2 Flashcards
What does the physical examination consist of?
1) Color and clarity
2) Clarity
3) Foam
4) Odor
5) Concentration
What is the definition of a “Random” type (timing of collection)?
Unspecified, can be collected at any time, most common screening purposes, can sometimes give an inaccurate view of a patient’s health
What is the definition of a “First Morning” type (timing of collection)?
First voided the urine is generally more concentrated, contains relatively higher levels of cellular elements, or protein
What is the definition of “fasting-second” type (timing of collection)?
Voided after 8 hours of fasting
What is the definition of “postprandial-first” type, (timing of collection)?
Voided is before a meal, and to collect a specimen 2 hours after eating
What are the types of “Timing of Collection”?
1) Random
2) First Morning
3) Fasting - second
4) Postprandial - first
What is the definition of the “Timed” aka 24 hour collection?
It is a collection of urine that measures creatinine **, urine urea nitrogen, glucose, sodium, and potassium
What is the definition of a “Midstream Clean Catch” (timing of collection)?
Urine is the preferred type of specimen for bacteria culture* and sensitivity testing because of the reduced incidence of cellular and microbial contamination
For a routine urinalysis, what is needed?
a fresh (less than 1-hour old clean-catch urine sample)
What happens when urine stands at room temperature for a long time?
Casts and red cells undergo lysis, and the urine becomes alkalinized with precipitation of salts
If you are testing urine specimens within a two hour window what do you need to do?
Refrigeration or Chemical preservation should be utilized
What is used for chemical preservation?
- Boric Acid (MOST COMMON*)
- Chloroform
- Formalin
- Thymole
- Toluene
- Preservation Tablet
Preserved urine specimens can be stored at room temperature until _____
time of testing
What are the steps of Routine Urinalysis?
1) Physical Exam
2) Chemical Exam
3) Microscopic Exam
What are you looking for during the physical exam of urine?
- Color
- Transparency (clarity)
- Foam
- Odor
What are the 3 things that are being assessed during the physical examination of urine?
Appearance, Specific gravity, and volume
What is the pigment that gives urine it’s characteristic yellow color?
Urochrome (urobilin)
What substance in urine may contribute to some pinkish or reddish color in urine?
Uroerythrin
What are the 4 colors that are “normal?”
Colorless, straw, yellow, amber/dark yellow
If urine is white and pathogenic, what will it contain?
Chyle, lipids, pyuria
If urine is white and NONpathogenic, what will it be the result of?
phosphates and vaginal creams
Define “Chyle”
A milky body fluid consisting of lymph and emulsified fats, or free fatty acids
Pyuria =
many WBC’s
If you have yellow to amber/orange urine and it’s pathologic, what would be the cause of this?
liver dysfunction (excessive urobilin or bilirubin), and also some Chemotherapy drugs**
If you have yellow to amber/orange urine and it’s NON pathologic, what would you expect the reason for this color change?
- carrots
- concentrated
- urine dehydration
- food color
- vitamin B complex or C
What is the NON pathologic list of things associated with urine chasing to a yellow/amber/orange color?
nitrofurantoin, pygidium, quinacrine, rhubarb, senna, serotonin, sulfasalazine-acriflavine, azo ganstrisin
If you urine has changed to yellow/green, what would be the pathologic reason for this change?
Biliverdin and Bilirubin
If your urine is yellow/green and it is NON pathologic, what is the most likely cause?
Asparagus
If your urine is pink/red, what is the most likely pathologic reason for this?
RBCs, Hemoglobin, Myoglobin, and Porphyrin
If your urine is pink/red and it is NON pathologic, what is the most likely cause?
Beets (anthocyanin) and food colors: (long list)
If your urine is red to purple and it is pathologic what is the most likely cause?
Porphyrin
If your urine is red to purple, can this be non pathologic?
NO, there is definitely something wrong
If your urine is red to brown, what is the most likely Pathologic cause?
Methemoglobin and Myoglobin
If your urine is red to brown, is there any way it can be non-pathologic?
NO, this is bad
If your urine is brown to black, what is the most likely Pathologic cause?
- Bilirubin **
- Methemoglobin**
- Myoglobin **
- Homogentistic Acid (alkapton ***
If your urine is brown to black, what is the most likely cause in NON pathologic cases?
- Iron compounds*
- Fava beans*
- Aloe *
If your urine is Blue to Green and it is pathologic, what is the most likely cause?
- Biliverdin (green)*
- Psudomonas infection*Indicans
If your urine is blue to green and it is NON pathologic, what is the most likely cause?
- Vitamin B12*
- Thymole*
- Diuretic Therapy* (blue urine color)
Why would urine become cloudy?
Due to precipitation of amorphous crystals
Amourphous phosphates precipitate =
WHITE
Amorphous urate precipitate =
PINK (uroerythrin)
Cloudy urine may contain ____
Salts/crystals**
Hazy urine may contain _____
Mucus**
Smoky urine may contain _____
RBCs ***
Turbid urine may contain _____
leukocytes, bacteria, pus, proteins, and epithelial cells **
Milky urine may contain ____
Fat or chyle **
Various non-urinary substances can cause _____
urine specimens to appear hazy or cloudy
If your urine is clear, what is the most likely cause it would be a Pathologic problem?
Very dilute or Polyuria (DM, or DI)
If your urine is clear, what is the most likely cause it would be a NON pathologic problem?
Over hydrated
If urine is cloudy to turbid, what is the most likely pathologic cause of this?
Varying degrees of:
- Casts
- Cells
- Crystals and Calculi
- Fat (lipid, chyle)
- Microorganisms
- Fecal Contamination
If urine is cloudy to turbid, what is the most likely NON-pathologic cause of this?
- Creams, lotions
- Crystals
- Mucus
- Radiographic dyes
- Powders
- Fecal Contamination
What is the tell all sign that foamy urine is pathologic?
It is PERSISTENTLY* foamy urine and becomes more noticeable over time
What is the tell all sign that foamy urine is NON pathologic?
It SOMETIMES develops (the foam)
What are the main causes of foamy urine in regards to Pathologic problems?
- Significant amounts of protein (kidney disease)
- UTI (pus)
- Fistula from colon to bladder
What are the main causes Urine would be foamy under Non-pathologic circumstances?
- Rapid urination
- Foam increased with urine concentration (dehydration)
- Toilet cleaner
Sweet or fruity urine is associated with:
Ketones (e.g. DM)
Pungent urine is associated with:
Bacteria (ammonia) (e.g. UTI)
Maple syrup smelling urine is associated with:
Amino acids (maple syrup urine disease)
Musty or mousy urine odor of an infant is associated with:
Phenylketonuria
Rancid butter or fishy urine odor is associated with:
Hypermethioninemia
Stronger ammonia smelling urine is associated with:
Dehydration
What does a urine concentration test actually test?
specific gravity, refractive index, pKa, osmolarity
What is Urine Specific Gravity (USG)?
Ratio of the weight of a volume of urine to the weight of the same volume of distilled water at a constant temperature
What is Urine Specific Gravity used to measure (USG)?
Measures the concentrating and diluting ability in the kidney
What is one of the first functions to be lost as a result of tubular damage?**
Concentrating ability**
What is the normal range in regards to Urine Specific Gravity (USG)?
1.003-1.035
Urine Specific Gravity simple definition:
Simply the ratio of the density of a substance to the density of water. It is one of the few unites quantities in chemistry
What is the definition of “Refractive Index?”
Ratio of the velocity of light in air to the velocity of light in solution, using a Total Solids (TS) Meter (refractometer)
What is actually occurring when checking the Refractive Index?
The path of light is deviated when it enters a solution, and the degree of deviation or refraction is proportional to the density of the solution
What does Refractive index vary with?
With temperature, but the TS meter is temperature-compensated for temperatures between 60-100 degrees, and requires no corrections in that range
What are you testing with a refractometer?
Testing specific gravity of urine
What is a schematic representation of the refractometer?
Schematic Refractometer TS scale
What does Specific Gravity Reagent Strips (pka) measure?
Measures pKa change of polyelectrolytes in relation to ionic concentration; actually measures ionic concentration
What does specific gravity reagent strips (pka) relate to?
Urine specific gravity
When more ions are present during the specific gravity reagent test strips, what happens?
When more ions are present, more acid groups become disassociated, releasing hydrogen ions and causing pH to change
What would we use to measure the change in pH of urine?
Specific Gravity Reagent Strips (pKa)
In regards to Specific Gravity Reagent Strips (pKa), when urine has an increased specific gravity, what will the reagent pad become?
more Acidic
What does urine osmolality measure?
It measures total solute concentration
What does Urine osmolality depend on?
The number of particles in the solution**
What does specific gravity depend on?
The number and weight of the solutes**
What is a better indicator of the concentrating and diluting abilities of the kidney?
Osmolality because it is unaffected by the density of solutes
What should be used in pathological urines?***
Direct measurement of urine osmolality should be used (uncontrolled diabetes mellitus, nephrotic syndrome and in assessing hydration status)
