Podcast
Questions and Answers
What is the significance of gross (painless) hematuria?
What is the significance of gross (painless) hematuria?
- Associated with dehydration
- Indicative of malignancy until proven otherwise (correct)
- Always indicates trauma
- Only occurs in UTIs
What can cause a false positive result for leukocyte esterase on dipstick testing?
What can cause a false positive result for leukocyte esterase on dipstick testing?
- Exercise
- Presence of inflammatory processes (correct)
- Dehydration
- Menstruation
Which bacterial organisms are responsible for converting nitrate to nitrite in the urine?
Which bacterial organisms are responsible for converting nitrate to nitrite in the urine?
- Streptococcus
- E. coli (correct)
- Enterococcus
- Staphylococcus
What is the normal range for Glucose and Ketones in urine?
What is the normal range for Glucose and Ketones in urine?
What is the purpose of ordering a urine culture and sensitivity test?
What is the purpose of ordering a urine culture and sensitivity test?
In urine testing, what does a positive result for Nitrite indicate?
In urine testing, what does a positive result for Nitrite indicate?
Which renal function test is a product of muscle mass and usually excreted in urine?
Which renal function test is a product of muscle mass and usually excreted in urine?
What does a BUN:Cr Ratio of greater than 20:1 indicate?
What does a BUN:Cr Ratio of greater than 20:1 indicate?
Which substance in urine reflects the hydration status and has a normal range of 1.016-1.022?
Which substance in urine reflects the hydration status and has a normal range of 1.016-1.022?
What does an elevated level of urobilinogen in urine suggest?
What does an elevated level of urobilinogen in urine suggest?
Which condition is indicated by a positive result for bilirubin in the urine?
Which condition is indicated by a positive result for bilirubin in the urine?
What does hematuria in urine indicate?
What does hematuria in urine indicate?
What is the main role of urinary electrolytes in the diagnostic process?
What is the main role of urinary electrolytes in the diagnostic process?
In hypokalemia, why is the measurement of urinary potassium levels useful?
In hypokalemia, why is the measurement of urinary potassium levels useful?
What does a urine sodium level greater than dietary intake suggest?
What does a urine sodium level greater than dietary intake suggest?
Which condition is associated with a low urine sodium level in the presence of hypernatremia?
Which condition is associated with a low urine sodium level in the presence of hypernatremia?
What does FENa measure in the diagnostic process?
What does FENa measure in the diagnostic process?
How is FENa useful in differentiating between hypovolemia and acute tubular necrosis?
How is FENa useful in differentiating between hypovolemia and acute tubular necrosis?
What is the normal range for Serum Creatinine (SCr) in adults?
What is the normal range for Serum Creatinine (SCr) in adults?
What does an elevation in Blood Urea Nitrogen (BUN) and Creatinine (Cr) levels suggest?
What does an elevation in Blood Urea Nitrogen (BUN) and Creatinine (Cr) levels suggest?
Which condition should be primarily considered when encountering a patient with elevated BUN and Cr levels?
Which condition should be primarily considered when encountering a patient with elevated BUN and Cr levels?
Why is it important to rule out post-renal causes first when determining pre-renal, renal, or post-renal conditions?
Why is it important to rule out post-renal causes first when determining pre-renal, renal, or post-renal conditions?
When looking for nephrotoxic agents, what role do baseline labs play in the assessment?
When looking for nephrotoxic agents, what role do baseline labs play in the assessment?
What does an elevated BUN:Cr ratio (>20:1) suggest?
What does an elevated BUN:Cr ratio (>20:1) suggest?
What does a low urine sodium level along with hypernatremia indicate?
What does a low urine sodium level along with hypernatremia indicate?
What is the significance of having a urinary Fractional Excretion of Sodium (FENa) of 2-3%?
What is the significance of having a urinary Fractional Excretion of Sodium (FENa) of 2-3%?
In hypokalemia, what might falsely elevate urinary BUN levels?
In hypokalemia, what might falsely elevate urinary BUN levels?
What might be mimicked by appendicitis in terms of urine analysis?
What might be mimicked by appendicitis in terms of urine analysis?
What condition does an enlarged prostate in males commonly lead to, warranting a rectal examination?
What condition does an enlarged prostate in males commonly lead to, warranting a rectal examination?
What is the main purpose of utilizing renal function tests to differentiate between pre-renal, intra-renal, and post-renal causes of decreased kidney function?
What is the main purpose of utilizing renal function tests to differentiate between pre-renal, intra-renal, and post-renal causes of decreased kidney function?
In a clinical scenario, what is the significance of the fractional excretion of sodium (FENa) in the diagnostic process?
In a clinical scenario, what is the significance of the fractional excretion of sodium (FENa) in the diagnostic process?
What does the Cockcroft-Gault equation help to calculate in the context of uronephrology?
What does the Cockcroft-Gault equation help to calculate in the context of uronephrology?
When discussing urine analyses, what aspect is the Chemical (urine dip) component primarily focused on?
When discussing urine analyses, what aspect is the Chemical (urine dip) component primarily focused on?
Study Notes
UroNephrology Labs
- Renal Function Tests: Utilize renal function tests to differentiate between pre-renal, intra-renal, and post-renal causes of decreased kidney function.
Approach to Renal Function Tests
- Elevated BUN and Cr: Look at baseline labs, look for nephrotoxic agents, and determine if it's pre-renal, renal, or post-renal.
- Rule out post-renal causes first: Think obstruction, especially in males (enlarged prostate).
- Look at BUN:Cr ratio: Helps differentiate pre-renal vs renal issues.
- BUN:Cr ratio normal range: 10:1.
Urinary Fractional Excretion of Sodium (FENA)
- Purpose: Indicates % of sodium filtered in glomerulus and excreted in urine.
- Normal range: 2-3% (acute tubular necrosis).
- Less than 1%: Hypovolemia (dehydration, CHF) – pre-renal causes.
- Greater than 2-3%: Acute tubular necrosis (kidney damage).
Basic Metabolic Panel (BMP)
- Components: BUN, Creatinine, Glucose, Na+, K+, Cl-, CO2, SCr.
- SCr (Serum Creatinine): Product of muscle mass, waste product of muscles, usually excreted in urine (does not change rapidly).
- BUN (Blood Urea Nitrogen): Product of breakdown of blood, can change more rapidly.
- Elevation of BUN and Cr: Azotemia.
Urine Analysis
- Macroscopic: Color, clarity, specific gravity.
- Microscopic: RBCs, WBCs, bacteria, casts.
- Chemical (Urine Dip): pH, protein, glucose, ketones, bilirubin, urobilinogen, nitrite, leukocyte esterase.
Kidney Function Tests
- Glomerular Filtration Rate (GFR): Indicates kidney function.
- Creatinine Clearance (CrCl): Indicates kidney function, can be calculated using the Cockcroft-Gault equation.
Clinical Pearls
- Treat the patient, not the urine: Except in extreme cases (young, old, pregnancy).
- Appendicitis can mimic UTI: Mild pyuria, proteinuria, hematuria.
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Description
Learn how to utilize renal function tests to distinguish between pre-renal, intrarenal, and post-renal causes of decreased kidney function. This quiz covers topics such as BMP, BUN, creatinine, and the BUN:Cr ratio.
