Flashcards
Week 11
Cards in this deck (36)
- 1What are the advantages of urinalysi?-Non-invasive
-Easily obtained
-Normal composition is mostly known
-Indicated renal/pre-renal disease - 2What do the normal levels of urinary secretion depend on?-Sex
-Age
-State of health
-Ethnicity
-Activity levels - 3What is a urine sample collected in?-Clean/sterile container
-Preservatives (eg. sodium chloride) are added if refrigeration is not possible - 4How are random samples collected?-Clean catch midstream specimen
-Timing of sampling depends on the test required
-Test as soon as possible (pathogens lost, crystals form, becomes acidic) - 5How are 24 hr specimens collected?Empty the bladder first, then start collection
- 6What is the normal volume of urine excreted in 24 hrs? What does this depend on?0.8-2.0 L
Body size, diet, fluid intake, health - 7What is the normal appearance of urine? ... when dehydrated?Pale yellow (due to urobilin) and clear
Dark - 8What causes foamy and cloudy urine?Foamy: protein
Cloudy: phosphates - 9What causes red (blood in) urine at the different stages of micturition?Early- urethra
Throughout- bladder
End- prostate/base of bladder - 10What can cause pseudohematuria (appearance of blood)?-Free Hb
-Myoglobin
-Porphyrins
-Drugs (eg. laxatives, anti-inflammatories) - 11What is the cause for red/brown urine? Black?Conjugated bilirubin due to blocked bile ducts
Melanin - 12What sign indicates alkaptonuria and/or porphyria?Urine darkening on standing
- 13What do you examine urine for microscopically?-Bacteria (confirm by dipstick test for nitrite production)
-White blood cells (neutrophils, leukocyte esterase) for kidney infection
-RBC (1 indicates kidney damage)
-Casts (normally found post-exercise)
-Crystals - 14Is the presence of crystals normal?Yes
A high output can lead to aggregates forming into stones - 15When are ... formed? -oxalate crystals -phosphate -cystine-Acidic urine
-Alkaline urine
-Impaired re-absorption of amino acids - 16What is the normal pH range for urine?4.5-8
- 17What diet can cause acidic/alkaline urine?Acidic: much meat
Alkaline: citrus fruits and veg - 18What diseases cause acidic urine?-Uncontrolled diabetes
-Starvation
-Dehydration
-Respiratory disorders - 19What diseases cause alkaline urine?-UT obstruction
-Respiratory disorders (alkalosis) - 20What type of stones form in acidic/alkaline urine?Acidic: uric acid, cystine
Alkaline: Ca/Mg phosphate, calcium carbonate - 21What is the function of creatinine phosphate?Major energy reserve in muscles
- 22Why does variation occur in excreted creatinine?Increased: excessive meat diet, sports supplements
Decreased: wasting disease, malnutrition, poor renal flow/function, severe liver disease - 23What are the pre-renal causes of overspill?-Increased solute filtration (due to increased production in the body)
-Abnormal metabolite (no transporter) - 24What are the pre-renal causes of decreased solute filtration?-Decreased production in the body
-Decreased delivery - 25What are the renal causes of abnormal solute excretion?-Glomerular malfunction (infection, AI, inflammation)
-Tubular malfunction (infection, AI, inflammation, necrosis, drugs, toxins) - 26What increases excretion of urea?-Excess protein intake
-Protein broken down during malnutrition
-Uncontrolled type 1 diabetes
-Infections
-Burns
-Wasting diseases
-Trauma - 27What decreases urea excretion?-Low protein diet
-Severe liver disease
-Glomerular nephritis
-Acute tubular necrosis
-Poor renal blood supply/obstruction - 28What happens when there is decreased urea excretion?-Back-flow from the liver
-Ammonia builds up in the blood and is ionised into NH4+
-Crosses BBB and can cause coma
-Prevented by minimising protein intake - 29Causes of high glucose in the urine?-Metabolic hyperglycaemia due to diabetes type 1, anxiety/stress
-Reduced renal threshold
-Tubular malfunction - 30What else can be found in the urine that is not normally present?-Galactose
-Lactose
-Fructose
-Pentose
-Ketones
-Amino acidurias
-Conjugated bilirubin - 31What is phaeochromocytoma?-Secreting adrenal medullary tumour (can be ectopic)
-Excessive secretion of adrenaline
-Diagnosed by excessive adrenaline breakdown products in urine
-Treated by surgery - 32What is phenylketonuria?-Excretion of phenylpyruvate
-Early symptoms: irritability, fits
-Later: mental retardation, observable after 4-6 months
-Phe hydroxylase deficiency
-Diagnosis: urinalysis for phenylketones. Vital it is early to minimise neurological damage
-Treatment: dietary management - 33What normally prevents protein in the urine?Glomerular basement membrane restricts protein entry to the glomerulus
- 34What are some pre-renal problems that cause proteinuria?High plasma concentration of protein with low molecular weight which is then filtered
- 35What are some renal problems that cause proteinuria?-Increased glomerular permeability
-Impaired/saturated reabsorption of protein filtered by normal glomeruli
-Secretion by kidneys/epithelium of urinary tract - 36What does protein size indicate about a (pre-) renal problem?Pre-renal: low Mr. Kidney is normal
Renal: medium-high Mr