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6- UA > 3- Chemical Analysis of Urine > Flashcards

3- Chemical Analysis of Urine Flashcards

1
Q

Def: a basic diagnostic tool used to determine pathological changes in a patient’s urine in standard urinalysis

A

urine test strip

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2
Q

urine test strip aka

A

dipstick

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3
Q

whats the time frame to read the dipstick

A

60 to 120 seconds

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4
Q

Urine pH normally fluctuates between

A

acidic and alkaline

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5
Q

what is the Acid indicator

A

methyl red

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6
Q

what is the Alkaline indicator

A

bromthymol blue

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7
Q

Urine pH range

A

5.0 to 8.5

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8
Q

more phosphates, sulfates results in more

A

acidic urine

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9
Q

Vegetable diet results in urine pH higher than

A

6

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10
Q

Factors resulting in persistent Acidity

A

– Dehydration
– Diarrhea
– Fever
– Diabetes ketoacidosis
– Gout
– Pulmonary emphysema
– High protein diets or cranberries
– Renal tubular acidosis (proximal tubular, distal tubular) metabolic acidosis
– Acidifying drugs ( for ammonium magnesium stone prevention)

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11
Q

Factors resulting in persistent Alkalinity

A

– Acute and chronic renal failure
– Urinary tract infections
– Bacterial contamination of urine
– Alkaline drugs
– Diuretics

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12
Q

the source of low–molecular weight protein could be found in the urine

A

genito-urinary tract

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13
Q

Mucoprotein Tamm-Horsfall (T-H) is secreted by

A

renal tubules (renal epithepial cells)

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14
Q

Mucoprotein Tamm-Horsfall (T-H) is not derived from

A

blood plasma

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15
Q

the amount of T-H protein is
excreted in urine?

A

Less than 150 mg/24 h (or 20 mg/dL)

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16
Q

T-H protein is a ____ for formation of calculi or casts

A

matrix

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17
Q

Testing for protein is based on

A

Protein Error of pH Indicators

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18
Q

define “Protein Error of pH Indicators”

A

ability of protein to alter the color of some acid-base indicators without altering the pH

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19
Q

Protein Error of pH Indicators is more sensitive
to _____ than ______

A

more sensitive to albumin than to globulin

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20
Q

Urine protein:

false positive May result from

A
  • highly buffered alkaline urine (medications or old urine)
  • prolonged exposure to the sample (too long)
  • container cleaning compounds (quaternary ammonia)
  • some skin cleaners
  • blood in urine
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21
Q

Urine protein:

false negative may result from:

A
  • diluted urines
  • elevated amounts of proteins other than albumin
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22
Q

Urine protein: significance

Which factors which could result in temporary proteinuria (transient proteinuria, “trace”):

A
  • strenuous exercise
  • postural proteinuria
  • dehydration
  • exposure to heat or cold
  • fever
  • emotional stress
  • pregnancy
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23
Q

what Diseases tha resutl in persistent proteinuria

A
  • glomerulonephritis
  • pyelonephritis
  • malignant hypertension
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24
Q

____ % of glucose is reabsorbed in the proximal tubules

A

100%

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25
Q

*** Usually, urine doesn’t present unless threshold levels exceeded ______

A

160-180 mg/dl

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26
Q

*** Dipstick test is sensitive for what kind of sugars?

A

Glucose only

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27
Q

Urine glucose:

false positive may result from

A
  • after using oxidizing cleaniers (peroxide, hypochlorite)
  • in patients taking Levodopa (Parkinson’s disease)
  • high levels of ketones in urine
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28
Q

Urine glucose:

false negative may result from

A
  • cool urine
  • high specific gravity urine (due to uricosuria)
  • alkaline urine due to bacterial contamination of old urine
  • ascorbic acid (Vitamin C) in high doses can inhibit the enzymatic reaction
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29
Q

Glucose can be present in urine after how many hours from eating sweets?

A

2 hours

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30
Q

urine glucose that presnt after eating sweets is known as:

A

transient glucosuria

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31
Q

Glucosuria depends on

A

– blood glucose levels
– glomerular filtration rate
– tubular reabsorption

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32
Q

Glucosuria is seen in patient with

(what conditions)

A

diabetes mellitus

congenital forms of glucosuria

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33
Q

Persistent glucosuria develops in:

A
  • diabetes mellitus
  • CNS problems (stroke, neoplasms)
  • kidney problems (e.g. uremia)
  • endocrine problems (e.g. acromegaly, pheochromocytoma)
  • liver disorders (e.g. glycogen storage disease)
  • pharmaceutical agents (e.g. diuretics, birth control pills)
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34
Q

a second method for the measurement of sugar in urine

A

Clinitest

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35
Q

what kind of sugars does clinitest measures?

A

Glucose, and other reducing sugars

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36
Q

Clinitest: false positive may result from

A

• Ascorbic acid
• Cephalosporins
• Probenecid (treating gout and hyperuricemia)
• Urinary preservatives:
– formalin<br></br> – formaldehyde

37
Q

Clinitest: false negative may result from

A

Technique errors

38
Q

what test is used to determine the presence of
reducing sugars?

A

Benedict’s test

39
Q

reducing sugars in urine includes

A

fructose

glucose

maltose

galactose

lactose

40
Q

Urine reducing sugar test Is used for early screening detection of

A

galactosemia or diabetes

41
Q

_____ are produced normally by the liver as part of
fatty acid metabolism

A

Ketones

42
Q

Normally, the urine (should/should not) contain a noticeable concentration of ketones

A

Should not

43
Q

Dipstick test determines wich acid? (acetoacetic acid/beta-hydroxybutyric acid)

A

acetoacetic acid

44
Q

Urine ketones: false positive or atypical color

results from:

A

• Highly pigmented urine
• Combination of high specific gravity and a low pH
• Dehydration
• Phenylketones
• Some medications
• Ascorbic acid
• Positive and questionable results may be confirmed with a
tablet test

45
Q

Urine ketones: false negative
resutls from

A
  • Delay in testing (old urine)
  • Loss of reagent reactivity
46
Q

Urine ketones confirmatory test is called

A

Acetest

47
Q

does Acetest react with beta-hydroxybutyric acid?

A

No

(no body likes beta-hydroxybutyric)

48
Q

• Ketone bodies can be determined in the following diseases:

A
  • diabetes mellitus
  • malabsorption syndrome (diarrhea)
  • exposure to cold
  • fasting
  • fever
  • insufficient carbohydrate intake
  • malnutrition
  • strenuous exercise
  • vomiting
49
Q

Hematuria: blood in urine may be released from any organ of ________

A

genito-urinary tract

50
Q

Hemoglobinuria is due to

A

intravascular distraction of RBC - Glomerular filtrate

51
Q

Myoglobinuria is due to

A

muscle damage - Glomerular filtrate

52
Q

Blood color chart

A
53
Q

Urine blood/hemoglobin: false positive

A
  • Cleanser - Oxidizing contaminant (Hypochlorites)
  • Bacterial peroxidases
  • Menstrual blood
54
Q

Urine blood/hemoglobin: false negative

A
  • Technique errors inadequate mixing of urine sample
  • Formalin preservative
  • High concentrations of ascorbic acid (Vitamin C)
  • High specific gravity
  • Nitrites
  • Proteins
55
Q

Define Hematuria

A

the presence of blood or intact RBCs in the urine

56
Q

highly alkaline urine or has a very lowspecific gravity (1.007) can cause the red cells to

A

Lyse and release hemoglobin to urine

57
Q

empty red cell membranes aka

A

“ghost” cells

58
Q

Transient hematuria may result from:

A
  • strenuous exercises
  • menstrual contamination
59
Q
  • *Persistent** hematuria:
  • can develop in renal diseases in:
A

glomerular
tubular
interstitial
vascular
trauma of kidneys

60
Q
  • *Persistent** hematuria:
  • also present in patients with
A

urolithiasis (kidney stones)
urinary tract infections
urinary tract tumors

bleeding disorders related to anticoagulant therapy prostatic cancer
gynecological disorders
virus infection (e.g. Ebola)
61
Q

Define myoglobinuria

A

Damage to cardiac or skeletal muscles

62
Q

Both hemoglobin & myoglobin will be + on strip blood results becasue both contain:

A

heme

63
Q

Normal Bilirubin Pathway

A
64
Q

because only conjugated bilirubin appears in
urine, bilirubinuria implies what diseases?

A

Liver or cholestatic diseases

65
Q

Why unconjugated bilirubin is not filtered by the glomerulus?

A

bilirubin is tightly bound to albumin

66
Q

A positive test for urine bilirubin confirms that any raised plasma levels are from:

A

conjugated hyperbilirubinemia

67
Q

Normally, _____ amounts of bilirubin are present in urine

A

no detectable

68
Q

Urine bilirubin: false positive

A

• Technique errors:
– reading after the prescribed time
• Atypical color reactions produced by some medicines
• Confirm results with Ictotest

69
Q

Urine bilirubin: false negative

A

• Large amounts of ascorbic acid decrease the sensitivity of the dipstick
• High levels of nitrite
• Exposure to light and room temperature
– bilrubin oxidizes to biliverdin

70
Q

Urine bilirubin confirmatory test is called

A

Ictotest

71
Q

The presence of bilirubin in urine indicate to:

A

– gallbladder, bile duct obstruction
– liver pathology (e.g. hepatitis)

72
Q

About ____% of urobilinogen reabsorbed into the bloodstream, returns to the liver, and reexcreted into the intestines

A

10–15

73
Q

Normal level of urobilinogen excretion

A

1–4 mg/24 h

or

less than 1.0 Ehrlich unit/2h

74
Q

Urobilinogen color chart

A
75
Q

Urine urobilinogen: false positive

A
  • aspirin
  • sulfonamides
  • nitrites (e.g. in UTI)
  • porphyria
76
Q

– which test is used to differentiate
between porphobilinogen and urobilinogen

A

Watson-Schwartz test

77
Q

Urine urobilinogen: false negative

A
  • Use of stale urine that has been exposed to light
  • Formalin
  • Antibiotics (broadspectrum) which alter the normal<br></br>bacteria flora in the intestines, because urobilinogen<br></br>cannot be formed in the intestines.
78
Q

urobilinogen Peak levels between

A

2-4 p.m

79
Q

urobilinogen Elevated in

(diseases)

A

– Liver disease
– Intestinal obstruction
– Hemolytic anemia

80
Q

a rapid, indirect method for the early
detectionof significant and asymptomaticbacteriuria

A

nitrite

81
Q

To convert nitrate to nitrite, urine must have incubated in the bladder for a minimum of

A

4 hours

82
Q

If UTI is caused by __________, the reaction will be negative

A

non-nitrate reducers (e.g. Mycobacteria),

83
Q

Nitrite color chart

A
84
Q

Urine nitrite: false positive

A

The dipstick is highly sensitive to air exposure
The urine should be tested shortly after voided, because at room temperature for several hours specimen could be contaminated by bacteria

85
Q

Urine nitrite: false negative

A
  • Specimen containing non-nitrate reducing pathogens
  • Insufficient time in the bladder (less than 4 hours)
  • Low or no nitrate diet
  • Elevated specific gravity of urine
  • High level of urobilinogen in urine
  • Ascorbic acid
86
Q

If there are clinical symptoms, then ______________ should be performed, even if the nitrite test is negative

A

regular bacteriology tests

87
Q

Leukocyte Esterase color chart

A
88
Q

Urine leukocyte esterase: false positive

A
  • Trichomonas infection
  • Contamination by vaginal discharge
  • Formalin used as preservative
89
Q

Urine leukocyte esterase: false negative

A
  • High level of Ascorbic acid
  • High level of protein, glucose ( high specific gravity)
  • Some antibiotics (Cephalexin, Keflex,Tetracycline)

6- UA (9 decks)

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