Creatinine generation in females?

Back 49

20 to 25 mg/kg/day

15 to20 mg/kg/day

Front 50

SERUM CREATININE

- Creatinine is filtered where?
(give quantitative value)

- Creatinine is reabsorbed where?
(give quantitative value)

- Creatinine is secreted where?
(give quantitative value)

Back 50

- Glomerulus (90%)

- not reabsorbed (0%)

- Tubules (10%)

Front 51

SERUM CREATININE

- Normal Serum Creatinine levels in males

- Normal Serum Creatinine levels in females

Back 51

0.8 to 1.3 mg/dL

0.6 to 1.1 mg/dL

Front 52

SERUM CREATININE

- Serum Creatinine poses a problem as a measure of what pathology?

Back 52

- Renal failure

Front 53

SERUM CREATININE:
PROBLEMS in MEASURE of RENAL FAILURE

T/F : A single value may identify renal failure

Back 53

False

Front 54

SERUM CREATININE
PROBLEMS in MEASURE of RENAL FAILURE

- is serum creatinine DOUBLES, then how is GFR affected?

- does this occur even if the Creatinine remains "normal" range?

Back 54

- GFR decreases 50%

- yes. GFR decreases by 50% despite Creatinine remaining in the "normal" range

Front 55

SERUM CREATININE
PROBLEMS in MEASURE of RENAL FAILURE

- Drugs can falsely elevate Serum Creatinine by interfering with what process?

- list the drugs. x4

Back 55

- Interfering with Creatinine Secretion

(TACT)
- Trimethoprim (Ab)
- Amiloride (diuretic)
- Cimetidine (antacid)
- Triamterene (diuretic)

Front 56

SERUM CREATININE
PROBLEMS in MEASURE of RENAL FAILURE

- In the elderly, describe the levels of serum creatinine

- In the elderly, describe generation rate of creatinine

- reason for above answer

Back 56

- normal range

- Creatinine formation decreases

- b/c dependent on muscle mass, and muscle mass decreases with aging.
(thus elderly make less creatinine)

Front 57

SERUM CREATININE
PROBLEMS in MEASURE of RENAL FAILURE

- In the elderly, why is the Serum Creatinine levels normal when there is a decrease in Creatinine production?

Back 57

- due to Decreased GFR

Front 58

SERUM CREATININE
PROBLEMS in MEASURE of RENAL FAILURE

- what decreases with aging, that is seen in elderly? x2

- what stays in the Normal range with aging, that is seen in elderly?

Back 58

- Creatinine production
- GFR

- Serum Creatinine levels

Front 59

GLOMERULAR FILTRATION

- GFR can be accurately measured using what marker?

Back 59

- Inulin

Front 60

GLOMERULAR FILTRATION

- GFR can be clinically equal to what renal process?

- give the equation for above?

Back 60

GFR = Creatinine clearance

Ccr = ([U]cr x V) / [P]cr

Front 61

GLOMERULAR FILTRATION

- in order to get the 24 hour Creatinine clearance, what is the equation used?

Back 61

Creatinine Clearance (UV/P) multiplied by 1440

(1440 is number of minutes in 24 hours)

Front 62

PITFALLS

- what values will OVERestimate GFR?

- what values will UNDERestimate GFR?

Back 62

- Creatinine clearance

- Urea clearance

Front 63

PITFALLS

- what 3 pitfalls can be involved when assessing GFR?

Back 63

- Overestimation of Creatinine clearance

- Underestimation of Urea clearance

- Inadequate collection of 24 hour urine

Front 64

TUBULAR FUNCTION TESTS
ACIDIFICATION OF URINE

- Acidification of Urine makes the Arterial pH LESS than?

- THUS, the Urine pH should be LESS than?

- IF the Urine pH is GREATER than above value, then it suggests what?

Back 64

< 7.3

< 5.3

RTA
(Renal Tubular Acidosis)

Front 65

TUBULAR FUNCTION TESTS
FRACTIONAL EXCRETION of SOLUTES

- Fractional Excretion of Solutes =
(equation)

- FENa equation =

Back 65

= (Clearance of Solutes) / (Clearance of Creatinine)

= [U/V]na+ / [U/V]cr

Front 66

TUBULAR FUNCTION TESTS
FRACTIONAL EXCRETION of SOLUTES

- FENa is useful as a measure of what pathology?

Back 66

- Acute Oliguric Renal Failure

Front 67

TUBULAR FUNCTION TESTS
FRACTIONAL EXCRETION of SOLUTES

- FENa < 1% suggests what?

- FENa > 1% suggests what?

Back 67

- PRE-renal failure

- Parenchymal Renal Dz
(e.g. - ATN)