Body Fluids: Urine Flashcards
Red Urine is seen in what conditions? (3)
*Urine dipstick results
- Hematuria (RBCs)
- Hemoglobinuria (Free Hgb)
- Myoglobinuria
*All 3 will produce a positive hemoglobin result on dipstick
Red urine with Negative Hemoglobin on dipstick causes? (5)
- Porphyria
- Rifampin
- Pyridium
- L-Dopa (aldomet)
- Beets
What conditions produce a Brownish/Black urine? (2)
- Alkaptonuria
- Methemoglobinuria
What causes Blue/Green Urine?
Pseudomonas infection
Glycosuria with normal renal function:
- “Renal Threshold”
- Pregnancy
180 mg/dL serum glucose (“Renal Threshold”)
-Pregnancy Lower the threshold
Glycosuria with renal tubular dysfunction:
- Caused by
- Serum glucose
Impaired Reabsorption
-Serum glucose may be normal
The presence of what, inhibits several dipstick tests?
-Test (5)
Ascorbate Inhibits Dipstick tests for:
- Glucose
- Hemoglobin
- Bilirubin
- Nitrite
- Leukocyte esterase
What is the normal urine protein amount?
-predominantly what protein?
150 mg/day
-Tamm-Horsfall (Tubular) protein
T/F: Vigorous excercise, dehydration and fever may cause increased urine protein.
True
The urine dipstick is sensitive mainly to what protein?
Albumin
What are the 3 major ketones in blood and urine?
- Acetone
- Acetoacetic Acid
- B-Hydroxybutyrate
What ketone is the urine dipstick mainly sensitive to?
*what other urine test is the same
Acetoacetic Acid
*Tablet Test (Acetest)
Hematuria - Microscopic findings.
Erythrocytes in urine
Hemoglobinuria - Microscopic findings.
-Stain
Hemosiderin-laden macrophages/monocytes
-Prussian Blue stain
How is Myoglobinuria distinguished from Hematuria and Hemoglobinuria? (3)
- Clinical History
- Creatine Kinase
- Normal Haptoglobin
Urinary Bilirubin is indicative of what?
Conjugated Hyperbiliriubinemia
What type of bilirubin does NOT pass through the Glomerulus?
Unconjugated bilirubin
*Urinary Bilirubin is indicative of Conjugated Hyperbilirubinemia
Urobilinogen is the product of what?
Hydrolysis of bilirubin by Intestinal Bacteria
Urine Bilirubin Interpretation - Normal:
- Urine Bilirubin
- Urine Urobilinogen
Urine Bilirubin Interpretation - Normal:
- Urine Bilirubin - (Neg)
- Urine Urobilinogen - (+/-)
Urine Bilirubin Interpretation - Unconjugated Bilirubinemia:
- Urine Bilirubin
- Urine Urobilinogen
Unconjugated Bilirubinemia:
- Urine Bilirubin - (Neg)
- Urine Urobilinogen - (Neg)
Urine Bilirubin Interpretation - Conjugated Bilirubinemia:
- Urine Bilirubin
- Urine Urobilinogen
Conjugated Bilirubinemia:
- Urine Bilirubin - (Pos/+)
- Urine Urobilinogen - (Pos/+++)
The presence of urine Nitrate indicates what?
Presence of Nitrite producing organisms
-E. coli
What are Nitrite Negative Agents of UTIs? (3)
- Enterococci
- N. gonorrhoea
- M. tuberculosis
What urine test is a reflection of the number of urinary neutrophils?
Leukocyte Esterase
What are possible sources of a False-Positive Urine Leukocyte Esterase? (2)
- Trichomonads
- Eosinophils
The urine specific gravity is _______ when the urine is concentrated
Increased
*The urine specific gravity is Increased when the urine is concentrated
What is isothenuria?
- Specific Gravity
- Cause/Result
Specific Gravity is fixed at 1.010
-Tubular Damage results in the urine specific gravity equaling the glomerular filtrate
What is the normal Urine pH?
Urine pH = 6.0
-mildly acidic
In general, patients with Acidosis (metabolic or respiratory) should be producing urine with a pH of __, whiles those with Alkalosis (metabolic or respiratory) should produce urine with pH of __.
- pH = 6.0
- pH = >6.0
What happens to urine pH in Renal Tubular Acidosis (RTA)? (2)
- Urine is inappropriately Alkaline relative to blood pH
- Kidneys cannot acidify the urine beyond pH 6.5
Urine Crystal Morphology:
-Calcium oxalate
“Envelopes”
Urine Crystal Morphology/Polarization:
-Uric Acid
- Pleomorphic (Diamond, Square, Rod-shaped)
- Polarize in a variety of colors
Urine Crystals - Triple Phosphate:
- Composition (2)
- Morphology
- Complication
Magnesium Ammonium Phosphate/Struvite
- “Coffin Lids”
- “Staghorn Calculi” (75% are Struvite)
Urine Crystals - Triple Phosphate:
-When do they form? (2)
- Alkaline pH
- Urea-splitting organisms (P. mirabilis)
What organisms is capable of urea-splitting and can cause Staghorn Calculi?
Proteus mirabilis
Urine Crystals with “Thorn Apples” morphology.
Ammonium burate
Urine Crystals - Morphology:
-Cystine
*related to what?
Hexagonal cystals
*related to cystinuria
Urine Crystals - Morphology:
-Tyrosine (2)
-“Silky”
or
-“Sheaves of Wheat”
Urine Crystals - Morphology:
-Cholesterol
“Broken Panes of Glass”
Urine Crystals - Morphology:
-Sulfa
“Fans”
Urine Crystals - Morphology:
-Bilirubin
Yellow-Brown Needles
The majority of kidney stone are composed of what?
- 2nd
- 3rd
Calcium Oxalate (70%)
- Calcium Phosphate
- Struvite (magnesium ammonium phosphate or triple phosphate stones)
What promotes the formation of Calcium Oxalate crystals? (4)
- Low Urine Volume (ALL stone types)
- Low Urinary Citrate
- Hypercalciuria
- Oxaluria
What causes Increased Oxaluria? (2)
- Crohn’s Dz (s/p sm. bowel resection)
- Ingestion of Rubarbs, Spinach, Nuts
T/F: Urinary pH has little effect on calcium oxalate cyrstallization
True
What promotes the formation of Calcium Phosphate stones? (3)
- Low Urine Volume
- Hypercalciuria
- Elevated (Alkaline) pH
What promotes the formation of Urate stones? (2)
- Acidic pH
- Hyperuricosuria
What are the microscopic findings in Glomerular Bleeding? (3)
- Polymorphous RBCs
- RBC casts
- Erythrophagocytosis
What are the microscopic findings in Non-Glomerular Bleeding? (3)
- Uniform RBCs
- NO RBC casts
- NO erythrophagocytosis
Red Cell Casts:
- Specific for?
- Morphology (2)
Glomerulonephritis
- Lumpy edges
- Anucleate, slight reddish, pale discs
White Cell Casts:
- Found in what condition?
- Morphology
Tubulointerstitial Nephritis/Pyelonephritis
-Nucleate cells w/ typical lobated nuclei of neutrophils
Tubular Casts:
- Indication of what?
- Composed of?
- Morphology
- Acute Tubular Necrosis
- Renal Tubular Cells
- Mononuclear, cuboidal cells
Granular Casts:
- Nonspecific but typically present when?
- Morphology
- Often found with what other Cast
Significant Renal Disease
- Acellular
- Rough, Granular (fine or coarse) surface
- Hyaline casts
Granular and Hyaline casts can been seen in what conditions? (4)
- Vigorous exercise
- Dehydration
- Heat-related Trauma
- Renal disease
Waxy Casts:
- Indicative of what?
- Morphology (4)
Severe Renal Disease
- Acellular
- Blunt Ends
- Pale Yellow color
- Cracks along their lenght
How do you distinguise Waxy casts from that of Nonspecific Casts (Granular/Hyaline)?
Diameter is >2X that of nonspecific casts
Broad Casts:
- Indicate
- Morphology
- Correspond to what?
- Endstage Renal Disease
- Unusually broad (waxy,hyaline,or granular casts)
- Widely dilated collecting ducts seen in advance atrophy
Fatty Casts:
- Indicative of
- Common feature
- Morphoology
- Polarized light
Nephrotic syndrome
- Lipiduria is common feature
- Cellular casts in which lipid droplets are absorbed
- Maltese Cross appearance w/polarized light
Urine Microscopy in Acute Renal Failure - Acute Tubular Necrosis (ATN):
- RBCs
- Casts
- Erythrophagocytosis (+/-)
- Granulocytes (+/-)
Acute Tubular Necrosis (ATN):
- RBCs - normal numbers (nonglomerular)
- Casts - Tubular
- Erythrophagocytosis - NO
- Granulocytes - Scant
Urine Microscopy in Acute Renal Failure - Rapidly Progressive Glomerulonephritis (RPGN):
- RBCs
- Casts
- Erythrophagocytosis (+/-)
- Granulocytes (+/-)
Rapidly Progressive Glomerulonephritis (RPGN):
- RBCs - Increased (Glomerular)
- Casts - Red Cell
- Erythrophagocytosis - PRESENT
- Granulocytes - Scant
Urine Microscopy in Acute Renal Failure - Acute Interstitial Nephritis (AIN):
- RBCs
- Casts
- Erythrophagocytosis (+/-)
- Granulocytes (+/-)
Acute Interstitial Nephritis (AIN):
- RBCs - Normal numbers (nonglomerular)
- Casts - Tubular Casts
- Erythrophagocytosis - NO
- Granulocytes - Numerous (neuts/eosinophils)
