Term
| most commonly excreted protein... |
|
Definition
|
|
Term
| seen in concentrated urine, febrile diseae, following stenuous exercise, and during the course of diuretic therapy |
|
Definition
|
|
Term
| characteristic of pyelonephritis, may also be seen in interstitial nephritis |
|
Definition
|
|
Term
| intraparenchymal bleeding, hallmark of GN |
|
Definition
|
|
Term
| characteristic of acute tubular necrosis |
|
Definition
|
|
Term
| non-specific cast but usually pathologic. can be seen in ATN, GN, or tubulointerstitial disease |
|
Definition
|
|
Term
| form in tubules that have become dilated and atrophic due to chronic parenchymal disease, often seen in CRF |
|
Definition
|
|
Term
| pear shaped organism with flagella |
|
Definition
|
|
Term
| may provide defense against UTI's |
|
Definition
|
|
Term
| most common yeast seen in urine - budding and clumps |
|
Definition
|
|
Term
| identification of this organism in an uncontaminated specimen implies infection and must be confirmed by culture. gram staining can be helpful. |
|
Definition
|
|
Term
| presence of this substance indicates contamination of the specimen |
|
Definition
| squamous epithelial cells |
|
|
Term
| if noted in large numbers or clumps these cells should raise concern about possible neoplasm |
|
Definition
| transitional epithelial cells |
|
|
Term
|
Definition
|
|
Term
| useful for the diagnosis of UTI's, urinary stone disease, and RTA |
|
Definition
|
|
Term
| normal urine protein score |
|
Definition
|
|
Term
| dipsticks are most sensitive to this protein |
|
Definition
|
|
Term
| this is often the first indication of renal disease |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what two processes may lead to increased urinary levels of urobilinogen |
|
Definition
| hemolytic processes, or hepatic disease |
|
|
Term
| how much bilirubin is normally detected in urine? |
|
Definition
|
|
Term
| what is normal UA glucose? what should you do if it's abnormal? |
|
Definition
normal = negative
if positive screen for diabetes |
|
|
Term
| what causes a false positive ketone test |
|
Definition
| fasting, post-exercise, pregnancy |
|
|
Term
| positive nitrites can indicate |
|
Definition
|
|
Term
| what is leukocyte esterase produced by? |
|
Definition
| neutrophils, if positive think bacteria |
|
|
Term
| what does blood in an UA measure? |
|
Definition
| erythrocytes, free hemoglobin, and myoglobin. Cofirm with microscopy. |
|
|
Term
| what high power field must be used in micropscopic urinalysis |
|
Definition
|
|
Term
| what is considered significant pyuria? |
|
Definition
| > 5 leukocytes per high power field. |
|
|
Term
| leukocytes are indicative of (2), and associated with (5) |
|
Definition
injury to the urinary tract, or infection.
associated with stones, strictures, neoplasm, GU TB, glomerulonephropathy, or interstitial cystitis |
|
|
Term
| presence of ____ erythrocytes per high power field is considered significant and warrants further investigation. |
|
Definition
|
|
Term
| urine osmolality gives important insight to (2) |
|
Definition
| hydration status and concentrating ability of kidneys. Normal = 1.003 - 1.030 |
|
|
Term
| presence of ______ erythrocytes per high power field is considered significant and requiers more investigation |
|
Definition
|
|
Term
| amount of sodium actually excreted by body relative to amount filtered by kidneys |
|
Definition
| Fractional Excretion of Sodium (FENa) |
|
|
Term
|
Definition
| Ccr = (140 - age) x weight in kg/ Pcr x72 |
|
|
Term
|
Definition
| body size, age, and phsiologic state |
|
|
Term
|
Definition
|
|
Term
|
Definition
| high protein or salt diet, and pregnancy |
|
|
Term
| evaluation of renal disease should include (3) |
|
Definition
| thorough H&P, UA with dipstick and microscopic analysis, assessment of GFR |
|
|
Term
|
Definition
|
|
Term
| where is urea synthesized? excreted? |
|
Definition
| syntehsized in the liver, excreted by glomerular filtration |
|
|
Term
| what is the serum marker of urea level? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| BUN is increased with (3) |
|
Definition
| acute and chronic renal failure and urinary obstruction |
|
|
Term
| casues of increaed BUN (6) |
|
Definition
| dehydration, reduced renal profusion (CHF, hypovolemia), increased dietary protein, accelerated catabolism (fever, trauma, GI bleed), steroids, tetracycline |
|
|
Term
| causes of decreased BUN levels |
|
Definition
| overhydration, increased renal perfusion (pregnancy, SIADH), restriction of dietary protein/malnutrition, liver disease |
|
|
Term
| creatinine is the product of |
|
Definition
| muscle catabolim, produced at a fairly constant rate and cleared by renal excretion. Freely filtered by the glomerulus. |
|
|
Term
| what is the normal means of estimating GFR |
|
Definition
|
|
Term
| serum creatinine elevated with (3), also increased with (6) |
|
Definition
| acute or chronic renal failure and urinary tract obstruction. Also increased with increased cooked meat intake, increased muscle mass, and meds such as cephalosporins, cimetidine, probenecid, and trimethoprim |
|
|
Term
| normal BUN/creatinine ratio |
|
Definition
10:1
creatinine may overestimate GFR
BUN may underestimate GFR
with ESRD take the average of the two |
|
|
Term
| "gold standard" for measuring GFR |
|
Definition
| clearance of injected carbohydrate - insulin |
|
|
Term
| used to identify thickness and echogenecity of renal cortex, medulla, and pyramids along with a dilated urinary collecting system |
|
Definition
|
|
Term
| kidney length of _____ indicates significant irreversible renal disease |
|
Definition
|
|
Term
| difference of ____ is oberved in unilateral renal disease |
|
Definition
|
|
Term
| US is great for the eval of (2) and useful for (3) |
|
Definition
great = hydronephrosis and cysts
useful = obstruction, to characterize renal masses, ADPKD screening |
|
|
Term
| used to evaluate post void residual urine volume of the bladder |
|
Definition
|
|
Term
| used to diagnose medullary sponge kidney and papillary necrosis |
|
Definition
|
|
Term
what is replacing IVP to avoid dye?
what is replacing IVP for stone eval? |
|
Definition
|
|
Term
| CT is especially useful for the eval of (2) |
|
Definition
| solid or cystic lesions in the kidney or retroperitoneal space |
|
|
Term
| CT has a definitive role in (2) |
|
Definition
| staging renal neoplasms and imaging kidneys following trauma |
|
|
Term
| this test is useful for hematuria work up |
|
Definition
| computerized tomography urogram (CTU) = combination IVP and abd. CT |
|
|
Term
| loss of corticomedullay function (GN, hydronephrosis, renal vascular occlusion, and renal failure) will be evident on this test |
|
Definition
|
|
Term
| this test can be used to stage renal cell carcinoma and evaluate a renal mass when contrast is contraindicated |
|
Definition
|
|
Term
| study of choice for blood vessels |
|
Definition
|
|
Term
| preferred method of eval for urinary reflux. |
|
Definition
| voided cystourethrography (VCUG) |
|
|
Term
| treatment for urinary reflux |
|
Definition
| long term abx that cover E. Coli |
|
|
Term
| major functions of the kidney (7) |
|
Definition
| regulation of blood ionic composition (Na, K, Ca, Cl, HPO4), blood pH, blood volume, blood pressure, blood osmolarity, production of hormones (calcitrol and erythropoietin), blood glucose level |
|
|
Term
|
Definition
| 300 milliosmoles per liter |
|
|
Term
| kidneys allow for excretion of these wastes (5) |
|
Definition
| ammonia, urea, bilirubin, creatinine, uric acid |
|
|
Term
| 3 basic processes in urine production |
|
Definition
| glomerular filtration, tubular resorption, tubular secretion |
|
|
Term
| normal daily amount of glomerular filtrate |
|
Definition
| 150-180 liters with 99% being resorbed which allows 1-2 liters for excretion |
|
|
Term
| 3 components of the filtration membrane |
|
Definition
| glomerular endothelial fenestrations, basal lamina, slit membrane of filtration slits. |
|
|
Term
| glomerular filtration depends on these 3 pressures |
|
Definition
glomerular blood hydrostatic pressure (GBHP) = 55mmgHg, promotes filtration of water and solutes.
Capsular Hydrostatic Pressure (CHP) = 15 mmHg, opposes filtration.
Blood Colloid Osmotic Pressure (BCOP) = 30mmHg, opposes filtration.
Net filtration pressure = 10mmHg |
|
|
Term
| amount of filtrate formed by both kidneys per minute |
|
Definition
| glomerular filtration rate |
|
|
Term
| GFR depends on these 3 regulations |
|
Definition
| renal autoregulation, neural regulation, hormonal regulation |
|
|
Term
| 2 main GFR regulation mechanisms |
|
Definition
1. control of blood flow in and out of glomerulus by changing diameter of afferent and efferent arterioles.
2. control of glomerular surface area via constriction or relaxation of mesangial cells. |
|
|
Term
| where is ADH released from? |
|
Definition
|
|
Term
| ADH released in response to (4) |
|
Definition
| increased plasma oncotic pressure, left atrial distention, exercise, certain emotional states |
|
|
Term
| what is ADH's effect on the collecting tubules? |
|
Definition
| promote the resorption of free water |
|
|
Term
| ADH insuffieciency causes what? |
|
Definition
| diabetes insipidus - inability of the kidney to concentrate urine (can be central or nephrogenic) |
|
|
Term
|
Definition
| decreased blood flow to kidneys --> Renin secretion from kidneys --> renin reaction with angiotensinogen --> angiotensin 1, converted to angiotensin 2 by ACE in lungs --> adrenal cortex secretes aldosterone into blood --> initiation of Na/K ATPase in kidneys --> increased blood pressure |
|
|
Term
| resorption of excessive amounts of free water that leads to hyponatremiam cerebral edema, and neurologic dysfunction |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Cl, HCO3, proteins, lipids |
|
|
Term
| number of particles dissolved in a solution |
|
Definition
|
|
Term
| major cation of extracellular fluid |
|
Definition
|
|
Term
|
Definition
| nausea, generalized weakness, mental confusion, seizures |
|
|
Term
| total body water decreases, total body sodium decreases to a greater extent. ECFV is decreased. |
|
Definition
|
|
Term
| TBW increased while total sodium remains normal, ECFV is increased minimally to moderately without the presence of edema |
|
Definition
|
|
Term
| total body sodium increases, TBW increses to a greater extent. ECFV is markedly increased with the presence of edema |
|
Definition
| hypervolemic hyponatremia |
|
|
Term
| water shifts from intracellular to the extracellular compartment, with a resultant dilution of sodium. TBW and total body sodium are unchanged. Occurs with hyperglycemia or administration of mannitol |
|
Definition
| redistributive hyponatremia |
|
|
Term
| The aqueous phase is diluted by excessive proteins or lipids. TBW and total body sodium are unchanged. seen with hypertriglyceridemia and multiple myeloma. |
|
Definition
|
|
Term
| what kind of electrolyte imbalance? SIADH, Severe hyperglycemia, polydipsia, diuretics, hypothyroidism |
|
Definition
|
|
Term
| adequate levels of circulating adh, but collecting tubules unresponsive to adh |
|
Definition
| nephrogenic diabetes insipidus |
|
|
Term
| absence or deficiency of adh from the posterior pituitary |
|
Definition
| central diabetes insipidus |
|
|
Term
| clnical syndrome of non-osmotic release or enhancement of ADH action leading to pathologic H20 retention and hyponatremia |
|
Definition
|
|
Term
| what electrolyte imbalance? loss of fluid (GI, burns), thiazide diuretics, K depletion in cells, aldosterone deficiency |
|
Definition
|
|
Term
| what electrolyte imbalance? CHF, hepatic cirrhosis, overhydration, nephrotic syndrome, renal failure |
|
Definition
| hypervolemic hyponatremia |
|
|
Term
| thirst is the major defense mechanism against.... |
|
Definition
|
|
Term
| symptoms of hypernatremia (5) |
|
Definition
| tremors, irritability, ataxia, confusion, coma |
|
|
Term
| what electrolyte imbalance? dehydration, profuse sweating, vomiting or diarrhea |
|
Definition
| hypovolemic hypernatremia |
|
|
Term
| what electrolyte imbalance? skin/lung loses |
|
Definition
| normovolemic hypernatremia |
|
|
Term
| what electrolyte imbalance does DM cause? |
|
Definition
| normovolemic hyponatremia |
|
|
Term
| what electrolyte imbalance does DI cause? |
|
Definition
| normovolemic hypernatremia |
|
|
Term
| what electrolyte imbalance? hypertonic saline or sodium bicarb treatment, hyperaldosteronism, Cushing's syndrome |
|
Definition
| hypervolemic hypernatremia |
|
|
Term
| how is potassium regulated? |
|
Definition
| proximal tubules of the kidneys and by aldosterone (sodium, potassium exchange) |
|
|
Term
| what electrolyte imbalance? decreased dietary intake, diuretics, insulin, alkalosis, hypomagnesemia, hyperaldosteronism |
|
Definition
|
|
Term
| these diuretics increase sodium delivery to the distal segment of the distal tubule |
|
Definition
|
|
Term
| these diuretics increase potassium and hydrogen loss in exchange for resorbing sodium |
|
Definition
|
|
Term
| what electrolyte imbalance? excess intake, acidosis, insulin deficiency, drugs, ACE-I, decreased excretion |
|
Definition
|
|
Term
| symptoms of hyperkalemia (3) |
|
Definition
| muscle weakness, cardiac arrythmias/arrest, often fatal if not corrected |
|
|
Term
| major extracellular anion |
|
Definition
|
|
Term
| chloride is inversely related to __________ and directly related to ______. |
|
Definition
|
|
Term
| what electrolyte imbalance? dehydration, hyperventilation, excess loss of bicarb (GI, Renal tubular acidosis) |
|
Definition
|
|
Term
| what electrolyte imbalance? prolonged vomiting, metabolic alkalosis, pyelonephritis |
|
Definition
|
|
Term
| this is based on carbonic anhydrase to maintain a systemic pH of 7.4 |
|
Definition
|
|
Term
| ___ leads to loss of serum HCO3 and Na |
|
Definition
|
|
Term
| ____ leads to loss of H and resorption of HCO3 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| causes of incrases anion gap metabolic acidosis...MUDPILES |
|
Definition
| methanol, uremia, diabetic ketoacidosis, paraldehyde, iron/ischemia/isoniazides, lactic acidosis, ethanol, salicylates/starvation |
|
|
Term
normal values:
sodium
potassium
chloride
bicarb
anion gap |
|
Definition
sodium = 135-145
potassium = 3.5-5
chloride = 95-110
bicarb = 20-32
anion gap = 8-14 |
|
|
Term
|
Definition
| normal saline, lactated ringers |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| indications for IV fluids (4) |
|
Definition
| shock, hemorrhage, burns, volume depletion |
|
|
Term
| what fluid repalcement? burns, hemorrhage, shock, ECFV depletion, post op fluid management, IV solutions/IV orders, with blood transfusions |
|
Definition
|
|
Term
| desired to expand ECFV and deliver free H20 |
|
Definition
|
|
Term
| what fluid replacement? hyperglycemia, hypernatremia with ECFV depletion |
|
Definition
|
|
Term
| used to provide only Free H20 |
|
Definition
|
|
Term
| why cant pure water be given IV? |
|
Definition
|
|
Term
| what fluid replacement? hypernatremia, delivery of meds to a non-diabetic pt, or as KVO in states of ECFV overload |
|
Definition
|
|
Term
| situations to give potassium IV, how much? |
|
Definition
profound, life threatening hypokalemia or pt unable to tolerate K po.
No more than 20mEq in one liter at the most. |
|
|
Term
| daily requirement for H20 |
|
Definition
| 2000-2500 cc per day, significantly greater in pts with a fever, on a mechanical ventilator, or with GI losses. |
|
|
Term
| how much daily sodium should be supplied? |
|
Definition
| 50-100 mEq/day. In pts with renal disease, cirrhosis, or CHF... as little as possible! |
|
|
Term
| how much potassium should be supplied per day? |
|
Definition
| 20-60 mEq in maintenance IV solutions (monitor serum K+ carefully!) |
|
|
Term
| one of the most helpful techniques available to define the cause of glomerular disease. |
|
Definition
|
|
Term
| typical findings of glomerular disease (4) |
|
Definition
| hematuria, proteinuria, HTN, reduced GFR |
|
|
Term
| inflammation of the internal kidney structures, often cause by immune response triggered by an infection or other disease. |
|
Definition
| nephritic syndrome (acute glomerulonephritis) |
|
|
Term
| essentials of dx = edema, hypertension, hematuria |
|
Definition
|
|
Term
| severe acute glomerulonephritis with >50% loss of nephron function over a course of just weeks to months. |
|
Definition
| rapidly progressing glomerulonephritis |
|
|
Term
| prolonged inflammatory changes can result in chronic GN that may progress to |
|
Definition
|
|
Term
| prolonged inflammatory changes can result in chronic GN that may progress to |
|
Definition
|
|
Term
| S&S = cola colored urine, periorbital and scrotal edema, possible HTN and JVD or adventitious lung sounds |
|
Definition
|
|
Term
| treatment for nephritic syndrome |
|
Definition
admit, salt/water restriction, diuretic therapy, possible dialysis.
inflammatory glomerular injury = corticosteroids and cytotoxic agents. |
|
|
Term
| often caused by Group A Beta-hemolytic stretococci, especially type 12. Commonly appears after pharyngitis or impetigo. |
|
Definition
|
|
Term
| S&S = oliguria, edematous, and variably hypertensive |
|
Definition
|
|
Term
| labs for post infectious GN |
|
Definition
| ASO titer (elevated), throat cx, cola colored urine, urinary RBC's, red cell casts, and proteinuria < 3.5 g/day |
|
|
Term
| treatment for postinfectious GN |
|
Definition
supportive, bedrest, appropriate abx, antihypertensives, salt restriction, diuretics PRN.
Kids = favorable prognosis.
Adults = prone to crescent formation and chronic renal insufficiency. |
|
|
