Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clinical lab > basic examination of urine > Flashcards

basic examination of urine Flashcards

1
Q

how much blood perfuses the kidney each minute ?/

A

1200ml = 25 percent of cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is basic urine analysis ?

A

specimen evaluation
gross/physical evaluation
chemical screening
sediment examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the types of urine probe ?

A

the first retractable urine in the morning

single random specimen

24 hour urine collection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

appearance and colour if urin directed to its diagnosis ?

A

colurless - very dilute
diabetes insipidus - polyurea

cloudy - phosphates ,
carbonates
dissolves with acetic acid

urates and uric acid dissolves at 60 degrees in alkaline

leukocytes 
bacteria 
spermatazoa 
prostatic fluid 
insoluble in acetic acid

milky
neutrophils -pyuria

lipidurea - nephrotic syndrome , fractures of major long bones
soluble in ether

chylurea - lymphatic obstruction soluble in ether
causes parasitic infections - wuchereria bancrofti / abdominal lymph node enlargemet / tumors
paraffin based vaginal creams

yellow /orange -
concentrated - dehydrated
urobilin in excess

yellow /green
bilirubin/ biliverdin

yellow brown
bilirubin / biliverdin

red / brown
hemoglobin 
erythrocytes 
myoglobin 
reagent strip for blood positive

brown black
methhemoglobin
melanin

uric acid and urates can be white , pink , orange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

urin door of extensive bacterial overgrowth ?

A

ammoniacal fetid odour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lack of odor in urine from patients with acute renal failure suggests

A

acute tubular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The average adult produces how much urine per day ?

A

600–2000 mL

night - less than 400ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Production of more than 2000 mL of urine in 24 hours is termed?

A

polyurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

excretion of more than 500 mL of urine at night with a specific gravity of less than 1.018 is called?

A

nocturea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

causes of polyurea?

A

diabetes insipidus :
pituatory gland not producing enough adh
renal unresponsivness
15L of urin

Defective Renal Salt/Water Absorption
administration of diuretic agents, abnormality of the renal tubules, progressive chronic renal failure.

Osmotic Diuresis- diabetes mellitus with hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cause of decrease in urine volume ?

A

water deprivation, acute renal failure, chronic progressive renal disease

prerenal - chf
sepis
renal artery stenosis or embolic occlusion

post renal - bilateral hydronephrosis
prostatic hyperplasia
bilateral ureteral obstruction - sones

renal - glomerulonephritis
acute tubular necrosis
chronic renal failure - hypertension - nephroscelerois diabetes -associated nephrosclerosis
interstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

methods for measuring specific gravity ?

A

reagent strip ,
refractometer
urinometer
falling drop method

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

most of the specific gravity of urine is done by ?

A

urea
sodium chloride
sulfate
phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the normal specific gravity of urine ?

A

1.003-1.035

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

urine of low specific gravity is called what ?

A

hyposthenuric less than 1.007

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cause of low specific gravity ?

A

diabetes insipidus ,
pyelonephritis
glomerulonehritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the cause for high specific gravity / hypersthenourea ?

A

dehydration - diarhhea , sweating , emesis
glucourea
RAS - renal artery stenosis
adrenal insufficiency
hepatorenal syndrome - decreased flow of blood to kidneys
CHF - decreased blood to kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what s isothenuria and what is t indicative for ?

A

little or no variability in specific gravity around 1.010
indicative for severe renal damage
concentrating and diluting abilities lost
such as in loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the normal osmolality in urine ?

A

500-850 mosm/kg water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the method of evaluating osmolality ?

A

the freezing point depression method

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

for chemical screening of urin what is used ?

A

reagent strips are primarily used

automated instruments available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

in healthy individuals what is the urin ph ?

A

4.6-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the cause of an acidic urine?

A

diet high in meat protein
fruits such as cranberries
metabolic or respiratory acidosis
higher amount of ammonium ions released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the cause of alkaline urine ?

A

diet high in fruits and veg especially citrus
metabolic alkalosis
respiratory alkalosis
increased excretion of bicarbonate in both cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the method of checking urine ph ?

A

reagent strip or Ph electrode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how much protein is excreted daily ?

A

150mg

2-10 mg/dl conc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

most of the urin protein excreted is what ?

A

1/3rd is albumin
Tamm - horsfall glycoportien secreted by DCT and cells of ascending loops of henle - 1/3rd or more
the remaining globulins -a , b and y

small amounts:
plasma proteins with molecular weight less than 50,000 - 60,000
retinol binding 
b2 microglobulin 
immunoglobulin light chains 
lysosmes 
IgA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

reagent strip method is senstive o which type of proteins in urine?

A

only albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what method is used to detect the albumin and globulins and every other proteins in urine ?

A

acid precipitation

electrophoretic separation of urine protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is functional porteinurea ?

A

less than 0.5g /day protein
transient increase in urinary protein excretion caused by changes in glomerular hemodynamics
RESOLVES with appropriate treatment within 2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the cause of functional porteinurea ?

A 
dehydration 
excersise
congestive heat failure 
cold exposure
fever 
postural or orthostatic poteinurea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

in whom can we see transient proteinuria?

A

seen with normal history , normal kidney and normal physical examination occasionally
Normal pregnancy - any porteinurea in pregnancy will need investigation - ABNORMAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

persistant portein urea of 1-2g/day n any asymptomatic person has what ?

A

poorer prognosis than transient intermittent or postural prteinurea
esp accompanied by heamturea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the range for heavy porteinurea and what causes it

A

more than 4g /day

nephrotic syndrome (low serum albumin level , general edema , increased serum lipids - tag , cholesterol)

acute , rapidly progressive , chronic types glomerlunephritis - accompanied by erythrocyte casts
see erythrocytes and casts

malaria / sickle cell

malignant hypertension

neoplasia

toxaemia of pregnancy

heavy metal

drug - penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the range of moderate porteinurea and what causes it ?

A

1-4g /day

causes - nephrosclerosis
multiple myeloma
toxic nephropathy
degenerative/malignant / iflammatory conditions of the LUT such as presence of calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the range of minimal proteinureaand what is the cause ?

A

less than 1g /day

cause - chronic pyleonephritis 
nephrosclerosis
chronic interstitial nephritis 
polycystic disease 
meduallary cystic disease 
RENAL TUBULAR DISEASE!

interstitial nephritis - erythrocytes , leukocytes and tubular cells may be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how can glomerulopathies cause heavy porteinurea ?

A

loss and reduction of the fixed negative charge of the basement membrane allows albumin to permeate into bowman capsule more than they can be reabsorbed

other similar size lost - antithrombin , transferrin , pre albumin

tubular function still intact - very small plasma protein are absorbed largely
also large proteins are absoluetley not seen in urine while the glomerulus is still selective such as a2 macro globulin
b-lipoprotein

larger proteins appears the proteinuria is less selective indicating greater damage to the glomerulus - such as membranous nephropathy and proliferative glomerulonephritis

38
Q

what is tubular pattern of proteinuria associated with

A

associated with small amount of urinary protein that would otherwise be largely reabsorbed

often low molecular weight -a micro globulin , b globulin , b2 micro globulin , light chain immunoglobulin and lysosomes

without a predilection for albumin sized molecules

renal tubular diseases - FANCONI SYNDROME, WILSON DISEASE , CYSTINOSIS , PYELONEPHITIS AND RENAL TRANSPLANATION REJECTION

about 1-2g/day

39
Q

which type of prteiurea maybe missed in reagent strip ?

A

tubular proteinuria because of very low albumin levels or absence
but detected in acid precipitation method

40
Q

what is bench jones prteinurea associated with ?

A

multiple myeloma , macroglobulinemia and malignant lymphomas

41
Q

bence jones porteinurea is missed if what is used to diagnose it ?

A

only a reagent strip is used
need to use electrophoresis and immunofixation electrophoresis
immunoassay measurement of light chains

42
Q

what is the pathophysiology of bench jones porteinurea ?

A

excretion of bench jones protein in are amount causes the tubular cells to deteriorate because of the high levels of protein be reabsorbed

damaged kidney called - myeloma kidney
causing less reasorbition of proteins
and nephrotic syndrome may follow

43
Q

what is the definition of microalbuminurea

A

presence of albumin in urine above normal level but below the detectable level of urine dipstick method

44
Q

what is the cause of microalbuminurea ?

A

lower levels of albumin ranging from 20-200mg/L indicator for early and reversible glomerular damage

diabteic patients (micoalbuminurea associated with four to sixfold increase of cardiovascular mortality and renal mortality risk)

more prevelant in hypertensive

45
Q

what is the method of testing in micoralbuminurea ?

A

immunologic testing and dye binding chemical test strips

46
Q

what is the term for glucose in urine ?

A

glycoseuria

47
Q

what is the cause for glycosuria ?

A

glucose level in blood surpasses renal table capacity of reabsorption
usually when glucose level in the blood is greater than 180-200mg/dl
due to diabetes

but does not have to be concomitant with hyperglycaemia

48
Q

what influences the appearance of glycosuria ?

A

glomerular blood flow
tubular reabsoprtion rate
urine flow

49
Q

what diagnoses method is used for glycosuria ?

A

urine dipstick

can identify also gravitas at increased risk for gestational diabetes

50
Q

what are the cases for ketones in urine ?

A

diabetic ketonurea - diabetes type 1
non diabetic ketoneurea
lactic acidosis
(acetone, acetoacetic acid 3- hydroxybutyrate- any of these three is satisfactory to meet this condition)

51
Q

how can we diagnose ketonuria ?

A

in urine - reagent strips

tablets reacting to 10mg of acetoacteic acid per decilitre

52
Q

how can asymptomatic microscopic hematurea be him detected ?

A

dipstick testing - 16 percent of screening population

53
Q

what is the causes for hematurea ?

A 
membranous nephropathy 
IgA nephropathy 
non IgA mesangioproleferative glomerulonephritis 
focal glomerulosclerosis
neoplastic 
calculi 
anticogulant usage 
cyclophosphamid 
urinary tract infections
54
Q

what is the downfall in using the reagent strip or dipstick method to asses hematurea or hemoglobinurea ?

A

interfering substances, commonly ascorbic acid, and this problem emphasizes the need for a routine microscopic examination to screen for hematuria.

55
Q

what is the cause of hemoglobinurea

A

indicates significant intravascular HEMOLYSIS as opposed to extravascular hemolysis.

hemolytic anemia

erythrocyte trauma - prosthetic cardiac valves
ostium primum repair - turbulence
extensive burns

organisms - malaria , bartonella , clostridium welchii toxin

erythrocyte enzyme deficiency- glucosa -6 -phosphate deficiency - exposure to oxidant drugs -sulfamethazole
antimalarial
fava beans - with diabetic acidosis and infection

unstable haemoglobin disease - exposure to oxidant drugs

56
Q

in moderate hemolysis what is present in the urine test

A

conugated bilirubin is absent
urobilinogen is normal or elevated
hemoglobin is absent
hemosiderin is absent

57
Q

in moderate hemolysis what is the plasma levels

A

bilirubin is elevated
haptoglobin is decrease
hemoglobin is elevated

58
Q

in marked hemolysis what is found in urine?

A 
bilirubin is absent 
urobilinogen is elevated 
hemoglobin is present 
hemosiderin is present l
but in late stages
59
Q

in marked hemolysis what is found in plasma levels ?

A

bilirubin is elvated
haptoglobin is absent
hemoglobin is elevated (markedly)

60
Q

what is the differentiation between hematuria , hemoglobinurea and myoglobinurea

A

hematurea
plasma colour: normal

urine :
color - smoky or pink , red , brown 
many erythrocytes , 
if the initial specimen contain red blood cell  - urethra 
last specimen having it - bladder 
all specimens have red blood cells - upper urinary tract or bladder 
lower urinary tract - no cell casts 
protein can be present or absent

renal - there is red blood cell casts and protein increase

hemoglobinuria
plasma color - pink early
haptoglobin low

urine - 
color - pink , red , brown 
erythrocytes occasionally 
pigment casts - occasionally 
protein - present or absent 
hemosiderin - late 
myoglobinurea 
plasma 
colour - normal
haptogobin - normal 
creatin kinase - marked increase 
aldolase - increased 
urine 
colour - red , brown
erythrocytes - occasional (dense brown?)
casts - occasional 
protein present or absent
61
Q

This conjugated form of bilirubin is called

A

direct bilirubin

62
Q

increased bilirubinurea is caused by

A

alkalosis

bilirubinuria may be present when intracanalicular pressure rises secondary to periportal inflammation, fibrosis, or hepatocyte swelling

Gallstones in the common bile duct and carcinoma of the head of the pancreas

Bilirubinuria is often seen with acute viral hepatitis or drug-induced cholestasis before the appearance of jaundice

typically accompanies jaundice for acute alcoholic hepatitis

exposed to potentially hepatotoxic drugs or toxins, a positive test for bilirubinuria may be an early indication for cholestasis or liver damage

63
Q

congenital hyperbilirubinemias, bilirubin will appear in the urine what types

A

Dubin-Johnson and Rotor types, and is not present with Gilbert’s disease or Crigler-Najjar disease

64
Q

what are the normal urine and fecal findings ?

A

urinary bilurubin is absent
urinary urobilinogen is present
decal colour is dark

65
Q

what are the urinary and fecal findings in post hepatic jaundice or obstructive jaundice ?

A

urinary bilirubin - increased, dark urine

urinary urobilinogen - neoplasm low or absent
gall stones variable

decal colour - pale
with gallstones in bile duct
persistent with neoplasm in duct or pancreas

66
Q

what are the urinary and decal findings in pre hepatic jaundice - haemolytic anemia

A

urinary bilirubin - absent

urinary urobilinogen - increased

fecal colour is dark

67
Q

what are the urinary and decal findings in hepatic jaundice - hepatitis , cholestasis ?

A

urinary bilirubin - increased early

urinary urobilinogen - decrease early , and then increased

decal colour is - pale early
and dark late in hepatitis
just pale with cholestasis

68
Q

how does urobilinogen form?

A

conjugated bilirubin is released into duodenum with cholesterol and bile salts and phospholipids

passes to colon

bacteria hydrolyses there

free bilirubin reduced to urobilinogen , mesobilirubinogen and sterocobilinogen

50 percent of the urobilingen is reabsorbed into the portal circulation , recreated unconjugated into the bile
the remaining urobilinogen excreted in feces as coloured urobilin and sterobilin (by hydrogen removal)

small amount excreted in urine

69
Q

Output of urobilinogen in urine is increased in ?

A

alkaline urine

decreased in acidic urine

liver is unable to efficiently remove the reabsorbed urobilinogen from the portal circulation,
more urobilinogen than normal is routed through the kidney and hence is excreted in the urine

  • viral hepatitis,
    drugs, or toxic substances,

some cases of cirrhosis.

congestive heart failure prevents effective urobilinogen handling, and reexcretion into the bile is impaired.

If an infection is present, such as cholangitis associated with obstruction, large amounts of urobilinogen are excreted in urine, together with bilirubin.

70
Q

an excess of urobilinogen in urine together with absent bilirubin is typically associated with

A

hemolysis -cute lysis of erythrocytes, as well as with destruction of erythrocyte precursors in the bone marrow with megaloblastic anemias

Increased urobilinogen also accompanies bleeding into tissues and the subsequent formation of excess bilirubin.

71
Q

Persistent absence of urinary urobilinogen occurs with?

A

complete obstruction of the outflow of bile into the intestine, accompanied by pale stools

Broad-spectrum antibiotics, which suppress the normal intestinal flora, may prevent the conversion of bilirubin to urobilinogen

72
Q

two most commonly utilized testing modalities for indirect assessment of bacteriuria and leukocyturia?

A

reagent strip nitrite and leukocyte esterase

73
Q

“gold standard” for detecting bacteriuria

A

Microscopic urinalysis serves as a rapid confirmatory test for the presence of leukocytes and bacteria, with bacteriologic culture

74
Q

Many bacteria that are urinary tract pathogens are able to do what ?

A

reduce nitrate to nitrite

75
Q

Common organisms giving positive nitrite reagent test ?

A

Escherichia coli, Klebsiella, Enterobacter, Proteus, Staphylococcus, and Pseudomonas

76
Q

which bacteria is unable to produce nitrites ?

A

Enterococcus

77
Q

If the nitrite test is positive what should follow

A

culture should be considered

78
Q

what is the procedure urine testing for bacteria in UTI

A

A first morning clean-voided midstream specimen is best

79
Q

there can be a false negative testing for nitrites in diagnosing bacteria why ?

A

conversion of nitrate to nitrite by bacterial action in the urine. Because overnight (minimum of 4 hours) bladder incubation is typically required for the infecting bacterial population to convert urinary nitrate to nitrite, a first morning specimen is best

may be due to ascorbic acid, urobilinogen, or low pH (<6)

Random specimens collected during the day and urine from patients with draining catheters

some nitrate- reducing organisms form compounds other than nitrite, such as ammonia, nitric and nitrous oxide, hydroxylamine, and nitrogen, and therefore give a negative nitrite test result.

Lack of dietary nitrate may also produce false- negative results

80
Q

false positiv results for nitrites include ?

A

poorly collected/stored specimens as the result of contaminants and postcollection bacterial proliferation.

False-positives may also be produced by medications that color the urine red or turn red in an acid medium (e.g., phenazopyridine)

81
Q

numbers of neutrophils in the urine suggests urinary tract infection has difficulty why ?

A

determining suitable cutoff points for normal and abnormal numbers of these cells. Because quantitative counts are so low, precision is poor

82
Q

Positive leukocyte esterase results correlate with

A

“significant” numbers of neutrophils

83
Q

in leukocyte esterase results the number of false negative and false positive results are ?

A

low

84
Q

what may all decrease (false negative) test results for leukocyte esterase

A

Elevated urine specific gravity, protein, and glucose, boric acid and certain antibiotics such as tetracycline

Very large amounts of ascorbic acid may inhibit the reaction

85
Q

what may give false positive results for leukocyte esterase

A

Contamination of urine with vaginal fluid

Trichomonas and eosinophils may represent alternative cellular sources of esterases

86
Q

examination of the urine sediment is best reserved and most useful for who?

A

with abnormal dipstick results

87
Q

Cellular elements are derived from two sources in urine which are?

A

Desquamated/spontaneously exfoliated epithelial
lining cells of the kidney and lower urinary tract

cells of hematogenous origin (leukocytes and erythrocytes). Cellular and noncellular casts may be seen; these are formed in the renal tubules and collecting ducts

Crystals of variable clinicopathologic significance may also be present.

Organisms (bacteria, fungi, viral inclusion cells, parasites) and neoplastic cells

88
Q

Cells and casts begin to lyse within how may hours of collection and what can prevent it?

A

2 hours of collection

Refrigeration (2°–8° C) helps prevent the lysis of pathologic entities; however, this may increase the precipitation of various amorphous and crystalline material

89
Q

Midstream collection is recommended for females why?

A

reduce contamination from vaginal elements.

90
Q

methods for examining urine sediment ?

A 
Bright-field Microscopy
• Phase-Contrast Microscopy
• Polarized Microscopy
• Quantitative Counts
• Microscopic Components in Urine Sediment- Erythrocytes, Leukocytes, Transitional (Urothelial) Epithelial Cells, Casts(Hyaline Casts, Waxy Casts, Erythrocyte
91
Q

concentrating ability can be considered normal if

A

random specimen of urine has a specific gravity of 1.023

92
Q

Minimum specific gravity after a standard water load

A

be less than 1.007

clinical lab (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions