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PT: Nutrition Exam 2 > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What is the excretory function?

A
  1. Elimination of a toxic and waste products (urea, etc.)
    Excretion = filtration + secretion - reabsorption
  2. Electrolyte, fluid, & Acid/Base Balance
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2
Q

What is the endocrine function (renal)?

A
  1. Erythropoietin

2. Renin

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3
Q

What is the renal metabolic function?

A
  1. Vitamin D activation
  2. Gluconeogenesis
  3. Insulin and Steroid metabolism
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4
Q

What circulatory aspects are part of the urinary system?

A
  1. Oxygenated: Aorta, renal arteries, afferent arterioles
  2. Glomerulus
  3. Deoxygenated: efferent arterioles, renal veins, inferior vena cava
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5
Q

What are the aspects of the urinary collecting system?

A

ureter, bladder, urethra

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6
Q

How many nephrons are in the kidney?

A
  1. 1 millon (2 million total)
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7
Q

What is the rate of blood flow into the kidney?

A

1 liter/minute
125 mL/min are filtered
0.8 mL/min are urine

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8
Q

What are the components of the nephron?

A
  1. Bowman’s capsule (Glomerulus–Filters size/charge)
  2. Proximal tubule (reabsorption)
  3. Loop of Henle (Na, water flux)
  4. Distal convoluted tubule (ALD)
  5. Collecting Duct (ADH)
  6. Ureter, Bladder, Urethra
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9
Q

What is the capacity of the bladder?

A

400 mL

@ 150 mL micturition sensation will occur

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10
Q

How long is the urethra in the male/female respectively?

A
  1. Male = 24 cm

2. Female = 4 cm

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11
Q

How can you assess how well the kidneys are working?

A
  1. Clinical S/S

2. Laboratory evidence (excretory, metabolic, endocrine)–Serum Creatinine

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12
Q

Why would you assess renal function?

A
  1. To dx renal disease
  2. To monitor disease progress
  3. To monitor response to treatment
  4. To find changes in function that may impact drug therapy
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13
Q

What GFR results in ‘kidney damage with normal or increased GFR’?

A

> 90 mL/min/1.73m2 (most prevalent)

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14
Q

What GFR results in ‘kidney damage with small decrease in GFR’?

A

60-89 mL/min/1.73m2 (2)

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15
Q

What GFR results in ‘kidney damage with moderate decrease in GFR’?

A

30-59 mL/min/1.73m2 (3)

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16
Q

What GFR results in ‘kidney damage with large decrease in GFR’?

A

15-29 mL/min/1.73m2 (4)

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17
Q

What GFR results in ‘kidney failure with need for dialysis’?

A

<15 mL/min/1.73m2 (5)

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18
Q

As creatinine clearance gets smaller what do you need to do to the dosage of drugs?

A

Decrease the dose or spread out the interval

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19
Q

How can you define renal function?

A
  1. GFR: the volume (mL) of plasma completely cleared of a substance per unit of time (min)
  2. Clearance
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20
Q

How many L of blood does that adult body filter per day?

A
  • 180 L*
  • 1.5 L are excreted
  • 99% reabsorbed
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21
Q

What different variables can affect ‘renal function’?

A
  1. Renal blood flow
  2. Hydrostatic/Oncotic pressures across the glomerulus
  3. Integrity of the glomerulus
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22
Q

When completing a physical exam what clinical evidence would support renal dysfunction?

A
  1. Edema, Skin turgor
  2. Fontanelle, membranes
  3. weight
  4. intake/output
  5. BP/Pulse
  6. Pulmonary auscultation
  7. JVD
  8. Bladder palpation
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23
Q

What patient complaints with warrant clinical evidence of renal dysfunction?

A
  1. Voiding habits
  2. Force of stream
  3. Pain
  4. SOB
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24
Q

What is an ‘ideal renal function test’?

A

Desired properties
1. Reflects glomerular filtration
(100% filtered, no secretion, no reabsorption)
2. Not influenced by other disease states
3. Easy to obtain

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25
How can you quantify renal function?
Insulin, dyes, radio-labeled compounds | Accurate... but expensive, time consuming, and impractical (research only)
26
What is a BUN?
Blood urea nitrogen
27
What are the limits of BUN?
1. Filtered then 50% reabsorbed 2. Protein intake 3. Liver function (AA to NH4+ to urea)
28
What is the normal SCr level of male/femal respectively?
1. Adult Male: 0.9-1.3 mg/dL 2. <19 y Male: 0.4-1.3 mg/dL 3. Adult Female: 0.6-1.1 mg/dL 4. <19 y Female: 0.4-1.3 mg/dL
29
Given ____, CrCl can be approximated.
1. [SCl]
30
____ is a proxy for CFR
CrCl
31
What are the physiological limitations of SCr?
1. Cr is 90% filtered and 10% secreted by tubules 2. Variable muscle mass - Sex, Age, Health
32
What are other limitations of SCr?
1. Changing renal function 2. Diet (protein meal) - best in AM 3. Concomitant drug therapy
33
How do the kidneys handle SCr?
1. Tubular secretion-- Min effect = 10% & increased proportion as filtration increases 2. Drugs & Cr compete for secretion
34
What can effect Cr entry (Crin) physiologically?
1. Sex, Age, Health, Habitus, Diet
35
What can effect CrCl physiologically?
Tubular secretion & medications
36
What are the limits to *measured* CrCl?
1. Tubular Secretion 2. Sample Loss 3. Time (24 hours)
37
What is the Cockcroft & Gault equation for *estimated CrCl*?
(140 - age) x Weight / (SCr x 72) = mL/min FOR ADULT WOMEN MULTIPLY RESULT BY *0.85*
38
What are the limitations of the Cockcroft/Gault equation?
1. Not for peds! 2. Unreliable with rapidly changing renal function 3. Muscle mass should be considered (Obesity over estimates, cachexia) 4. Drugs may alter secretion 5. Diminished MM with elderly and malnourished
39
How can you estimate CrCl in kids?
1. Traub equation | 2. Schwartz equation
40
What are the different renal function tests?
1. Inulin (best accuracy) 2. Iothalamate (better accuracy) 3. 24-hour CrCl (good accuracy) 4. SCr (with equations) (best-ish accuracy) Increasing Clinical Use Decreasing Cost
41
What conditions may yield a "falsely" low SCr, and thereby a falsely elevated *calculated estimate of* CrCl?
GFR appears better than it truly is 1. Diminished muscle mass 2. tubular secretion of Cr (@ low GFR)
42
What are the advantages of a random urine collection?
collect anytime, convenient for patient & examiner
43
What are the advantages of a first void urine collection?
best for chemical and microscopic examination
44
What are the advantages of a 24-hour urine collection?
quantify urine substances
45
What are the advantages of a fasting urine collection?
glucose metabolism
46
What are the advantages of a post-prandial urine collection?
glucose metabolism
47
What are the advantages of a post-void residual urine collection?
evaluated residual urine in bladder after voiding (work-up of obstruction/incontinence)
48
What is the normal urine output of an adult?
1.2-1.5 L/day
49
What constitutes polyuria? Why?
1. >2,000 mL/day | 2. Water vs. solute
50
What constitutes nocturia?
polyuria at night
51
What constitutes oliguria? Why?
1. < 400 mL/day (Peds <0.5 mL/kg/hr) | 2. Pre-renal, intrinsic, post-renal
52
What constitutes anuria?
complete absence of urine production
53
Yellow urine
urochrome
54
Green urine
infection/drug
55
Pink/red urine
blood/drug
56
orange urine
bili/drug
57
foam urine
protein (albumin)
58
faint odor urine
normal
59
strong ammonia odor urine
bacteria convert to urea | UTI
60
fruity odor urine
ketones (fat metabolism)
61
What does a positive test for nitrates imply?
bacteria presence due to bacterial enzymes reducing nitrate to nitrite false (-)/false (+) possible
62
What is the normal pH of urine?
4.5-8 (help to confirm not dx)
63
What does acidic urine imply?
metabolic acidosis, DM, dehydration, diarrhea, gout, respiratory acidosis, UTI
64
what does alkaline urine imply?
metabolic alkalosis, respiratory alkalosis, UTI, acute/chronic renal failure, RTA, diuretics, alkaline drugs (bacteria produce NH4+ with increase pH)
65
what are the normal protein-urine levels?
1. < 150 mg/day | 2. Albumin < 30 mg/day
66
what would constitute microalbuminuria?
30 to 300 mg/day | consider albumin:creatinine ration in urine
67
what would constitute albuminuria?
>300 mg/24 hours
68
what would constitute proteinuria?
>500 mg/day | Ranges from trace to 4+
69
What is the etiology of pre-renal proteinuria?
Overflow--increased plasma proteins hemoglobinuria: hemolysis (casts) myoglobinuria: myolysis (casts)
70
What is the etiology of renal/glomerular proteinuria?
selective glomerular <1 gm/day | -membrane is intact but charge is lost
71
What sorts of diseases can cause proteinuria?
1. Autoimmune (glomerulonephritis) 2. Systemic Disease (DM, Lupus) 3. Drugs (Li)
72
What happens in nonselective glomerular proteinuria?
1. glomerular barrier seriously compromised 2. massive amounts of protein (casts) 3. lipid bodies may also pass into urine 4. patient will have systemic complaints (edema, etc.) 5. Disease states (glomerulonephritis)
73
What is the etiology of renal/tubular proteinuria?
- Tubular injury secondary to antibiotics - Loss of proteins normally filtered then reabsorbed - Disease states/Drugs
74
What is the etiology of post- renal proteinuria?
- Urinary tract proteins (<2g/day) | - Inflammation, malignancy, injury
75
what is the etiology of non-pathological proteinuria?
1. exercise 2. pregnancy 3. fever All usually < 2 gm/day
76
What is pre-renal glucosuria?
elevated blood glucose | 40 mg/min
77
what is renal glucosuria?
defective renal absorption of glucose due to pregnancy or heavy metal poisoning 60 mg/min
78
What can result in hyperglycemia without glycosuria?
Abnormal glucose filtration -Poor renal perfusion, renal atherosclerosis 0 mg/min
79
What is ketonuria?
Ketones present in the urine (absence = normal) - Acetone - Acetoacetic acid - betahydroxybutyric acid - metabolites of lipid catabolism
80
What is the normal level of urobilinogen in the urine?
0.2-1 mg/dL
81
What happens in the body with there is urobilinogen in the urine?
- reduction of conjugated bilirubin by intestinal bacteria - reabsorption from gut, some renal excreted - False (+)/False (-
82
What is bilirubin?
intermediated product of Hgb breakdown | --bound... NO renal elimination
83
What can cause bilirubin to be in the urine?
1. Cellular diseases | 2. Obstructive diseases
84
What is hematuria?
presence of blood in the urine
85
what would cause blood to be present in the urine?
Source: kidney (glomerulus, tubules), urinary tract, or contaminant
86
what are the two different aspects of hemoglobinuria?
1. Isolates = hemolysis | 2. RBCs + Hgb = lysed RBCs in urine
87
What is the normal specific gravity of urine?
1.002-1.030
88
What can cause high specific gravity in urine?
sugar, protein, contrast dye, dehydration
89
What can cause low specific gravity in the urine?
DI, renal disease, dilute urine, inability to concentrate
90
What is notable about leukocyte esterase's?
1. enzyme released by neutrophils 2. pyuria = presence of pus in the urine 3. good correlation with a UTI
91
What are urine casts?
1. precipitation of mucoproteins | 2. shape indicates origin
92
Where would you find squamous cells in the urinary tract?
lower 3rd of the urethra and vagina
93
Where would you find transitional cells in the urinary tract?
present in the ureter and bladder
94
Where would you find renal tubular cells in the urinary tract?
renal tubules
95
Crystals in urine
``` uric acid calcium oxalate sulfonamides ampicillin radiopaque dye ```
96
Bacteria present in urine
>100,000 colonies | only in 30-50% of cases
97
When would you consider a contamination in urine sample with microorganisms?
no PMNs | >3 bacteria present
98
yeast in urine sample
UTI vs contamination
99
trichomonas vaginitis urine sample
vaginal contamination
100
spermatozoa urine sample
male: normal female: contaminant
101
ova and parasites in urine
ova and parasites | fecal vs vaginal

PT: Nutrition Exam 2 (10 decks)

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