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69 Cards in this Set
- Front
- Back
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describe the CCr in normal pregnancy
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increased CCr
normal increase in plasma volume causes an increase in the GFR leading to an increase in CCr highest at the end of the first trimester |
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describe the CCr in early diabetic glomerulopathy
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increased CCr
efferent arteriole becomes constricted due to hyaline arterioloclerosis causing an increase in the GFR and CCr Increased GFR damages the glomerulus |
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describe the findings in CCr in elderly people
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GFR normally decreased with age causing corresponding decrease in the CCr
danger when using nephrotoxic drugs |
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describe the lab findings of CCr in acute and chronic renal failure
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Decreased CCr
ARF due to acute tubular necrosis CRF due to diabetic glomerulopathy |
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what does dark yellow urine indicate?
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concentrated urine
bilirubinemia increased UBG vitamins |
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what does a red or pink urine color indicate?
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hematuria
hemoglobinuria myoglobinuria drugs porphyria |
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what does a smoky color urine indicate?
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acid pH urine converts Hb to hematin
common finding in nephritic type of glomerulonephritis |
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what does black urine after exposure to light indicate?
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alkaptonuria: AR disease with deficiency of homogentisate oxidase with an increase in homogentisic acid in the urine
turns black when exposed to light |
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Cloudy urine with alkaline pH
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normal finding most often due to phosphates
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Cloudy urine with acid pH
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normal finding most often due to uric acid
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what is the function measuring the specific gravity of urine?
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evaluates urine concentration and dilution
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what does a specific gravity of urine > 1.023 (UOsm 900 mOsm/kg) indicate?
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urine concentration and excludes intrinsic renal disease
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urine specific gravity of 1.015 (UOsm 220 mOsm/kg) describes what type of urine?
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hypotonic urine
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what is the best indicator of urine concentration and dilution
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UOsm
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if a patient has a fixed specific gravity of 1.008-1.010 what does this indicate?
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correlates with UOsm
lack of concentration and dilution - chronic renal failure |
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what is the pH of urine determined by?
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diet and acid-base status of the patient
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what is the urine pH of a pure vegan normally?
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alkaline pH due to citrate converted to bicarbonate
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what is the urine pH of a meat eater normally?
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acid pH due to organic acids in meats
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a patients urine sample presents with an alkaline pH and a smell of ammonia, what does this indicate?
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urease producing pathogen (Proteus)
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what does the chemical dipstick for protein detect?
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detects albumin (not globulins)
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what chemical dipstick can detect globulins?
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SSA detects albumin and globulins (BJ protein)
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Lab findings for a patient are albuminuria. How would this diagnosis be made?
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reagent strip and SSA have the same result for protein dipstick
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A patient has a BJ protein present in the urine, how would this diagnosis be made? confirmed?
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SSA greater than reagent strip result
always confirm BJ protein with immunoelectrophoresis |
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describe the Glucose dipstick and what it is used to determine?
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specific for glucose, will not detect fructose or other sugars
detects glucose in urine as low as 30 mg/dL increased serum glucose + glucosuria: DM normal serum glucose + glucosuria: normal pregnancy, benign glucosuria |
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what is the first sign of diabetic nephropathy?
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microalbuminuria
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what does the ketone dipstick detect?
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acetone, acetoacetic acid
NOT b-OHB nitroprusside in the test system only reacts with AcAc and acetone |
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when are ketones usually present in the urine?
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DKA
starvation ketogenic diets pregnancy isopropyl alcohol poisoning |
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T/F
Bilirubin present in the urine is a normal finding |
False
the Bilirubin dipstick detects conjugated bilirubin Bilirubinuria: viral hepatitis, obstructive jaundice |
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patient UBG & bilirubin dipstick:
absent urine UBG, increased urine bilirubin |
obstructive jaundice
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patient UBG & bilirubin dipstick:
increased urine UBG absent urine bilirubin |
extravascular hemolytic anemia
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patient presents with
increased UBG and increased urine bilirubin |
hepatitis
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what does the blood dipstick detect in a urinalysis?
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RBCs, Hb, myoglobin
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common cause of hematuria
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renal stone
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common cause of hemoglobinuria
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intravascular hemolytic anemia
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common cause of myoglobinuria
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crush injuries
increased serum creatine kinase |
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why would leukocyte esterase be present in a patients urine?
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Dipstick detects esterase in neutrophils (pyuria)
infections: urethritis, cystitis, pyelonephritis |
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what type of infection produces sterile pyuria?
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neutrophils present but negative standard urine culture
Chlamydia trachomatis urethritis, tuberculosis, drug induced interstitial nephritis |
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what are bacteria in urinalysis usually indicative of?
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bacteria are usually a sign of urinary tract infection
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what are RBCs in urine a sign of?
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hematuria: renal stone, cancer (bladder, renal), glomerulonephritis
hematuria is > 2-3 RBCs per HPF |
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Dysmorphic RBCs in urine.
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indicated hematuria of glomerular origin
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Neutrophils present in the urine.
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UTI
Sterile pyuria pyuria refers to > 10 WBCs/HPF in centrifuged specimen or > 5 WBC/HPF in an uncentrifuged specimen |
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Oval fat bodies in urine.
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renal tubular cells with lipid
- nephrotic syndrome |
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what are Casts found in urine?
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Cast are formed in tubular lumens in the kidney
they are composed of a protein matrix (Tamm-Horsfall protein) within which ar entrapped cells, debris, or protein leaking through the glomeruli their presence proves renal origin of disease |
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Hyaline cast
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acellular, ghost-like cast containing protein
NO significance in the absence of proteinuria |
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RBC cast
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nephritic type of glomerulonephritis (post-streptococcal glomerulonephritis)
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WBC casts
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acute pyelonephritis
acute tubulointerstitial nephritis |
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Renal tubular cell cast
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acute tubular necrosis
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Fatty cast
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contain lipid
sign of nephrotic syndrome |
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Waxy (broad) cast
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refractive, acellular cast
sign of chronic renal failure |
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what type of crystals can be found in a patients urinalysis?
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Calcium oxalate
Uric acid Triple phosphate Cystine |
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why would calcium oxalate crystals be present in a pt's urine?
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pure vegan diet
ethylene glycol poisoning calcium oxalate stone |
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why would uric acid crystals be present in a patients urine?
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hyperuricemia associated with gout or massive destruction of cells after chemotherapy
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why would triple phosphate crystals be present in a patients urine?
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may be a sign of urinary tract infection due to urease producing uropahtogens
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why would cystine crystals be present in a patients urine?
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hexagonal crystal seen in cystinuria
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most common cystic disease in children?
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renal dysplasia
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T/F there is no inheritance pattern in renal dysplasia.
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True
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describe renal dysplasia?
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abnormal development of one or both kidneys: abnormal structures persists in the kidneys (cartilage, immature collecting ductules)
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how does renal dysplasia present?
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presents as an enlarged, irregular, cystic unilateral (bilateral) flank mass
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what accounts for ~20% of cases of CRF in children?
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renal dysplasia
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what type of inheritance plays a role in Juvenile polycystic kidney disease?
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AR inheritance
- mutation must occur in both alleles |
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describe juvenile polycystic kidney disease.
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bilateral cystic disease; cysts in the cortex and medulla
cysts also occur in the liver associated with congenital hepatic fibrosis leading to portal HTN |
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what is the most serious form of juvenile polycystic kidney disease?
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enlarged kidneys at birth (perinatal)
most serious types are incompatible with life |
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what is associated with Juvenile polycystic kidney disease?
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maternal oligohydramnios (decreased amniotic fluid): newborns have Potter's facies, a deformation due to oligohydramnios; findings include low-set ears, parrot beak nose, lung hypoplasia
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what type of inheritance is associated with Adult polycystic kidney disease?
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AD inheritance
defect on chromosome 16 |
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describe adult polycystic kidney disease.
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bilateral cystic disease develops by 20-25 years of age; bilaterally palpable kidneys; cysts involve all parts of the nephron in the cortex and medulla
cysts are present in the liver, pancreas, and spleen |
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what are some associations with adult polycystic kidney disease?
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hypertension associated with stroke due to ruptured berry aneurysm, intracranial hemorrhage, lacunar infarcts
CRF begins at age 40-60 due to destruction of kidneys by slowly expanding cysts, accounts for ~10% of cases of CRF; it is the most common cause of death others: sigmoid diverticulitis, hematuria, mitral valve prolapse, slight risk for developing renal cell carcinoma |
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describe medullary sponge kidney
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no inheritance pattern
most commonly discovered with an IVP striations are present in the papillary ducts of the medulla multiple cysts of the collecting ducts are present in the medulla Recurrent UTIs, hematuria, and renal stones |
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Describe acquired polycystic kidney disease
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most common cause of renal dialysis
occurs in ~50% of patients on long term dialysis tubules are obstructed by interstitial fibrosis or oxalate crystals small risk for developing renal cell carcinoma |
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describe simple retention cysts
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most common adult renal cyst
derived from tubular obstruction may produce hematuria requires needle aspiration to distinguish it from renal cell carcinoma |
