1
Q
the urinary system is composed of what four main components and their functions
A
- Kidneys- produce urine/ metabolic balance / produce hormones ( erythropoitin, renin, calcitrol)
- ureters- carry urine to bladder
- bladder- stores the urine produced
- urethra - delivers the urine for excretion
2
Q
The renal artery, renal vein and ureter all leave the kidney through the indentation of the ___ of each kidney
A
Hilus
3
Q
The internal kidney consists of what:
A
- cortex
- medulla ( pyramids
- minor calyces, major calyces
- renal pelvis
4
Q
what is the main functional unit of the kidney
A
nephron
5
Q
where are the nephrons located
A
renal cortex
renal medulla
6
Q
the nephron consists of:
A
glomerulu - for blood filtration
- proximal convuluted tubule
- loop of hence
- distal convoluted tubule
7
Q
T/F
proximal convoluted tubule, loop of henle and distal convolutes tubule are for blood filtration
A
False
glomerulus is for blood filtration .. the rest is for reabsorption and secretion
8
Q
Nephrons empty into ____ that run out to the minor calyx, major calyx , renal pelvis
A
collecting ducts
9
Q
Name the 2 nephron types and their location
A
- cortical nephrons are mostly within the cortex, have short length of the loop of hence
- Juxtamedullary - extend deep into the medulla and ;have long loop of henle
10
Q
____ % of the blood leaving the left ventricle of the heart enters the kidneys via the renal arteries
A
20-25
11
Q
what is the rate of the blood passes through the kidneys
A
1200 ml/min or 600ml/min/kidney
12
Q
T/F
the Efferent arterioles form the capillary tuft known as the glomerulus
A
False
afferent
13
Q
what surrounds each glomerulus
A
bowman’s capsule
14
Q
The outer layer of Bowman’s capsule is composed of squamous epithelium … what is the AKA of those cells
A
parietal epithelial cells
15
Q
the visceral layer of bowman’s capsule is composed of what kind of specialized cells
A
podocytes
aka visceral epithelial cells
16
Q
what are the three major components of glomerular capillary wall accounting for the glomerular filtration
A
- endothelial cells with fenestra
- glomerular basement membrane
- visceral epithelial cells aka podocytes
17
Q
T/F
glomerular walls are ultra filters that are very permeable to water
A
true
18
Q
approximately ___ or ___ of the renal plasma is filtered in the glomeruli
A
- 90- 120
- one- fifth
19
Q
Ultrafiltrate is composed of what:
A
- water electrolytes - glucose - amino acids - urea - uric acid - creatinine - ammonia
20
Q
what is a key indicator of kidney function and is used to monitor kidney disease progression
A
Glomerular filtration rate ( GFR)
21
Q
AKA for dipstick
A
reagent strip testing
22
Q
what are the two main objectives of pH
A
- diagnostic ( metabolic abnormalities )
2. Therapeutic ( regulation of diet )
23
Q
pH color chart
- acid indicator= ?
- alkaline indicator = ?
A
- methyl red
- bromthymol blue
24
Q
T/F
read dipstick 90 seconds after dipping
A
false
60 seconds
25
what is the pH ranges
5.0 to 8.5
26
List the factors in persistent acidity
- acidifying drugs
- dehydration
- diarrhea
- fever
- diabetes
- gout
- high protein diets
- pulmonary emphysema
27
List the factors resulting in persistent alkalinity
- alkaline drugs
- acute and chronic renal failure
- diuretics
- urinary tract infections
28
T/F
| Mucoprotein Tamm- Horsfall (T-H) is derived from blood plasma
False
it is not derived from blood plasma
is secreted by the renal tubules
29
less than ___ or ___ of T-H protein is excreted
- 150 mg/24h
| - 20 mg/dl
30
T-H is a matrix for formation of ___ or ___
- calculi
| - casts
31
what is testing for protein based on phenomenon what does it mean
- which protein is most sensitive
- which is the most common indicator
protein error of indicators
- ability of protein to alter the color of some acid - base indicators without altering the pH
- albumin
- tetrabromphenol blue
32
urine protein false positive may result from
- highly buffered alkaline urine (meds or old pee)
- prolonged exposure to the sample
- container cleaning compounds
- some skin cleaners
- blood in urine
33
urine protein false negative may result from :
- dilute urines
| - elevated amounts of proteins other than albumin
34
list the factors that could result in temporary proteinuria (transient proteinuria)
- strenuous exercise
- postural proteinuria
- dehydration
- exposure to heat or cold
- fever
- emotional stress
- pregnancy
35
name the diseases causing persistent proteinuria
- glomerulonephritis
- pyelonephritis
- malignant hypertension
36
T/F
| Glucose is usually present in urine
False
| usually not present unless threshold levels exceeded 160--180 in blood mg/dl
37
List the factors for urine glucose : false positive :
- after using oxidizing cleaning agents for urine containers
- peroxide - hypochlorite
- patients taking levodopa
- when high levels of ketones are present in urine
38
Urine glucose False negative:
- cool urine
- urine with high specific gravity due to uricosuria
- alkaline urine due to bacterial contamination of old urine
- ascorbic acid ( vitamin C) in high doses
39
What is know ass Transient glucosuria
- glucose can be present in urine in two hours after sweet food
40
Glucosuria dependent on :
- blood glucose levels
- glomerular filtration rate
- tubular reabsorption
- seen in diabetes mellitus and congenital forms of glucosuria
41
Persistent glucosuria develops in
- diabetes mellitus
- CNS problems (stroke , neoplasms)
- kidney problems
- endocrine problems
- liver disorders
- pharamaceutical agents
42
what test is used as a method for the measurement of sugars in urine
- Clinitest
43
Clinitiest detects all reducing sugars except ___
glucose
44
Clnitest is used predominately for diagnosis of ____ because the dipstick test does not work
galactosemia
45
Clinitest false positive
- ascorbic acid
- cephalosporins
- probenecid
- urinary preservatives
46
Clinitest false negative
technique errors
47
This test is a screening test for diagnosis of genetic disorders of carbohydrate metabolism
Urine reducing sugar test
48
the urine reducing sugar test predominately used for early detecting of what disorder
Galactosemia
49
____ are produced normally by the liver as part of fatty acid metabolism
Ketones
50
when may it occur that ketones would show up in the urine
if the body cannot get enough glucose for energy it will switch to using body fats - resulting in an increase in ketone production
51
Ketones bodies that commonly appear in the urine when fats are burned for energy are:
- acetoacetic acid
- beta- hydroxybutric acid
- acetone is also produced and is expired by the lungs
52
T/F
| the urine should contain a noticeable concentration of ketones to give a positive reading
False
| it should not contain
53
T/F
| dipstick test determine acetoacetic acid and acetone but not beta- hydroxybutric acid
False
| it only determines acetoacetic acid
54
T/F
| dipstick test determine acetoacetic acid and acetone but not beta- hydroxybutric acid
False
| it only determines acetoacetic acid
55
name the characteristics of urine ketones with false positive or atypical color
- highly pigmented urines
- combination of high specific gravity and low pH
- dehydration
- phenlketones
- meds
- ascorbic acid
56
What determines urine ketone falls negative
delay in testing (old purine)
57
ketone bodies can be determined in :
- diabetes mellitus
- malabsorption syndrome
- exposure to cold
- fasting - fever
- insufficient carbohydrate intake
- maltutrition
- strenous exercise
- vomiting
58
Urine blood test false positive
- oxidizing contaminants
- hypochlorites
- bacterial peroxidases
- menstrual blood
59
Urine blood test false negative
- technique errors inadequate mixing
- formalin preservative
- high concentrations of absorbic acid
- high specific gravity
- nitrates
- proteins
60
what is the significance of hematuria
- intact RBCs are found in urine sediment
- if they are lysed - ghosts cells
- urine may appear normal with small amounts of RBCs
- urine gets red color with greater amounts of blood
61
Transient hematuria may result from :
- strenous exercise
| - menstrual contamination
62
when would persistent hematuria occur
- renal diseases
- patients with
- urolithiasis
urinary tract infections
- urinary tract tumors
63
when would persistent hematuria occur
- renal diseases
- patients with
- urolithiasis
urinary tract infections
- urinary tract tumors
- prostatic cancer
-related to anticoagulant therapy
64
significance of hemoglobinuria ?
- incompatible blood transfusion
- hemolytic anemias
- immunohemolytic anemias
- burns
- electric shock
65
Myoglobinuria may be due to
- damage to cardiac or skeletal muscles
- rhabdomyolysis
- electric shock
- myocardial infection
- heroin abuse
- alcoholism
- after strenuous physical activity
66
T/F
| both hemoglobin and myoglobin will produce positive reagent strip blood results because both contain heme
True
67
clear plasma plus red urine equals ____
myoglobulin
68
Red plasma plus red urine equals ___
hemoglobin
69
Red plasma plus red urine equals ___
hemoglobin
70
Red plasma plus red urine equals ___
hemoglobin
71
The amount go conjugated bilirubin present in serum in healthy subjects is less than ___ %
10
72
An elevated level of conjugated serum bilirubin implies:
- liver disease
| - cholestatic diseases
73
- bilirubinuria also implies what
liver or cholestatic diseases
74
urine bilirubin false positive
- technique errors
- atypical color reactions produced by some medicines
- confirm results with ictotest
75
urine bilirubin false negative
- large amounts of ascorbic acid decrease the sensitivity of the dipstick
- high levels of nitrite
- exposure to light and room temp
76
when bilirubin is present in urine it may indicate :
- gallbladder - bile duct obstruction
| - liver pathology
77
when bilirubin is present in urine it may indicate :
- gallbladder - bile duct obstruction
| - liver pathology
78
urobilinogen (colorless) oxidizes to ____
urobilin
79
what is the normal level of urobilinogen
1-4mg/24h or less than 1.0 ehrlich
80
urine urobilinogen false positive
- aspririn
- sulfonamides
- nitrites
- porphyria
81
urine urobilinogen false negative
- use of stale urine that has been exposed to light
| - formalin
82
what is the significance of urine urobilinogen significance
- normally present in low amounts
- peak levels between 2-4 pm
- elevated in
- liver disease
- intestinal obstruction
- hemolytic anemia
- hemolysis
83
urine nitrite false positive
dipstick is highly sensitive to air exposure
| - specimen contaminating by bacteria
84
urine nitrite : false negative
- specimen containing non- nitrate reducing pathogens
- insufficient time in the bladder
- low or no nitrate diet
- elevated specific gravity of urine
- high level of urobilinogen in urine
- ascorbic acid
85
what is the appearance of a RBC when specific gravity is more than 1.025
it becomes crenated the RBC loses the smooth texture
| the urine becomes hypertonic
86
when urine is hypotonic urine .. the speicif gravity is less than ____
1.025
87
what does the RBC appear like in hypotonic urine
it appears as Ghosts cells ( partially lyesd)
88
More than 3 RBC per high power field is ____
hematuria
89
list the causes of Hematuria
1. Glomerular disease
2. Other renal diseases
3. other urniary tract diseases
4. pathology outside of urinary system
90
what is the normal amount of WBC in a high power field
0-5 per high power
91
More than 20 WBC per HPF may indicate _____
pyuria
92
T/F
| WBC contain nuclei and granules
True
93
Increased WBC could be found in what type of physiological states
- dehydration , fever
| - strenous exercise
94
Increased WBC could also be found in what other type of diseases
- acute pyelonephritis
- kidney stones
- inflammation of ureter , bladder, urethra
- urolithiasis
- prostatis
- balantis
95
name the three type of epithelial cells found in urine
- rena
- transitional
- squamous cells
96
Name the origin of the epithelial cells
- renal
- transitional
- squamous
- convuluted tubules
- renal pelvis to proximal two thirds of urethra
- lower urethra or vagina
97
T/F
| renal cells are very common to be seen in urine
False
| very rare
98
increased numbers of renal epithelial cells may suggest tubular damage in
- pyelonephritis
- acute tubular necrosis
- acute trauma of kidney
- kidney transplant rejection
- neoplasms
99
Oval Fat bodies are what kind of epithelial cell
Renal tubular epithelial
100
What are Oval Fat bodies
absorbed lipoproteins with cholesterol and triglycerides leaked from nephrotic glomeruli
101
The presence of any oval fat bodies may be accompanied by what kine of problems
- proteinuria ( nephrotic syndrome)
102
T/F
| Fat is detected by chemical tests
False
103
Lipilduria develops due to :
1. degeneration of tubules
2. fat embolism
3. extensive injuries
4. fractures of the long bones
104
What type of cell originates outside of kidneys .. look like hard boiled egg and contains small nucleus
Transitional cell
105
What is the normal amount of transitional cells
0-few
106
increased amount of transitional cells could be found in what disorders
- urinary tract infection
- cetherterisation
- cancer of unrinary tract
107
Which cell is flat scale - like
| contains small nuclei
Squamous
108
larger number of squamous cells could represent in what
- vaginitis
- urethritis
- testicular tumor
109
what is the normal amount of squamous cells
- 30 cells per field
110
what is smooth, colorless
- may be budding
- can be mistaken as RBC
Yeast
111
T/F
| crystals are usually not found in freshly voided urine
true
112
what are the prerequisites for identification of crystals
- pH of urine
- morphology of crystals
- crytsals solubility
- crystals polarization
113
What type of light is used for identification of crystals
polarized
114
Normal crystals found i acidic urine
- uric acid
- calcium oxalates
- amorphous urates
115
uric acid is commonly formed when urine pH is ___
116
when are uric acid crystal pathological
when seen in freshly voided uroine
117
a high uric acid level in urine may be due to what
- gout
- high purine diet
- Lesch- Nyhan syndrome
- cancer metatases
- rhabdomyolisis
- myeloproliferative disroders
118
Low uric acid levels may indicate what
- inability of kidney to get rid of uric acid well
- chronic glomerulonehritis
- lead poisoning \- long- term alcohol use
119
Amorphous urates often seems in :
- acidic urine
- after refrigeration
-
120
Sodium urates are formed in urine when pH is what
6.8 - 7
121
What are the crystals commonly found in alkaline urine
- triple phosphates
- calcium carbonates
- ammonium biurate
122
AKA for triple phosphate crystals
magnesiums ammonium phospahte
123
Ammonium Biurate in alkaline urine pH ___
9
124
what are the abnormal crystals of metabolic origin
- Cystine
- tyrosine
- leucine
- cholesterol
125
Cystine are typically found in ___ urine with pH ___
acidic
| pH
126
Cystine stones which fill in ___ system , results in formation of ____
renal collecting
| - staghorn
127
Which abnormal crystal is found in severe liver disorders
Tyrosine
128
Cholesterol crystals are accompanied by
- positive biochem test for protein
- oval fat bodies
- fatty casts
- free fat droplets
129
Epithelial cell casts may be present in what type of kidney problems
- acute tubular necrosis after exposure to nephrotoxic agents
- due to damage that accompanies glomeerular injury
- in rejection of a kidney allograft
130
which casts can result from either from breakdown of cellular casts or inclusion of aggregates of plasma proteins or immunoglobulin
- usually indicate chronic renal diseases
Granular casts
131
___ casts represent the end stage of cast evolution , suggest the very low urine flow associated with severe longstanding kidney disease such as renal failure
Waxy Casts
132
GFatty casts are present in which type of degenerative tubular disease
- nephrotic syndrome with heavy proteinuria
- diabteticnephropathy ( diffuse glomerulosclerosis Kimmelstiel- Wilson lesions)
- Luppus nephritis
- toxic renal poisoning
133
The formation of casts at the distal convoluted tubule may produce structures with a tapering end, referred to as _______
cylindroids
134
what are some congenital variations affecting the urinary tract
- duplicate set of ureters
- horeshoe kidney
- Vesicoureteral reflex
135
what are some acquired problem affecting the urinary tract
- accidents and injures damage the kidneys or UT
| - Benign prostatic hyperplasia
136
which is the most common renal congenital abnormality which is characterized by presence of additional ureter
Duplicated ureter
137
Renal fusion or super kidney is a congenital disorder affecting 1 out 500 people
horseshoe kidney
138
what are the most common disorders seen with horseshoe kidney
- turner syndrome
| - trisomy 18
139
T/F
Trisomy 21 is a serious chromosome abnormality characterized by defects in nearly all organs and systems , including development of kidney in 20% of affected children
False
| it is trismoy 18
140
T/F
| horseshoe kidney is most common in females
True
141
T/F
| horseshoe kidney is often very symptomatic
False
| it is asymptomatic
142
Horseshoe kidney may increase risk for development of :
- kidney obstruction
- hydronephrosis
- pyelonephritis
- urolithiasis
- kidney cancer
143
_______ is an abnormal retrograde movement of urine from bladder into ureters
Vesicoureteral Reflux (VUR)
144
T/F
| VUR primary occurs when an obstruction in the bladder or urethra causes urine to flow backward into kidneys
False --- secondary
| - primary is the defect in development of the uretral valve at the end of the ureter ( only in children)
145
VUR may result in :
- hydronephrosis
| - pyelonephritis
146
Name the signs and symptoms for acute cystitis
- dysuria
- increased frequency of urination
- increased urinary urgent
- lower abdominal pain
- rare fever, chills
147
list the signs and symptoms of pyelonephrits
- fever, chills
- flank pain
- dysuria
- nausea, vomitting
148
what are the urinary tract infection urinalysis findings
- increased count of leukocytes
- positive leukocyte esterase
- prescience of bacteria
- may be positive for nitrite
- WBC ssts may be present, they indicate only kidney infection
149
______ are common cause of upper urinary tract obstruction
Kidney stones
150
what is the classic presentation for a patient with acute renal colic
sudden onset of severe pain originating in the flank and radiating inferiorly and anteriorly
151
chemical substances that forms stones
- calcium oxalte
- calciumm phosphate
- magnesium ammonium phosphate
- uric acid
- cystine
152
Diabetic neuropathy is characterized by
- glomerular lesions
- renal angiopathy
- pyelonephritis
153
what is the significance of good pasture's syndrome
- autoimmune
formation of autoantibodies againsts glomerular and alveolar basement membranes
-- lungs are also affected
154
Berger's disease is characterized by deposition of IgA and IgA immune complexes into mesangium
T/F
True
155
the most common disease associated with nephrotic syndrome in adults
mebranous glomerulunephritis
156
what is characterized with membranous glomerulunephritis
diffuse thickening of the glomerular capillary wall
157
what is the most frequent cause of nephrotic syndrome in children
minimal change disease ( Lipoid Nephrosis)
158
what is characterized by Lipod Nephrosis
diffuse loss of foot processes of podocytes that cannot be detected by light microscopy but can be found by electron microscopy
159
this lesion is characterized by sclerosis of some glomeruli and in the affected glomeruli and in the affected glomeruli only a portion of the capillary tuft is involved
Focal segmental glomerulosclerosis
UA
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