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

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Flashcards in 05.11 - Urinalysis (Huch) - PP + Handout, No reading Deck (98):
1

Renal Tubular Epithelial Cells are most commonly found when there is

Acute Tubular Injury

1

When do you see Waxy Casts

CHRONIC Kindey Disease

2

Nephrotic Range of proteinuira

3.5 grams/24 hours

2

Proteinuria in Renal vs Extra-Renal origin hematuria

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

3

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

Waxy

4

What forms matrix of all casts

Tamm-Horsfall protein

5

Specific gravity is determined by

Numer and weight of solutes

6

Cystine crystals are associated with

Always pathologic, associated with very dense nephrolithiasis

6

RBC Casts is Pathognomonic for

Glomerulonephritis

7

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

Pure Nephrotic Urine

7

Negative Anion Gap means

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

8

Which Bilirubin is water soluble?

Conjugate (Direct)

8

Urinary Anion Gap is an assessment of

Hyperchloremic Metabolic Acidosis

9

RBC Casts in Renal vs Extra-Renal origin hematuria

RBC casts are pathognomonic for renal origin/glomerulonephritis

10

Mesangial Pattern Urine

Hematuria and probably RBC casts, in absence of major proteinuria

10

Granular Casts represent

Breakdown of cellular debris as it passes thru tubules

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RBC range in normal urine

0-2 rbc/hpf; Negative diptick

11

Protein in Hyaline Casts is

Tamm-Horsfall

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Where is Tamm-Horsfall protein produced

Thick Ascending Limb cells - forms matrix of all casts

13

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

Nephritic Urine

13

Crenated RBC's indicate

Concentrated supernatant

13

Fatty Casts are Pathognomonic for

Nephrotic Syndrome

15

What should lead to Pure Nephrotic Urine

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

16

Nephritic implies

Active inflammation with cellular infiltration (ie proliferative changes)

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

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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

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Injury typically caused by Ischemia (ATN)

Non-Inflammatory Tubular

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Larger, denser, acellular casts

Waxy

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Urine with high specific gravity

Tubular: damage to tubules causing inability to dilute or concentrate

44

Hallmark of Tubular Urine

Granular Casts

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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

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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

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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