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ClinChem2 NPNs more

Review test for ClinChem2 NPNs, proteins, enzymes. Deltech MLT Owens.

QuestionAnswer
What are the 2 distinct areas of the kidneys? 1. cortex (outer layer) 2. medulla (inner layer)
What is the functional unit of the kidney? nephrons
How many nephrons are in each kidney? 1-1.5 million
What are the 3 major functions of the kidneys? 1. glomerular filtration 2. tubular reabsorption 3. tubular secretion
The blood pressure to the glomerular capsules is high because of ? the difference in size between the afferent and efferent arterioles.
Why does the basement membrane repel large, negatively charged molecules such as proteins? the membrane is also negatively charged.
The urinary system consists of (6 things, 4 items on list)? 1. 2 kidneys 2. 2 ureters 3. bladder 4. urethra
The concentration above which a substance cannot be totally reabsorbed, and is therefore excreted into the urine, is called the ? renal threshold
In order for a substance to be absorbed by the renal tubules, it must be combined with a __ __. This requires expenditure of energy or ATP. carrier protein
Absorption of a substance into the renal tubules using energy (ATP) is an example of ? active transport
Absorption of a substance into the renal tubules using no energy and involving movement from an area of high concentration to one of lower concentration is an example of ? passive transport
Water and urea are always absorbed through active or passive transport? passive transport
The passage of substances from the peritubular capillaries into the tubular filtrate is known as ? tubular secretion
One of the major functions performed by tubular secretion is the elimination of waste products NOT filtered by the ? glomerulus
A major function of tubular secretion is the regulation of acid-base balance in the body. This is done by secreting 90% of the __ __ excreted by the kidney. hydrogen ions
Nonprotein nitrogen (NPN) refers to products of catabolism of __ and __ __. proteins and nucleic acids
The proteins and nucleic acids catabolized by the body (which creates NPNs) contain __ but are not part of the protein molecule. nitrogen
BUN (blood urea nitrogen) concentration in NPN should be about __%. 45
Amino acid concentration in NPN should be about __%. 20
Creatinine concentration in NPN should be about __%. 5
Uric acid concentration in NPN should be about __%. 20
Creatine concentration in NPN should be about what percentage? 1-2%
Ammonia concentration in NPN should be about __%. 0.2
The major nitrogen-containing metabolic product of protein catabolism in humans is ? BUN (blood urea nitrogen)
What 2 things is BUN formed from? 1. exogenous protein (diet) 2. endogenous protein (cell breakdown in the body)
How much of the BUN is reabsorbed and how much is excreted in a patient with a normal to increased GFR (glomerular filtration rate)? 40% reabsorbed 60% excreted
A well hydrated patient will excrete (more or less?) BUN. more
If a patient excretes increased amounts of BUN, the result will be a (lower or higher?) serum BUN? lower serum BUN
What are the 3 variables that affect BUN levels? 1. Urea concentration 2. GFR 3. hydration
An increased BUN and other NPN compounds is called ? azotemia
In increased urea/BUN is called ? uremia
Uremia is azotemia + ? kidney failure or kidney problems
Azotemia is classified into 3 categories, including prerenal. Prerenal azotemia refers to problems that occur ? before the kidney, usually due to decreased renal blood flow.
Azotemia is classified into 3 categories, including renal azotemia. Renal azotemia refers to problems ? of or at the actual kidneys.
Azotemia is classified into 3 categories, including postrenal azotemia. Postrenal azotemia occurs ? after urine has left the kidney, usually resulting from an obstruction of urine flow through the kidneys, bladder, or urethra.
Bladder or prostate gland tumors can be a cause of which kind of azotemia? postrenal
Congestive heart failure can be a cause of which kind of azotemia? prerenal
Uremia can be a cause of which kind of azotemia? renal
Gynecologic tumors can be a cause of which kind of azotemia? postrenal
Uremic syndrome can be a cause of which kind of azotemia? renal
Dehydration can be a cause of which kind of azotemia? prerenal
Shock can be a cause of which kind of azotemia? prerenal
Prostatic hypertrophy can be a cause of which kind of azotemia? postrenal
Kidney stones (renal calculi or nephroliathis) can be a cause of which kind of azotemia? postrenal
Advanced cirrhosis can be a cause of which kind of azotemia? prerenal
Glomerularnephritis can be a cause of which kind of azotemia? renal
Severe infections can be a cause of which kind of azotemia? postrenal
Sepsis can be a cause of which kind of azotemia? prerenal
Starvation can be a cause of which kind of azotemia? prerenal
High fever can be a cause of which kind of azotemia? prerenal
Steroids can be a cause of which kind of azotemia? prerenal
Uncontrolled diabeted mellitus and gastrointestinal bleeding can be a cause of which kind of azotemia? prerenal
Increased protein metabolism can be a cause of which kind of azotemia? prerenal
The normal BUN:CR ratio (blood urea nitrogen to creatinine) is between ? 12:0 - 20:1
In a patient with renal disease, BUN and CR will be elevated __. proportionally
BUN and CR will be elevated proportionally in patients with renal disease. But will the BUN:CR ratio fall within the normal range? Yes
If a patient's BUN:CR ratio is high - above 20:1 - with a high BUN but a normal or only slightly elevated CR, this is associated with what? prerenal azotemia
Patients with a high BUN:CR with an elevated CR probably have? postrenal azotemia (obstruction) or prerenal azotemia in addition to renal disease.
The ammonium ion reacts with phenol and hypochlorite in an alkaline medium to form indophenol blue. The indophenol blue is the chromagen that is measured. This takes place during which reaction? Berthelot's reaction
Adding a double iodide compound (2Hgl2 + 2Kl) causes the formation of a yellow to orange-brown compound with NH4+. This takes place during which reaction? Nessler's reaction
The disappearance of NADPH is measured as a decrease in absorbance as NADPH is oxidized to NAD+. This takes place during which reaction? Glutamate dehydrogenase (GLDH)
A colorimetric reaction based on the condensation of diacetyl with urea to form the chromogen diazine. This takes place during which reaction? Diacetyl or Fearon reaction
Of the 4 reactions used with urease, which is the most commonly used? Glutamate dehydrogenase (GLDH)
What is the reference range for BUN? 7-18 mg/dL
A high protein diet will decrease BUN. True or false? False. High protein diets, over time, will increase BUN.
Creatinine is synthesized where in the body? The liver
From what 3 amino acids does the liver synthesize creatinine? 1. arginine 2. glycine 3. methionine
Creatinine is a waste produce. What 2 things is derived from? 1. creatine 2. creatine phosphate
The constancy of the creatinine produced is proportional to what in the individual? muscle mass
Is creatinine released into the body fluids at a constant or inconstant rate? constant
Creatinine is filtered by the __ and does not undergo significant tubular __. glomeruli, reabsorption
The 3 main variables to creatinine levels in the body are ? 1. relative muscle mass 2. creatine turnover 3. renal function
Creatinine can be used to measure renal __ and the glomerular filtration rate. function
Increased serum creatinine is present when? formation or excretion of urine is impaired due to prerenal, renal, postrenal causes.
How can you detect whether urine has been diluted, and how can you tell if a fluid really is urine? creatinine levels
The reaction between creatinine and picric acid in an alkaline medium yielding a red orange compound, which is creatinine and a picrate ion, is called what kind of reaction? Jaffe Reaction
A kinetic method was developed to reduce the effect of interfering substances. What are the 7 interfering substances? 1. ascorbic acid 2. ketoacids 3. protein 4. uric acid 5. acetone 6. glucose 7. medications (cephalosporins and other antibiotics)
The preferred creatininase method (which is used instead of Jaffe now) uses creatininase followed by what 3 enzymes? 1. creatinase 2. sarcosine oxidase 3. peroxidase
Another method that also fuses creatinase but requires a larger sample is followed by what 3 enzymes? 1. creatine kinase 2. pyruvate kinase 3. lactate dehydrogenase
What kind of acid is the product of purine (adenine and guanine) catabolism in man and higher primates? uric acid
Uric acid is produced in the liver from xanthine by the action of ? the enzyme xanthine oxidase
Uric acid is formed, in part, from exogenous (dietary) __. nucleotides
Uric acid is formed, in part, from endogenous nucleotides. Where do endogenous nucleotides come from? cells breaking down and being replaced
Increases in dietary intake, liver overproduction of uric acid, underexcretion of uric acid, and specific enzyme defects are all causes of ? hyperuricemia
Gout is a cause of which kind of hyperuricemia. Primary or secondary? primary
Renal disease or failure is a cause of which kind of hyperuricemia. Primary or secondary? secondary
A higher than normal level of uric acid in the body is called ? hyperuricemia
Glycogon storage disease is a cause of which kind of hyperuricemia. Primary or secondary? secondary
Cytotoxic chemotherapy is a cause of which kind of hyperuricemia. Primary or secondary? primary
Toxemia of pregnancy is a cause of which kind of hyperuricemia. Primary or secondary? secondary
Severe exercise is a cause of which kind of hyperuricemia. Primary or secondary? secondary
Radiation therapy for leukemia or lymphoma is a cause of which kind of hyperuricemia. Primary or secondary? primary
Lead and alcohol poisoning are causes of which kind of hyperuricemia. Primary or secondary? secondary
Cancer is a cause of which kind of hyperuricemia. Primary or secondary? primary
Drug therapies like diuretics and salicylates are causes of which kind of hyperuricemia. Primary or secondary? secondary
Lesch-Nyhan syndrome (affects the tubules) is a cause of which kind of hyperuricemia. Primary or secondary? secondary
Primary gout is found mostly in men aged __ to __ years old. 30 to 50
Primary gout is how many times more common in men than in women? 7
Primary gout can be caused by an inborn error of ? metabolism
Symptoms of gout include what 3 things? 1. arthritis 2. nephropathy (kidney disease) 3. nephrolithiasis (kidney stones/renal calculi)
What group of women tend to get gout more often than other women? menopausal
What 6 things can precipitate gout? 1. alcohol 2. high-protein diets 3. stress 4. acute infection 5. surgery 6. meds
What kind of acid is reduced by uric acid in an alkaline medium, thus allowing us to measure the development of the reaction by observing a change to a tungsten blue color? phosphotungstic acid
Uricase catalyzes the oxidation of uric acid to allantoin measured by the decrease in absorbance at __ nm. 293
The rate that the kidneys remove a substance from the plasma or blood is called ? renal clearance
Creatinine is a great indicator of GFR. One reason for this is that creatinine is freely filtered by the ? glomeruli
Creatinine is a great indicator of GFR. One reason for this is that creatinine isn't reabsorbed by the __ to any significant extent. tubules
Creatinine is a great indicator of GFR. One reason for this is that creatinine is released into the __ at a constant rate. plasma
What is the formula for determining creatinine clearance? Clearance (X) = Urine concentration TIMES urine flow DIVIDED by plasma concentration.
Actute glomerulonephritis (AGN) is usually associated with what groups of people? children and young adults with group A streptococcal infections (strep throat)
What are the 7 symptoms of acute glomerulonephritis (AGN)? 1. rapid onset 2. fever 3. malaise 4. nausea 5. oliguria (low urine) 6. hematuria (blood in urine) 6. proteinuria
Secondary complications of AGN include abnormal renal function tests. What sort of test results would someone have with this condition? elevated BUN and creatinine, decreased GFR.
Aside from abnormal renal function test results, what other 3 complications might you see with AGN? 1. edema (knees, ankles, around eyes) 2. hypertension 3. electrolyte imbalance (Na+ and K+)
What are the 7 symptoms of chronic glomerulonephritis? 1. edema 2. fatigue 3. hypertension 4. anemia 5. metabolic acidosis 6. proteinuria 7. oliguria or anuria (low or no urine excretion)
What are the 5 symptoms of nephrotic syndrome? (A collection of symptoms which occur because the the glomeruli in the kidney become leaky. This allows protein to leave the body in large amounts.) 1. massive proteinuria 2. albuminuria 3. pitting edema 4. hyperlipidemia 5. hypoalbuminemia
An inflammatory process involving a gram-negative bacterial infection of the renal tubules is called ? acute pyelonephritis
Pyelonephritis is an (ascending or descending?) infection that usually causes temporary damage to the renal tubules. ascending
Name 5 causes of pyelonephritis. 1. incomplete emptying of bladder 2. vesicoureteral reflux (a condition in which urine flows from the bladder, back up the ureter, and back into the kidneys) 3.diabetes 4. urinary obstruction 5. catherization
Chronic pyelonephritis is due to permanent scarring of the __ __ and can lead to renal failure. renal tubules
What is the most common cause of vesicoureteral reflux nephropathy? chronic pyelonephritis
A patient whose urine has an alkaline pH, is positive for leukocyte esterase, moderate proteinuria, low specific gravity, with granular, waxy, broad casts and/or WBCs and renal cell casts, who also has polyuria and nocturia, may have ? chronic pyelonephritis
Cystitis is a bladder infection characterized by ? dysuria
Chronic pyelonephritis patients will often have cellular casts. What sort of cellular casts do cystitis sufferers have? none
Patients with chronic pyelonephritis will often have what in their urine? Small protein, hematuria, leukocyte esterase, nitrite, and increased WBCs, bacteria, and transitional epithelial cells
What 6 things is chronic kidney disease (CKD) associated with? 1. hypertension 2. diabetes 3. autoimmune diseases 4. UTI 5. nephrolithiasis 6. meds
67% of renal calculi are made with or without ? phosphate
12% of renal calculi are made from ? magnesium ammonium phosphate
8% of renal calculi are made from __ __ and another 8% are made from __. calcium phosphate, urate (uric acid)
1-2% of renal calculi are made from ? cystine
2-3% of renal calculi are made from ? mixtures
Increased concentration of chemical salts due to dehydration or increases in dietary salts can cause ? kidney stones
Changes in urinary __ can cause kidney stones. pH
Presence of a foreign __ can cause kidney stones. body
Urinary __ can cause kidney stones. stasis
What percentage of a renal calculi is made from magnesium ammonium phosphate? 12%
What percentage of a renal calculi is made from cystine? 1-2%
What percentage of a renal calculi is made from urate? 8%
What percentage of a renal calculi is made from calcium oxalate? 67%
What percentage of a renal calculi is made from calcium phosphate? 8%
What percentage of a renal calculi is made from various mixtures? 1-2%
Proteins are complex polymers of __ acids that are produced by living cells in all forms of life. a-amino (alpha amino)
Each protein is composed of a max of __ different amino acids in varying numbers and sequences. 20
All proteins contain what 4 substances? 1. hydrogen 2. oxygen 3. nitrogen 4. carbon
Amino acids contain an what 3 groups along with hydrogen? amino, carboxyl, R
In amino acids, when both NH2 group and the proton-donating group are ionized, the amino acid is called ? an ampholyte or a dipolar ion
What do you call the pH at which an amino acid or protein has no net charge? isoelectric point
When an amino acid or protein has a pH greater than the isoelectric point, it carries a (negative or positive?) charge. negative
The end of the protein that has the amino-free group is called the ? N-terminal end
The end of the protein that has the carboxyl-free group is called ? C-terminal end
When an amino acid or protein has a pH that is less than its isoelectric point, the protein has a (negative or positive?) charge. positive
Secondary structure of a protein is determined by the interaction of adjacent ? amino acids
What are the 3 possible conformations describing the secondary structure of a protein? 1. a-helix 2. B-pleated 3. random coils
The a-helix structure looks like a ? coiled spring
A b-pleated sheet structure looks like ? triangular moutains
The random coil structure looks like a ? squiggly line
What do you call the way that the protein structure folds back upon itself to form a 3-dimensional structure? tertiary structure
Which structure determines the chemical and physical properties of the protein? tertiary
The arrangement of 2 or more polypeptide chains to form a protein is called ? quaternary structure
Which kind of proteins have a quaternary structure? Proteins with more than one polypeptide chain
Disruption of the bonds holding the secondary, tertiary, or quaternary structures together is called ? denaturation
Proteins that support the body, tissues, or cells, (like collagen) are ? structural proteins
What transport protein binds with thyroxine and triiodothyronine (thyroid horomones) and retinol (vitamin A)? Transthyreti (TTR - pre-albumin)
Albumin is synthesized in the liver and comprises about __ of the total serum protein. 60%
What is the main function of albumin? Maintain plasma colloidal osmotic pressure (COP)
A1-antitrypsin (AAT) is the major a1- globulin in the body. It makes up what percent of the a1-proteins? 90%
A1-antitrypsin (AAT) is an acute phase reactant and an anti __; meaning that it neutralizes WBC elastase and collagenase. protease
AAT deficiency is one of the most common genetically lethal diseases in __, affect 1 in every 4000. caucasians
Emphysema onset at __ years of age or earlier (in the absence of smoking) is a common symptom of AAT deficiency. 45
A congenital deficiency of AAT can causes juvenile __ __ where AAT is synthesized by hepatocytes but not released. hepatic cirrhosis
A1-acid glycoprotein (AAG) is the major glycoprotein to increase during __, making it an acute __ __. inflammation, phase reactant
What is the principle fetal protein in maternal serum used to screen for antenatal diagnosis of neural tube defects, such as spina bifida and anencephaly? alpha-fetoprotein (FP)
What is decreased in Down syndrome and trisomy 18? alpha-fetoprotein (AFP)
AFP (alpha-fetoprotein) can be used as a __ marker. tumor
What protein is an a2-globulin and an acute phase reactant that binds free hemoglobin? haptoglobin
Haptoglobin depletion is the most sensitive indicator of __ __. intravascular hemolysis
What is the principle copper-containing protein found in plasma, containing 95% of the total serum copper? ceruloplasmin (Cp)
The main storage place for ceruloplasmin (Cp) in the body is the __ and main site of excretion is the __ __. liver, biliary tract
What is the name of a rare autosomal recessive trait where ceruloplasmin (Cp) levels are reduced and the dialyzable copper concentration is increased. Wilson's Disease (WD)
In cases of Wilson's Disease, copper deposits can form in the eyes. These are called ? Kayser-Fleischer rings
AMG (a2-macroglobulin) is increased up to 10 times normal during what syndrome? nephrotic syndrome
Besides nephrotic syndrome, AMG (a2-macroglobulin) is elevated in what conditions? 1. liver disease 2. diabetes mellitus (slightly) 3. estrogen (as in hormone replacement therapy and birth control)
What kind of proteins have a metal ion attached to the protein? Ceruloplasmin is one. metalloproteins
What kind of proteins contain lipids like cholesterol, triglycerides, and phospholipids? lipoproteins
What kind of proteins consist of simple proteins and carbs that make up less than 4% of total weight? glycoproteins
Mucoproteins are linked to ? large, complex carbs
A combination of simple protein and nucleic acids (DNA, RNA) are called ? nucleoproteins
Conjugated proteins without their nonprotein groups or ligands are called ? apoproteins
Compact, folded, coiled chains that are pretty soluble are called __ proteins. They are one of the 2 major protein groups. globular
Fibrous proteins, one of the 2 major protein groups, are __ proteins. structural
Proteins that are composed only of amino acids, like albumin, are called ? simple proteins
Proteins with nonprotein groups attached to them are called ? cojugated proteins
Who are most at risk of PEM (protein-energy malnutrition)? There are 3 answers. The elderly, the hosptilized, nursing home
A sensitive indicator of quality of someone's protein intake is ? TTR (transthyretin)
What is the reference range for transthyretin? 190-359 mg/dL
What is the most common cause of decreased albumin levels? hypoalbuminemia due to tissue damage and inflammation
A congenital defect in the walls of the spine that allows a protrusion of the spinal cord or meninges is called ? spina bifida
A congenial absence of the brain or cranial vault is called ? anencephaly
What protein removes heme from circulation? hemopexin
Increased levels of hemopexin are found in cases of ? pregnancy and diabetes mellitus
Decreased levels of hemopexin are found in cases of ? malignancies, hemolytic anemias, Duchenne-type muscular dystrophy
C-Reactive proteins levels in the serum are usually less than __ and are often undetectable in healthy patients. .8 mg/dL
What is the reference range for albumin? 3.4-5.0 g/dL (or 34-50 g/L)
The migration of charged solutes of particles in a liquid medium under the influence of an electrical field is called ? protein electrophoresis
Which element distinguish proteins from carbs and lipid compounds? Hydrogen
What is the common property of amino acids? They're obtained on hydrolysis of starch
Amino acids are joined to form proteins through ? peptide bonds
At its isoelectric point, a protein is ? neutral
The chemical bond between amino acids in the primary structure of proteins are ? peptide bonds
Alpha helixes and b-pleated sheets describe the __ structure of proteins. secondary
The primary function of albumin is to ? regular colloidal osmotic pressure
What is the most common cause of hyperproteinemia? dehydration
Transferrin transports ? ferric ions
Which protein transports thyoxine and vitamin A in the blood and even serves as a marker of nutritional status? transthyretin
Wilson's disease is associated with a deficiency of ? ceruloplasmin
Early onset of emphysema and juvenile cirrhosis are associated with a deficiency of ? a-1 antitrypsin
Hypoproteinemia would be found in cases of ? nephrotic syndrome
Globulin in serum is usually determined by ? calculation as difference between total protein and albumin
Albumin, Transthyretin, and transferrin are all negative ? acute phase reactants
pH 8.6 is used for serum protein electrophoresis so that ? All serum proteins have a net negative charge
Hepatic cirrhosis is associated with what kind of bridging? beta gamma bridging
How many heavy chains and how many light chains make up an IgG molecule? 2 heavy 2 light
Haptoglobin migrates in the a2-globulin region at what pH? 8.6
Elevated serum protein and decreased albumin are associated with ? multiple myeloma
What's the clinical significance of testing of prealbumin? could indicate poor nutrition
__ is associated with an acute inflammatory pattern on protein electrophoresis? myocardial infarction
The screening test for antenatal detection of neural tube defects is ? alpha feloprotein
What are the 4 steps of blood flow through the nephron? 1. afferent arteriole 2. efferent arteriole 3. peritubular capillaries 4. vasa recta
What are the 3 primary substances removed from the blood by tubular secretion? 1. protein bound substances (like penicillin) 2. hydrogen 3. potassium
What comprises the majority of the the nonprotein-nitrogen fraction in serum? urea
True or false: severe liver disease elevates the plasma concentration of urea. false
The plasma urea concentration is increased by ? urinary stasis OR dehydration
Tumors in the bladder that obstruct urine flow will cause what kind of azotemia? postrenal
Uremia and nephrotic syndrome are causes of what kind of azotemia? renal
A BUN of 9 mg/dL is obtained by a technologist. What is the urea concentration? 19.3
Urea may be determined after a reaction with urease by measuring __ in an indicator reaction. ammonia
What is the range of the normal ratio of urea nitrogen to creatinine? 12:1 - 20:1
A high BUN:CR ration with a significantly elevated creatinine is usually seen in what condition? tubular necrosis
The amount of creatinine in urine is directly related to what? severity of renal disease
The measurement of creatinine is based on the formation of yellow-red color when creatinine reacts with ? alkaline picrate
Creatinine clearance is used to estimate the ? GFR
If a patient's urine creatinine is 90mg/dL, serum creatinine is .90mg/dL, total body mass is 1.73m2, and 24 hour urine volume is 1500mL, then the patient's creatinine clearance in mL/min should be ? 104 mL/min
Uric acid is derived from the catabolism of ? purines
Gout is a pathological condition characterized by the accumulation of which of the following in joints? uric acid
John Doe is admitted to the hospital for a complete workup. His chemistry screening profile results are: BUN 12mb/dL, CR 1.5mg/dL, uric acid 60 g/dL. What condition does the patient have? gout
A patient has a creatinine of 2.5mg/dL, cholesterol of 200mg/dL, glucose of 110mg/dL, urea (BUN) of 40mg/dL, and uric acid of 6.9mg/dL. What condition are these results most consistent with? Impaired renal function
A tech obtains a BUN of 59mg/dL and serum CR of 3.1mg/dL on a patient. These result indicate that the patient has ? renal disease
Are plasma levels or creatinine highly dependent on diet? no
True or false: A uric acid level of 11mg/dL correlates with the rapid turnover of chemotherapy treatments. true
Created by: IsaacJ