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71 Cards in this Set
- Front
- Back
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What are the main functions of the kidney |
Regulates composition and volume of extracellular fluid Removal of waste products and toxins Acid base balance Retention of essential nutrients Production/secretion of hormones |
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What is pyelonephritis |
Infection of the kidney |
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What is cystitis |
Infection of the bladder |
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How much ultrafiltrate do you make per day |
7.2 liters |
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How much urine do you produce per day |
1.2-1.5 liters |
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What crystals are abnormal in the urine |
Leucine, tyrosine, cystine, bilirubin, cholesterol |
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What is oliguria |
Producing less than 600ml in 24 hours Caused by dehydration, renal ischemia, toxins, renal calculi, acute glomerularnephritis |
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What is anuria |
No urine formation |
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What happens to urine at room temperature after 30 minutes? (6 things) |
Bacteria multiply Glucose decreases Nitrates reduced to nitrites Breakdown of urea to ammonia raises pH Ketones evaporate Bilirubin and urobilinogen oxidizes |
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What is the functional unit of the kidney |
Nephron |
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What are the 3 barriers used by the glomerulus to keep large molecules from being filtered |
Fenestrated capillary epithelium Negative charge of basement membrane Podocytes of bowman's capsule |
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What normal crystals are seen in acidic urine? |
Uric acid, amorphous urates, and calcium oxalate |
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What normal crystals are seen in alkaline urine |
Triple phosphate, ammonium biurate, calcium carbonate, amorphous phosphates, calcium phosphate |
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What factors contribute to cast formation |
High solute concentration Acidic environment Urinary stasis Increased protein |
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What happens in the proximal convoluted tubular? |
Active transport - reabsorption of molecules- glucose, albumin, as, salts, sodium, uric acid Passive transport- urea and water |
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What happens in the loop of henle? |
Descending limb- water passively reabsorbed Ascending limb- Cl actively reabsorbed, Na passively, impermeable to water, urea passively reabsorbed |
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What happens in the distal convoluted tubule? |
Na is actively reabsorbed when triggered by the RAAS |
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What happens in the collecting ducts? |
ADH causes water reabsorption by making cells more permeable to water |
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Explain the renin angiotensin aldosterone system |
Low bld pressure or bld volume is sensed by juxtamedullary apparatus of kidney causing renin secretion. Renin converts angiotensinogen to angiotensin 1 which is further metabolized to angiotensin 2. Angiotensin 2 causes vasoconstriction and aldosterone secretion. Aldosterone causes Na reabsorption from kidney. Increased bld volume and pressure ensues. |
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What is secreted directly into the tubules? |
Creatinine Uric acid Toxins H, HCO3, Cl |
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What is an enzymatic reaction on the urine reagent strip? |
Blood, glucose, leukocyte |
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What is the confirmatory urine test for protein? |
Sulfosalicyclic acid test |
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What is the confirmatory test for bilirubin in the urine? |
Ictotest |
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What test is used to differentiate urobilinogen and porphobilinogen in urine? |
Watson-Schwartz test |
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When performing the Watson-Schwartz test, which analyte is soluble in chloroform and butanol? |
Urobilinogen |
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What test is used to confirm glucose in the urine? |
Clinitest or copper sulfate test |
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Why would you have turbid urine? |
Crystals, cells or casts |
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What is normal specific gravity for urine? |
1.002-1.030 Most people are 1.015-1.025 |
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If someone has protein or glucose in their urine, what must be done to the specific gravity of it was performed on a refractometer |
Make an adjustment of - 0.003 |
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If the urine is alkaline (pH >or= 6.5) what needs to be done to the specific gravity if it was performed on a reagent strip? |
Add 0.005 |
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What are reasons to have low urine s.g. |
Diabetes insipidus Glomerulonephritis Pyelonephritis |
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What causes a person to have abnormally high urine s.g. |
Diabetes mellitus Adrenal insufficiency Liver disease CHF |
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What is normal urine pH? |
5-6 |
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What causes glucosuria? |
Renal glucosuria-inherited condition Diabetes mellitus Alimentary glucosuria- eating high levels of sugar in diet Epinephrine response Liver damage |
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What are causes of proteinuria? |
Transient- fever, thyroid disease, exercise, heart disease, orthostatic Persistent- multiple myeloma, septicemia, glomerulonephritis, nephrotic syndrome, pyelonephritis, renal tubular nephrosis |
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What urine dip stick test has a citrate buffer? |
Protein |
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How do you get false poitives on the protein dip stick test? |
High urine oH Excessive exposure to urine |
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Why would you have false negative result in a bilirubin dip stick test? |
Old sample- bilirubin will be oxidized to biliverdin High levels of vitamin C or nitrites |
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What is the reagent in the bilirubin dip stick urine test? |
Diazo reagent |
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When will you see increased urobilinogen in the urine? |
Hemolytic anemias Liver disease |
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What three things will cause a positive on the reagent strip for blood? |
Hemoglobin, RBCs, and myoglobin |
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Explain the nitrite test principle? |
An aromatic amine reacts with nitrite in the presence of an acid buffer to form a diazonium compound. This compound coupled with a due to produce a pink color. |
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What causes false negatives on the nitrite test? |
Marked diuresis No nitrates in diet Vitamin C Urine not within bladder for 4 hours |
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What causes false positives on the nitrite test? |
Sample tested after 4 hours of collection |
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What can cause a false negative with the leukocyte test? |
High levels of glucose and protein High levels of vitamin C Antibiotics |
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What are the three types of ketones? |
Acetone, diactic acid, beta-hydroxybutyric acid |
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Which ketone is most common in the urine? |
Beta-hydroxybutyric acid |
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How are ketones formed? |
From the metabolism of fatty acids in the liver |
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What is the reagent in the ketone dipstick test? |
Sodium nitroprusside |
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What causes elevated ketones? |
Low carbohydrate diet High fat diet Starvation Insulin deficiency Prolonged vomiting and diarrhea |
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Why will ketones be low in old urine? |
Diabetic acid get converted to acetone and evaporated |
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What are the two ketone tests? |
Rothera's Acetest |
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What diseases are associated with increased numbers of renal tubular cells in the sediment? |
Pyelonephritis Acute tubular necrosis Transplant rejection Toxicity |
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Where are caudate transitional cells located? When do you typically see them? |
Upper urethra They are secondary to catheterized samples |
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What diseases are oval fat bodies associated with? |
Nephrotic syndrome Acute tubular necrosis |
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How do you dissolve amorphous urates in urine? |
Place it in a warm water bath |
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How do you dissolve amorphous phosphates? |
Add 2% acetic acid |
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Describe the appearance of a waxy cast? |
Opaque slightly refractive Sharp edges Appears cracked Brittle |
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What will you see with nephrotic syndrome? |
Oval fat bodies, fatty casts, broad waxy casts |
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What microscopic finding indicates a poor collection? |
Squamous epithelial cells |
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What would you see microscopically and on dip stick with an upper UTI? |
Nitrites, leukocytes, RBCs, bacteria, WBCs, +/- WBC casts |
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What is inborn error of metabolism? |
Failure to inherit a gene to produce a particular enzyme therefore preventing the end product of a metabolic patheay from being produced and causing a build up of an abnormal level |
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PKU is a lack of what enzyme? |
Phenylalanine hydrolase |
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Tyrosyluria is a lack of what enzyme? |
Tyrosine aminotransferase 4-hydroxyphenylpyruvate dioxygenase Fumarylacetoacetic acid hydrolase |
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What enzyme is lacking with alkaptonuria? |
Homogentisic acid oxidase |
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What enzyme is lacking with acute intermittent porphyria? |
Porphobilinogen deaminase |
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What enzyme is lacking with porphyria cutanea tarda? |
URO decarboxylase |
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What backs up in the system with porphyria cutanea tarda? |
Uroporphyrin 1 and 3 |
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What enzymes are not present with lead poisoning? |
Porphobilinogen synthase COPRO oxidase Ferrochelatase |
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What is read on low power? |
Crystals except amorphous Casts Mucous strands |
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What porphyrins do not fluorescence? |
ALA and porphobilinogen |
