4 - Lab Testing Flashcards
He said
This stuff is high yield, maybe focus a little more on it
But i’m not your mom do what you want
Pt evals for suspected renal disease must include (at a min):
- H/P
- UA w dipstick/microscope
- BUN and
- serum creatinine
- assessment of GFR
UA is aka?
Poor man’s renal biopsy
Urine is assessed for?
Assessed for:
- Apperance
- chemical test (dipstick)
- microscopic exam
Preferred collection method?
Clean catch, midstream sample
What does the exam of the urine sediment tell you?
Valuable clues about renal parenchyma
Apperiance factors for urine?
Color
Clarity
Odor
Urine color indicates?
Normally clear-dark yellow
Color darkens
- H concentration (dehydration)
- myoglobinuria
- bilirubinuria
- kidney disease
Color changes:
- orange: phhenazopyrieind, nitrofurantoin, rifampin, metrnidazol
- pink: hemolysis
Pic on slide 11
Clarity values?
- cloudy -> pyruia and suspended crystals
- alkaline urine
Examples of normal results and dipstick pics?
Slides 12-16
What is leukocyte esterase?
An enzyme produced by neutrophils
POS: WBCs in urine
False pos/neg for leukocyte esterase?
False pos: contamination
False neg: glycosuria, concentrated urine, drugs, not waiting long enough for testing
What causes nitrites?
Many gram-neg bacteria (esp e. Coli) can reduce nitrate to nitrite
1st morning void is best
Positive nitrite?
Bacterial infection
- neg doesnt r/o bacterial infection
Trace protein =
= 150mg
Protein indicates?
Usually 1st indication of renal disease
Mostly albumin on dipsticks
Normal pH?
- 0-6.0 - 1st morning sample
- 5-8.0 - random samples
The dipstick shows 5.0-8.5 so random is basically useless
Urinary pH is useful in the diagnosis of?
UTIs
Urinary stone
Disease
Renal tubular acidosis
Blood is 7.4ish so how does urine get more acidic?
Glomerular filtrate enters the tubule at normal physiologic pH (7.4) and acidifies in the DCT and collecting duct
What does the blood square measure?
Intact erythrocytes
Free hemoglobin
Myoglobin
False pos/neg blood?
False pos: menses, concentrated urine
False neg: high ascorbic acid
Normal specific gravity?
1.005-1.030
Spec gives indication of?
Insight into
- urine osmolality
- dehydration and shock (high)
- overhydration or impaired ability to concentrate (lower)
Ketones
Detects acetic acid
Normal urobilinogen?
0.2-1.0mg/dL
(Shows as “normal” on the dipstick
Where does urobilinogen come from?
Formed in intestinal tract by bacterial breakdown
of conjugated bilirubin
– 50% reabsorbed into portal circulation & reprocessed
by liver
– small amount is normally excreted in urine
– majority is excreted via feces
High urobilinogen suggest?
Hemolysis
Hepatocellular disease
- hepatitis and cirrhosis
If you still dont understand the bili process
Slide 32 has a pic
Cant hurt its only been taught 5-6 times maybe this time itll stick
High bilirubin in serum (bilirubinemia) leads to:
Bilirubinuria (bilirubin in the urine)(normally urine should have NO bilirubin)
Suggest hepatocellular disease
- liver can’t clear conjugated bili
- cirrhosis or hepatitis
Normal glucose?
<0.1% (below the sensitivity level of UA dipstick)
How is the microscopic analyses processed?
Centrifuged urine sediment exam under microscope
You must request “micro”
What is “significant” level of erythrocytes?
> 3 RBCs per HPF (high power field)
The need a further workup
RBC appearance/morphology?
Round/normal: disease in epithelial tract
Dysmorphic: (irregular) nephrotic syndrome
Creanated (shrunken/scalloped) concentrated urine
Cell ghosts: swollen RBCs due to dilute urine
Regular ghosts: paranormal infection