Biochemical and Paraclinical Kidney Examination
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Questions and Answers

Which symptom is commonly associated with uremia?

  • Fried tongue (correct)
  • Severe thirst
  • Increased appetite
  • Dry mouth

What cardiovascular complication is associated with uremia?

  • Hypertension
  • Myocarditis (correct)
  • Coronary artery disease
  • Atrial fibrillation

Which of the following is a common digestive symptom of uremia?

  • Melena (correct)
  • Acid reflux
  • Liver enlargement
  • Constipation

What electrolyte disturbance is frequently seen in uremia?

<p>Increased potassium (A)</p> Signup and view all the answers

Which sign is indicative of neurological involvement in uremic conditions?

<p>Babinski sign (B)</p> Signup and view all the answers

What is the typical characteristic of urine in acute diffuse glomerulonephritis?

<p>Brown and oliguria (A)</p> Signup and view all the answers

What indicates a urinary infection when counting microbes?

<p>Over 100,000 microbes/mm3 (B)</p> Signup and view all the answers

In a urinalysis, what does an overwhelming presence of red blood cells indicate?

<p>Glomerulonephritis (A)</p> Signup and view all the answers

Which type of nephropathy is associated with tubular dysfunction?

<p>Tubular nephropathies (C)</p> Signup and view all the answers

What is the significance of the Addis-Hamburger test in urine analysis?

<p>It determines the quantity of red blood cells. (C)</p> Signup and view all the answers

What could a protein level of 5 g/l in urine indicate?

<p>Nephrotic syndrome (D)</p> Signup and view all the answers

When centrifuging a urine sample, what is the expected number of leukocytes for normal values?

<p>2,000/min (D)</p> Signup and view all the answers

What is indicated by a urine specific gravity greater than 1030?

<p>Intact tubular function (C)</p> Signup and view all the answers

What occurs during the polyuric period of renal recovery?

<p>Slow increase in diuresis (B)</p> Signup and view all the answers

What is a danger associated with the polyuric period?

<p>Elimination of electrolytes like Na+ and K+ (A)</p> Signup and view all the answers

What characterizes compensated chronic renal failure?

<p>50% to 25% functional nephrons (D)</p> Signup and view all the answers

Which of the following is NOT a cause of chronic renal failure?

<p>Diabetes insipidus (D)</p> Signup and view all the answers

What indicates decompensated chronic renal failure?

<p>Presence of oliguria (A)</p> Signup and view all the answers

What is a characteristic finding in compensated chronic renal failure?

<p>Polyuria without nitrogen retention (A)</p> Signup and view all the answers

What is the urine output during the polyuric phase?

<p>6-9 liters per day (B)</p> Signup and view all the answers

What is the primary compensatory mechanism in chronic renal failure?

<p>Hypertrophy of intact nephrons (B)</p> Signup and view all the answers

What is a characteristic urine finding in chronic pyelonephritis?

<p>Pale appearance (D)</p> Signup and view all the answers

Which of the following is true regarding the leukocyturia in chronic pyelonephritis?

<p>Leukocyturia occurs intermittently (B)</p> Signup and view all the answers

Which factor contributes to renal edematous syndrome?

<p>Increased capillary permeability (C)</p> Signup and view all the answers

What is a common symptom observed in patients with renal edematous syndrome?

<p>Palpebral edema (B)</p> Signup and view all the answers

What mechanism is triggered in acute diffuse glomerulonephritis due to glomerular damage?

<p>Activation of the basal membrane (B)</p> Signup and view all the answers

What is a consequence of membranous glomerulitis in nephrotic syndromes?

<p>Decreased circulating plasma volume (B)</p> Signup and view all the answers

Which symptom is commonly associated with cerebral edema in renal edematous syndrome?

<p>Headache (A)</p> Signup and view all the answers

What change occurs in blood osmolarity due to the retention of water in acute renal syndrome?

<p>Blood osmolarity increases (A)</p> Signup and view all the answers

What condition is characterized by a significant amount of protein loss due to damage to the basement membrane?

<p>Nephrotic syndrome (B)</p> Signup and view all the answers

Which statement best describes the presence of hematuria in acute diffuse glomerulonephritis?

<p>Hematuria occurs intermittently (D)</p> Signup and view all the answers

What is a common feature of chronic nephropathies?

<p>Decreased levels of proteins in the blood (B)</p> Signup and view all the answers

What type of renal failure results from fluid loss due to conditions like vomiting or diarrhea?

<p>Functional acute renal failure (A)</p> Signup and view all the answers

Which of the following is NOT typically associated with acute renal failure?

<p>Chronic kidney disease (B)</p> Signup and view all the answers

What clinical sign is associated with hyperhydration phenomena in acute renal failure?

<p>Cerebral edema (A)</p> Signup and view all the answers

How does renal failure affect electrolyte levels?

<p>Na+ levels decrease while K+ levels increase (A)</p> Signup and view all the answers

What kind of disorders result from the accumulation of nitrogenous waste in renal failure?

<p>Toxic syndrome disorders (C)</p> Signup and view all the answers

Which of the following conditions can lead to organ failure due to hypoperfusion of the kidneys?

<p>Nephrons suffering from ischemia (B)</p> Signup and view all the answers

What type of acute renal failure is characterized by obstruction of urine flow?

<p>Postrenal failure (A)</p> Signup and view all the answers

Which of the following is considered a nephrotoxic agent?

<p>Chloroform (A)</p> Signup and view all the answers

Which electrolyte disturbance is commonly observed in acute renal failure?

<p>Increased potassium concentrations (B)</p> Signup and view all the answers

What is considered the minimum urine volume produced in 24 hours?

<p>500 ml (C)</p> Signup and view all the answers

Which condition results in an increase in urine volume greater than 2000 ml per day?

<p>Diabetes mellitus (DM) (A)</p> Signup and view all the answers

What is the characteristic urine specific gravity range for normosthenuria?

<p>1020 - 1025 (A)</p> Signup and view all the answers

In what condition is hypouricemia most likely to occur?

<p>Hereditary xanthine oxidase deficiency (B)</p> Signup and view all the answers

What is the typical color of urine produced when hydration is high?

<p>Pale yellow (D)</p> Signup and view all the answers

Which substance is primarily responsible for increased urine pH towards alkaline levels?

<p>Vegetable diet (A)</p> Signup and view all the answers

What type of urine appearance is associated with pyuria?

<p>Cloudy (C)</p> Signup and view all the answers

Which pathological condition is indicated by persistent proteinuria?

<p>Acute Glomerulonephritis (D)</p> Signup and view all the answers

How is renal colic often characterized in terms of urine production?

<p>Decreased urine output (C)</p> Signup and view all the answers

What biochemical compound in urine reflects protein metabolism?

<p>Urea (A)</p> Signup and view all the answers

What does an increase in urinary density typically indicate?

<p>Dehydration (C)</p> Signup and view all the answers

What is a common symptom of urinary infections based on urine smell?

<p>Slightly ammoniacal (C)</p> Signup and view all the answers

In which situation would hematuria likely occur?

<p>Hemorrhagic conditions (A)</p> Signup and view all the answers

What is the normal pH range of urine?

<p>5.2 - 8.2 (C)</p> Signup and view all the answers

Flashcards

Uremia

A condition characterized by an accumulation of waste products in the blood due to severe kidney dysfunction.

Uremic Syndrome

A complex set of symptoms that arise from the accumulation of waste products, electrolytes, and toxins in the blood due to kidney failure.

Uremic Coma

A potentially fatal complication of uremia, characterized by deep unconsciousness and a range of neurological symptoms.

Uremia - Elevated Urea

The presence of abnormally high levels of urea in the blood, a hallmark of kidney dysfunction.

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Uremic Skin

The characteristic pale yellowish skin discoloration observed in patients with uremia.

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Urinary Tract Infection (UTI)

Urinary tract infections (UTIs) are caused by bacteria entering the urinary tract. A significant number of microbes, often greater than 100,000 per mm3, in a urine sample is a sign of a UTI. The sensitivity of bacteria to antibiotics can be determined through a culture and sensitivity test.

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Urinary syndrome

Urinary syndrome is a broad term that refers to changes in the physical and chemical properties of urine. These changes can be caused by various conditions affecting the kidneys or other parts of the body.

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Glomerulonephritis

Glomerulonephritis is an inflammatory condition of the glomeruli, the filtering units of the kidneys. It can cause various urinary symptoms, including proteinuria, hematuria, and decreased urine output.

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Addis-Hamburger test

The Addis-Hamburger test is a laboratory technique that measures the number of red blood cells, white blood cells, and casts in the urine. It helps to assess the severity of kidney disease and monitor its progression.

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Nephrotic syndrome

Nephrotic syndrome is a condition characterized by excessive protein in the urine, low albumin levels in the blood, swelling, and high cholesterol.

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Glomerulonephrosis

Glomerulonephrosis is a condition with a similar pathophysiology to glomerulonephritis and is often associated with nephrotic syndrome.

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Tubular nephropathies

Tubular nephropathies are conditions that primarily affect the tubules of the kidneys, the structures responsible for reabsorbing and secreting substances in urine.

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Interstitial nephropathies

Interstitial nephropathies are conditions that affect the interstitial tissue of the kidneys, the space between the tubules and blood vessels.

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Chronic Renal Failure

The kidneys are unable to filter blood effectively, leading to a build-up of waste products, such as urea, creatinine, and uric acid. Nitrogen retention occurs in early stages.

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Intact Nephron Theory

The body compensates for declining kidney function by increasing the size and activity of remaining healthy nephrons to maintain normal function. However, with progressive loss of nephrons, the ability to compensate diminishes.

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Polyuria in Compensated CRF

A condition where the kidneys are unable to concentrate urine, resulting in large amounts of diluted urine. Typically occurs in the early stages of chronic renal failure.

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Nitrogen Retention

A condition where the kidneys are unable to filter waste products from the blood effectively, leading to a build-up of nitrogenous waste.

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Decompensated Chronic Renal Failure

A condition where the kidneys are shutting down, resulting in a significant drop in urine output and a worsening of symptoms.

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Tubule Regeneration

The regeneration of the tubules in the kidneys after damage, replacing the damaged simple epithelial cells with new ones. While it's a sign of repair, it's a long and sometimes incomplete process.

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Chronic Pyelonephritis

Chronic pyelonephritis is an inflammation of the kidneys, often caused by bacterial infections, leading to scarring and damage over time.

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Pale urine in Chronic Pyelonephritis

Pale urine can be a sign of chronic pyelonephritis, indicating a reduced ability of the kidneys to concentrate urine.

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Polyuria in Chronic Pyelonephritis

Increased urine production in Chronic Pyelonephritis is a compensatory mechanism to try and flush out toxins and bacteria.

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Isosthenuria in Chronic Pyelonephritis

Isosthenuria in Chronic Pyelonephritis refers to the inability of the kidneys to concentrate urine, leading to urine with a low specific gravity.

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Leukocyturia in Chronic Pyelonephritis

Leukocyturia in Chronic Pyelonephritis is the presence of white blood cells in the urine, indicating an inflammatory response.

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Bacteriuria in Chronic Pyelonephritis

Bacteriuria in Chronic Pyelonephritis is the presence of bacteria in the urine, usually indicating an active infection.

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Renal Edematous Syndrome

Renal edematous syndrome is a collection of symptoms characterized by widespread swelling due to fluid buildup.

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Acute Diffuse Glomerulonephritis

Acute diffuse glomerulonephritis is a type of kidney disease involving inflammation of the glomeruli, the filtering units of the kidneys.

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Membranous Glomerulitis

Membranous glomerulitis is a type of kidney inflammation characterized by damage to the basement membrane of the glomeruli, leading to protein loss.

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Chronic Nephropathy and GFR

A reduction in the glomerular filtration rate (GFR) due to chronic kidney disease.

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Abnormal Blood Proteins in Chronic Nephropathy

Abnormal blood protein levels caused by chronic nephropathy. Specific changes include a decrease in albumin, serine, and globulin.

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Increased Lipid Levels in Chronic Nephropathy

Increased lipid levels in the blood, specifically triglycerides, cholesterol, and sometimes lipemia, are a consequence of chronic nephropathy.

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Rapidly Progressive Atherosclerosis

A rapid progression of hardening of the arteries (atherosclerosis) due to chronic kidney disease.

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Hypouricemia

A condition where the amount of uric acid in the blood is lower than normal. This is uncommon.

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Hereditary Xanthine Oxidase Deficiency

This is a rare inherited disorder where the enzyme xanthine oxidase is deficient. As a result, the body cannot break down xanthine and hypoxanthine into uric acid.

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Renal Failure Syndrome

A condition of severe kidney failure characterized by abuild-up of waste products in the blood, metabolic imbalances like acid-base and electrolyte disturbances, and fluid retention.

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Prerenal Causes of Acute Renal Failure

Factors that decrease blood flow to the kidneys, impacting the GFR, leading to a decline in filtration.

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Severe Liver Diseases

Conditions like cirrhosis or severe liver diseases can reduce the liver's ability to synthesize uric acid, leading to decreased levels in the blood.

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Drugs Affecting Uric Acid Levels

Certain medications can affect the levels of uric acid in the blood. Some drugs promote the excretion of uric acid, while others inhibit the enzyme xanthine oxidase.

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Renal Causes of Acute Renal Failure

Damage to the kidney tissue itself, leading to a decrease in filtration and impaired function.

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What is urine?

The final product of kidney activity, urine provides insights into kidney function and any potential diseases.

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Postrenal Causes of Acute Renal Failure

Conditions that block the flow of urine from the kidneys, leading to an increase in pressure within the kidney and a decline in the GFR.

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Diuresis

The total volume of urine excreted in 24 hours. It reflects the balance between water intake and losses.

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Oligoanuric Period

A period of significantly reduced urine output (less than 500 ml per day) that occurs during acute renal failure, often lasting 6-14 days.

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Clinical Signs of Uremia

A collection of symptoms that occur during acute renal failure due to the buildup of waste products, fluid retention, and electrolyte imbalances, including digestive, neurologic, hematologic, and respiratory manifestations.

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Normal Urine Volume (VN)

The normal range for urine volume in a 24-hour period, typically between 2000-2500 ml.

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Minimum Urine Volume

The minimum amount of urine needed to be excreted daily, usually around 500 ml.

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Facultative Diuresis

This is the flexible part of urine volume, ranging from 500-1500 ml. It depends on the balance between water intake and losses.

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Polyuria

A condition characterized by excessive urine production, exceeding 2000 ml per day.

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Physiological Polyuria

Polyuria due to normal causes like increased fluid intake, emotional states or cold exposure.

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Extrarenal Polyuria

Polyuria caused by conditions outside the kidneys, such as Diabetes Insipidus or Diabetes Mellitus (DM).

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Diabetes Insipidus (DI)

A type of polyuria caused by a lack of ADH (antidiuretic hormone), leading to excessive urine loss. Urine density is similar to water.

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Osmotic Diuresis in DM

Polyuria due to osmotic diuresis, where increased blood sugar spills into urine, taking water along with it. Urine density is slightly elevated.

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Study Notes

Biochemical Exploration of the Kidneys

  • The kidneys play a vital role in the body by forming urine, excreting waste from metabolism, maintaining fluid balance, and controlling acid-base balance.
  • Urine formation relies on glomerular filtration, tubular reabsorption, and tubular secretion.
  • Normal urine contains urea, creatinine, and phosphates, but not glucose, proteins, or bicarbonates. Physical characteristics include specific pH, density, volume, color, and smell.

Paraclinical Examination of the Kidneys

  • Urine Examination: includes assessing pH, specific gravity, volume, color, and presence of substances like proteins or glucose.
  • Blood Parameter Examination: involves measuring various blood components such as urea, creatinine, uric acid, blood sugar, total proteins, Na, K, Cl, Ca, P, Mg, and bicarbonate.
  • Effort Tests: used to evaluate kidney function under stress, such as after exercise.
  • Instrumental Exploration of the Parenchyma: includes using techniques to examine the inner structure of the kidneys.
  • Radiological Explorations: use of X-rays or imaging to investigate kidney structure and function.
  • Radioisotopic Explorations: employ radioactive substances to study blood flow and function of the kidneys.
  • Puncture-Renal Biopsy: a procedure where a sample of kidney tissue is taken for examination.

Blood Examination

  • Non-protein Nitrogen (NPN) substances:
    • Urea (15-45 mg/dl)
    • Creatinine (0.6-1.2 mg/dl)
    • Uric acid (2.5-7 mg/dl)
  • Additional blood parameters: Blood sugar, total proteins, Na (135-145 mEq/l), K (3.5-5 mEq/l), Cl (95-109 mEq/l), Ca(9-11 mg/dl), P (3-4.5 mg/dl), and Mg (2-3 mg/dl); Bicarbonate (22-28 mEq/l).

Urine Examination

  • pH: measured in the morning and throughout the day, typically 5.2 to 8.2
  • Density (ρ): ranging from 1020-1025 in healthy individuals.
  • Volume: normal, oliguria (low urine output), or anuria (no urine output).
  • Appearance: Clarity, color, smell.
  • Substances: Proteins, carbohydrates, Urobilinogen, Bile pigments, Na, K, Cl, urea, creatinine, uric acid (Clearance), Ca, P, Mg, oxalate, citrate, urate.

Urea

  • Urea is the primary nitrogenous waste product
  • Urea is synthesized in the liver
  • It undergoes transformations within the kidneys, converting a toxic form into a nontoxic compound
  • It's highly soluble and is readily excreted via the urinary system.

Creatinine

  • Creatinine comes from creatine (predominantly synthesized by the liver).
  • It is found in biological fluids
  • Creatinine is filtered from the blood in the glomerulus
  • It is actively secreted in the proximal convoluted tubule, contributing to its excretion
  • Normal range is 0.6-1.3 mg/dl.

Uric Acid

  • Uric acid results from purine catabolism
  • The body synthesizes uric acid from exogenous and endogenous sources
  • It's in the extracellular fluids, primarily as monosodium urate
  • Kidneys eliminate uric acid via glomerular filtration and reabsorption in the proximal convoluted tubule
  • Normal range is 2.5-7 mg/dl (women) and 3-7 mg/dl (men).

Urine Volume/Diuresis (24-hour)

  • Urine volume varies with fluid intake and loss (e.g., perspiration, diarrhea).
  • Normal range is 2000-2500 ml per 24 hours.
  • Minimum acceptable quantity is 500ml.

Kidney Function Tests

  • Different tests used to examine various characteristics of urine (e.g., color, smell, components, and volume) to evaluate kidney function.
  • Assessment of kidney function enables early diagnosis and treatment of potential disorders.

Other Substances in Urine Notes

  • Proteinuria
  • Hematuria
  • Pyuria
  • Glycosuria
  • Ketone Bodies
  • Salts
  • Uroculture

Renal Function and Disease

  • Detailed conditions affecting kidney function and their related symptoms, such as glomerulonephritis, pyelonephritis, etc.
  • Signs and symptoms related to kidney failure.

Renal Edematous Syndrome

  • Edema, characterized by puffiness, is primarily caused by impaired kidney function.
  • Symptoms like hoarseness, and cardiomegaly are possible symptoms.

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Biochemical Exploration of the Kidneys PDF

Description

This quiz explores the biochemical functions of the kidneys, urine formation, and the critical parameters involved in urine and blood examinations. It also discusses the importance of kidney assessments through various tests, including physical, biochemical, and instrumental evaluations.

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