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Liz's Urinalysis > Renal and Metabolic Diseases > Flashcards

Renal and Metabolic Diseases Flashcards

1
Q

List the glomerular disorders discussed in lecture

A
  • Acute poststreptococcal glomerulonephritis
  • Rapidly progressive glomerulonephritis
  • Good Pasture’s Syndrome
  • Chronic glomerulonephritis
  • Nephrotic syndrome
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2
Q

List the two tubular disorders discussed in lecture

A
  • Acute tubular necrosis

- Fanconi’s Syndrome

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3
Q

List the interstitial disorders discussed in lecture

A
  • Cystitis
  • Acute pyelonephritis
  • Chronic pyelonephritis
  • Acute interstitial nephritis
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4
Q

List the vascular disorders discussed in lecture

A
  • Acute renal failure

- Chronic renal failure

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5
Q

This disorder results from immune-mediated processes whereby antigen-antibody complexes or complement complexes accumulate in the glomeruli; induces inflammation that leads to tissue damage

A

Glomerular diseases

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6
Q

Are the specimens in glomerular disorders sterile or non-sterile?

A

Sterile

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7
Q

This is the most common cause of acute glomerulonephritis; usually occurs in children and young adults following infection with certain strains of group A strep; inflammation damages glomeruli

A

Acute poststreptococcal glomerulonephritis

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8
Q

List symptoms of acute poststreptococcal glomerulonephritis

A
  • Rapid onset of hematuria and edema
  • Fever
  • Hypertension
  • Oliguria → anuria
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9
Q

Lab findings for acute poststreptococcal glomerulonephritis

A
  • Blood cultures: negative

- ↑ BUN

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10
Q

Important urinalysis findings in acute poststreptococcal glomerulonephritis

A
  • Marked hematuria

- RBC casts

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11
Q

Prognosis for acute poststreptococcal glomerulonephritis

A

Permanent kidney damage seldom occurs

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12
Q

This is caused by the deposition of immune complexes in glomerulus leading to the formation of crescentic structures which permanently damage the glomerulus; often associated with systemic lupus erythematosus (SLE)

A

Rapidly progressive glomerulonephritis

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13
Q

Important urinalysis findings in rapidly progressive glomerulonephritis

A
  • Hematuria
  • Low GFR
  • Proteinuria
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14
Q

Prognosis for rapidly progressive glomerulonephritis

A

Progresses to chronic glomerular nephritis and eventually end stage renal failure

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15
Q

This disorder is due to the antiglomerular basement membrane autoantibody that is formed after a viral respiratory infection; complement activation destroys capillaries

A

Goodpasture Syndrome

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16
Q

Symptoms associated w/ Goodpasture Syndrome

A

Pulmonary complaints

  • Hemoptysis
  • Dyspnea
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17
Q

Important urinalysis findings in Goodpasture Syndrome

A
  • Proteinuria
  • Hematuria
  • RBC casts
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18
Q

Prognosis for Goodpasture Syndrome

A

Progression to chronic glomerulonephritis and end-stage renal failure is common

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19
Q

This disorder is caused by a marked ↓ in renal function resulting from glomerular damage precipitated by other renal disorders; gradually worsening symptoms until eventual kidney failure

A

Chronic glomerulonephritis

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20
Q

Symptoms associated w/ chronic glomerulonephritis

A
  • Fatigue
  • Anemia
  • Hypertension
  • Edema
  • Markedly ↓ GFR
  • ↑ BUN and creatinine
  • Electrolyte imbalance
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21
Q

Important urinalysis findings in chronic glomerulonephritis

A

Waxy and broad casts (indicating end-stage renal disease)

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22
Q

Prognosis for chronic glomerulonephritis

A

Will continually worsen until kidneys failure

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23
Q

This is a group of symptoms that often occur together following glomerular damage; this damage is coupled with the disruption of the electrical charge of the tubular epithelium resulting in a leaky tubular epithelium; gradual progression to chronic renal failure

A

Nephrotic syndrome

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24
Q

What is nephrotic syndrome called in children?

A

Minimal change disease

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25
Q

What is nephrotic syndrome called in adults?

A

Membranoproliferative glomerulonephritis

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26
Q

Important urinalysis findings in nephrotic syndrome

A
  • Urine protein > 3.5 g/day (EXTREMELY HIGH)
  • Lipiduria (oval fat bodies)
  • Fatty casts
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27
Q

Prognosis for nephrotic syndrome

A

Gradual progression to chronic renal failure

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28
Q

This symptom in nephrotic syndrome is caused by lowered plasma albumin which lowers plasma oncotic pressure; this leads to increased reabsorption of sodium ions and water from the distal tubules

A

Edema

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29
Q

This tubular disorder is caused by the damage to the renal tubular cells caused by ischemia (lack of blood flow) or exposure to toxic agents

A

Acute tubular necrosis (ATN)

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30
Q

Important lab findings associated w/ ATN

A

Low hemoglobin and hematocrit

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31
Q

Important urinalysis findings in ATN

A
  • Renal tubular epithelial cells

- Renal tubular epithelial cell casts

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32
Q

Prognosis for ATN

A

Variable prognosis depending on underlying cause

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33
Q

This tubular disorder is classified as generalized failure of reabsorption in the proximal convoluted tubule; glucose, Na+, K+, HCO3-, phosphorus, and amino acids not being reabsorbed normally; inherited or aquired

A

Fanconi’s Syndrome

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34
Q

What are 2 common disorders causing Fanconi’s syndrome?

A
  • Cystinosis

- Hartnup disease

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35
Q

What is cystinosis?

A

The accumulation of cystine in lysosomes

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36
Q

What is Hartnup disease?

A

Defect in absorption of certain amino acids from intestines or kidneys

37
Q

Important lab findings associated w/ Fanconi’s syndrome?

A
  • Abnormal serum electrolytes (↓)
  • Abnormal amino acid chromatography (↓)
  • Normal blood glucose
38
Q

Important urinalysis findings associated w/ Fanconi’s syndrome?

A
  • Glucose (b/c PCT can’t reabsorb it)

- Cystine crystals (VERY RARE)

39
Q

This group of disorders usually involves infections and inflammatory conditions

A

Interstitial disorders

40
Q

Most common bacterial causes of UTIs

A
  • E. coli (most common)
  • Proteus spp
  • Klebsiella spp
  • Enterobacter spp
41
Q

This disorder is known as a lower UTI or bladder infection

A

Cystitis

42
Q

Symptoms associated w/ cystitis

A
  • Burning and pain in urination,
  • Dysuria
  • Increased frequency of urination
  • Mental confusion in elderly
43
Q

Important lab findings associated w/ cystitis

A

Normal BUN and creatinine

44
Q

Important urinalysis findings associated w/ cystitis

A
  • Urine culture: positive
  • Leukocyte esterase: positive
  • Bactera: small to large
  • NO CASTS
45
Q

This disorder is an infection of the tubules and interstitium; caused by ascending movement of bacteria from a lower UTI or from reflux nephropathies

A

Acute pyelonephritis

46
Q

Symptoms associated w/ acute pyelonephritis

A
  • Burning during urination
  • Increased frequency of urination
  • Flank and lower back pain
  • Nausea and headache
  • Confusion (in elderly)
47
Q

Important urinalysis findings associated w/ acute pyelonephritis

A
  • Urine culture: positive
  • Leukocyte esterase: positive
  • WBC casts present
  • Bacteria: small → large
48
Q

Prognosis of acute pyelonephritis

A

Proper antibiotic treatment should resolve the problem w/o permanent damage to tubules

49
Q

This disorder occurs when persistent inflammation of the renal tissue causes permanent scarring that involves the renal calyces and pelvis

A

Chronic pyelonephritis

50
Q

What is the most common cause of chronic pyelonephritis?

A

Reflux nephropathies

51
Q

Important lab findings associated w/ chronic pyelonephritis

A

↑ BUN

52
Q

Important urinalysis findings associated w/ chronic pyelonephritis

A
  • Urine culture: positive
  • Leukocyte esterase: positive
  • WBC casts
  • Granular and waxy broad casts: present
  • Bacterial casts: present
53
Q

Prognosis for chronic pyelonephritis

A
  • Usually diagnosed in childhood

- 10-15% will end in renal failure requiring dialysis

54
Q

This disorder is caused by inflammation of the renal interstitium followed by inflammation of the renal tubules; often caused by allergic reactions to medications

A

Acute interstitial nephritis

55
Q

Rapid onset of symptoms associated w/ acute interstitial nephritis

A
  • Skin rash
  • Oliguria
  • Edema
56
Q

Important lab findings associated w/ acute interstitial nephritis

A
  • ↑ BUN and creatinine
  • ↓ GFR
  • Fever
57
Q

Important urinalysis findings associated w/ acute interstitial nephritis

A
  • WBCs: numerous (no bacteria seen)
  • Eosinophils
  • Proteinuria: mild to moderate
58
Q

This group of disorders results from any conditions which reduces the blood flow to the kidneys

A

Vascular disorders

59
Q

This disorder is characterized by a SUDDEN onset, decrease in GFR, azotemia, oliguria (leading to anuria) and has a high mortality

A

Acute renal failure

60
Q

What are the three stages of acute renal failure?

A
  • Pre-renal
  • Renal
  • Post-renal
61
Q

This mechanism of acute renal failure is caused by decrease in blood flow below 80 mmHg, decreased cardiac output, blood loss, severe diarrhea, and vomiting

A

Pre-renal

62
Q

This mechanism of acute renal failure is due to damage to the glomerulus or tubular regions, usually in acute tubular necrosis

A

Renal

63
Q

This mechanism is due to obstructions in urine flow such as crystalline deposition (calculi) or neoplasms

A

Post-renal

64
Q

Lab findings associated w/ acute renal failure

A
  • Urine osmolality > serum osmolality
  • ↑ BUN (uremia)
  • ↓ GFR (low creatinine clearance)
  • Edema
  • Oliguria
65
Q

Prognosis for acute renal failure

A
  • High mortality rate usually caused by simultaneous infection or potassium intoxication
  • Monitor electrolytes and fluids along w/ dialysis to control azotemia
66
Q

This disorder is caused by a gradual loss of function caused by glomerulonephropathies, diabetic nephropathy, chronic pyelonephritis, and hypertension

A

Chronic renal failure

67
Q

Important lab findings in chronic renal failure

A
  • Azotemia
  • ↓ GFR
  • Bleeding
  • Electrolyte imbalance
68
Q

Important urinalysis findings in chronic renal failure

A
  • Isotenuria
  • Marked protein
  • All types of casts ESPECIALLY waxy and broad
69
Q

This disorder is caused by renal calculi as they form in the calyces and pelvis of the kidney, ureters, and bladder; 75% are composed of calcium oxalate or calcium phosphate

A

Renal lithiasis

70
Q

Four factors that affect the formation of kidney stones

A
  • Super saturation of chemical salts in urine
  • Optimal urinary pH
  • Urinary stasis
  • Nucleation or initial crystal formation
71
Q

Symptoms associated w/ kidney stones

A
  • Pain radiating from kidney and continuing down to genitalia and leg
  • Nausea
  • Vomiting
  • Sweating
  • ↑ urge to urinate
  • Bloody urine
72
Q

Where do kidney stones form?

A
  • Calyces and pelvis of kidney
  • Ureters
  • Bladder
73
Q

Use of high energy waves to break stones into smaller pieces

A

Lithotripsy

74
Q

75% of stones are composed of ____ ____ or ____ ____

A

Calcium oxalate; calcium phosphate

75
Q

Four factors that prevent formation of kidney stones

A
  • Maintaining urine pH at a level which will prevent crystallization of the crystals in question
  • Medication to prevent excretion of or to change metabolism of calculi forming compound
  • Adequate hydration to prevent urinary stasis
  • Dietary restrictions
76
Q

What is the GFR historical reference method?

A

Inulin clearance

77
Q

What is the advantage of using inulin?

A

Not absorbed by GI system or tubules, not modified, readily passes through glomerulus

78
Q

Disadvantage of using inulin?

A

Exogenous substance that must be administered intravenously during test

79
Q

Most common methods currently used for assessment of glomerular function

A
  • Creatinine (most common)
  • Beta2-microglobulin
  • Cystatin C
80
Q

Creatinine clearance test

A
  • Not affected by urine flow rate
  • Not reabsorbed by tubules
  • Not affected by diet
  • Produced at a constant rate
  • Dependent on muscle mass
81
Q

What is the average production of creatinine?

A
  1. 2 mg/day

- Proper preservation must be used (bacteria may falsely lower creatinine)

82
Q

How is a creatinine clearance tested?

A

Time specimen is necessary (24 hour urine collection)

83
Q

Normal GFR

A

120 mL/min

- If GFR > 90 mL/min, patient is normal

84
Q

This calculation uses serum creatinine, age, gender, and ethnicity; typically reported in patients with <60 mL/min GFR

A

Estimated GFR

85
Q

this assessment of glomerular function is a more sensitive indicator of a decrease in GFR than crea clearance; not reliable in patients with immunologic disorders or malignancy; good test to assess tubular function; it dissociates from the membrane of nucleated cells at a constant rate and is rapidly filtered by the glomerulus and reabsorbed and catabolized by the tubules

A

Beta2-Microglobulin

86
Q

This is produced at a constant rate by all nucleated cells; readily filtered by the glom and reabsorbed and broken down by tubules; recommended test for peds, elderly, diabetics, and critically ill; INDEPENDENT of muscle mass

A

Cystatin C

87
Q

Three treatment options for renal failure

A
  • Hemodialysis
  • Peritoneal dialysis
  • Renal transplant
88
Q

In this treatment, the patient’s blood is cleansed as particles diffuse across a semipermeable membrane into a commercially available dialysis solution; preferred access point is through a fistula

A

Hemodialysis

89
Q

This treatment involves using a sterile solution of dialysis solution allowing it to drain into the peritoneal cavity; the peritoneal membrane acts as a selectively permeable membrane that allows diffusion and osmosis of wastes into the dialysis solution; this solution is then drained and discarded

A

Peritoneal dialysis

Liz's Urinalysis (6 decks)

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