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Clin Lab Review
Terms in this set (84)
The kidney functions are
Excretion, homeostatic regulation and endocrine (hormone synthesis)
increases red blood cell production
hormone-like functions (i.e urine contractions)
Reduced renal function strongly correlates with:
Increased morbidity and mortality
Renal concentration is regulated by
Increase in hydration =
Decreased ADH= Increase urine volume
How many liters of urine is the average adult volume?
What is the ph of urine?
Acidic in nature
Changes in unpreserved urine
The most routinely used method of specimen preservation is?
Refrigeration at 2-6 C
Positive Bilirubin in Urine
Indication of liver problems --> liver cannot handle extra Hgb
Increase level of bilirubin in the urine (bilirubenuria) is due to?
Inability of the liver to excrete all conjugated bilirubin in to the CBD
Causes of CBD
Cirrhosis, hepatitis, liver or pancreatic cancer, gallbladder stones that cause biliary obstruction
Dark stool color indicates
Intravascular RBC destruction (increased hemolysis)
Lab values accompanying dark stools
Negative urine bilirubin and increased urobilinogen
What is the mucoprotein synthesized by the DCT cells that is involved in cast formation?
What is the confirmatory test for ALL urine proteins?
Sulfosalicylic Acid (SSA)
Proteinuria is considered pathologic when level exceeds 150 mg/day. What is the most common disease causing this?
Method of choice to detect elevated protein
Albumin to creatinine ratio (ACR)
Increased albumin excretion (high albuminuria) is a marker of
Microvascular disease (early renal involvement in DM)
Where is urobilinogen reabsorbed?
Approx. 50% is reabsorbed into the portal circulation and is reprocessed by the liver
What is responsible for converting conjugated bilirubin to urobilinogen?
What could yield a FALSE NEGATIVE nitrite result for a pt with UTI?
UTI pathogen does not reduce nitrate OR
Urine was not held in bladder long enough for adequate nitrate reduction to occur
What could yield a FALSE POSITIVE nitrite result for a pt with UTI?
Improper handling of specimen may result in artificial overgrowth of bacterial contaminant
What does pyuria indicate?
Inflammation/infection of the GU tract
What is the best indicator combination for a true UTI?
A positive leukocyte esterase AND positive nitrate
What do pancreatic beta cells do?
Release insulin = Lowers blood glucose
What do pancreatic alpha cells do?
Release glucagon = increase glycogen breakdown --> increase blood glucose
Normal values for A1C
Normal values for Fasting Plasma Glucose
99 or below
Normal values for Oral Glucose Tolerance Test
139 or below
A1C pre-diabetes values
5.7 to 6.4
Fasting Plasma Glucose Pre-diabetes values
Oral Glucose Tolerance Test Pre-diabetes values
Diabetes A1C diagnostic value
6.5 or above
Fasting Plasma Glucose diagnostic value for Diabetes
126 or above
Oral Glucose Tolerance Test diagnostic value for Diabetes
200 or above
AMA panel for DM management include?
BMP, HbA1C, Anion gap and lipid profile
Other labs to know for DM management
Ketone bodies, micro albumin, fructoseamine
What is the most common symptom of DM type 2?
Polyuria and the urine has very low SG
What is the major extracellular cation?
What is the major intracellular cation?
What is the major extracellular anion?
What is another extracellular anion along with Cl ?
How is bicarbonate calculated?
Calculated from CO2 (NOT A DIRECT MEASURE)
What is the anion gap?
Difference between anions & cations
What is the anion gap useful for?
To assess metabolic status of pt
What are direct measures of ABG
PH, PCO2 and PO2
low pH, low HCO3
Metabolic acidosis compensation
Lungs hyperventilate to eliminate CO2 and increase pH
high pH, high HCO3
Metabolic alkalosis compensation
Hypoventilation to retain CO2 and decrease pH
low pH, high CO2
Respiratory acidosis compensation
Kidneys conserve HCO3- and secrete H+ into urine
high pH, low CO2
Respiratory alkalosis compensation
Kidneys excrete bicarb and conserve H+
What is the major component of non-protein nitrogen?
Urea (~75% of non protein nitrogens)
Pyrimidines are catabolized to generate?
Purines are catabolized to generate?
NH3 is catabolized to generate?
Creatine is catabolized to generate?
What is the best combination test to assess kidney function?
Combination of both serum urea nitrogen (BUN) and serum creatinine
A patient presents with increased levels of BUN and Creatinine in blood but with normal BUN/Cr ratio in urine, what is this a potential indicator of?
What characteristics does a substance in urine have to meet to be an indicator of GFR?
-Show stable concentration in plasma
-Should freely flow through the glomerulus
-Should not be secreted, reabsorbed, synthesized or metabolized by the kidney
Creatinine meets these characteristics therefore it is the best indicative of GFR
Why is creatinine clearance an excellent indicator of renal clearance?
Creatinine is completely filtered by the glomerulus
What does hyperuricemia indicate?
Precipitation of uric acid --> GOUT, a form of inflammatory arthritis
What is homocysteine?
Promotes atherosclerosis by damaging cells that line the arteries which may promote build up of plaque which can lead to CHD.
CHD= High homocysteine levels and Low CRP
What is CRP used for?
CRP is used to monitor infections. The high sensitivity version can also be used as a cardiac marker
Before troponin, what has historically been used as a cardiac marker?
CK-MB (exists primarily in heart tissue)
What is the gold standard for the diagnosis of heart attacks?
What could cause urine specimen to be clear red-brown?
Hemoglobin and myoglobin
What are the plasma proteins synthesized in the liver?
What protein constitutes 60% of the total protein in plasma and 80% of colloidal osmotic pressure in the peripheral blood?
Removes circulating heme and porphyrins
Elevated ALT/AST indicate
Liver disease. ALT is much more specific for liver damage
-Carrier protein for thyroid hormones T4 and T3
-Transport vitamin A
These cause increased pre-albumin levels
-chronic renal failure
These cause decreased pre-albumin levels
-acute inflammatory responses
Pre-albumin clinical significance
Sensitive marker of inadequate dietary protein intake
Alkaline Phosphatase (ALP) function
Present on cell surfaces in most tissues; catalyzes the alkaline hydrolyses of may substances. Associated with small intestine, bone, liver and placenta
Elevated Alkaline Phosphatase (ALP) indicates
Bone disorders and liver disease
Lipase (LPS) function
Hydrolyzes the ester linkages of fats (triglycerides) to produce alcohol and fatty acids. Found predominantly in the pancreas
Elevated Lipase (LPS) indicates
Pt presents with c/o severe flank pain, urinary urgency and frequency. Labs show positive blood in urine, negative ,leukocyte esterase and negative protein. Microscopy showed epithelial cells and intact RBCs in urine. What could be the cause?
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