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Renal > 05.11 - Urinalysis (Huch) - PP + Handout, No reading > Flashcards

05.11 - Urinalysis (Huch) - PP + Handout, No reading Flashcards

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1
Q

Renal Tubular Epithelial Cells are most commonly found when there is

A

Acute Tubular Injury

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1
Q

When do you see Waxy Casts

A

CHRONIC Kindey Disease

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2
Q

Nephrotic Range of proteinuira

A

3.5 grams/24 hours

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2
Q

Proteinuria in Renal vs Extra-Renal origin hematuria

A

Renal Origin Hematuria often associated with proteinuria; absent in extra-renal origin

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3
Q

Cast with bright white line around edges, cracks around sides, broken edges

A

Waxy

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4
Q

What forms matrix of all casts

A

Tamm-Horsfall protein

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5
Q

Specific gravity is determined by

A

Numer and weight of solutes

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6
Q

Cystine crystals are associated with

A

Always pathologic, associated with very dense nephrolithiasis

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6
Q

RBC Casts is Pathognomonic for

A

Glomerulonephritis

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7
Q

Diseases affecting only the glomerular basement membrane in a non-inflammatory manner should lead to

A

Pure Nephrotic Urine

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7
Q

Negative Anion Gap means

A

GI losses, and kidneys are excreting as much acid as possible into urine

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8
Q

Which Bilirubin is water soluble?

A

Conjugate (Direct)

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8
Q

Urinary Anion Gap is an assessment of

A

Hyperchloremic Metabolic Acidosis

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9
Q

RBC Casts in Renal vs Extra-Renal origin hematuria

A

RBC casts are pathognomonic for renal origin/glomerulonephritis

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10
Q

Mesangial Pattern Urine

A

Hematuria and probably RBC casts, in absence of major proteinuria

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10
Q

Granular Casts represent

A

Breakdown of cellular debris as it passes thru tubules

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11
Q

RBC range in normal urine

A

0-2 rbc/hpf; Negative diptick

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11
Q

Protein in Hyaline Casts is

A

Tamm-Horsfall

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12
Q

Where is Tamm-Horsfall protein produced

A

Thick Ascending Limb cells - forms matrix of all casts

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13
Q

Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop should result in

A

Nephritic Urine

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13
Q

Crenated RBC’s indicate

A

Concentrated supernatant

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13
Q

Fatty Casts are Pathognomonic for

A

Nephrotic Syndrome

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15
Q

What should lead to Pure Nephrotic Urine

A

Diseases affecting only the glomerular basement membrane in a non-inflammatory manner

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16
Q

Nephritic implies

A

Active inflammation with cellular infiltration (ie proliferative changes)

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17
Which Bilirubin will not be present in urine
Unconjugated (indirect) b/c not water soluble
19
How will Obstructive Uropathy typically present
Tubular Pattern of Urine
20
Lipiduria =
Nephrotic Syndrome, Heavy Proteinuria
21
Tubular Proteinuria
Smaller amounts: Failure to reabsorb low molecular weight proteins in proximal tubule
22
Flat, six-sided crystals
Cystine Crystals
23
Renal Tubular Epithelial Cells are hallmark of
Acute Tubular Necrosis (ATN)
24
Specific gravity of 1.010 corresponds to what Osmolality
300 mOsm/kg
24
RBC morphology in Renal vs Extra-renal origin hematuria
Dysmorphic in Renal Origin (pass thru glomerulus)
24
Conditions with Urinary WBC's
Commonly UTI; Also Pyelonephritis, Allergic Interstitial Nephritis, Intense Glomerulonephritis
26
When is Leukocyte Esterase positive?
Increased numbers of Neutrophils in urine
27
Alternative to measuring proteinuria over 24 hour period
Ratio of urine protein over creatinine is reliable estimate of quantitative proteinuria
27
Waxy casts are also known as
Renal Failure Casts
29
What leads primarily to Hematuria
Diseases which have active proliferative inflammation that involve the mesangium
31
Tubular Urine
No heavy proteinuria, maybe Microscopic Hematuria, maybe Renal Tubular Epithelial Cells, GRANULAR CASTS, High specific gravity
32
Cellular infiltration and Pyuria in Non-Inflammatory Tubular Injury
None or little of either
32
3+ and 4+ proteinuria suggests
Nephrotic Range Proteinuria
32
Type of casts seen in chronic kidney disease
Waxy
33
Origin of Tamm-Horsfall proteins
Secreted by Tubular Cells
34
What do Squamous Epithelial Cells indicate in urine
Nothing, can be predominant if vaginal contamination of sample
36
Cellular infiltrate directly injuring tubules, such as Allergic Interstitial Nephritis
Inflammatory Tubulitis
36
When is specific gravity not a marker of concentration
When there are abnormal numbers of heavy solutes in urine (glycosuria, contrast media)
37
In metabolic acidosis, urinary pH is below
5.3
38
What test detects all protein in urine
Sulfosalicylic Acid Test
39
Renal Tubular Epithelial Cells should make you think
Acute Kidney Injury, ATN
41
Injury typically caused by Ischemia (ATN)
Non-Inflammatory Tubular
42
Larger, denser, acellular casts
Waxy
43
Urine with high specific gravity
Tubular: damage to tubules causing inability to dilute or concentrate
44
Hallmark of Tubular Urine
Granular Casts
45
Urine in Nephrotic Syndrome
Proten and Lipid
46
Clots in Renal vs Extra-Renal origin hematuria
Clots may be present in Extra-Renal origin
48
What is almost invariably present in Inflammatory Tubulitis
Sterile Pyuria
49
Urinary Anion Gap helps you distinguish
Whether etiology is GI (diarrhea secretion of HCO3-) or Urinary (inability to excrete H+)
50
Only normal cast in urine
Hyaline Cast
52
Which is found in normal urine, Nitrite or Nitrates?
Nitrate
53
Are ketones found in normal urine?
No
55
Positive Nitrite suggests
UTI with Nitrate-Reduing Bacteria (gram negative)
56
Intense Glomerulonephritis is usually a feature of
Lupus
57
Glycosuria in presence of normal blood glucose implies
Proximal Tubular Dysfunction
58
Urine pH \> 7.5-8.0 suggests
UTI with Urea-Splitting Bacteria (proteus)
59
When Free Hemoglobin and Myoglobin in urine
Dipstick positive, but urinary sediment will be negative for RBC's
61
What is Pyelonephritis
Infected Tubules
62
Heaviest proteinuria is found when
source is glomerulus
63
Triple Phosphate Crystals are associated with
Infection
65
Injury typically caused by Direct Tubular Toxins
Non-Inflammatory Tubular
66
Normal range of Urinary pH
5-6.5
67
Most common Uropathogens
Gram Negative Bac
68
Urinar Casts represent
Precipitates of protein forming in lumen of tubules
69
What is present in urine of Pyelonephritis
Pyuria and Bacteruria
69
Normal range for urinary WBC's
0-4/hpf
70
Large, plate-like cell with abundant cytoplasm and very small nucleus
Squamous Epithelial Cell
71
Non-inflammatory Tubular Injury would be typical of
Ischemia (ATN) or Direct Tubular Toxins
72
Urine: Varying levels of protein, almost invariable hematuria, frequently RBC casts
Nephritic Urine
74
What should result in Nephritic Urine
Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop
75
When do you seen Uric Acid Crystals in urine
Normal urine that's been sitting or refrigerated
76
When are Ketones present in urine
Fasting, DKA, AKA
77
Negative dipstick for albumin, but positive sulfosalicylic acid test indicates
Light Chain proteinuria (MM)
79
Any pathologic process that leads to renal injury should also lead to
Abnormal urinalysis with potential changes in GFR
80
What does Tubular Proteinuria reflect
Promxial Tubular Dysfunction
81
RBC Casts are Pathognomonic for
Glomerulonephritis
83
Large cell with nucleus about same size as WBC
Renal Tubular Epithelial Cell
84
"Coffin Lid" crystals
Triple Phosphate Crystals
86
Specific gravity of 1.030 corresponds to what Osmolality
1200 mOsm/kg
87
Osmolality is determined by (as opposed to specific gravity)
Only the number of solutes
88
Hyaline Casts are found in healthy persons in states of
Volume Depletion
89
Diseases only involving the tubules should lead to
Tubular Pattern of Urine
90
Diseases involving the microcirculation will lead to
Altered GFR, frequently signs of glomerular injury with proteinuria and hematuria
91
Urine: Heavy proteinuria, Lipiduria, and signs of proliferation/inflammation with hematuria
Mixed Nephritic and Nephrotic
92
Morphology of Urinary WBC's
Granular cytoplasm, irregular nucleus, "glitter cells"
93
Diseases which have active proliferative inflammation that involve the mesangium only lead to
Primarily to hematuria
94
Most common type of Renal Stone
Calcium Oxalate Crystals
95
Nephritic changes will be manifest in urine by
Varying levels of protein and hematuria, frequently with RBC casts
96
Elevated levels of plasma conjugated bilirubin lead to
Urinary excretion
97
Most common cause of positive dipstick for blood is
presence of RBC's in urinary sediment
98
Normal limit of protein excretion
Less than 150mg/day

Renal (31 decks)

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