Act 3-7: Chemical Determination Of Urine

Question 1

The most indicative of renal disease is the

Answer 1

urinary protein determination.

Question 2

is often associated with early renal disease, making this test important to any physical examination.

Answer 2

presence of proteinuria

Question 3

The protein content of urine consists primarily of ________________ that have been filtered by the glomerulus and proteins produces in the genito-urinary tract.

Answer 3

low-molecular-weight serum proteins

Question 4

is the major serum protein found in normal urine but content is low because majority of the __________ presented to the glomerulus is not filtered and much of the filtered form is reabsorbed by the tubules.

Answer 4

Albumin

Question 5

Other proteins include

Answer 5

small amounts of serum and tubular microglobulins, Tamm-Horsfall protein produced by the tubules and proteins from prostatic, seminal and vaginal secretion.

Question 6

The causes of proteinuria are grouped into three major categories.

Answer 6

Pre-renal proteinuria
Renal proteinuria
Post-renal proteinuria

Question 7

Example of pre-renal proteinuria

Answer 7

Bence Jones Protein

Question 8

An abnormal protein secreted by
persons with Multiple Myeloma

Answer 8

Bence Jones Protein

Question 9

Bence Jones Protein Coagulates at temperature between ________ and dissolves when the
temperature reaches _______

Answer 9

40 ̊C and 60 ̊C; 100 ̊C

Question 10

is a proliferative disorder of the immunoglobulin producing plasma cells in which the serum contains markedly elevated levels of monoclonal immunoglobulin light chains (Bence Jones Protein)

Answer 10

Multiple Myeloma

Question 11

Associated with true renal disease and may be the result of either glomerular or tubular damage

Answer 11

RENAL PROTEINURIA

Question 12

are the major causes of proteinuria due to glomerular damage.

Answer 12

amyloid material, toxic substances and the immune complexes found in lupus erythematosus and streptococcal glomerulonepthritis

Question 13

Caused by protein that has been added as the urine passed through the structures of the lower urinary tract

Answer 13

POSTRENAL PROTEINURIA

Question 14

is proteinuria that occurs frequently in young adults. It occurs following periods spent in a vertical posture and disappears when a horizontal position is assumed.

Answer 14

Orthostatic
proteinuria)

Question 15

is used to denote proteinuria that cannot be detected by routinely used reagent strips.

Answer 15

Microalbuminuria

Question 16

Microalbuminuria is used to denote proteinuria that cannot be detected by routinely used reagent strips. Values are reported as the albumin excretin rate (AER) in ug/min. mg/24hrs and the almubin:creatinin ratio. This is considered significant when the AER is

Answer 16

20 to 200 ug/min, 30 to 300 mg of albumin are excreted in 24 hours or the albumin:creatini ratio is greater than 3.4mg/mmol.

Question 17

Urinary protein is denatured by acid and heat so that it became less soluble and is precipitated and coagulated respectively by acid and heat.

Answer 17

Heat and Acetic Acid Test:

Question 18

Procedure of Heat and Acetic Acid Test? 3 steps

Answer 18

1. Fill a clean test tube almost the top with clear urine. The supernatant clear urine in the centrifuge tube can be used.
2. Heat the upper third to the boiling point. The lower portion should not be heated, since it serves as a contrast.
3. If a cloud forms add a few drops of 5% acetic acid. Heat once more and place in a rack. Read the results at once.

Question 19

Positive result of heat and acetic acid test

Answer 19

Cloudiness or precipitate

Question 20

Heat and acetic acid test: If cloudiness remains after the addition of acid, it is due to ___________; but it if disappears, it is due to ________.

Answer 20

Albumin or nucleoprotein; phosphates

Question 21

Heat and Nitric Acid Test (Heller’s) procedure (2)

Answer 21

1. Boil about 5cc. of filtered urine in a test
   tube
2. Add 1 to 3 drops of concentrated nitric
   acid

Question 22

Positive result of heat and nitric acid test (heller’s)

Answer 22

A white cloud of flocculent precipitate

Question 23

Procedure of Sulfosalicylic Acid Test (2)

Answer 23

1. Place a 2mL of urine in a test tube
2. Add an equal volume of Exton’s reagent

Question 24

Positive result of sulfosalicylic acid test

Answer 24

Cloudiness or precipitate

Question 25

Procedure of reagent strip (5)

Answer 25

1. Place 10-12mL of urine in a test tube 2. Dip a reagent strip into the urine specimen 3. Wait for the result. Follow the specified time indicated on the container 4. Compare the result of the strip with the chart printed at the back of the container 5. Note down the results.

Question 26

Methods of chemical determination of protein in urine (4)

Answer 26

Heat and acetic acid test Heat and nitric acid test Sulfosalicylic acid test Reagent strip

Question 27

Glucose is present in glomerular filtrate and is reabsorbed by the?

Answer 27

proximal convoluted tubule

Question 28

If the blood glucose level exceeds the reabsorption capacityof the tubules, glucose will

Answer 28

appear in the urine

Question 29

Tubular reabsorption of glucose is by ___________ in response to the body’s need to maintain an adequate concentration of glucose.

Answer 29

active transport

Question 30

The blood level at which reabsorption steps is termed renal threshold, which for glucose is

Answer 30

160-180 mg/dl (9-10 mmol/L)

Question 31

These are based on the reduction of cupric ions by glucose. When the compounds are added to urine, a heat reaction takes place. This result in precipitation and a change in the color of the urine if glucose is present.

Answer 31

Reduction Tests (Clinitest)

Question 32

Reference value of glucose in urine: Random specimen and 24 hour specimen

Answer 32

Random Specimen: Negative 24 hour specimen: 1-15 mg/dl (60-830 umol/L) or, <0.5 g/24 hours

Question 33

Principle of reduction tests

Answer 33

Soluble cupric ions of copper sulfate in heated, strongly alkaline solution are reduced by urinary reducing agents such as glucose from yellow to brick red insoluble cupric ions of cuprous oxide

Question 34

Procedure of benedict’s test (3)

Answer 34

1. Place 5 ml of Benedict’s qualitative solution in a clean test tube 2. Add 8 to 10 drops of urine and mix thoroughly 3. Boil for several minutes and allow to cool spontaneously

Question 35

Positive result for benedic’s test

Answer 35

a red or yellow precipitate will appear.

Question 36

Procedure for fehling’s test (3)

Answer 36

1. Prepare Fehling’s qualitative reagent by mixing equal parts of A and B solutions. Dilute approximately four parts of distilled water. 2. Place about 5cc of the diluted reagent in a clean test tube. Heat to the boiling point. 3. Add urine drop by drop until about 5cc have been added. Boil once more.

Question 37

Positive result for fehling’s test

Answer 37

a red or yellow precipitate will form.

Question 38

Methods for chemical examination of glucose in urine

Answer 38

Benedict’s test Fehling’s test

Question 39

Ketones, which result from the metabolism of fatty acid, consist mainly of three substances:

Answer 39

Acetone, beta- hydroxybutiric acid and acetoacetic acid.

Question 40

which result from the metabolism of fatty acid

Answer 40

Ketones

Question 41

The excess presence of ketones in the urine (ketonuria) is associated with

Answer 41

dibetes or altered carbohydrate metabolism.

Question 42

Sodium nitoprusside is decomposed in alkaline solution. The resulting compound are strong, oxidizing agents in the presence of diabetic acid and sensitive diacetic acid than for acetone. This is the principle for?

Answer 42

Chemical determination of acetone in urine

Question 43

Positive result for Rothera’s Test

Answer 43

A red purple color will develop at the point of contact. The color may appear for 10-15 minutes.

Question 44

This substance frequently appears in connection with dextrose. It appearance in diabetic patients seems to indicate an advanced case.

Answer 44

Levulose

Question 45

Levulose come from the word __________ due to the fact that it rotates to the left.

Answer 45

levo- rotary

Question 46

Procedure of Resorcinol-Hydrochloric Acid Test (Seliwanoff’s Test) (3)

Answer 46

1. Take 5 ml of Seliwanoff’s reagent in a test tube 2. Add a few drops of urine under test 3. Heat the mixture to boiling for about one minute.

Question 47

Positive result for Resorcinol-Hydrochloric Acid Test (Seliwanoff’s Test)

Answer 47

Red color production and separation of a red precipitate.

Question 48

Procedure of Borchardt’s Test (7)

Answer 48

1. Take 5 ml of urine in a test tube 2. Add 25% of hydrochloric acid 3. Add few crystals of resorcinol 4. Boil for not more than 1⁄2 minute 5. Cool in running water, pour into a beaker 6. Reder alkaline with sodium or potassium hydroxide (solid) 7. Return solution into the test tube and add 2cc of acetic acid and shake

Question 49

Positive result of Borchardt’s Test

Answer 49

The ether will be colored yellow

Question 50

Substances that will interfere in the Borchardt’s test

Answer 50

Indican and nitrites

Question 51

is present in the urine of nursing women as well as in those towards the last months of pregnancy.

Answer 51

Lactose or mil-sugar

Question 52

It has been demonstrated in the urine of patients who have been on an exclusive milk diet for a sufficiently may be mistaken for glucose, since it gives positive reactions with copper reducing substance.

Answer 52

Lactose or mil-sugar

Question 53

Procedure of Rubner’s Test (6)

Answer 53

1. Take 10 ml of urine in a test tube 2. Add 3 grams of lead acetate 3. Shake well and filter off the precipitate 4. Boil the filter for a few minutes ( a yellowish brown color appears) 5. Then add 1 or 2 ml of strong ammonia 6. heat the mixture again

Question 54

Positive result of rubner’s test

Answer 54

The solution will turn brick- red and a red precipitate will separate

Question 55

Glucose gives a red solution with a yellow precipitate, therefor the precipitate is

Answer 55

criterion

Question 56

are of little clinical importance. Maltose reduces copper salts but sucrose does not. Both sugars are fermentable by yeast.

Answer 56

Maltose and Sucrose (cane-sugar)