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Urinalysis and Body Fluids 4214 > Exam 2: Renal and Urinary Tract Diseases > Flashcards

Exam 2: Renal and Urinary Tract Diseases Flashcards

1
Q

Most common outpatient infection?

A

UTIs

-with a lifetime incidence of 50−60% in adult women
-Men start getting UTIs as they age.

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2
Q

UTIs can lead to pregnancy complications and about 10% of UTI lead to complications such as…

A

sepsis and pyelonephritis

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3
Q

Most common etiologic agent of UTIs?

A

E. coli

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4
Q

Main symptom of UTIs?

A

painful urination

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5
Q

lower urinary tract via the urethra and ascend the urinary tract

A

Ascending UTI

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6
Q

can arise through infections in the bloodstream seeding the kidney with organisms deposited in the upper urinary tract and descend the urinary tract.

A

Descending UTI

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7
Q

What are the typical findings associated with UTIs?

A

-increased neutrophils,
-presence of bacteria
-positive leukocyte esterase)
positive nitrite

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8
Q

infection of the kidney/ureters.
Rapid onset, urinary frequency, burning, lower back pain

A

Pyelonephritis

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9
Q

Pyelonephritis urinalysis is similar to cystitis with what three exceptions?

A

-protein often positive in pyelonephritis
-pyelonephritis has presence of WBC casts*
-presence of renal epithelial cells rather than transitional epithelial cells*

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10
Q

Most common cause of chronic pyelonephritis?

A

congenital structural defects

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11
Q

-long standing kidney infection
-can be caused by inflammation that occurs repeatedly that permanently damages the kidney and can lead to end-stage- renal disease.

A

Chronic pyelonephritis

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12
Q

chronic pyelonephritis is similar to pyelonephritis (blood, protein, WBCs) But increased…

A

protein, WBC, waxy and broad casts

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13
Q

absence of __________ may occur in later stages of chronic pyelonephritis.

A

bacteria

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14
Q

What are kidney stones called?

A

Calculi

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15
Q

Calculi are usually composed of ________but there are other kinds (e.g. uric acid)

A

calcium

-Fairly common. Patients will usually have blood in urine and in great pain

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16
Q

On UA, what is seen when calculi is present?

A

macro- and micro hematuria, maybe WBCs, crystals. pH can help determine type of crystal.

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17
Q

What are the common substances that form stones?

A

-Calcium oxalate (80%)
-Calcium phosphate
-Cystine
-Magnesium ammonium
-phosphate
-Uric acid

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18
Q

How common is CKD?

A

More than 1 in 7, that is 15% of US adults or 37 million people, are estimated to have CKD. As many as 9 in 10 adults with CKD do not know they have CKD.

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19
Q

How are changes in kidney function measured with hypertension?

A

-creatinine level, BUN (azotemia)
-May affect glomerular filtration rate (GFR)
-Protein on dipstick or positive microalbumin

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20
Q

Diabetes patients may have blood vessel damaged to the small vessels, the pt may develop ________.

A

edema

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21
Q

Kidney damage caused by diabetes can be detected by urinary…

A

-Protein and microalbuminuria
-creatinine level and BUN (azotemia)
-glomerular filtration rate (GFR) may be affected

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22
Q

Chronic kidney disease caused by obesity will have what changes?

A

-proteinuria
-decreased GFR

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23
Q

How does obesity cause CKD?

A

a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term.

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24
Q

What are the two regular screening tests used for patients with diabetes and/or hypertension?

A

-GFR or eGFR
-urine microalbumin

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25
Q

Kidney disease is present at a eGFR of ______.

A

less than or equal to 60 mL/min

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26
Q

assessed by comparing the amount of micro-albumin to the urine creatinine level in a single urine sample

A

Urine microalbumin

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27
Q

disease indicated with more than ___mg of albumin per gram of creatinine, with or without a decreased eGFR.

A

30

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28
Q

What is a key sign of nephritic syndrome/ inflammation of the glomeruli?

A

blood in urine

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29
Q

What is an important marker of nephrotic syndrome?

A

proteinuria

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30
Q

Damage to glomeruli resulting in massive proteinuria and edema.

A

nephrotic syndrome

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31
Q

Difference between nephritic syndrome and nephrotic syndrome?

A

major difference is blood in urine

Both have proteinuria, but higher in nephrotic. Nephritic can cause some edema, but much less than nephrotic.

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32
Q

True or False,

BUN/creatinine is decreased with glomerular diseases?

A

False, increased

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33
Q

Causes of glomerular diseases?

A

-immunological processes
-can be systemic or primary origin
-can be genetic or acquired
-acute or chronic

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34
Q

Nephrotic syndrome/nephrosis… a set of symptoms that happen together and affect your kidneys. These include:

A

-Swelling in legs, ankles, or around eyes (edema)
-Large amounts of protein in urine (proteinuria). Causes foamy urine.
-Loss of protein in blood
-High levels of fat lipids in blood (high cholesterol)
-High blood pressure (in some cases)

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35
Q

What are possible symptoms of nephrotic syndrome/nephrosis is advanced?

A

symptoms may be like those ofkidney failure. People may report fatigue, a poor appetite, headache, itchy skin, shortness of breath and/or nausea.

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36
Q

About a week after Group A streptococcal infection (strep throat), a few individuals create antibodies to a specific component of strep cells (Protein ____). The antibody-antigen complexes accumulate at the glomeruli.

A

M

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37
Q

How can diagnosis be made for Acute Poststreptococal Glomerulonephritis (AGN)?

A

Test for the antibody produced, Antistreptolysin O (ASO)

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38
Q

What are the expected lab results for AGN?

A

protein, LE, and blood positive

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39
Q

What is the prognosis of rapidly progressive glomerulonephritis?

A

Spontaneous remission is rare, and 80 to 90% of untreated patients progress to end-stage renal disease within 6 months. Prognosis improves with early treatment.

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40
Q

Symptoms of rapidly progressive glomerulonephritis arise after…

A

deposition of immune complexes from anti-glomerular membrane antibody (GBM), anti-neutrophil cytoplasmic antibody (ANCA) or patient has lupus.

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41
Q

What is a characteristic shape/form in Bowman’s space associated with rapidly progressive GN?

A

crescents form

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42
Q

What are the typical lab results for rapidly progressive GN?

A

-Smoky colored urine, decrease in urine volume, edema.
-Urinalysis: protein, blood, WBCs, RBC casts
-Serologic testing available
-Visualization of crescents due to immune complex deposition but need a biopsy to visualize.

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43
Q

autoimmune disease caused by autoantibodies to collagen (antiglomerular basement membrane antibodies)

A

Goodpasteur syndrome

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44
Q

Looks like rapidly progressing and same poor prognosis, but here there is lung involvement so patient will have shortness of breath, cough, may cough up blood.

A

Goodpasteur syndrome

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45
Q

What are the lab results similar to for Goodpasteur syndrome?

A

like post streptococcal and rapidly progressive.

46
Q

Pronounced thickening of the glomerular basement membrane resulting from deposition of immune complexes (IgG) leading to destruction of the glomerulus

A

Mebranous Glomerulunephritis (MGN)

47
Q

What is the most common cause of nephrotic syndrome in adults?

A

Mebranous Glomerulunephritis (MGN)

48
Q

What is the prognosis of Mebranous Glomerulunephritis (MGN)?

A

Most go on to chronic glomerulonephritis – but 1/3 resolve with treatment of underlying disorder.

49
Q

Lab results for Mebranous Glomerulunephritis (MGN)?

A

blood and very high protein and histology

50
Q

Glomeruli look normal under light microscopy, but morphologic changes are seen with electron microscopy
-No immune complex deposits, but thought to be immunologic, maybe T-cell dysfunction.

A

Minimal Change Disease (Lipid Nephrosis)

51
Q

Minimal Change Disease (Lipid Nephrosis) is mostly seen in __________.

A

children

52
Q

Prognosis for Minimal Change Disease (Lipid Nephrosis)?

A

Good prognosis, steroids, remission

53
Q

Minimal Change Disease (Lipid Nephrosis):

symptoms and lab findings are like ____________, with a better prognosis.

A

adult nephrotic syndrome

54
Q

What are significant lab findings with Minimal Change Disease (Lipid Nephrosis)?

A

profound proteinuria and oval fat bodies and fatty casts may be observed.

55
Q

symptoms of chronic glomerulonephritis?

A

Fatigue, anemia, hypertension, edema, oliguria gradually worsening
Markedly decreased GFR

56
Q

Chronic GN urinalysis shows…

A

-Dysmorphic RBCs
-protein
-Casts mix of granular, cellular, waxy, and broad.

57
Q

How is kidney function monitored with chronic GN?

A

of BUN, creatinine, and the GFR or eGFR.

58
Q

Immunoglobulin A nephropathy is called…

A

Berger disease

59
Q

What is the most common cause of chronic glomerulonephritis.

A

Immunoglobulin A nephropathy

60
Q

Berger’s disease may follow what type of infections?

A

mucosal infection (upper respiratory, GI or urinary tract) that stimulates IgA. Often begins at a younger age and develops over time

61
Q

-IgA Immune complexes deposit on the glomerular membrane and serum levels of IgA are increased.
-May progress to chronic glomerulonephritis

A

Berger Disease

62
Q

Lab findings with Berger disease?

A

IgA in serum, bloody urine or RBCs

63
Q

Diabetic Nephropathy Continual damage to the glomerular membrane is called

A

Kimmelsteil-Wilson Disease

64
Q

What is believed to be the main cause of Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?

A

high blood pressure

65
Q

Diabetic Nephropathy (Kimmelsteil-Wilson Disease) results in….

A

vascular sclerosis (thickening)***

66
Q

prognosis of Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?

A

Progresses to end stage renal disease

67
Q

Thickening of the glomerular basement membrane occurs in all diabetic patients. _________ eventually develops in up to 55% of diabetic patients.

A

Proteinuria

68
Q

Lab results for Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?

A

persistent albinuria, progressive decline in GFR, high blood pressure

69
Q

-Disease of the glomerulus with scar tissue forming on some of the glomeruli and in some areas (focal).
-Not a single disease. Often follows another glomerular disease, infection or drug abuse (Many causes).

A

Focal Segmental Glomerulosclerosis

70
Q

Focal Segmental Glomerulosclerosis progresses to…

A

nephrotic syndrome and can lead to kidney failure, requiring dialysis or kidney transplant

71
Q

Lab findings with Focal Segmental Glomerulosclerosis?

A

Moderate to heavy proteinuria; microscopic hematuria (RBCs, not casts), hyaline and broad casts

72
Q

Inherited sex-linked and autosomal disorder affecting basement membrane
Males more severely affected

A

Alport’s Syndrome

73
Q

Macroscopic hematuria with respiratory infections by age 6 years. Vision and hearing may be affected.
Membrane laminated with thinning; no immune complexes

A

Alport’s Syndrome

74
Q

Prognosis of Alport’s syndrome?

A

Mild to persistent hematuria, later nephrotic syndrome, renal failure for some.

75
Q

Lab findings with Alport’s syndrome?

A

RBCs, protein, casts, renal tubular epithelial cells (RTE)

4+ protein, RBCs, fat bodies, fatty and waxy casts, RTEs

76
Q

Prognosis of Acute Tubular Necrosis (destruction of epithelial cells)

A

Reversible:
hydration, stop meds,
treat any resulting damage

77
Q

Two types of acute tubular necrosis

A

-ischemic ATN
-toxic ATN

78
Q

What can cause ischemic ATN?

A

Sepsis, shock, trauma,
dehydration

79
Q

What can cause toxic ATN?

A

Endogenous:
myoglobin (rhabdomyolysis), hemoglobin
Exogenous: drugs, dyes and anesthetics, organic solvents

80
Q

Lab findings with acute tubular necrosis?

A

Noticeable renal tubular epithelial (RTE) cells and muddy brown casts, hyaline, waxy, granular, broad casts
Increased BUN and creatinine
High sodium in urine

81
Q

What is the specific gravity with acute tubular necrosis?

A

Specific gravity stays at 1.010

82
Q

-Hereditary or acquired later in life due to kidney disease
-Tubular disease with inadequate reabsorption at proximal tubule due to altered influx mechanisms.

A

Fanconi’s Syndome

83
Q

Fanconi’s Syndome:

urine accumulates…

A

-amino acids
-Glucose
-Bicarbonates (results in acidosis)
-phosphorus, sodium, and potassium

84
Q

What could a urinalysis show with Fanconi’s syndrome?

A

-higher levels of substances normally reabsorbed
-abnormal crystals, in some cases

85
Q

Group of disorders involving…

-either the decreased ability to secrete hydrogen ions in the distal tubule
-or a decreased ability to reabsorb bicarbonate in the proximal tubule.

A

Renal Tubular Acidosis

-results in chronic metabolic acidosis

86
Q

How is Renal Tubular Acidosis diagnosed?

How is it treated?

A

blood too acidic; urine too alkaline

often drinking a bicarbonate solution

87
Q

Inflammatory: Acute Interstitial Nephritis. Can be acute or chronic and is usually caused by

A

an allergic reaction to a drug.

Medication allergy to penicillin, methicillin, ampicillin, cephalosporins, NSAIDs, diuretics
Discontinue and use steroids to treat

88
Q

What are the lab findings with acute interstitial nephritis?

A

Urinalysis, hematuria, proteinuria,↑ WBCs, WBC casts, no bacteria
Hansel stain for eosinophils
May also see renal tubular epithelial cells

89
Q

Acute renal failure is cauterized by a sudden decrease in GFR and presence of…

A

azotemia and oliguria

90
Q

What is the assessment of acute renal failure based on?

A

serum creatinine, GFR and urine output.

91
Q

Prognosis for acute renal failure?

A

Mortality from acute renal failure is high but can start dialysis while treating underlying causes.

92
Q

symptoms of acute renal failure?

A

Person will not feel well (nausea, edema, no urine output, chest pains, fatigue). Seizures in severe cases.

93
Q

the most common causes of chronic kidney disease and kidney failure?

A

Diabetes and high blood pressure

94
Q

Monitoring patients with diabetes for the presence of _____________ a is important for early detection of the onset of diabetic nephropathy

A

microalbuminuri

95
Q

Bacteria may not be present in what

A

Chronic glomerulnephritis
Acute intestinal nephritis

96
Q

Common Urinary lab finding in a patient with urithitis ( stones).

A

WBC casts

97
Q

Chronic renal failure is a GFR below

A

50%

98
Q

Focal segment glomerusclerosis lab diagnosis

A

Very high protein, blood, hyaline and broad casts (not RBC casts)

Sclerosis in some glomeruli; many causes but ass. With drug use and HIV

99
Q

Diabetic nephropathy

A

Albinuria, low creatinine clearance/GFR
Blood: ↑glucose, ↑BUN, ↑Creatinine

Most common cause of ESRD; Sclerosis due to glucose and high blood pressure

100
Q

What can increase the changes of getting a UTI

A

Obstruction, foreign bodies, or the presence of catheters can increase the risk of acquiring a urinary tract infection.

101
Q

Nephrotic Syndrome

A

-Membranous GNP
-Minimal Change Disease
-Rapidly Progressive Glomerulonephritis
-Focal Seg
-Membranoproliferative GNP
-Diabetic kidney Disease

102
Q

Nephritic Syndrome (I)

A

Primary Glomerulonephritis such as IgA

Poststreptococcal

Goodpastures

Membranoproliferative GNP

Vasculitis

103
Q

Diminished renal reserve

A

GFR drops to about 50% of normal. Now considered to be in chronic renal failure.

104
Q

Renal insufficiency

A

further GFR decrease, BUN and serum creatinine increase (aztemia), anemia and hypertension

105
Q

Renal failure

A

GFR <20%, loss of urine volume and solute regulation, acidosis, edema, hyperkalemia

106
Q

End stage renal disease

A

GFR <5%, GFR, scarring, tubular fibrosis, loss of kidney mass.
Dialysis and/or kidney transplant required for survival.

107
Q

Most common cause of ESRD is

A

Diabetic nephropathy

108
Q

Waxy and broad cast more likely in

A

Chronic conditions

109
Q

WBC cast in

A

Acute renal failure

110
Q

RBC cast indicate

A

Nephrotic syndrome ( IgA and poststreptococcal)

Urinalysis and Body Fluids 4214 (14 decks)

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