Podcast
Questions and Answers
What does a positive nitrite test indicate?
What does a positive nitrite test indicate?
Which bacteria are more likely to give a positive nitrite test?
Which bacteria are more likely to give a positive nitrite test?
What condition allows conjugated bilirubin to appear in urine?
What condition allows conjugated bilirubin to appear in urine?
Which of the following conditions can lead to ketonuria?
Which of the following conditions can lead to ketonuria?
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What normal range is indicated for urine pH?
What normal range is indicated for urine pH?
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What is the primary functional unit of the kidney?
What is the primary functional unit of the kidney?
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Which conditions are associated with alkaline urine?
Which conditions are associated with alkaline urine?
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Which renal process is responsible for filtering blood and allowing substances to pass into the nephron?
Which renal process is responsible for filtering blood and allowing substances to pass into the nephron?
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How does ascorbic acid affect testing results?
How does ascorbic acid affect testing results?
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What is a clinical significance of urine pH testing?
What is a clinical significance of urine pH testing?
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What substance is reabsorbed almost completely in the proximal tubules?
What substance is reabsorbed almost completely in the proximal tubules?
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What condition is characterized by hematuria, oliguria, azotemia, and hypertension?
What condition is characterized by hematuria, oliguria, azotemia, and hypertension?
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What is defined as the presence of detectable amounts of proteins in urine?
What is defined as the presence of detectable amounts of proteins in urine?
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Which of the following best describes the glomerular filtration rate (GFR)?
Which of the following best describes the glomerular filtration rate (GFR)?
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Which test is NOT typically part of a blood analysis for kidney function?
Which test is NOT typically part of a blood analysis for kidney function?
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What threshold determines the renal reabsorption or secretion of sodium?
What threshold determines the renal reabsorption or secretion of sodium?
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Which mutation is associated with Bartter's syndrome?
Which mutation is associated with Bartter's syndrome?
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What characterizes Gitelman syndrome?
What characterizes Gitelman syndrome?
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What is the main regulator of aldosterone secretion?
What is the main regulator of aldosterone secretion?
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PHA is characterized by which of the following?
PHA is characterized by which of the following?
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What happens to cortisol in the collecting duct?
What happens to cortisol in the collecting duct?
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What condition is Liddle's syndrome associated with?
What condition is Liddle's syndrome associated with?
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What electrolyte disorder is common in Gitelman syndrome?
What electrolyte disorder is common in Gitelman syndrome?
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Familial hyperkalemic hypertension (FHH) is characterized by which of the following?
Familial hyperkalemic hypertension (FHH) is characterized by which of the following?
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What is the range of normal specific gravity for urine?
What is the range of normal specific gravity for urine?
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What does a high specific gravity in urine indicate?
What does a high specific gravity in urine indicate?
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Which of the following substances are urinary casts primarily composed of?
Which of the following substances are urinary casts primarily composed of?
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Which type of cast is indicative of bleeding in the urinary tract?
Which type of cast is indicative of bleeding in the urinary tract?
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What condition is associated with low specific gravity in urine?
What condition is associated with low specific gravity in urine?
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What types of crystals are likely to form in alkaline urine?
What types of crystals are likely to form in alkaline urine?
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Which type of crystal is indicated by yellow-brown granules in urine and can be associated with gout?
Which type of crystal is indicated by yellow-brown granules in urine and can be associated with gout?
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Which type of urinary cast is formed in the distal convoluted tubule or the collecting duct?
Which type of urinary cast is formed in the distal convoluted tubule or the collecting duct?
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Which of the following ions is primarily preserved by the kidneys to help regulate body pH?
Which of the following ions is primarily preserved by the kidneys to help regulate body pH?
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What is the appearance of calcium oxalate crystals in urine?
What is the appearance of calcium oxalate crystals in urine?
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In which part of the nephron is approximately 80% of the filtered sodium load actively reabsorbed?
In which part of the nephron is approximately 80% of the filtered sodium load actively reabsorbed?
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Which transporter in the loop of Henle is responsible for the passive reabsorption of NaCl?
Which transporter in the loop of Henle is responsible for the passive reabsorption of NaCl?
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What happens to CO2 in the proximal tubules of the kidney?
What happens to CO2 in the proximal tubules of the kidney?
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Which of the following statements is true about acid-base equilibria in the kidneys?
Which of the following statements is true about acid-base equilibria in the kidneys?
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What is the outcome of sodium and chloride reabsorption in the proximal tubules?
What is the outcome of sodium and chloride reabsorption in the proximal tubules?
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Which of the following does NOT form crystals in acidic urine?
Which of the following does NOT form crystals in acidic urine?
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What is the primary effect of mutations in Pseudohypoaldosteronism type la on ENaC?
What is the primary effect of mutations in Pseudohypoaldosteronism type la on ENaC?
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How does licorice affect adrenal function and electrolyte balance?
How does licorice affect adrenal function and electrolyte balance?
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What are the primary humoral factors influencing tubular reabsorption of Na+?
What are the primary humoral factors influencing tubular reabsorption of Na+?
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Which of the following statements about the regulation of ADH secretion is true?
Which of the following statements about the regulation of ADH secretion is true?
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Hypokalemia can be caused by which of the following mechanisms?
Hypokalemia can be caused by which of the following mechanisms?
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What is the result of glutamine deamination in renal tubules?
What is the result of glutamine deamination in renal tubules?
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How does catecholamine influence sodium reabsorption?
How does catecholamine influence sodium reabsorption?
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Which factor is NOT a contributor to sodium reabsorption regulation?
Which factor is NOT a contributor to sodium reabsorption regulation?
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Study Notes
Kidney Function Tests
- Kidney function tests assess kidney health.
- Urine analysis checks total protein, albumin, hemoglobin, and glucose.
- Blood analysis checks creatinine, urea, and uric acid.
Nephrons
- The nephron is the functional unit of the kidney.
- In nearly all renal diseases, impaired kidney function is due to a lower number of functioning nephrons.
Glomerular Filtration
- All substances except cells and large molecules pass into the nephron from incoming blood during glomerular filtration.
- Adequate blood pressure from heart pumping is necessary for the filtration process.
- A large percentage (99+%) of the filtrate is reabsorbed.
Reabsorption
- Reabsorption occurs in nearly all segments of the nephron.
- The renal threshold for each substance determines whether it is reabsorbed or secreted.
- Glucose is actively reabsorbed in the proximal tubules according to the renal threshold.
- Sodium (Na) is actively reabsorbed based on diet.
GFR
- Glomerular filtration rate (GFR) is the initiating phase of all nephron functions.
Nephrotic vs. Nephritic Syndrome
- Nephrotic syndrome is marked by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia/hyperlipidu.
- Nephritic syndrome is marked by hematuria, oliguria, azotemia, and hypertension.
Urine Analysis
- Glucose: Presence in urine indicates possible hyperglycemia or diabetes.
- Bilirubin: Presence in urine can indicate liver disease.
- Ketones: Present with ketosis (high fat metabolism).
- Protein: Presence indicates possible kidney damage or disease.
- Specific Gravity: Measures urine concentration.
- Blood/Hemoglobin: Indicates possible urinary tract problems or kidney problems.
- pH: Measures urine acidity or alkalinity.
- Nitrite: Presence indicates possible bacteria in the urine.
- Leukocytes: Presence indicates possible infection.
- Urobilinogen: A byproduct of normal red blood cell breakdown; its presence can indicate liver or gallbladder issues.
- Urobilin: A breakdown product of urobilinogen
Renal Physiology
- The three basic renal processes are:
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion
Proteinuria
- A small amount of protein in 24 hours of normal urine is considered normal.
- More than 150 mg/day is considered proteinuria.
- Proteinuria is the presence of detectable proteins in urine.
- Proteinuria can be from decreased reabsorption, or increased filtration.
Causes of Proteinuria
- There are several causes including prerenal (overflow/overload), tubular, and glomerular proteinuria.
Blood and Hemoglobin (Hematuria, Hemoglobinuria)
- Hematuria: The presence of red blood cells (RBCs) in the urine, indicative of kidney problems (e.g., disease, tumor, stones, trauma) or lower urinary tract problems (infection, tumor, calculi, trauma).
-
Hemoglobinuria: Free hemoglobin in the urine, caused by intravascular hemolysis (e.g., certain blood disorders like thalassemia or sickle cell anemia).
- Causes can include leukemia, thrombocytopenia, hemophilia, and sickle cell trait.
Glomerular Haematuria Pathogenesis
- Glomerular haematuria is related to disorders impacting the filtration barrier of the glomerulus such as slit diaphragm disorders, endothelial diseases, mesangioal deposits, GBM disorders.
Glomerular Filtration Rate (GFR)
- GFR is the initial phase of normal nephron function.
Causes of Myoglobinuria
- Myoglobinuria is caused by conditions involving muscular trauma, prolonged coma, or convulsions.
Keton Bodies
- Keton bodies are: acetone, acetoacetic acid, and beta-hydroxybutyric acid.
- Ketonuria may occur in starvation, or loss of carbohydrates.
Specific Gravity
- Specific gravity measures the concentration of urine. A value between 1.002 and 1.035 is considered normal.
Kidney Microscopic Examination
-
Cells in urine, casts in urine, crystals in urine, and others in urine.
- Cells: Examples are epithelial cells, pus cells, and red blood cells.
- Casts: Consist mostly of proteins, cells, or debris from kidney tubules. Examples: hyaline casts, red blood cell casts, granular casts, broad casts.
- Crystals: Can indicate problems with metabolic processes, kidney function or presence of drugs. Example: calcium oxalate crystals, calcium phosphate crystals.
- Others: These include mucin threads, fat droplets, or bacteria.
Causes/Conditions affecting Urine Parameters
- Glycosuria: is caused by impaired reabsorption of glucose, renal diseases, or high blood glucose (such as diabetes mellitus).
- pH: Normal range for urine pH is 4.6 – 8.0, average 6.0. Altered pH can indicate metabolic acidosis or alkalosis, or dietary issues.
- Bilirubin: Indicates possible liver or gallbladder conditions.
- Ketones: Appear in urine due to conditions like starvation or lack of carbohydrates in the diet leading to ketosis.
- Unorganized Sediment Crystals : Unorganized sediment crystals, such as uric acid crystals, calcium oxalate crystals, or triple phosphate crystals, can often point to metabolic or other imbalances or conditions, such as gout.
- Abnormal crystals: These include cystine, cholesterol, leucine, tyrosine, bilirubin, sulfonamides, radiographic dyes, and medications (e.g., ampicillin).
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