CEREBROSPINAL FLUID & AMNIOTIC FLUID Flashcards by SHAINA MAE CASPE

Q

viscous CSF

A

Metastatic mucin-producing adenocarcinoma
Cryptococcal meningitis
Liquid Nucleus Pulposus

(MCL)

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Q

Routinely performed on CSF

A

wbc count

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Q

to correct for wbc count and total protein concentration, subtract ______ for every 700 RBCs seen

A

1 wbc

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Q

to correct for wbc count and total protein concentration, subtract ______ in total protein concentration for every 10,000 RBCs/uL

A

8mg/dL

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Q

in CSF differential count, specimen should be ______ first before preparing a smear

A

concentrated

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Q

4 types of csf differential count

A

routine centrifugation
cytocentrifugation
sedimentation
filtration

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Q

in cytocentrifugation, addition of _________ will increase cell yield or recovery and decreases cellular distortion

A

30% albumin

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Q

Viral, Tubercular, & Fungal Meningitis
Multiple Sclerosis
a. neutro
b. lympho, mono
c. macro

A

b

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Q

Bacterial meningitis
Early case of viral, tubercular & fungal meningitis
Cerebral hemorrhage
a. neutro
b. lympho, mono
c. macro

A

a

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Q

Intracranial hemorrhage
a. neutro
b. lympho, mono
c. macro

A

c

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Q

BLAST FORMS

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

a

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Q

Lymphoma cells

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

b

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Q

plasma cells

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

c

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Q

EPENDYMAL, CHOROIDAL,
& SPINDLE-SHAPED CELLS

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

d

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Q

MALIGNANT CELLS

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

e

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Q

MALIGNANT CELLS

a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma

A

e

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Q

normal value of CSF protein in adults

A

15-45 mg/dL

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Q

normal value of CSF protein in infants

A

150 mg/dL

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Q

normal value of CSF protein in immature

A

500 mg/dL

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Q

MAJOR CSF PROTEIN

A

albumin

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Q

2ND MOST PREVALENT

A

pre-albumin

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Q

ALPHA GLOBULINS

A

haptoglobin, ceruloplasmin

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Q

BETA GLOBULINS

A

b2- transferrin,
“tau”

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Q

GAMMA-GLOBULINS

A

IgG and IgA

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clinical significance of pellicle

tubercular meningitis

NOT FOUND in CSF

1. IgM 2. fibrinogen 3. lipoprotein

CSF protein decreased results

1. CSF leakage/trauma 2. recent puncture 3. rapid CSF production 4. water intoxication

2 methods in CSF protein determination (TOTAL PROTEIN)

turbidimetric dye-binding

2 methods in turbidimetric

trichloroacetic acid sulfosalicylic acid

which of the following is the preferred method a. Sulfosalicylic acid b. Trichloroacetic acid

b

which of the following precipitates both albumin and globulin a. Sulfosalicylic acid b. Trichloroacetic acid

b

which of the following precipitates albumin only a. Sulfosalicylic acid b. Trichloroacetic acid

a

in sulfosalicylic acid, adding _______ will precipitate globulins

Na2SO4

in total protein - dye binding, we use

coomasie brilliant blue

2 methods in CSF protein determination

total protein and protein fractions

2 methods in protein fractions

CSF/serum albumin index IgG index

normal value in CSF/serum albumin index

<9

normal value in CSF/serum albumin index

<9

abnormal value in CSF/serum albumin index

>9

CSF/SERUM ALBUMIN INDEX 9-14 a. Slight impairment b. Moderate impairment c. Severe impairment d. Complete damage to BBB

a

CSF/SERUM ALBUMIN INDEX 9-14 a. Slight impairment b. Moderate impairment c. Severe impairment d. Complete damage to BBB

a

CSF/SERUM ALBUMIN INDEX 15-30 a. Slight impairment b. Moderate impairment c. Severe impairment d. Complete damage to BBB

b

CSF/SERUM ALBUMIN INDEX >30 a. Slight impairment b. Moderate impairment c. Severe impairment d. Complete damage to BBB

c

CSF/SERUM ALBUMIN INDEX 100 a. Slight impairment b. Moderate impairment c. Severe impairment d. Complete damage to BBB

d

IgG index normal value

<0.70

IgG index abnormal value

>0.70

detection of oligoclonal bands in gamma region, indicates immunoglobulin production

CSF electrophoresis

Presence of 2 oligoclonal bands in CSF but not in serum can be seen in

MS. NENG 1. multiple sclerosis 2. neurosyphilis 3. encephalitis 3. neoplastic disorder 4. guillain-barre syndrome

demyelinating disorder, Abs against myelin sheath

MS

1. (+) Anti-myelin sheath autoantibody 2. (+) oligoclonal band in CSF but not in serum 3. (+) Myelin Basic Protein (MBP) 4. Inc. IgG Index

MS

CSF GLUCOSE is collected ___ hrs before ____________

2 spinal tap

CSF glucose normal values

60-70% (2/3) or 50-80 mg/dL of blood glucose

CSF glucose is normal in

viral meningitis

waste product of glucose metabolism

CSF LACTATE

glucose is _______________ to lactate

inversely proportional

CSF lactate normal values

10-24 mg/dL

product of ammonia and alpha-ketoglutarate in brain cells

CSF GLUTAMATE

indirect test for presence of excess NH3 in CSF

CSF GLUTAMATE

CSF GLUTAMATE normal values

8-18 mg/dL

CSF lactate is increased in

1. bacterial meningitis 2. tubercular and fungal meningitis 3. hypoxia

CSF lactate is normal in

viral meningitis = <25 mg/dL

CSF glutamate increased in

1. disturbance of consciousness 2. reye's syndrome

ISOENZYMES IN CSF

LDH

brain tissues a. LD 2 & 3 b. LD 1 & 2 c. LD 4 & 5

b

lymphocytes a. LD 2 & 3 b. LD 1 & 2 c. LD 4 & 5

a

neutrophils a. LD 2 & 3 b. LD 1 & 2 c. LD 4 & 5

c

Normal distribution LD isoenzymes IN SERUM

2>1>3>4>5

Normal distribution LD isoenzymes IN CSF

1>2>3>4>5

CSF pattern seen in serum (flipped pattern)

AMI/hemolytic anemia

If serum pattern seen in CSF this indicates

neurologic abnormalities

In CSF pattern: 5>4>3>2>1- indicates

BACTERIAL meningitis

Creatine kinase is increased in

Stroke MS Degenerative disorder Brain tumor Bacterial and viral meningitis Epileptic seizure

Aspartate aminotransferase is increased in

intracerebral and subarachnoid hemorrhage bacterial meningitis

BACTERIAL MENINGITIS COMMON AGENTS

1. Group B strep- neonates 2. E. coli and gram neg bacilli- NB to 1 y.o 3. N. meningitidis- 3 mos. older 4. S. pneumoniae- 3 mos. older 5. H. influenzae- 3 mos. to 18 y.o 6. L. monocytogenes-

TUBERCULAR MENINGITIS common agent

mycobacterium tuberculosis

(+) Gram Stain (+) Culture (+) Limulus Lysate Test

bacterial meningitis

(+) AFB Stain (+) Pellicle/weblike clot formation after

tubercular meningitis

TUBERCULAR MENINGITIS common agent

Mycobacterium tb

(+) Gram Stain (+) India Ink (+) Latex Agglutination Test

FUNGAL MENINGITIS

AMOEBIC MENINGOENCEPHALITIS COMMON AGENTS

1. Naegleria fowleri 2. Acanthamoeba spp. 3. Balamuthia mandrillaris

(+) RBCs (+) Acridine Orange Stain

AMOEBIC MENINGOENCEPHALITIS

VIRAL MENINGITIS common agents

1. enteroviruses (coxsackie, echo, polio) 2. arboviruses

RT-PCR can detect

VIRAL MENINGITIS

2 types of SPIROCHETAL MENINGITIS

1. Neurosyphilis 2. Neuroborreliosis

diagnosis for SPIROCHETAL MENINGITIS

1. nontreponemal tests- VDRL, FTA-Abs 2. ELISA 3. Western blot

function of amniotic fluid

1. cushion 2. allows fetal movement 3. stabilize temp 4. lung maturity

The _____________ is the ultimate source of amniotic fluid water and solutes

placenta

normal volume of amniotic fluid during third trimester

800-1200 mL

Decrease fetal swallowing of urine

POLYHYDRAMNIOS >1200 mL Neural tube defects

Increased fetal swallowing of urine

OLIGOHYDRAMNIOS <800 mL Membrane leakage Urinary tract deformities

amniocentesis is safe to perform on

14th week of gestation

Maximum amount in amniocentesis

30 mL, first 2-3 mL is discarded

16th week, chromosomal studies (Trisomy 21/DS) a. 2ND TRIMESTER AMNIOCENTESIS b. 1st TRIMESTER AMNIOCENTESIS c. 3RD TRIMESTER AMNIOCENTESIS

a

fetal lung maturity, fetal hemolytic disease a. 2ND TRIMESTER AMNIOCENTESIS b. 1st TRIMESTER AMNIOCENTESIS c. 3RD TRIMESTER AMNIOCENTESIS

c

TEST FOR FETAL LUNG MATURITY (FLM) a. kept at RT or body temp (37degC) b. placed on ice during delivery, kept refrigerated c. protect from light; use amber-colored bottle, foil, black plastic cover

b

TEST FOR CYTOGENETICS STUDIES/ MICROBIAL STUDIES a. kept at RT or body temp (37degC) b. placed on ice during delivery, kept refrigerated c. protect from light; use amber-colored bottle, foil, black plastic cover

a

TEST FOR HEMOLYTIC DISEASE OF THE NEWBORN (HDN) a. kept at RT or body temp (37degC) b. placed on ice during delivery, kept refrigerated c. protect from light; use amber-colored bottle, foil, black plastic cover

c

AMNIOTIC FLUID vs MATERNAL URINE

Amniotic fluid Protein: + Glucose: + Urea: <30 mg/dL Creatinine: <3.5 mg/dL Maternal urine Protein: - Glucose: - Urea: >30 mg/dL Creatinine: >10 mg/dL

Detects ruptured amniotic membranes

FERN TEST

specimen in FERN TEST

vaginal fluid

(+) result in fern test

fern-like crystals (protein and NaCl)

normal color of amniotic fluid a. DARK GREEN b. BLOOD-STREAKED c. colorless to pale yellow d. YELLOW e. DARK RED-BROWN

c

Traumatic tap, abdominal trauma, intra-amniotic hemorrhage a. DARK GREEN b. BLOOD-STREAKED c. colorless to pale yellow d. YELLOW e. DARK RED-BROWN

b

bilirubin- HDN a. DARK GREEN b. BLOOD-STREAKED c. colorless to pale yellow d. YELLOW e. DARK RED-BROWN

d

meconium (first fetal bowel movement) a. DARK GREEN b. BLOOD-STREAKED c. colorless to pale yellow d. YELLOW e. DARK RED-BROWN

a

fetal death/demise a. DARK GREEN b. BLOOD-STREAKED c. colorless to pale yellow d. YELLOW e. DARK RED-BROWN

e

TEST FOR HEMOLYTIC DISEASE OF THE NEWBORN (HDN) aka _________________

Optical density 450 (OD450)

normal absorbance of amniotic fluid

increased at 365 nm decreased at 550 nm

abnormal absorbance of amniotic fluid

increased at 450 nm (max. bilirubin absorbance)

in OD450 results are plotted in a

liley graph

OD450- Zone I a. moderately affected fetus b. nonaffected/mildly affected fetus c. severely affected fetus

b

OD450- Zone II a. moderately affected fetus b. nonaffected/mildly affected fetus c. severely affected fetus

a

OD450- Zone III a. moderately affected fetus b. nonaffected/mildly affected fetus c. severely affected fetus

c

Interferences in OD450

cells, meconium, debris, Hgb (peak abs 410 nm)

birth defect where there is incomplete closing of the backbone and membranes around the spinal cord

Spina bifida/split spine

absence of major portion of the brain and scalp

Anencephaly

AFP is _____________ in spina bifida and Anencephaly

increased

AFP is _____________ in down syndrome

decreased

confirmatory test for neural tube defect

acetylcholinesterase (AChE)

do not perform AChE if bloody, could lead to _________

false increase

Most frequent complication of early delivery

RESPIRATORY DISTRESS SYNDROME

7th most common cause of morbidity and mortality among premature infants

RESPIRATORY DISTRESS SYNDROME

RESPIRATORY DISTRESS SYNDROME is caused by

lack of lung surfactants (phospholipids)

reference method for FETAL LUNG MATURITY (FLM)

LECITHIN/SPHINGOMYELIN (L/S) RATIO

<1.6 L/S Ratio a. mature fetal lungs - > preterm delivery is safe b. <35 wk

b

≥2.0 L/S Ratio a. mature fetal lungs - > preterm delivery is safe b. <35 wk

a

L/S Ratio false increase

blood and meconium

AMNIOSTAT-FLM

immunologic test for phosphatidylglycerol

phosphatidylglycerol's production is ___________ to lecithin

parallel

microviscosity is _________________ to phospholipid

inversely proportional

MICROVISCOSITY measured by

fluorescence polarization

Surfactant-to-albumin (S/A) ratio is measured

MICROVISCOSITY

Dye bound to Surfactant a. decreased fluorescence, high polarization b. longer fluorescence, low polarization

b

Dye bound to Albumin a. decreased fluorescence, high polarization b. longer fluorescence, low polarization

a

stored form of phospholipid in fetus

LAMELLAR BODY COUNT

_________________ produce lung surfactants stored in the form of ___________________

Type II pneumocyte, lamellar bodies

Methods in lamellar body count

impedance and optical scatter method

amount of adequate fetal lung maturity based on lamellar body count

>32,000 / uL

Increased lamellar bodies = _______________ O.D.

increased

OD of __________ is equivalent to * L/S Ratio of ______________ * Presence of _______________

≥ 0.150 ≥2.0 - fetal lung is matured phosphatidylglycerol not affected by blood and myconium

TEST FOR FETAL AGE

AMNIOTIC FLUID CREATININE

AMNIOTIC FLUID CREATININE <36 weeks gestation

1.5 - 2.0 mg/dL

AMNIOTIC FLUID CREATININE 36 weeks gestation

>2.0 mg/dL

in urine specimen preparation, warming @37 degC may

dissolve some crystals

standard amount of urine ____ ______ is frequently used

10-15 mL 12 mL

urine centrifugation

5 mins @400rcf

Volumes of ____________________are frequently used (uniform amount of urine and sediment)

0.5 mL and 1 mL

in Conventional Glass Slide Method: Recommended volume is _______________ covered by a _______ glass cover slip

20 uL 22x22 mm

this objective detects casts, ascertain the general composition of sediment

LPO

this objective identifies urinary sediments

HPO

in conventional glass slide method, _____ have a tendency to locate near the edges of the coverslip

casts

point of reference in urine microscopic examination

epithelial cells

what is reported in average number per LPF

casts

what is reported in average number per 10 HPF

RBCs and WBCs

what is reported in Semi-quantitative

EC, crystals and other sediments

Most frequently used stain in urinalysis a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

c

component of sternheimer-malbin stain

crystal violet and safranin O

Sedi stain and KOVA stain a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

c

Use to confirm the presence of triglycerides, neutral fats and cholesterol a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

a

Identification of bacterial casts, which can be confused from granular casts a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

b

Preferred stain for urinary eosinophils (In cases of drug-induced allergic reaction producing inflammation of the renal interstitium) a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

e

components of hansel stain

methylene blue and eosin Y

Stain for iron (Hemosiderin Granules: Blue) a. Lipid stains b. gram stain c. sternheimer-malbin stain d. Prussian blue stain e. hansel stain

d

Objects appear dark against a light background, is most frequently used in the clinical laboratory a. Bright-Field Microscopy b. Dark-field Microscopy c. Phase-Contrast Microscopy d. Polarizing Microscopy e. Fluorescence Microscopy f. Interference Contrast

a

Aids in identification of Treponema pallidum a. Bright-Field Microscopy b. Dark-field Microscopy c. Phase-Contrast Microscopy d. Polarizing Microscopy e. Fluorescence Microscopy f. Interference Contrast

b

Enhances visualization of elements with low refractive indices, such as hyaline casts, mixed cellular casts, mucous threads, and Trichomonas. a. Bright-Field Microscopy b. Dark-field Microscopy c. Polarizing Microscopy d. Phase-Contrast Microscopy e. Fluorescence Microscopy f. Interference Contrast

d

Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals a. Bright-Field Microscopy b. Dark-field Microscopy c. Polarizing Microscopy d. Phase-Contrast Microscopy e. Fluorescence Microscopy f. Interference Contrast

c

Allows visualization of naturally fluorescent microorganisms or those stained by a fluorescent dye including labeled antigens and antibodies. a. Bright-Field Microscopy b. Dark-field Microscopy c. Polarizing Microscopy d. Phase-Contrast Microscopy e. Fluorescence Microscopy f. Interference Contrast

e

Produces a three-dimensional microscopy image and layer by-layer imaging of a specimen a. Bright-Field Microscopy b. Dark-field Microscopy c. Polarizing Microscopy d. Phase-Contrast Microscopy e. Fluorescence Microscopy f. Interference Contrast

f

Frequently performed independently of routine urinalysis for detection of malignancies of the lower urinary tract

Cytodiagnostic Urine Testing

In cytodiagnostic urine testing, Preparation of permanent slides using cytocentrifugation followed by staining with ________________ provides an additional method for detecting and monitoring ________________.

Papanicolaou stain Renal disease

In cytodiagnostic urine testing, Preparation of permanent slides using cytocentrifugation followed by staining with ________________ provides an additional method for detecting and monitoring ________________.

Papanicolaou stain Renal disease

Appearance: smooth, non-nucleated biconcave disc a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

b

Hypersthenuric (Concentrated) RBC appears as

crenated

Hyposthenuric (Diluted) RBC appears as

ghost cells

In Glomerular Bleeding, RBC appears as

dysmorphic (cellular protrusions, fragmented)

RBC reported in

0-2 cells/10 HP

frequently associated with advanced glomerular damage but is also seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation, and coagulation disorders a. Microscopic Hematuria b. Macroscopic Hematuria

b

can be critical to the early diagnosis of glomerular disorders and malignancy of the urinary tract and to confirm the presence of renal calculi (kidney stones) a. Microscopic Hematuria b. Macroscopic Hematuria

a

Movement: Appear as glitter cells a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

a

increased in urinary WBC is called

Pyuria

Hypotonic WBC exhibits

Brownian movement

predominant WBC in urine

neutrophil

drug-induced interstitial nephritis, UTI, renal-transplant rejection a. neutrophil b. basophil c. eosinophil d. lymphocyte

c

seen in increased numbers in the early stages of renal transplant rejection a. neutrophil b. basophil c. eosinophil d. lymphocyte

d

Primary concern in identification of WBC in urine

differentiation of mononuclear cells and disintegrating neutrophils from round renal tubular epithelial (RTE) cells

Normal, Sloughing Off, largest cells found in urine sediment a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

d

Point of Ref: represents normal cellular sloughing and have no pathologic significance a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

d

1. urothelial cell, smaller than squamous and appear in several forms; spherical, polyhedral and caudate. 2. these differences are caused by the ability of transitional ec to absorb large amounts of water 3. originate from lining of renal pelvis, calyces, ureters and bladder and from the upper portion of male urethra a. SEC b. TEC c. RTE

b

renal fragment cells a. SEC b. TEC c. RTE

c

larger than any RTE cells, rectangular thus referred to as columnar or convoluted cells, resembles a cast a. PCT b. DCT c. CD d. Oval fat bodies e. Bubble cells

a

smaller, round or oval, can be mistaken for WBC or spherical transitional EC a. PCT b. DCT c. CD d. Oval fat bodies e. Bubble cells

b

cuboidal and are never round, if they appear in groups of three or more, they are called renal fragments. a. PCT b. DCT c. CD d. Oval fat bodies e. Bubble cells

c

lipid containing RTE cells a. PCT b. DCT c. CD d. Oval fat bodies e. Bubble cells

d

RTE cells containing non-lipid filled vacuoles (acute tubular necrosis) a. PCT b. DCT c. CD d. Oval fat bodies e. Bubble cells

e

squamous EC covered with Gardnerella coccobacillus (bacterial vaginosis) a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

e

not normally present in urine a. White Blood Cell b. Red Blood Cell c. Bacteria d. Epithelial Cell e. Clue Cells

c

gram-negative rods, most frequent associated w/ UTI

Enterobacteriaceae

Small Refractile oval structures (may or may not contain bud) a. White Blood Cell b. Red Blood Cell c. Bacteria d. Yeast e. Clue Cells

d

opportunistic pathogenic yeast that can be seen in DM, Vaginal Moniliasis, Immunocompromised Individual

Candida albicans

most frequent parasite encountered in the urine

Trichomonas vaginalis

bladder parasite (ova)

Schistosoma haematobium

most common fecal contaminant

E. vermicularis

Routine UA in spermatozoa

do not report

major constituent of mucus

uromodulin

only elements found only in urine which is unique to the kidney

casts

in casts, this indicates presence of urinary cast

cylinduria

true geometrically structure or amorphous materials a. White Blood Cell b. Red Blood Cell c. Bacteria d. Yeast e. Crystals

e

highly refractile sphere with dimpled center a. fibers/hair b. pollen grains c. starch d. Fecal Contamination

c

appear as spheres with a cell wall and occasional concentric circles a. fibers/hair b. pollen grains c. starch d. Fecal Contamination

b

may resemble casts however these polarized while casts do not a. fibers/hair b. pollen grains c. starch d. Fecal Contamination

a

appear as plant and meat fibers or as brown amorphous material a. fibers/hair b. pollen grains c. starch d. Fecal Contamination

d

Most frequently seen urinary casts a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

c

Normally Increased in: strenuous exercise, dehydration, heat exposure, emotional stress a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

c

Hyaline casts are pathologically increased in

P- pyelonephritis A- acute glomerulonephritis C- CHF C- chronic renal disease

greater stasis of urine a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

b

Glomerular damage (glomerulonephritis) is associated with proteinuria and dysmorphic erythrocytes a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

b

blood casts is indicative of

bleeding with the nephron

In WBC casts, acute interstitial nephritis is indicative of a. bacterial inflammation b. non-bacterial inflammation

b

In WBC casts, pyelonephritis is indicative of a. bacterial inflammation b. non-bacterial inflammation

a

Primary marker for distinguishing pyelonephritis from cystitis a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

a

Containing bacilli both within and bound to the protein matrix are seen in pyelonephritis. a. WBC Casts b. RBC Casts c. Hyaline Casts d. Bacterial Casts

d

_________ may resemble granular cast, confirmation is _______

bacterial cast GRAM STAIN

Cast containing RTE Cells a. WBC Casts b. Epithelial Cell Casts c. Hyaline Casts d. Bacterial Casts

b

epithelial cell casts is indicative of

advance tubular obstruction

frequently associated with nephrotic syndrome, toxic tubular necrosis, DM, crush a. fatty casts b. Epithelial Cell Casts c. Hyaline Casts d. Bacterial Casts

a

Casts with multiple cell types, include RBC & WBC casts in glomerulonephritis and WBC and RTE, or WBC and bacterial casts in pyelonephritis. a. fatty casts b. Epithelial Cell Casts c. Mixed Cellular Casts d. Bacterial Casts

c

result of cellular disintegration a. fatty casts b. Granular Casts c. Mixed Cellular Casts d. Bacterial Casts

b

increased cellular metabolism occurring during periods of strenuous exercise accounts for the transient increase of these casts that accompany the increased hyaline cast a. fatty casts b. Granular Casts c. Mixed Cellular Casts d. Bacterial Casts

b

fragmented with jagged ends and have notches on sides a. fatty casts b. Granular Casts c. waxy Casts d. Bacterial Casts

c

indicative of extreme urine stasis (chronic renal failure) a. fatty casts b. Granular Casts c. waxy Casts d. Bacterial Casts

c

"renal failure casts" a. Broad Casts b. Granular Casts c. waxy Casts d. Bacterial Casts

a

destruction "widening" of tubular walls a. Broad Casts b. Granular Casts c. waxy Casts d. Bacterial Casts

a

Acidic, rhombic, four-sided flat plates (whetstones), wedges, rosettes a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

d

Highly birefringent; distinguishing feature from cystine crystals a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

d

Significantly increased in gout, lesch-nyhan syndrome a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

d

Acidic, yellow-brown granules, becomes pink when refrigerated a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

a

Alkaline, similar to amorphous urates a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

b

Dihydrate (most common form): colorless, octahedral envelope or as two pyramids joined at their base a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

c

Monohydrate: oval or dumbbell shaped (ethylene glycol "anti-freeze" poisoning a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

c

Majority of renal calculi is composed of ____ a. Amorphous Urates b. Amorphous Phosphates c. Calcium Oxalate d. Uric Acid

c

Alkaline, colorless, flat rectangular plates, thin prisms in rosette form a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

d

Confused with sulfonamide crystals (when urine pH is neutral) a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

d

Distinguished by addition of DILUTE ACETIC ACID a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

d

In addition of dilute acetic acid in calcium phosphate, which of the following dissolves a. calcium phosphate b. sulfonamide

a

In addition of dilute acetic acid in calcium phosphate, which of the following does not dissolves a. calcium phosphate b. sulfonamide

b

alkaline, also known as ammonium magnesium phosphate a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

b

prism shape, resembles "coffin-lid" a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

b

acidic, thorny apples, spicule covered shapes a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

c

Most often encountered in old specimen, ammonia-urea splitting bacteria a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

c

ammonium biurate dissolves at ____ and convert into ____ when ________ is added

60degC Uric acid crystals Glacial acetic acid

alkaline, small, colorless, dumbbell of spherical shapes a. Calcium Carbonate b. Triple Phosphate c. Ammonium Biurate d. Calcium Phosphate

a

resemble amorphous material a. Calcium Carbonate b. Calcium Oxalate c. Uric Acid d. Calcium Phosphate

a

calcium carbonate distinguished by addition of _________

acetic acid (formation of gas)

Most often found in ACIDIC URINE or rarely in NEUTRAL URINE

Abnormal Urinary Crystals

colorless, hexagonal plates (thick or thin) a. Cholesterol b. Tyrosine c. Ampicillin d. Cystine

d

Distinguished from uric acid a. Cholesterol b. Tyrosine c. Ampicillin d. Cystine

d

confirmation for cystine

cyanide-nitroprusside test

Metabolic disorder that prevents reabsorption of cysteine by renal tubules

cystinuria

rectangular plates with notch on one or more corners a. Cholesterol b. Tyrosine c. Ampicillin d. Cystine

a

can be seen in nephrotic syndrome in conjunction with fatty casts and oval fat bodies a. Cholesterol b. Tyrosine c. Ampicillin d. Cystine

a

colorless flat plates, similar to cholesterol a. Sulfonamides b. Tyrosine c. Radiographic Dye d. Cystine

c

SG is markedly elevated a. Sulfonamides b. Tyrosine c. Radiographic Dye d. Cystine

c

colorless to yellow-brown, needles, rhombic, whetstones, "sheaves of wheat" and rosettes a. Sulfonamides b. Tyrosine c. Radiographic Dye d. Cystine

a

Distinguished from calcium phosphate a. Sulfonamides b. Tyrosine c. Radiographic Dye d. Cystine

a

Does not dissolve upon addition of dilute acetic acid a. Sulfonamides b. Tyrosine c. Radiographic Dye d. Cystine

a

colorless needles (tend to form bundles following refrigeration) a. Leucine b. Tyrosine c. Ampicillin d. Cystine

c

indication: precipitation of antibiotics following massive dosage of this penicillin compound without adequate hydration a. Leucine b. Tyrosine c. Ampicillin d. Cystine

c

Abnormal urinary crystals indicative of liver disorder

leucine tyrosine bilirubin

yellow-brown spheres (concentric circles with radial striations) a. Leucine b. Tyrosine c. Ampicillin d. Cystine

a

Should be accompanied by: tyrosine crystals a. Leucine b. Tyrosine c. Ampicillin d. Cystine

a

fine, colorless to yellow needles (clumps or rosettes) a. Leucine b. Tyrosine c. Ampicillin d. Cystine

b

Seen in conjunction with: leucine crystals and (+) chemical test for bilirubin a. Leucine b. Tyrosine c. Ampicillin d. Cystine

b

yellow, clump needles or granules a. Leucine b. Tyrosine c. Ampicillin d. Bilirubin

d

Glomerular a. Most often are IMMUNE-MEDIATED b. Result from INFECTIOUS or TOXIC SUBSTANCES c. Causes a renal perfusion that subsequently induces both MORPHOLOGIC & FUNCTIONAL changes in the kidney

a

Tubular a. Most often are IMMUNE-MEDIATED b. Result from INFECTIOUS or TOXIC SUBSTANCES c. Causes a renal perfusion that subsequently induces both MORPHOLOGIC & FUNCTIONAL changes in the kidney

b

Interstitial a. Most often are IMMUNE-MEDIATED b. Result from INFECTIOUS or TOXIC SUBSTANCES c. Causes a renal perfusion that subsequently induces both MORPHOLOGIC & FUNCTIONAL changes in the kidney

b

Vascular a. Most often are IMMUNE-MEDIATED b. Result from INFECTIOUS or TOXIC SUBSTANCES c. Causes a renal perfusion that subsequently induces both MORPHOLOGIC & FUNCTIONAL changes in the kidney

c

Nephrotic syndrome is what type of disease

glomerular disease

INCREASED permeability of the GLOMERULI to the passage of plasma proteins (ALBUMIN) a. Acute Tubular Necrosis b. Acute Glomerulonephritis c. Nephrotic Syndrome d. Focal Segmental Glomerulonephritis

c

Heavy proteinuria, hypoproteinemia and hyperlipidemia can be seen in a. Acute Tubular Necrosis b. Acute Glomerulonephritis c. Nephrotic Syndrome d. Focal Segmental Glomerulonephritis

c

TYPES OF GLOMERULONEPHRITIS

AFMIC acute focal segmental membranoproliferative IgA nephropathy Chronic

One cause: Post-Streptococcal Infection → known as: ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS (Group A βhemolytic Streptococci – those with M PROTEIN in their cell wall induces this type of nephritis) a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

c

ELEVATED ASO Titer a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

c

NON-AGN: non-streptococcal agent in acute glomerulonephritis

Bacteria: pneumococci Viruses: mumps, Hepa B Parasitic infection: malaria

SCLEROSIS of the GLOMERULI a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

b

Predominant Feature: PROTEINURIA a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

b

Cellular Proliferation of the MESANGIUM along with LEUKOCYTE INFILTRATION & THICKENING OF THE GLOMERULAR BASEMENT MEMBRANE a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

a

Development: Slow and Silent 80%: have previously some form of glomerulonephritis 20%: form of glomerulonephritis that has been unrecognized a. IgA Nephropathy b. Focal Segmental Glomerulonephritis c. Acute Glomerulonephritis d. Membranoproliferative Glomerulonephritis e. Chronic Glomerulonephritis

e

Destruction of RENAL TUBULAR Epithelial Cells

Acute Tubular Necrosis

2 types of Acute Tubular Necrosis

Ischemic ATN Toxic ATN

follows a HYPOTENSIVE event that result in decrease perfusion of the kidneys followed by renal tissue ischemia a. Toxic ATN b. Ischemic ATN

b

3 principal cause of Ischemic ATN

Sepsis Shock Trauma

results from exposure to NEPHROTOXIC AGENTS, caused by variety of agents a. Toxic ATN b. Ischemic ATN

a

give examples of endogenous nephrotoxin

hemoglobin myoglobin uric acid immunoglobulin light chain

give examples of exogenous nephrotoxin

therapeutic agents anesthetics radiographic contrast media chemotherapeutic drugs recreational drugs industrial chemicals

Alkaptonuria (Homogentesic Acid) MSUD Melanoma (Melanin) PKU a. Ammoniacal Silver Nitrite b. Ferric Chloride Test c. Nitrosonaphthol Test d. Hoesch Test e. Watson-Schartz Test f. Benedict’s Test

b

Alkaptonuria (Homogentesic Acid) a. Ammoniacal Silver Nitrite b. Ferric Chloride Test c. Nitrosonaphthol Test d. Hoesch Test e. Watson-Schartz Test f. Benedict’s Test

a or f

Tyrosinuria a. Ammoniacal Silver Nitrite b. Ferric Chloride Test c. Nitrosonaphthol Test d. Hoesch Test e. Watson-Schartz Test f. Benedict’s Test

c

Porphyria (Porphobilinogen) a. Ammoniacal Silver Nitrite b. Ferric Chloride Test c. Nitrosonaphthol Test d. Hoesch Test e. Watson-Schartz Test f. Benedict’s Test

d or e

Actively involved in the metabolism of Amino Acids

Liver & Kidney

TRANSAMINATION

Interconvertion of AA

DEAMINATION

Degradation of AA

INCREASE in the plasma levels of AA a. No-Threshold Aminoaciduria b. Overflow Aminoaciduria c. Renal Aminoaciduria

b

AA not reabsorbed by the tubules a. No-Threshold Aminoaciduria b. Overflow Aminoaciduria c. Renal Aminoaciduria

a

Plasma levels of AA: NORMAL Cause: Defect in tubules (congenital/acquired) → NOT Reabsorbed by the tubules = INCREASE amount in URINE a. No-Threshold Aminoaciduria b. Overflow Aminoaciduria c. Renal Aminoaciduria

c

a.k.a. “inborn errors of metabolism" a. Primary Aminoaciduria b. Secondary Aminoaciduria c. Cystinosis d. Nephropathic Cystinosis

a

2 types of defect in primary aminoaciduria

1. enzyme is defective 2. tubular reabsorptive dysfunction

Induced by: SEVERE LIVER DISEASE or GENERALIZED TUBULAR DYSFUNCTION (e.g. Fanconi Syndrome) a. Primary Aminoaciduria b. Secondary Aminoaciduria c. Cystinosis d. Nephropathic Cystinosis

b

MOI: Autosomal Recessive Lysosomal Storage Disease a. Primary Aminoaciduria b. Secondary Aminoaciduria c. Cystinosis d. Nephropathic Cystinosis

c

Most common & SEVERE FORM Accumulated CYSTINE CRYSTALLIZES within the PROXIMAL TUBULAR CELLS of the NEPHRONS (Fanconi syndrome) a. Primary Aminoaciduria b. Secondary Aminoaciduria c. Cystinosis d. Nephropathic Cystinosis

d

Nephropathic Cystinosis evident in

: FIRST YEAR OF LIFE

Intermediate Cystinosis evident in

ADOLESCENCE

RARE FORM Clinical Features: SAME with Nephropathic Cystinosis a. Ocular Cystinosis b. Intermediate Cystinosis c. Cystinosis d. Cystinuria

b

RARE FORM CYSTINE DEPOSITION in the CORNEA → Ocular Impairment a. Ocular Cystinosis b. Intermediate Cystinosis c. Cystinosis d. Cystinuria

a

MOI: Autosomal Recessive Due to: NEPHRONES (PTC) = UNABLE to REABSORBED AA (cysteine, dibasic AA e.g. arginine, lysine, ornithine) a. Ocular Cystinosis b. Intermediate Cystinosis c. Cystinosis d. Cystinuria

d

MOI: Autosomal Recessive Accumulation of branched-chain AA (leucine, isoleucine, valine) and their corresponding α-keto acids in BLOOD, URINE & CSF a. Melanuria b. Phenylketonuria c. Tyrosinuria d. Maple Syrup Urine Disease e. Alkaptonuria

d

MOI: Autosomal Recessive INCREASED urinary excretion of PHENYLPYRUVIC ACID (a ketone) and its metabolites a. Melanuria b. Phenylketonuria c. Tyrosinuria d. Maple Syrup Urine Disease e. Alkaptonuria

b

MOI: Autosomal Recessive Excretion of large amount of HOMOGENTISIC ACID (HGA) in the urine Unusual darkening of the urine when ALKALI is ADDED a. Melanuria b. Phenylketonuria c. Tyrosinuria d. Maple Syrup Urine Disease e. Alkaptonuria

e

Deficient enzyme in Maple Syrup Urine Disease a. PHENYLALANINE HYDROXYLASE b. Branched-Chain α-Keto Acid Dehydrogenase (BCKD) c. HOMOGENTISIC ACID OXIDASE

b

Deficient enzyme in Phenylketonuria a. PHENYLALANINE HYDROXYLASE b. Branched-Chain α-Keto Acid Dehydrogenase (BCKD) c. HOMOGENTISIC ACID OXIDASE

a

Deficient enzyme in Alkaptonuria a. PHENYLALANINE HYDROXYLASE b. Branched-Chain α-Keto Acid Dehydrogenase (BCKD) c. HOMOGENTISIC ACID OXIDASE

c

high SG a. Diabetes Insipidus b. Diabetes Mellitus

b

low SG a. Diabetes Insipidus b. Diabetes Mellitus

a

Enzymes Responsible for Galactosemia

1.Galactose 1-phosphate uridylyltransferase (GALT) 2.Galactokinase (GALK) 3.Uridine diphosphate galactose-4-epimerase (GALE)

Impaired ability to REABSORBED GLUCOSE a. Hartnup Disease (Monoamino – Monocarboxylic AA) b. Bartter’s Syndrome c. Renal Glucosuria d. Renal Tubular Acidosis Type II

c

Impaired ability to REABSORBED SPECIFIC AMINO ACIDS a. Hartnup Disease (Monoamino – Monocarboxylic AA) b. Bartter’s Syndrome c. Renal Glucosuria d. Renal Tubular Acidosis Type II

a

Impaired ability to REABSORBED SPECIFIC AMINO ACIDS a. Cystinuria (Cystine and Dibasic AA) b. Bartter’s Syndrome c. Renal Glucosuria d. Renal Tubular Acidosis Type II

a

Impaired ability to REABSORB SODIUM a. Cystinuria (Cystine and Dibasic AA) b. Bartter’s Syndrome c. Renal Glucosuria d. Renal Tubular Acidosis Type II

b

Impaired ability to REABSORB BICARBONATE a. Cystinuria (Cystine and Dibasic AA) b. Bartter’s Syndrome c. Renal Glucosuria d. Renal Tubular Acidosis Type II

d

Impaired ability to REABSORB CALCIUM a. Cystinuria (Cystine and Dibasic AA) b. Bartter’s Syndrome c. Idiopathic Hypercalciuria d. Renal Tubular Acidosis Type II

c

Excessive REABSORPTION of CALCIUM a. Cystinuria (Cystine and Dibasic AA) b. Bartter’s Syndrome c. Idiopathic Hypercalciuria d. Hypocalciuric Familial Hypercalcemia

d

Excessive REABSORPTION of SODIUM a. Gordon’s Syndrome b. Bartter’s Syndrome c. Idiopathic Hypercalciuria d. Hypocalciuric Familial Hypercalcemia

a

EXCESSIVE REABSORPTION of PHOSPHATE a. Gordon’s Syndrome b. Bartter’s Syndrome c. Pseudohypo parathyroidism d. Hypocalciuric Familial Hypercalcemia

c

Generalized LOSS OF PROXIMAL TUBULAR FUNCTION a. Gordon’s Syndrome b. Bartter’s Syndrome c. Pseudohypo parathyroidism d. Fanconi Syndrome

d

NOT REABSORBED form the ULTRAFILTRATE & EXCRETED in the URINE

WAGCPP water AA glucose calcium phosphorous potassium

Impaired ability to REABSORB PHOSPHATE a. Renal Salt-Losing Disorder b. Familial Hypophosphatemia (Vitamin D Resistant Rickets) c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Idiopathic Hypercalciuria

b

Impaired ability to REABSORB CALCIUM a. Renal Salt-Losing Disorder b. Familial Hypophosphatemia (Vitamin D Resistant Rickets) c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Idiopathic Hypercalciuria

c

Impaired ability to ACIDIFY URINE a. Renal Salt-Losing Disorder b. Familial Hypophosphatemia (Vitamin D Resistant Rickets) c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Renal Tubular Acidosis (Types I and IV)

e

Impaired ability to RETAIN SODIUM a. Renal Salt-Losing Disorder b. Familial Hypophosphatemia (Vitamin D Resistant Rickets) c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Renal Tubular Acidosis (Types I and IV)

a

Impaired ability to CONCENTRATE URINE a. Renal Salt-Losing Disorder b. Familial Hypophosphatemia (Vitamin D Resistant Rickets) c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Renal Tubular Acidosis (Types I and IV)

d

Excessive reabsorption of SODIUM a. Renal Phosphaturia b. Liddle’s Syndrome c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Renal Tubular Acidosis (Types I and IV)

b

Inability to REABSORB INORGANIC PHOSPHATES a. Renal Phosphaturia b. Liddle’s Syndrome c. Idiopathic Hypercalciuria d. Nephrogenic Diabetes e. Renal Tubular Acidosis (Types I and IV)

a

1. Urethra (Urethritis) 2. Bladder (Cystitis) Painful Urination (Dysuria) Burning Sensation Frequent urge to urinate a. Upper UTI b. Chronic Pyelonephritis c. Lower UTI d. Yeast Infections

c

1. Renal Pelvis Alone (Pyelitis) 2. Renal Pelvis including Interstitium (Pyelonephritis) a. Upper UTI b. Chronic Pyelonephritis c. Lower UTI d. Yeast Infections

a

bacterial infection that involves the renal tubules, interstitium, & renal pelvis a. Upper UTI b. Chronic Pyelonephritis c. Lower UTI d. Acute Pyelonephritis

d

develops when permanent inflammation of renal tissue causes permanent scarring that involves the renal calyces and pelvis a. Upper UTI b. Chronic Pyelonephritis c. Lower UTI d. Acute Pyelonephritis

b

allergic response to the interstitium of the kidney a. Yeast Infections b. Chronic Pyelonephritis c. Acute Interstitial Nephritis d. Acute Pyelonephritis

c

Candida species (e.g. Candida albicans) – normal flora of GIT & vagina a. Yeast Infections b. Chronic Pyelonephritis c. Acute Interstitial Nephritis d. Acute Pyelonephritis

a

most common cause of Acute Interstitial Nephritis

Acute Allograft Rejection of a transplanted kidney

Types of vascular diseases

Acute Renal Failure Chronic Renal Failure Calculi

Acute renal failure clinically sudden in:

DAO 1. DECREASE of GFR 2. Azotemia 3. Oliguria (Urine Output <400Ml)

Acute renal failure mechanism: result from DECREASE renal blood flow (25% of cases) a. Pre-renal b. Renal c. Post-renal

a

Acute renal failure mechanism: (Approx. 65% of cases) renal damage, can result from glomerular, tubular or vascular disease process a. Pre-renal b. Renal c. Post-renal

b

Acute renal failure mechanism: – (Approx. 10% of cases) obstruction in the urine flows a. Pre-renal b. Renal c. Post-renal

c

Progressive LOSS of RENAL FUNCTION caused by: IRREVERSIBLE & INTRINSIC RENAL DISEASE

chronic renal failure

Decreasing GFR slowly but continuously DECREASES

chronic renal failure

“END-STAGE RENAL DISEASE” / “END-STAGE KIDNEYS”

chronic renal failure

these can be seen in renal calyces, pelvis, bladder, ureter

Stones

Stones/calculi percentage

Calcium- 75% w/ oxalate- 35% w/ phosphate- 15% w/ others- 25% Magnesium ammonium phosphate- 15% Uric acid- 6% Cystine- 2%