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40 Cards in this Set
- Front
- Back
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Specific gravity or osmolality?
- relative proportion of dissolved solids to total volume |
specific gravity
- indicate density of a specimen |
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Specific gravity or osmolality?
- number of particles of solute per unit of solution - the most reliable method for assessment of renal concentrating function |
osmolality
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Hypo-, iso-, or hyper- sthenuria?
- low specitic gravity <1.007 - low osmolality <80mOsm/kg |
hyposthenuria
- diabetes insipidus - glomerulonephritis - pyelonephritis |
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Hypo-, iso-, or hyper- sthenuria?
- specitic gravity fixed around 1.010 - little variation in osmolality |
isosthenuria
- severe renal damage - inability to concentrate urine |
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Hypo-, iso-, or hyper- sthenuria?
- high specitic gravity >1.030 - high osmolality >1200mOsm/k |
hypersthenuria
- dehydration - adrenal insuffisiency - liver disease - congestive heart failure |
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What are some causes of acid urine (pH<6)?
- diet - disease - therapy |
- diet: excess meat protein, cranberries
- disease: metabolic or respiratory acidosis - therapy: ammonium chloride |
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What are some causes of alkaline urine (pH>6)?
- diet - disease - therapy |
- diet: excess citrus fruits
- disease: renal tubular acidosis, metabolic and respiratory alkalosis - therapy: drugs that treat salicylate poisoning or urinary tract calculi |
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What does this indicate?
- heavy proteinuria ( >3.5 gm/day) |
- nephrotic syndrome
- glomerular damage due to primary renal disease or systemic disease (eg ) |
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What does this indicate?
- mild proteinuria (<1gm/day) |
- dehydration, streneous exercise
- chronic pyelonephritis - chronic interstitial nephritis - congenital cystic disease |
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What does this indicate?
- moderate proteinuria (1-3.5gm/day) |
- disease that cause heavy proteinuria
- arteriolonephrosclerosis - multiple myeloma - toxic nephropathies - urinary tract calculi |
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What does this indicate?
- fructose in urine |
- inherited enzyme deficiencies
- parenteral feedings with fructose |
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What does this indicate?
- galactose in urine |
- inherited enzyme deficiencies
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What does this indicate?
- sucrose in urine |
- inherited enzyme deficiencies
- gut disease with sucrase deficiency - ingest too much sucrose |
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T/F: Copper reduction ("Clinitest") detects any reducing substance. All sugars positive.
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T.
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What test detect glucose only?
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Reagent strip (uses glucose oxidase)
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Name three ketone bodies that can appear in the urine.
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- acetoacetic acid
- acetone - 3-hydroxybutyrate chemical screening test for the first two. |
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What does this indicate?
- hematuria |
hematuria (RBC in urine)
- hemorrhage originating anywhere from glomerulus to urethra - bladder is the most common source - most common cause: infections, neoplasms, trauma, coagulation disorders, drugs |
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Common causes of hematuria.
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- infections
- neoplasms - trauma - coagulation disorders - drugs |
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What does this indicate?
- hemoglobinuria |
free hemaglobin(filtered as alpha-beta dimer) in urine
- intravascular hemolysis - mechanical trauma to RBC, DIC, infections, RBC enzyme dificiency, drug |
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Common causes of hemoglobinuria.
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- mechanical trauma to RBC
- DIC - infections - RBC enzyme dificiency - drug |
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What does thid indicate?
- myoglobinuria |
free myoglobin(monomer) dissolved in urine
- acute rhabdomyolysis |
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What does this indicate?
- hemosiderin in the urine |
hemorrhage in the past
- proximal tubule cell catabolize Hg to hemosiderin |
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Normally small amount of what Hg metabolite can be found in the urine?
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- bilirubin glucuronide
- urobilinogen |
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What is the cause?
- increased bilirubin (dark colored urine) - low urobilinogen - pale, gray fecal color |
neoplasm causing bile flow obstruction
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What is the cause?
- increased bilirubin (dark colored urine) - variable urobilinogen - pale, gray fecal color |
gallstones causing bile flow obstruction
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What is the cause?
- no urine bilirubin - increased urobilinogen - dark fecal color |
hemolysis
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What is the next step if reagent strip shows >1mg/dl urobilinogen?
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- Watson-Wchearz test or
- quantitative porphobilinogen - if increased, suspect porphyria |
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What are some indirect test for infection?
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- reagent strip test for nitrite: positve for GNR.
- reagent strip test for leukocyte esterase (more sensitive) |
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What does this indicate?
- oliguria - FE(Na) less than 1% |
prerenal ezotemia
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What does this indicate?
- oliguria - FE(Na) greater than 1% |
intrinsic renal failure
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When is FE(Na) unreliable?
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- if diuretics are used
- FE(urea) can be used for assessment of volume status |
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What does this indicate?
- FE(urea) <30% |
decreased effective circulating volume
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What is 24-hr urine collection for Ca2+, uric acid, oxalate, citrate, Na+, and creatinine used for?
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evaluation of patients with recurrent kidney stones.
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Failure to excrete K+ is seen in ____.
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volume depletion
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What does this indicate?
- hyperkelemia - K+ excretion <15mmol |
inadequate renal response
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What does this indicate?
- hyperkelemia - TTKG <4 |
- inadequate distal Na+ delivery
- inadequate distal K+ excretion |
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What does this indicate?
- hypokelemia - TTKG >10 |
- renal K+ wasting
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What does this indicate?
- negatively charged urine |
NH4+ in the urine
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How to calculate urine net charge?
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urine net charge = (urine Na+ + urine K+) - urine Cl-
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A fixed specific gravity of 1.010 is characteristic of what disease?
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chronic kidney disease
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