p.52
Assessment of Kidney Function
Why is urine microscopy performed?
To examine the cellular components of urine.
p.41
Assessment of Kidney Function
What is assessed through urine microscopy and culture?
Kidney damage and urinary tract infections.
p.58
Urinalysis: Techniques and Interpretation
What type of measurement is used in urinary calculi analysis?
Qualitative and semiquantitative measurement.
p.31
Pathophysiology of Kidney Diseases
What is glomerulonephritis often characterized by in its early phase?
It is often asymptomatic.
p.3
Nephron Structure and Function
What is the primary function of the kidney?
To filter blood and remove waste products.
p.11
Biochemical Features of Chronic Kidney Disease
What is uric acid?
It is the waste product of purine metabolism.
p.5
Nephron Structure and Function
What hormone regulates water reabsorption in the kidneys?
Antidiuretic hormone (ADH).
p.58
Urinalysis: Techniques and Interpretation
What specimens are analyzed for urinary calculi?
Kidney stones and bladder stones, collected or excised.
p.66
Urinalysis: Techniques and Interpretation
How are casts classified morphologically?
By types: cellular, granular, or waxy, depending on the stage of cell degeneration.
p.54
Renal Stones: Types and Causes
What are uric acid stones?
A type of kidney stone formed from uric acid.
p.1
Pathophysiology of Kidney Diseases
What can renal disease affect?
The kidneys' ability to filter waste and maintain fluid balance.
p.12
Assessment of Kidney Function
How is uric acid primarily excreted from the body?
Through the kidneys in urine.
p.50
Renal Stones: Types and Causes
What is the first step in stone formation?
Urine saturation of substance.
p.1
Renal Stones: Types and Causes
What are renal stones?
Solid mineral deposits that form in the kidneys.
p.18
Assessment of Kidney Function
What are the two biomarkers compared in the study for acute kidney injury?
Serum creatinine and serum cystatin C.
p.60
Urinalysis: Techniques and Interpretation
What conditions can urinalysis help screen for?
Renal diseases, urinary tract infections, diabetes, and some hepatic diseases.
p.58
Urinalysis: Techniques and Interpretation
Which method is used for the titrimetric determination of calcium in urinary calculi?
Titrimetric determination.
p.27
Biochemical Features of Chronic Kidney Disease
What are some cardiovascular risks associated with microalbuminuria?
Hypertension, obesity, and smoking.
p.3
Nephron Structure and Function
What is the process that occurs in the kidneys?
Filtration of blood to remove waste and excess substances.
p.39
Glomerular Filtration Rate (GFR) Measurement
What does GFR stand for?
Glomerular Filtration Rate.
p.61
Urinalysis: Techniques and Interpretation
What type of container should be used for spot urine collection?
A plain bottle with no preservatives.
p.5
Nephron Structure and Function
What ions can be exchanged or excreted by the nephron?
Potassium (K+) or hydrogen (H+).
p.27
Biochemical Features of Chronic Kidney Disease
What is microalbuminuria?
Small amounts of albumin in the urine.
p.5
Nephron Structure and Function
What is the primary function of the nephron?
To filter blood and form urine.
p.31
Pathophysiology of Kidney Diseases
What are the clinical presentations of glomerulonephritis?
Nephrotic syndrome and nephritic syndrome.
p.31
Pathophysiology of Kidney Diseases
What indicates mild glomerular damage in conditions like diabetes and hypertension?
Microalbuminuria, with normal blood urea and creatinine levels.
p.58
Urinalysis: Techniques and Interpretation
Which components are measured in urinary calculi analysis?
Calcium, oxalate, phosphate, magnesium, ammonium, uric acid, cystine, and carbonate.
p.33
Pathophysiology of Kidney Diseases
What is Interstitial Nephritis?
A condition where tubular function is impaired, with clinical presentations depending on the site and severity of damage.
p.20
Glomerular Filtration Rate (GFR) Measurement
What does eGFR stand for?
Estimated Glomerular Filtration Rate.
p.51
Renal Stones: Types and Causes
Where does the pain from renal stones typically extend?
From the loin down the line of the ureter to the groin.
p.8
Biochemical Features of Chronic Kidney Disease
What is urea?
A metabolic waste product of protein.
p.59
Renal Stones: Types and Causes
What did the X-ray reveal?
A stone in the left renal pelvis.
p.54
Renal Stones: Types and Causes
What is a common symptom of uric acid stones?
Severe pain in the back or side, often radiating to the lower abdomen.
p.12
Biochemical Features of Chronic Kidney Disease
What is uric acid?
A waste product formed from the breakdown of purines in the body.
p.18
Assessment of Kidney Function
In which journal was the comparison of serum creatinine and serum cystatin C published?
Indian Journal of Nephrology.
p.39
Glomerular Filtration Rate (GFR) Measurement
How does serum creatinine relate to GFR?
Serum creatinine levels are inversely related to GFR; as GFR decreases, serum creatinine levels typically increase.
p.29
Proteinuria and Its Clinical Implications
What risk is heightened due to proteinuria that involves blood clots?
Increased risk of thrombosis.
p.39
Glomerular Filtration Rate (GFR) Measurement
Is there a difference in serum creatinine and GFR relationship between different races?
Yes, the relationship between serum creatinine levels and GFR may vary among black and white men and women.
p.41
Assessment of Kidney Function
What is GFR an abbreviation for?
Glomerular Filtration Rate.
p.21
Acute and Chronic Renal Failure
What is the definition of Anuria?
Urine output less than 100 mL/day.
p.53
Renal Stones: Types and Causes
What are calcium oxalate stones?
They are a type of kidney stone formed from calcium and oxalate.
p.41
Assessment of Kidney Function
What does urine concentration assess in renal tubular function?
The kidney's ability to concentrate urine.
p.42
Biochemical Features of Chronic Kidney Disease
What are the clinical findings at the renal insufficiency stage (49% - 25% normal function)?
Anemia, hypertension, urinary concentration defects.
p.34
Acute and Chronic Renal Failure
How can decreased cardiac output cause acute kidney injury?
It can result from conditions like myocardial infarction.
p.41
Assessment of Kidney Function
What is the purpose of a renal biopsy?
To assess kidney damage and diagnose kidney diseases.
p.1
Assessment of Kidney Function
What do renal function tests measure?
The ability of the kidneys to filter blood and produce urine.
p.60
Urinalysis: Techniques and Interpretation
What is urinalysis?
A physical, chemical, and microscopic analysis of urine.
p.60
Urinalysis: Techniques and Interpretation
What are the purposes of urinalysis?
Screening for renal diseases, urinary tract infections, diabetes, and monitoring treatment.
p.66
Urinalysis: Techniques and Interpretation
What are casts in urine sediment?
Cylindrical structures composed mainly of mucoprotein secreted by epithelial cells.
p.66
Urinalysis: Techniques and Interpretation
What factors influence the formation of casts?
pH, protein/salt concentration, and flow rate of urine.
p.39
Glomerular Filtration Rate (GFR) Measurement
Can normal serum creatinine levels occur with a significant decrease in GFR?
Yes, significant decreases in GFR can occur despite normal or near-normal serum creatinine values.
p.34
Acute and Chronic Renal Failure
What are the main causes of acute kidney injury?
Pre-renal causes, renal causes, and post-renal causes.
p.33
Acute and Chronic Renal Failure
What is Acute Tubular Necrosis?
A severe, acute tubular injury that results in the death of tubular cells and loss of tubular functions.
p.34
Acute and Chronic Renal Failure
What are pre-renal causes of acute kidney injury?
Causes due to reduced effective circulating blood volume leading to renal hypoperfusion.
p.17
Glomerular Filtration Rate (GFR) Measurement
What is a key advantage of cystatin C over creatinine in GFR estimation?
Cystatin C is a more accurate marker of GFR.
p.20
Glomerular Filtration Rate (GFR) Measurement
What is the normal eGFR range in young adults?
120 – 130 mL/min/1.73 m².
p.51
Renal Stones: Types and Causes
What is hematuria?
The presence of blood in urine, associated with renal stones.
p.65
Urinalysis: Techniques and Interpretation
What are some other cellular constituents that can be found in urine sediment?
Spermatozoa, bacteria, yeast, parasites, and tumor cells.
p.32
Acute and Chronic Renal Failure
Which metabolic conditions can lead to tubulointerstitial impairment?
Diabetes, hyperuricemia, hemolysis, and rhabdomyolysis.
p.21
Acute and Chronic Renal Failure
What is Azotemia?
Retention of urea and other nitrogenous waste products of amino acids.
p.38
Glomerular Filtration Rate (GFR) Measurement
What does GFR stand for?
Glomerular Filtration Rate.
p.11
Biochemical Features of Chronic Kidney Disease
What are adenine and guanine?
They are purines that are precursors of nucleic acids ATP and GTP.
p.29
Proteinuria and Its Clinical Implications
What is a complication of proteinuria related to fluid retention?
Pulmonary edema due to fluid overload.
p.29
Proteinuria and Its Clinical Implications
What is a cardiovascular risk associated with proteinuria?
Increased risk of cardiovascular disease.
p.47
Renal Stones: Types and Causes
What are the conditions associated with calcium oxalate stones?
Primary hyperoxaluria, dietary hyperoxaluria, hypercalciuria, hyperuricosuria, hypocitraturia, hypercalcemia, renal tubular acidosis, primary hyperparathyroidism, and vitamin D toxicity.
p.66
Urinalysis: Techniques and Interpretation
What structures can be confused with casts?
Mucous threads, rolled squamous epithelial cells, and disposable diaper fibers.
p.67
Urinalysis: Techniques and Interpretation
What type of fibers can be found as contaminants in urine sediment?
Disposable diaper fibers.
p.7
Nephron Structure and Function
What characteristic of the glomerular membrane helps prevent the loss of plasma proteins?
It is negatively charged.
p.57
Renal Stones: Types and Causes
When is drug therapy indicated for stone disease?
When stone disease remains active despite dietary modifications for more than 6 months.
p.67
Urinalysis: Techniques and Interpretation
What type of contamination can oil droplets indicate in urine sediment?
Possible contamination from external sources.
p.35
Acute and Chronic Renal Failure
What metabolic and endogenous toxins can lead to acute kidney injury?
Hyperuricemia, hemolysis (hemoglobin), and rhabdomyolysis (myoglobin).
p.67
Urinalysis: Techniques and Interpretation
What does the presence of pollen grains in urine sediment indicate?
Environmental contamination.
p.65
Urinalysis: Techniques and Interpretation
What structures can be confused with red and white blood cells in urine sediment?
Various cellular debris and artifacts.
p.43
Biochemical Features of Chronic Kidney Disease
What neuromuscular complications are seen in chronic kidney disease?
Headache, peripheral neuropathy, paralysis, myoclonic jerks, seizures, and tetanic contractions due to hypocalcemia.
p.38
Glomerular Filtration Rate (GFR) Measurement
What is GFR a measure of?
The rate of clearance of substances filtered by the glomeruli.
p.1
Urinalysis: Techniques and Interpretation
What is the purpose of urinalysis?
To analyze urine for various substances and assess kidney function.
p.49
Renal Stones: Types and Causes
How does high animal protein intake affect kidney stone formation?
It increases the risk of developing calcium stones.
p.60
Urinalysis: Techniques and Interpretation
What are the advantages of urinalysis?
It is non-invasive and easy to collect.
p.60
Urinalysis: Techniques and Interpretation
Can urinalysis establish the pathological cause of a condition?
No, it rarely establishes the pathological cause.
p.50
Renal Stones: Types and Causes
What follows urine saturation in the stone formation process?
Super-saturation of substance.
p.52
Assessment of Kidney Function
What types of blood tests are included in renal function investigations?
Renal function tests, electrolytes, calcium, ionized calcium, phosphate, uric acid, and parathyroid hormone (intact PTH assay).
p.51
Renal Stones: Types and Causes
What is renal colic?
Sudden severe pain described as cramping, sharp, and stabbing.
p.7
Nephron Structure and Function
What are some examples of nitrogenous waste products excreted by the kidneys?
NH4+, urea, creatinine, uric acid.
p.52
Assessment of Kidney Function
What does the intact PTH assay measure?
Parathyroid hormone levels.
p.35
Acute and Chronic Renal Failure
What can cause renal ischemia leading to acute kidney injury?
Surgery and trauma (e.g., traffic accidents).
p.25
Proteinuria and Its Clinical Implications
What is the primary cause of nephrotic syndrome?
Idiopathic (no known cause).
p.62
Urinalysis: Techniques and Interpretation
What does macroscopic urinalysis analyze?
The physical characteristics of urine.
p.65
Urinalysis: Techniques and Interpretation
What are renal epithelial cells associated with in urine sediment?
Renal epithelial fragments, oval fat bodies, and fat globules.
p.62
Urinalysis: Techniques and Interpretation
What does polyuria or oliguria indicate?
The state of hydration status.
p.24
Proteinuria and Its Clinical Implications
What is the definition of nephrotic range proteinuria?
Urine total protein: ≥3.5 g/day.
p.17
Glomerular Filtration Rate (GFR) Measurement
In which situations is cystatin C preferred over creatinine?
In situations with creatinine variations.
p.15
Glomerular Filtration Rate (GFR) Measurement
What is GFR a measure of?
The rate of clearance of substances filtered by the glomeruli.
p.41
Assessment of Kidney Function
What role does renal imaging play in kidney function assessment?
To visualize kidney structure and detect abnormalities.
p.9
Biochemical Features of Chronic Kidney Disease
What factors influence the production rate of creatinine?
Muscle mass; plasma creatinine is higher in males than females and lower in children.
p.25
Proteinuria and Its Clinical Implications
What is selective glomerular proteinuria?
Leakage of only intermediate sized proteins (<100kDa) like albumin and transferrin.
p.42
Biochemical Features of Chronic Kidney Disease
What biochemical findings are common in all stages of chronic kidney disease?
Impaired glucose tolerance, hyperlipidemia, hyperuricemia.
p.27
Biochemical Features of Chronic Kidney Disease
What conditions is microalbuminuria related to?
Diabetes Mellitus (DM) and cardiovascular risks.
p.47
Renal Stones: Types and Causes
What increases the risk of calcium phosphate stone formation?
Hypercalciuria and alkaline urine.
p.47
Renal Stones: Types and Causes
What promotes the formation of uric acid stones?
Purine overproduction and excess purine ingestion.
p.64
Urinalysis: Techniques and Interpretation
What are some examples of biological components in urine sediment?
RBCs, WBCs, epithelial cells, fat, casts, bacteria, yeast, fungi, parasites, and spermatozoa.
p.7
Nephron Structure and Function
How do the kidneys maintain acid-base balance?
By excreting H+ and reabsorbing HCO3-.
p.47
Renal Stones: Types and Causes
What urine conditions favor the formation of oxalate, uric acid, and cystine stones?
Low urine pH and low urine volume.
p.20
Glomerular Filtration Rate (GFR) Measurement
What is the equation used to calculate eGFR?
eGFR (mL/min/1.73 m²) = 175 × (Creatinine serum (μmol/L) / 88.4) - 1.154 × (Age) - 0.203 × (0.742 if female) × (1.212 if African American).
p.25
Proteinuria and Its Clinical Implications
What type of immune disease can lead to nephrotic syndrome?
Systemic Lupus Erythematosus (SLE).
p.53
Renal Stones: Types and Causes
What are common symptoms of calcium oxalate stones?
Severe pain, hematuria (blood in urine), and frequent urination.
p.8
Assessment of Kidney Function
What does high plasma urea usually indicate?
Decreased renal excretion or renal disease.
p.21
Chronic Kidney Disease
What is the Intact Nephron Hypothesis?
Features of chronic renal failure are explained by progressive loss of whole nephrons while remaining nephrons are fully functional.
p.21
Acute and Chronic Renal Failure
What characterizes Acute Kidney Injury?
Rapid deterioration in renal function causing accumulation of nitrogenous wastes, usually accompanied by oliguria.
p.36
Acute and Chronic Renal Failure
What are clinical signs of uremia?
Nausea, vomiting, gastrointestinal bleed, and pericarditis.
p.58
Urinalysis: Techniques and Interpretation
What components are determined colorimetrically in urinary calculi analysis?
Oxalate, phosphate, magnesium, ammonium, uric acid, and cystine.
p.12
Biochemical Features of Chronic Kidney Disease
What can elevated uric acid levels indicate?
Potential kidney dysfunction or metabolic disorders.
p.66
Urinalysis: Techniques and Interpretation
What does the type of cast depend on?
The time it remained in situ in the tubules before being shed into the urine.
p.33
Pathophysiology of Kidney Diseases
What is a common clinical presentation of proximal tubule damage?
Tubular proteinuria, glucosuria, and acidosis.
p.34
Acute and Chronic Renal Failure
What is acute kidney injury?
A rapid decline in renal function causing accumulation of nitrogenous wastes in the body, accompanied by oliguria.
p.65
Urinalysis: Techniques and Interpretation
What is the clinical importance of red and white blood cells in urine sediment?
They can indicate various medical conditions.
p.45
Cardiorenal Syndromes
What is Type 1 Cardiorenal Syndrome?
Acute cardiac event leading to acute renal injury.
p.37
Chronic and Acute Renal Failure
What characterizes chronic renal failure?
It is a slow, progressive, and irreversible disorder of the kidney resulting in nephron destruction affecting both glomerular and tubular functions.
p.40
Chronic Renal Failure
What is a common physical symptom of chronic kidney disease?
Puffy face and swelling of feet and ankles.
p.35
Acute and Chronic Renal Failure
What is the event sequence leading to acute tubular necrosis?
Hypovolemia → reduced renal blood flow → decrease GFR → acute tubular necrosis.
p.8
Nephron Structure and Function
Why is urea reabsorption important in the kidney?
It helps form a high-osmolar urea gradient in the renal medulla to reabsorb more water for urine concentration.
p.42
Biochemical Features of Chronic Kidney Disease
What is a key characteristic of uremia (<12% normal renal function)?
Marked azotemia and severe metabolic acidosis.
p.54
Renal Stones: Types and Causes
What is the role of hydration in preventing uric acid stones?
Staying well-hydrated helps dilute urine and reduce stone formation.
p.48
Renal Stones: Types and Causes
What is a common factor associated with early onset of urolithiasis in children and teenagers?
Familial stone formation.
p.37
Pathophysiology of Kidney Diseases
What are the most common causes of chronic kidney disease?
IgA nephropathy, interstitial nephritis, diabetes mellitus, and hypertension.
p.48
Renal Stones: Types and Causes
Which metabolic condition is associated with stone formation?
Primary Hyperparathyroidism.
p.23
Proteinuria and Its Clinical Implications
What is the significance of beta-2-microglobulin in urine?
Indicates tubular proteinuria.
p.9
Assessment of Kidney Function
What does high plasma creatinine usually indicate?
Decreased renal excretion, often due to renal disease.
p.43
Biochemical Features of Chronic Kidney Disease
What skeletal complications arise from chronic kidney disease?
Renal bone disease (osteodystrophy) caused by acidosis, reduced vitamin D, and hypocalcemia.
p.15
Glomerular Filtration Rate (GFR) Measurement
What is the formula for calculating creatinine clearance?
Creatinine clearance (ml/min) = (Creatinine urine (μmol/L) x 24-hour urine volume (mL)) / (Creatinine serum (μmol/L) x 1440 (min)).
p.13
Glomerular Filtration Rate (GFR) Measurement
What is the normal glomerular filtration rate (GFR)?
120 mL/min or 172 L/24 hours.
p.22
Proteinuria and Its Clinical Implications
What is the normal urine protein excretion rate?
Less than 150 mg/day (average 80 mg/day).
p.26
Proteinuria and Its Clinical Implications
What is the association of severe proteinuria (A3 classification) with renal health?
Associated with worse renal survival.
p.12
Biochemical Features of Chronic Kidney Disease
What dietary factors can influence uric acid levels?
High intake of purine-rich foods, alcohol, and sugary beverages.
p.31
Pathophysiology of Kidney Diseases
What are the four cardinal features of nephrotic syndrome?
Heavy proteinuria (>3.5 g/day), hypoalbuminemia (<30 g/L), edema, and hypercholesterolemia.
p.55
Renal Stones: Types and Causes
What is the chemical composition of struvite stones?
Magnesium ammonium phosphate.
p.67
Urinalysis: Techniques and Interpretation
What are common contaminants found in urine sediment?
Starch, fibers, air bubbles, oil droplets, glass fragments, stains, pollen grains, and fecal contamination.
p.39
Glomerular Filtration Rate (GFR) Measurement
What factors can affect the relationship between serum creatinine and GFR?
Factors such as age, muscle mass, and race can influence serum creatinine levels and GFR.
p.30
Pathophysiology of Kidney Diseases
What are the main causes of acquired glomerular disease?
Immune mediated, metabolic, hemodynamic factors, and toxins.
p.55
Renal Stones: Types and Causes
What is a common characteristic of struvite stones?
They can grow rapidly and may form large stones.
p.40
Chronic Renal Failure
What are common early symptoms of chronic kidney disease?
Most patients have no symptoms until the disease is advanced.
p.55
Renal Stones: Types and Causes
What is a potential treatment for struvite stones?
Surgical removal or lithotripsy.
p.21
Acute and Chronic Renal Failure
What does Oliguria refer to?
Urine output less than 400 mL/day.
p.59
Renal Stones: Types and Causes
What was the history of kidney stones for the patient?
She had a kidney stone 5 years ago.
p.54
Renal Stones: Types and Causes
How can uric acid stones be diagnosed?
Through imaging tests like CT scans or ultrasounds and urine tests.
p.42
Biochemical Features of Chronic Kidney Disease
What biochemical findings are present in renal failure (24% - 12% normal function)?
Azotemia, impaired glucose tolerance, hyperlipidemia, hyperuricemia, hypocalcemia, hyperphosphatemia, mild metabolic acidosis.
p.33
Renal Stones: Types and Causes
What are the other types of renal stones and their prevalence?
5-10% are uric acid stones, 12% are infection stones, while cystine and xanthine stones are rare.
p.34
Acute and Chronic Renal Failure
What are post-renal causes of acute kidney injury?
Causes due to obstruction of the urinary tract, such as stones or prostatic hypertrophy.
p.25
Proteinuria and Its Clinical Implications
Which class of drugs is known to contribute to nephrotic syndrome?
Non-steroidal anti-inflammatory drugs (NSAIDs).
p.26
Proteinuria and Its Clinical Implications
What traditional cardiovascular risk factors are associated with microalbuminuria?
Hypertension, obesity, and smoking.
p.25
Proteinuria and Its Clinical Implications
What type of malignancy can cause secondary nephrotic syndrome?
Leukemia or solid tumors.
p.38
Glomerular Filtration Rate (GFR) Measurement
Which substances are used to measure GFR?
Inulin, plasma creatinine, and urea.
p.38
Glomerular Filtration Rate (GFR) Measurement
Why is urea less useful than creatinine for measuring GFR?
Some urea is reabsorbed passively by the renal tubules.
p.23
Proteinuria and Its Clinical Implications
What are Bence Jones proteins?
Kappa or lambda light chains identified in urine, indicating tubular proteinuria.
p.16
Glomerular Filtration Rate (GFR) Measurement
How is Cystatin C produced?
Constantly by all nucleated cells.
p.24
Proteinuria and Its Clinical Implications
What is associated with improved renal outcomes in proteinuria?
Reduction of proteinuria.
p.29
Proteinuria and Its Clinical Implications
How does proteinuria affect the risk of infections?
It increases the risk of bacterial infections.
p.50
Renal Stones: Types and Causes
What occurs after super-saturation in the stone formation process?
Crystal nucleation of substance.
p.52
Assessment of Kidney Function
What is measured in a 24-hour urine collection?
Volume, sodium, calcium, oxalate, phosphate, uric acid, citrate, and cystine.
p.35
Acute and Chronic Renal Failure
What are renal causes of acute kidney injury?
Prolonged hypotension, glomerulonephritis, and acute tubular necrosis.
p.61
Urinalysis: Techniques and Interpretation
Is spot urine collected for culture purposes?
No, it is not for culture purposes.
p.57
Renal Stones: Types and Causes
Should dietary calcium intake be limited to prevent stone formation?
No, do not limit dietary calcium intake.
p.47
Renal Stones: Types and Causes
What is cystinuria?
A rare metabolic disorder associated with cystine stones.
p.35
Acute and Chronic Renal Failure
What are examples of nephrotoxic injuries?
Heavy metals, ethylene glycol, organic solvents, aristolochic acid, and aminoglycosides (e.g., gentamycin).
p.8
Biochemical Features of Chronic Kidney Disease
How is ammonia related to urea?
Ammonia is converted to urea in the liver, which is less toxic.
p.67
Urinalysis: Techniques and Interpretation
What might glass fragments in urine sediment suggest?
Possible contamination or injury.
p.30
Pathophysiology of Kidney Diseases
What is the most common cause of chronic renal failure?
Immune complexes deposited in the glomeruli.
p.64
Urinalysis: Techniques and Interpretation
What do chemical components in urine sediment usually consist of?
Crystals of chemicals and amorphous material.
p.54
Renal Stones: Types and Causes
What dietary changes can help prevent uric acid stones?
Reducing intake of purine-rich foods, such as red meats and shellfish.
p.15
Glomerular Filtration Rate (GFR) Measurement
What does GFR stand for?
Glomerular Filtration Rate.
p.64
Urinalysis: Techniques and Interpretation
What types of analyses are performed on urine sediments?
Microscopic analysis, microbiology, and cytology.
p.13
Biochemical Features of Chronic Kidney Disease
What does glomerular filtrate contain?
Electrolytes, low molecular weight proteins, and nitrogenous waste (e.g., urea, creatinine, uric acid).
p.37
Nephron Structure and Function
What are the three types of adaptation to nephron loss?
A - no regulations (e.g., urea, creatinine); B - limited regulation (e.g., phosphate, hydrogen ions); C - regulated (e.g., water, sodium, potassium).
p.38
Glomerular Filtration Rate (GFR) Measurement
What is the formula for calculating creatinine clearance?
Creatinine clearance (ml/min) = (Creatinine urine (μmol/L) x 24-hour urine volume (mL)) / 1440 (min) / Creatinine serum (μmol/L).
p.21
Chronic Kidney Disease
What is a significant risk associated with Chronic Kidney Disease?
Increased risk for cardiovascular disease.
p.13
Assessment of Kidney Function
What is the typical urine production in 24 hours?
1 - 2 L (about 1 mL/min).
p.24
Proteinuria and Its Clinical Implications
What causes transient proteinuria?
Exercise or postural changes; it is a benign condition.
p.38
Glomerular Filtration Rate (GFR) Measurement
What substances can interfere with creatinine measurement?
Glucose, acetoacetate, and ascorbic acid.
p.46
Renal Stones: Types and Causes
Which type of kidney stones are more common in women of childbearing age?
Infection stones (triple phosphate stones).
p.27
Assessment of Kidney Function
How is the prognosis of chronic kidney disease (CKD) assessed?
By Glomerular Filtration Rate (GFR) and albuminuria.
p.61
Urinalysis: Techniques and Interpretation
What is the purpose of physical and chemical analysis of urine?
To identify the fluid as urine.
p.55
Renal Stones: Types and Causes
What conditions lead to the formation of struvite stones?
Alkaline urine and the presence of urease-producing bacteria.
p.30
Pathophysiology of Kidney Diseases
What type of glomerulonephritis is most commonly associated with immune complexes?
Antibody-mediated glomerulonephritis.
p.21
Acute and Chronic Renal Failure
What is Polyuria?
Urine output greater than 2000 mL/day.
p.53
Renal Stones: Types and Causes
What dietary factors can contribute to the formation of calcium oxalate stones?
High intake of oxalate-rich foods, low calcium intake, and dehydration.
p.7
Nephron Structure and Function
What hormones are synthesized by the kidneys?
Erythropoietin (EPO), renin, and the active form of vitamin D (calcitriol).
p.9
Biochemical Features of Chronic Kidney Disease
What is creatinine?
The breakdown product of creatine, a nitrogenous compound used for energy supply.
p.67
Urinalysis: Techniques and Interpretation
What does fecal contamination in urine sediment suggest?
Possible gastrointestinal issues or contamination.
p.24
Proteinuria and Its Clinical Implications
What are the four cardinal features of nephrotic syndrome?
Heavy proteinuria >3.5 g/day, hypoalbuminemia <30 g/L, edema, hypercholesterolemia.
p.64
Urinalysis: Techniques and Interpretation
What is the pathologic significance of abnormal crystals in urine?
They indicate potential health issues.
p.32
Acute and Chronic Renal Failure
What types of drugs are associated with tubulointerstitial impairment?
Aminoglycosides (especially gentamicin), X-ray contrast media, and NSAIDs.
p.24
Proteinuria and Its Clinical Implications
What characterizes glomerular proteinuria?
Protein from glomerular capillary blood (mainly albumin) into the urine: Urine total protein: 1 - 20 g/day.
p.25
Proteinuria and Its Clinical Implications
What is non-selective glomerular proteinuria?
Leakage of a range of different sized proteins, including larger proteins like immunoglobulins.
p.10
Glomerular Filtration Rate (GFR) Measurement
What is a major limitation of using creatinine as a marker of GFR?
Error in 24-hour urine collection.
p.46
Renal Stones: Types and Causes
In which gender are kidney stones more common?
Men (3:1 ratio compared to women).
p.63
Urinalysis: Techniques and Interpretation
What does a bilirubin level of 9 μM indicate?
Liver and biliary disease.
p.10
Glomerular Filtration Rate (GFR) Measurement
What is the 'creatinine blind GFR range'?
The range where creatinine levels may not indicate renal function loss until significant damage occurs.
p.6
Pathophysiology of Kidney Diseases
What is the role of the negatively charged glomerular membrane?
It acts as a barrier preventing the loss of plasma proteins into urine.
p.5
Pathophysiology of Kidney Diseases
What system involves renin, angiotensin, and aldosterone?
The renin-angiotensin-aldosterone system (RAAS).
p.7
Nephron Structure and Function
What is one of the primary functions of the kidney?
Excretion of nitrogenous metabolic waste products in urine.
p.55
Renal Stones: Types and Causes
What type of kidney stone is associated with urinary tract infections?
Struvite stones (Mg ammonium phosphate stones).
p.47
Renal Stones: Types and Causes
What is a common cause of infection stones?
Chronic urinary tract infection with urease-producing bacteria.
p.54
Renal Stones: Types and Causes
What conditions can lead to the formation of uric acid stones?
Dehydration, high protein diets, and certain metabolic disorders.
p.47
Renal Stones: Types and Causes
What is xanthinuria?
A rare metabolic disorder associated with xanthine stones.
p.65
Urinalysis: Techniques and Interpretation
What are the three main types of epithelial cells found in urine sediment?
Squamous, transitional (urothelial), and renal epithelial cells.
p.32
Pathophysiology of Kidney Diseases
What are some causes of inflammatory response in tubulointerstitial impairment?
Immune deposit, transplant rejection, tissue hypoxia, and infection.
p.64
Urinalysis: Techniques and Interpretation
Why are biological components important in urine sediment?
They are an important part of the urine sediment.
p.7
Nephron Structure and Function
What role do the kidneys play in water and electrolyte balance?
They reabsorb water or Na+ in exchange for K+/H+.
p.41
Assessment of Kidney Function
What do urine proteins indicate in kidney function assessment?
Possible kidney damage or disease.
p.13
Glomerular Filtration Rate (GFR) Measurement
What is the relationship between blood pressure in the capillaries and pressure in the nephron?
Blood pressure in the capillaries is greater than pressure in the nephron.
p.62
Urinalysis: Techniques and Interpretation
What factors can affect urine color?
Metabolism, physical activity, food intake, and diseases.
p.13
Nephron Structure and Function
What acts as a barrier to red blood cells and high molecular weight macromolecules in the nephron?
Nephron epithelium and basement membrane.
p.59
Renal Stones: Types and Causes
What was the composition of the stone?
Calcium, ammonium, magnesium, phosphate (infection stone).
p.30
Pathophysiology of Kidney Diseases
What syndrome is characterized by a thin basement membrane?
Thin basement membrane syndrome.
p.13
Glomerular Filtration Rate (GFR) Measurement
What factors determine glomerular filtration?
Pressure difference between blood and nephron, integrity of basement membrane, and number of functional nephrons.
p.43
Biochemical Features of Chronic Kidney Disease
What endocrine issues are associated with chronic kidney disease?
Secondary hyperparathyroidism, impaired growth and development, and amenorrhea.
p.22
Proteinuria and Its Clinical Implications
What is the definition of proteinuria?
24-hour urine protein excretion rate ≥ 150 mg/day.
p.24
Proteinuria and Its Clinical Implications
What is overflow proteinuria?
Urine total protein: up to 20 g/day; overproduction of small proteins leads to increased glomerular filtration.
p.38
Glomerular Filtration Rate (GFR) Measurement
What factors can lead to overestimation of GFR?
Tubular secretion of creatinine.
p.16
Glomerular Filtration Rate (GFR) Measurement
Why is Cystatin C suggested as an ideal marker?
It is an ideal endogenous marker for estimation of GFR.
p.22
Nephron Structure and Function
What is the molecular weight above which the glomerulus is impermeable to proteins?
Proteins with a molecular weight greater than albumin (66.5 kDa).
p.2
Nephron Structure and Function
What is the nephron?
The functional unit of the kidney.
p.52
Assessment of Kidney Function
What parameters are assessed in spot urine tests?
pH, red cells, white cells, nitrite, urine microscopy, and urine culture.
p.33
Pathophysiology of Kidney Diseases
What are the clinical presentations of distal tubule damage?
Acidosis and hyperkalemia.
p.32
Nephron Structure and Function
What structures of the kidney are considered tubulointerstitial?
Tubules and interstitium, which occupy more than 90% of the kidney volume.
p.54
Renal Stones: Types and Causes
How do uric acid stones differ from calcium stones?
Uric acid stones are formed from uric acid, while calcium stones are primarily made of calcium oxalate or calcium phosphate.
p.34
Acute and Chronic Renal Failure
What can lead to hypovolemia as a pre-renal cause?
Hemorrhage, loss of body fluids from vomiting or diarrhea.
p.43
Biochemical Features of Chronic Kidney Disease
What metabolic complications are associated with chronic kidney disease?
Impaired glucose tolerance, urine loss of protein, and muscle wasting.
p.37
Glomerular Filtration Rate (GFR) Measurement
What glomerular filtration rate level indicates chronic kidney disease?
Below 60 mL/min per 1.73m².
p.20
Glomerular Filtration Rate (GFR) Measurement
What are some limitations of eGFR?
Inaccurate in ages < 16 or > 70 years, pregnancy, patients on dialysis, vegetarian diet, high protein diet, creatine supplements, amputated, extremes of body size, and skeletal muscle diseases.
p.42
Biochemical Features of Chronic Kidney Disease
What electrolyte disorders are associated with uremic syndrome?
High plasma potassium and low plasma sodium.
p.16
Glomerular Filtration Rate (GFR) Measurement
What is Cystatin C?
A cysteine proteinase inhibitor and a new biomarker for GFR estimation.
p.8
Assessment of Kidney Function
What are causes of low plasma urea?
Low protein diet and pregnancy.
p.24
Proteinuria and Its Clinical Implications
Why are urine dipsticks not sensitive for detecting Bence Jones protein?
They are not sensitive to detect Bence Jones protein.
p.43
Biochemical Features of Chronic Kidney Disease
What skin manifestations are seen in chronic kidney disease?
Pallor, hyperpigmentation, and pruritus.
p.63
Urinalysis: Techniques and Interpretation
What are the ketone levels indicating ketotic states?
Acetoacetate 0.5 mM, acetone 7 mM.
p.22
Nephron Structure and Function
How are small proteins hydrolyzed in the proximal convoluted tubule?
By brush border peptidases, resulting in amino acids that are reabsorbed.
p.2
Biochemical Features of Chronic Kidney Disease
What are some biochemical features of chronic renal failure?
Electrolyte imbalances, metabolic acidosis, and uremia.
p.47
Renal Stones: Types and Causes
What role does citrate play in stone formation?
Citrate is a principal inhibitor of stone formation by combining with calcium to form a soluble complex.
p.45
Cardiorenal Syndromes
What characterizes Type 2 Cardiorenal Syndrome?
Chronic cardiac disease leading to progression of chronic kidney disease.
p.17
Glomerular Filtration Rate (GFR) Measurement
Why is cystatin C considered stable during infections?
It is not affected by inflammatory states.
p.45
Cardiorenal Syndromes
What is Type 3 Cardiorenal Syndrome?
Acute kidney injury leading to acute cardiac dysfunction.
p.40
Chronic Renal Failure
What unusual taste may patients with chronic kidney disease experience?
Food may taste like metal.
p.32
Pathophysiology of Kidney Diseases
What types of toxins can cause death of tubular epithelial cells?
Heavy metals (like mercuric chloride and cadmium), ethylene glycol, and organic solvents.
p.21
Acute and Chronic Renal Failure
What does Uremia indicate?
Clinical signs in patients with azotemia.
p.46
Renal Stones: Types and Causes
What are kidney stones also known as?
Renal calculi or nephrolithiasis.
p.43
Biochemical Features of Chronic Kidney Disease
How does chronic kidney disease affect hematologic function?
It reduces erythropoietin synthesis, causing anemia, coagulation defects, and increased infection risk.
p.15
Glomerular Filtration Rate (GFR) Measurement
Which substances can GFR be calculated from?
Inulin, plasma creatinine, and urea.
p.43
Assessment of Kidney Function
What urinary symptoms are common in chronic kidney disease?
Polyuria and nocturia due to concentration defects.
p.15
Glomerular Filtration Rate (GFR) Measurement
Why is urea less useful than creatinine for measuring GFR?
Some urea is reabsorbed passively by the renal tubules.
p.24
Proteinuria and Its Clinical Implications
What is Bence Jones proteinuria?
The presence of kappa or lambda light chains in urine.
p.40
Chronic Renal Failure
What changes in urine may indicate chronic kidney disease?
Changes in urine volume and appearance, such as foamy urine and dark colors.
p.63
Urinalysis: Techniques and Interpretation
What can a high pH in urine indicate?
Presence of micro-organisms that split urea.
p.22
Nephron Structure and Function
What prevents the filtration of protein in the glomerulus?
The negatively charged basement membrane.
p.48
Renal Stones: Types and Causes
What dietary risk is associated with low fluid intake?
Increased risk of stone formation.
p.22
Proteinuria and Its Clinical Implications
What constitutes the remaining 85% of daily urinary protein excretion?
Other plasma proteins (e.g., immunoglobulins, beta-2-microglobulin) and Tamm-Horsfall protein.
p.10
Glomerular Filtration Rate (GFR) Measurement
What effect does tubular secretion of creatinine have on GFR estimation?
It results in overestimation of GFR.
p.22
Nephron Structure and Function
How are large protein molecules reabsorbed in the proximal convoluted tubule?
Through pinocytosis and digestion by lysosomal enzymes.
p.2
Glomerular Filtration Rate (GFR) Measurement
What does GFR stand for?
Glomerular Filtration Rate.
p.2
Acute and Chronic Renal Failure
What are the two types of renal failure?
Acute and chronic renal failure.
p.41
Assessment of Kidney Function
What is urine acidification a measure of?
The kidney's ability to excrete hydrogen ions and maintain acid-base balance.
p.26
Proteinuria and Its Clinical Implications
What is the more sensitive measurement for detecting low levels of protein in urine?
Measurement of urine albumin.
p.43
Biochemical Features of Chronic Kidney Disease
What gastrointestinal symptoms can occur in chronic kidney disease?
Nausea, vomiting, anorexia, ammonia smell, stomatitis, esophagitis, and GI bleeding.
p.23
Proteinuria and Its Clinical Implications
What is the significance of Immunoglobulin G in urine?
Indicates glomerular selectivity and urinary tract infection.
p.53
Renal Stones: Types and Causes
What is the role of calcium in the formation of calcium oxalate stones?
Calcium combines with oxalate in the urine to form stones.
p.59
Renal Stones: Types and Causes
What did the microbiological analysis reveal?
Heavy growth of pseudomonas.
p.24
Proteinuria and Its Clinical Implications
What is tubular proteinuria?
Urine total protein: <2 g/day; passage of low molecular weight proteins into the urine.
p.63
Urinalysis: Techniques and Interpretation
What does specific gravity reflect in urine analysis?
The ability to concentrate urine.
p.46
Renal Stones: Types and Causes
What are the other types of kidney stones and their prevalence?
5 - 10% are uric acid stones, 12% are infection stones, cystine and xanthine stones are rare.
p.38
Glomerular Filtration Rate (GFR) Measurement
How does muscle mass affect creatinine levels?
Higher muscle mass can result in higher serum creatinine levels.
p.16
Glomerular Filtration Rate (GFR) Measurement
What is the relationship between Cystatin C levels and GFR?
Cystatin C levels increase as GFR decreases (inversely proportional).
p.10
Glomerular Filtration Rate (GFR) Measurement
How do age and sex affect serum creatinine levels?
Aging decreases muscle mass, and females generally have lower muscle mass.
p.36
Acute and Chronic Renal Failure
What causes pulmonary edema in acute kidney injury?
Secondary to salt and water retention.
p.63
Urinalysis: Techniques and Interpretation
What does a blood/Hb level of 5 Ery/μL indicate?
Coagulopathy, hemolysis, muscle damage.
What are cardiorenal syndromes?
Conditions where heart and kidney dysfunctions are interrelated.
p.17
Glomerular Filtration Rate (GFR) Measurement
What factors do not affect cystatin C levels?
Age, sex, race, muscle mass, and diet.
p.45
Cardiorenal Syndromes
What does Type 4 Cardiorenal Syndrome involve?
Chronic kidney disease leading to cardiac dysfunction.
p.64
Urinalysis: Techniques and Interpretation
How significant are chemical components compared to biological components in urine sediment?
They are less important than the biological portion.
p.45
Cardiorenal Syndromes
What is Type 5 Cardiorenal Syndrome?
Systemic conditions such as sepsis and diabetes mellitus leading to simultaneous dysfunction of the heart and kidney.
p.53
Renal Stones: Types and Causes
How can calcium oxalate stones be prevented?
By staying hydrated, reducing oxalate intake, and ensuring adequate calcium consumption.
p.42
Biochemical Features of Chronic Kidney Disease
What is the clinical finding associated with isosthenuria?
Urine osmolality close to plasma osmolality.
p.8
Assessment of Kidney Function
What are non-renal causes of high plasma urea?
High protein diet, GI bleeding, and dehydration.
p.53
Renal Stones: Types and Causes
What are the two forms of calcium oxalate stones?
Calcium oxalate monohydrate and calcium oxalate dihydrate.
p.17
Glomerular Filtration Rate (GFR) Measurement
How does cystatin C perform in detecting early acute kidney injury?
It is a good marker for early detection.
p.14
Nephron Structure and Function
What is the role of the distal convoluted tubule?
Final control of fluid composition and reabsorption of ~10% of bicarbonate and ~10% of filtered Na+.
p.10
Glomerular Filtration Rate (GFR) Measurement
What dietary factor can influence serum creatinine levels?
A high protein diet increases serum creatinine.
p.16
Glomerular Filtration Rate (GFR) Measurement
What is the equation for estimating GFR using Cystatin C?
eGFR cysC (mL/min/1.73 m²) = -4.32 + 80.35 / Cys C (mg/L).
p.10
Glomerular Filtration Rate (GFR) Measurement
When may plasma creatinine levels appear normal despite significant renal function loss?
Until about 50% of renal function is lost.
p.6
Pathophysiology of Kidney Diseases
How does hypertension affect the kidneys?
The kidneys are vulnerable to hypertension.
p.2
Proteinuria and Its Clinical Implications
What is proteinuria?
The presence of excess proteins in urine.
p.2
Renal Stones: Types and Causes
What are renal stones?
Solid mineral deposits that form in the kidneys.
p.9
Biochemical Features of Chronic Kidney Disease
Where is creatine stored in the body?
As creatine phosphate in muscles.
p.17
Glomerular Filtration Rate (GFR) Measurement
Why is serum cystatin C preferred in children?
It is a more accurate marker of GFR compared to creatinine.
p.17
Glomerular Filtration Rate (GFR) Measurement
What is a sensitivity advantage of cystatin C in GFR estimation?
It detects mild changes in GFR.
p.21
Chronic Kidney Disease
What is Chronic Kidney Disease?
A slow, progressive, and irreversible disorder of the kidney resulting in nephron destruction affecting both glomerular and tubular functions for longer than 3 months.
p.16
Glomerular Filtration Rate (GFR) Measurement
How does Cystatin C behave at the glomerulus?
It is freely filtered and not secreted by renal tubules.
p.14
Nephron Structure and Function
What hormone regulates final water reabsorption in the collecting ducts?
Antidiuretic hormone (ADH).
p.10
Glomerular Filtration Rate (GFR) Measurement
How does race influence serum creatinine levels?
Higher in African Americans and lower in Asians.
p.6
Pathophysiology of Kidney Diseases
Why are the kidneys more easily affected by toxic substances?
Because they have the highest flow per gram of organ weight in the body.
p.10
Glomerular Filtration Rate (GFR) Measurement
What non-specific interferences can affect creatinine measurement?
Substances like glucose, acetoacetate, acetone, ketone bodies, and ascorbic acid.
p.6
Pathophysiology of Kidney Diseases
What happens when there is glomerular injury?
It causes leakage of plasma proteins into urine.
p.6
Pathophysiology of Kidney Diseases
What is the nephron's role in the kidney?
It is the functional unit of the kidney.
p.62
Urinalysis: Techniques and Interpretation
What does urine clarity indicate?
It can range from clear to turbid due to cells, proteins, mucus, or crystals.
p.36
Acute and Chronic Renal Failure
What follows the oliguria phase in acute kidney injury?
A period of polyuria (recovery phase lasting 15 to 25 days).
p.17
Glomerular Filtration Rate (GFR) Measurement
What is the blind spot of creatinine-based GFR estimation?
Between 40 – 70 ml/min/1.73 m².
p.38
Glomerular Filtration Rate (GFR) Measurement
How is GFR expressed?
As mL/min per 1.73 m², corrected for body surface area.
p.43
Biochemical Features of Chronic Kidney Disease
What cardiovascular complications can occur in chronic kidney disease?
Increased risk of cardiovascular disease.
p.15
Glomerular Filtration Rate (GFR) Measurement
How is creatinine clearance corrected for body surface area (BSA)?
Ccr - corrected = Ccr x 1.73 BSA.
p.22
Nephron Structure and Function
What happens to proteins less than 5 kDa in the urine?
They freely enter the urine filtrate.
p.36
Biochemical Features of Chronic Kidney Disease
What are common biochemical features of acute tubular necrosis?
Progressive hyperkalemia, hyponatremia, metabolic acidosis, hyperphosphatemia, hyperuricemia, hypocalcemia, and edema.
p.48
Renal Stones: Types and Causes
What is a common feature of nephrocalcinosis?
Calcium deposits in the kidneys.
p.63
Urinalysis: Techniques and Interpretation
What can cause false negative results for blood in urine?
Exposure to air and high ascorbic acid levels.
p.38
Glomerular Filtration Rate (GFR) Measurement
What are some limitations of creatinine measurement in assessing GFR?
Errors in 24-hour urine collection, affected by muscle mass, diet, age, sex, tubular secretion, and non-specific interference.
p.10
Glomerular Filtration Rate (GFR) Measurement
How does muscle mass affect serum creatinine levels?
Higher muscle mass results in higher serum creatinine.
p.48
Renal Stones: Types and Causes
What condition is characterized by high levels of oxalate leading to stones?
Primary hyperoxaluria (PH).
p.14
Nephron Structure and Function
What effect does atrial natriuretic hormone have on the kidneys?
Increases Na+ excretion, leading to more water excretion to reduce blood volume.
p.6
Pathophysiology of Kidney Diseases
What is the consequence of decreased glomerular perfusion?
Hypoxia leading to kidney injury.
p.46
Renal Stones: Types and Causes
What are the characteristics of infection stones?
Large stag horn stones composed of calcium, ammonium, magnesium phosphate; associated with chronic urinary tract infection.
p.10
Glomerular Filtration Rate (GFR) Measurement
Why is serum cystatin C preferred over creatinine in children?
Due to low serum creatinine levels and differences in body composition.
p.63
Urinalysis: Techniques and Interpretation
What does leukocyte esterase indicate in urine?
Presence of white blood cells, suggesting urinary tract infection.
p.22
Nephron Structure and Function
How are amino acids reabsorbed in the proximal convoluted tubule?
By co-transport with sodium.
p.6
Pathophysiology of Kidney Diseases
How does nephron complexity affect kidney injury?
It facilitates the spreading of glomerular injury to the entire kidney.
p.2
Urinalysis: Techniques and Interpretation
What is urinalysis?
A test that examines urine for various substances.
