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REN > Urine as an Indicator of Disease > Flashcards

Urine as an Indicator of Disease Flashcards

1
Q

List 2 advantages of urinalysis.

A

1 - It is a non-invasive procedure.

2 - It is easily obtained.

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2
Q

List the contents of normal urine in order from highest mass present to lowest.

A

1 - Water.

2 - Urea.

3 - Cl-.

4 - Na+.

5 - K+.

6 - Creatinine.

7 - Bicarbonate.

8 - Uric acid.

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3
Q

What is the average volume of urine produced per day?

A

1.4L

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4
Q

List 4 factors that influence the volume of urine produced.

A

1 - Body size.

2 - Diet.

3 - Fluid intake.

4 - Health.

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5
Q

Define pseudohaematuria.

A

Red-coloured urine in the absence of blood.

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6
Q

List 4 causes of pseudohaematuria.

A

1 - Free Hb.

2 - Myoglobin.

3 - Porphyrins.

4 - Drugs.

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7
Q

What might be present in the urine to produce a red/brown colour?

A

Conjugated bilirubin.

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8
Q

What might be present in the urine to produce a black colour?

A

Melanin due to a disseminated melanoma.

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9
Q

How is a microscopic examination of a urine sample done?

A

1 - Centrifuge the sample.

2 - Examine sediment for bacteria, cells or urinary casts.

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10
Q

What are urinary casts?

A

Microscopic cylindrical structures composed of the Tamm-Horsfall mucoprotein, which is secreted by renal tubules.

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11
Q

When might urinary casts be present in the urine in the absence of disease?

A

Post-exercise.

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12
Q

How is the presence of bacteria seen in a microscopic examination confirmed?

A

By using a dipstick to test for nitrite production, then producing a culture.

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13
Q

List 2 cells that might be found in the urine that are indicative of disease.

For each cell, state the disease that they might indicate.

A

1 - White cells might indicate a kidney infection.

2 - Red cells might indicate damage to the urinary tract.

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14
Q

List 4 examples of crystals that might be present in the urine.

A

1 - Oxalate crystals.

2 - Triple phosphate crystals.

3 - Cystine crystals.

4 - Amorphous crystals.

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15
Q

List 3 diseases / conditions that cause acidic pH extremes.

A

1 - Uncontrolled diabetes.

2 - Starvation.

3 - Respiratory acidosis.

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16
Q

List 2 molecules that might be found in the urine due to acidic pH extremes.

A

1 - Cystine crystals.

2 - Excess uric acid.

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17
Q

List 2 diseases / conditions that cause alkaline pH extremes.

A

1 - Urinary tract obstructions.

2 - Respiratory alkalosis.

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18
Q

List 3 molecules that might be found in the urine due to alkaline pH extremes.

A

1 - Ca2+.

2 - CaCO3.

3 - MgPO4.

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19
Q

What is the normal pH range for urine?

A

4.5-8

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20
Q

Give an example of a food that causes acidic urine.

A

Meat.

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21
Q

List 2 foods that cause alkaline urine.

A

1 - Citrus fruits.

2 - Vegetables.

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22
Q

What is the function of creatine phosphate?

A

It is an energy reserve in muscles.

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23
Q

What might cause an increase in urine creatinine concentration?

A

Excessive meat intake.

24
Q

List 3 factors that might cause a decrease in urine creatinine concentration.

A

1 - Wasting diseases.

2 - Malnutrition.

3 - Poor renal blood flow / function.

25
Q

List 2 pre-renal causes of an increase in solute excretion in the urine.

A

1 - An increase in solute production elsewhere in the body (including increased intake).

2 - The solute is abnormal, so there is no suitable transporter preventing filtration.

26
Q

List 2 pre-renal causes of a decrease in solute excretion in the urine.

A

1 - A decrease in solute production elsewhere in the body (including decreased intake).

2 - A decrease in delivery due to cardiac failure, haemorrhage or burns.

27
Q

Give an example of a renal cause of an increase in solute excretion in the urine.

A

Glomerular malfunction due to infection, autoimmune disease or inflammation, causing leakage.

28
Q

List 6 causes of tubular malfunction.

A

1 - Infection.

2 - Autoimmune disease.

3 - Inflammation.

4 - Necrosis.

5 - Drugs.

6 - Toxins.

29
Q

What is the purpose of urea?

A

It is the non-toxic end product of nitrogen metabolism.

30
Q

List 7 factors that increase the concentration of urea in the urine.

A

1 - Excess protein intake.

Factors that trigger greater protein catabolism:

2 - Protein energy malnutrition.

3 - Uncontrolled type 1 diabetes.

4 - Infections.

5 - Burns.

6 - Wasting diseases.

7 - Trauma.

31
Q

List 6 factors that decrease the concentration of urea in the urine.

A

1 - Low protein diet.

2 - Severe liver disease.

3 - Glomerulonephritis.

4 - Acute tubular necrosis.

5 - Poor renal blood supply.

6 - Renal obstruction.

32
Q

What is the outcome of decreased urea excretion?

List 3 symptoms that might result from this outcome.

What causes these symptoms?

A
  • Hyperammonaemia.

1 - Lethargy.

2 - Irritability.

3 - Coma.

  • These symptoms are caused by excess ammonia crossing the blood brain barrier.
33
Q

What proportion of filtered glucose is normally found in the urine?

A

<0.1%.

34
Q

Give an example of a test for urine glucose.

A

A reagent strip containing glucose oxidase.

35
Q

List 3 causes of metabolic hyperglycaemia.

A

1 - Type 1 diabetes.

2 - Anxiety / stress.

3 - Phaeochromocytoma (adrenal tumour).

36
Q

List 3 conditions that reduce the renal threshold for glucose excretion (results in glucose excretion in the urine despite regular blood glucose concentration).

A

1 - Pregnancy.

2 - Renal glycosuria (a genetic condition).

3 - Tubular malfunction.

37
Q

What is fanconi syndrome?

A

A disorder of kidney tubule function that results in excess excretion of:

1 - Glucose.

2 - Bicarbonate.

3 - Phosphates.

4 - Uric acid.

5 - Potassium.

6 - Amino acids.

38
Q

List 2 causes of high ketone concentration in the urine.

A

1 - Uncontrolled type 1 diabetes.

2 - Starvation.

39
Q

List 3 causes of aminoaciduria.

A

1 - Generalised tubular damage.

2 - Specific transporter defects.

3 - Raised plasma amino acids.

40
Q

List 2 specific examples of aminoacidurias that are caused by transporter defects.

A

1 - Cystinuria.

2 - Hartnup’s disease.

41
Q

List 2 specific examples of aminoacidurias that are caused by raised plasma amino acids.

A

1 - Phenylketonuria.

2 - Cystinosis.

42
Q

List 2 causes of high urine concentration of conjugated bilirubin.

A

1 - Liver damage.

2 - Obstructed bile ducts.

43
Q

What is a phaeochromocytoma?

A

An adrenal medullary tumour causing excessive secretion of adrenaline.

44
Q

List 4 symptoms of excess adrenaline secretion (due to phaeochromocytomas).

A

1 - High plasma free fatty acids.

2 - Hyperglycaemia.

3 - Tachycardia.

4 - Hypertension.

45
Q

What is excreted in excess in a person with phenylketonuria?

A

Phenylpyruvate.

46
Q

Which enzyme is deficient in people with phenylketonuria?

What is the function of this enzyme?

A
  • Phenylalanine hydroxylase.

- It converts phenylalanine into tyrosine.

47
Q

List 3 symptoms of phenylketonuria.

A

1 - Irritability.

2 - Fits.

3 - Mental retardation.

48
Q

Describe the pathophysiology of phenylketonuria.

A
  • A deficiency in phenylalanine hydroxylase causes accumulation of phenylalanine and transamination byproducts such as phenylalanine pyruvate and phenylalanine acetate which can overspill into the urine.
  • Phenylalanine adversely affects the brain.
49
Q

Give an example of a treatment of phenylketonuria.

A

Dietary management.

50
Q

What is the cutoff molecular mass for glomerular filtration?

A

70kDa.

51
Q

What is the normal rate of excretion for proteins in the urine?

A

200mg / 24 hours.

52
Q

Give an example of a condition which might cause proteinuria.

Briefly describe the pathophysiology of this disease.

A
  • Nephrotic syndrome.

- Damage to the capillary tuft.

53
Q

What is orthostatic proteinuria?

A

Proteinuria that only occurs when standing.

54
Q

Give an example of an indicator of poor tubular function.

A

Presence of beta-2 microglobulin in the urine.

55
Q

How can you distinguish between prerenal and renal causes of proteinuria?

A
  • If the protein has a low Mr (e.g. myoglobin), the problem is likely prerenal.
  • If the protein has a high Mr (e.g. albumin), the problem is likely renal.

REN (19 decks)

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