CHAPTER 3: INTRO TO URINALYSIS Flashcards
References to the study of urine can be found in the drawings of
Cavemen and in Egyptian hieroglyphics, such
as the Edwin Smith Surgical Papyrus.
Although ancient physicians
lacked the sophisticated testing mechanisms now available,
they were able to obtain diagnostic information from such
basic observations as:
- Color
- Turbidity
- Color
- Volume
- Viscosity
- Sweetness (by noting that certain specimens attracted ants or tasted sweet)
During the ___________, physicians concentrated their efforts very
intensively on the art of uroscopy, receiving instruction in urine examination as part of their training
Middle Ages;
Wrote a book on “uroscopy” in the 5th Century
Hippocrates
In _____, Chemical testing progressed from “ant testing” and “taste testing” for glucose to __________ discovery of ___________ by boiling urine
1694; Frederik Dekkers’s; albuminuria
By _________, color charts had been developed that described the significance of 20 different colors
1140 CE
The credibility of urinalysis became compromised when
these charlatans without medical credentials began offering their predictions to the public for a healthy fee
Pisse Prophets
“Pisse Prophets,” became the subject of a book published by?
Thomas Bryant in 1627
The revelations in this book inspired the passing of the first medical licensure laws in England another contribution of urinalysis to the field of medicine
Thomas Bryant’s book
He introduced the concept of urinalysis as part of a doctor’s routine patient examination in 1827
Richard Bright
By the _____, however, the number and complexity of the tests performed in a urinalysis had reached a point of impracticality, and urinalysis began to disappear from routine examinations.
1930s
The invention of the microscope in the _______ led to the examination of urinary sediment and the development by ______________ of methods for quantitating the microscopic
sediment
17th century; Thomas Addis
Two unique characteristics of a urine specimen account
for this continued popularity:
- A urine specimen is readily available and easily
collected. - Urine contains information, which can be obtained by
inexpensive laboratory tests, about many of the body’s
major metabolic functions.
The kidneys continuously form urine as an?
ultrafiltrate of plasma
Reabsorption of water and filtered substances essential
to body function converts approximately __________ of
filtered plasma to the average daily urine output of ________,
depending on fluid intake.
170,000 mL; 1200 mL
Urine is normally 95%
_____ and 5% _______,
water; solutes
Factors that influence the variations in the concentrations of solutes in urine
- Dietary intake
- Physical activity,
- Body metabolism, and
- Endocrine function
A metabolic waste product produced in the liver from the breakdown of protein and amino acids
Urea
This accounts for nearly half of the total dissolved solids in urine
Urea
The major inorganic solid dissolved in urine is
Chloride
Inorganic components in urine (in order)
- Chloride
- Sodium
- Potassium
- Phosphate
- Ammonium
- Calcium
This greatly influences the concentrations of these inorganic compounds, making it difficult to establish normal levels
Dietary intake
Organic components in urine (in order)
- Urea
- Creatinine
- Uric Acid
Other substances found in urine include:
hormones, vitamins, and medications
Used to determine whether a fluid is a urine
The specimen can be tested for urea and creatinine content.
Both these substances are present in much higher concentrations in urine than in other body fluids, a fluid that is high in content of these can be identified as urine.
urea and creatinine
A decrease in urine output
Oliguria
Seen commonly when the body enters a state of dehydration as a result of excessive water loss
from vomiting, diarrhea, perspiration, or severe burns.
Oliguria
In Oliguria, how much decrease in urine output in:
- Infants
- Children
- Adults
- Infants: less than 1 mL/kg/hr
- Children: less than 0.5 mL/kg/hr in children
- Adults: less than 400 mL/day
This may result from any serious damage to the kidneys or from a
decrease in the flow of blood to the kidneys.
Anuria
Cessation of urine flow,
Anuria
The kidneys excrete ________more urine during the day than during the night
two to three times
An increase in the nocturnal excretion of urine is termed
nocturia
An increase in daily urine volume
Polyuria
Often associated with diabetes mellitus and diabetes insipidus
Polyuria
Polyuria may be induced artificially by:
- Diuretics
- Caffeine
- Alcohol
All of which suppress the secretion of ADH
In Polyuria, how much increase in urine output in:
- Children
- Adults
- Children: 2.5 to 3 mL/kg/day
- Adults: greater than 2.5 L/day
Primary organic component. Product of metabolism of protein and amino acids
Urea
Product of metabolism of creatine by muscles
Creatinine
Product of breakdown of nucleic acid in food and cells
Uric acid
Primary inorganic component. Found in combination with sodium (table salt) and many other inorganic substances
Chloride
Regulates blood and tissue fluid acidity
Ammonium
Combines with chloride, sulfate, and phosphate
Calcium
Primarily from salt, varies by intake
Sodium
Combined with chloride and other salts
Potassium
Combines with sodium to buffer the blood
Phosphate
Caused by a defect either in the pancreatic production of insulin or in the function of insulin, which results in an increased concentration of body glucose
Diabetes mellitus
The kidneys do not reabsorb
excess glucose, necessitating the excretion of increased amounts
of water to remove the dissolved glucose from the body
Results from a decrease in the production or function of ADH; thus, the water necessary for
adequate body hydration is not reabsorbed from the plasma
filtrate.
Diabetes insipidus
Polyuria accompanied by increased fluid intake is often the first symptom of either disease.
Diabetes mellitus or insipidus
________ should be used because they eliminate the chance of contamination due to improper washing
Disposable containers
Urine specimens must be collected in?
clean, dry, leakproof containers
______containers are suggested if more than 2 hours elapse between specimen collection and analysis.
Sterile
All specimens must be labeled immediately after collection
with the:
- Patient’s last and first name
- Identification number
- date and time of collection
The recommended capacity of urine container is _____, which
allows _____ of specimen needed for microscopic analysis,
additional specimen for repeat analysis, and enough room for
the specimen to be mixed by swirling the container
50 mL; 12 mL
Labels must be…
attached to the container, not to
the lid, and should not become detached if the container is
refrigerated or frozen
Caused by oxidation or reduction of metabolites
Color
These increase in unpreserved urine
OPeN Bacteria
Odor, pH, Nitrite, and Bacteria
These decrease in unpreserved urine
- Clarity
- Glucose
- Ketones
- Bilirubin
- Urobilinogen
- Red and white blood cells and casts
- Bacteria
- Trichomonas
Decrease in this is caused by bacterial growth and precipitation of amorphous material
Clarity
Increase is caused by bacterial multiplication causing breakdown of urea to ammonia
Odor
Decrease of this is caused by glycolysis and bacterial use
Glucose
Decrease in this is caused by volatilization and bacterial metabolism
Ketones
Decrease in this is caused by exposure to light/photo oxidation to biliverdin
Bilirubin
Increase in this is caused by multiplication of nitrate-reducing bacteria
Nitrite
Decrease in this is caused by oxidation to urobilin
Urobilinogen
Increase in this is caused by B\breakdown of urea to ammonia by urease-producing bacteria/loss of CO2
pH
Decrease in this is caused by disintegration/lyse in dilute alkaline urine
Red and white blood
cells and casts
Increase in this is caused by Multiplication
Bacteria
After collection, specimens should be delivered to the laboratory promptly and tested within?
2 hours
Decrease in this is caused by loss of motility, death
Trichomonas
A specimen that cannot be
delivered and tested within 2 hours should be ______ or have an appropriate _____________ added.
refrigerated; chemical preservative
The method of preservation used most routinely is refrigeration
at
2°C to 8°C
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured, up to _______.
24 hours
Specimens must be returned to
____________ before chemical testing by reagent strips because the enzyme reactions on the strips perform best at room temperature
room temperature
Can cause precipitation of amorphous urate and phosphate crystals.
Refrigeration
Does not interfere with
chemical tests however, this precipitates amorphous phosphates and urates
Refrigeration
The ideal preservative should be:
bactericidal, inhibit urease, and preserve formed elements in the sediment, does not interfere with chemical tests
Prevents bacterial growth
for 24 hours
Refrigeration
Keeps pH at about 6.0
Can be used for transport
of urine cultures
Acids (boric acid, HCL, acetic acid, tartaric acid)
Prevents bacterial growth
and metabolism
Acids (boric acid, HCL, acetic acid, tartaric acid)
interferes with analysis of
drugs and hormones
Acids (boric acid, HCL, acetic acid, tartaric acid)
Excellent sediment
preservative
Formalin (formaldehyde)
Acts as a reducing agent,
interfering with chemical
tests for glucose, blood,
leukocyte esterase, and
copper reduction
Formalin (formaldehyde)
Rinse specimen container
with formalin to preserve cells and casts
Formalin (formaldehyde)
Good preservative for drug
analyses
Sodium fluoride
Inhibits reagent strip tests
for glucose, blood, and
leukocytes
Sodium fluoride
Convenient when refrigeration is not possible. Have controlled concentration to minimize interference
Commercial preservative
tablets
Check tablet composition to
determine possible effects
on desired tests
Commercial preservative
tablets
It contains collection cup,
transfer straw, culture and
sensitivity (C&S) preservative tube, or UA tube
Urine Collection Kits4
(Becton, Dickinson,
Rutherford, NJ)
Do not use if urine is below
minimum fill line
Light gray and gray
C&S tube or Cherry red/yellow
Preservative Plus tube
Specimen stable at room
temperature (RT) for 48 hours; prevents bacterial growth and
metabolism
Light gray and gray
C&S tube
Preservatives in Light gray and gray C&S tube
- Boric acid
- Sodium borate
- Sodium formate
Keeps pH at about 6.0
Acids (boric acid, HCL, acetic acid, tartaric acid) or Light gray and gray C&S tube
Has round or conical bottom,
Yellow UA Plus tube or Cherry red/yellow Preservative Plus tube
Use on automated
instruments
Yellow UA Plus tube
Must refrigerate within 2 hours
Yellow UA Plus tube
Specimen stable for
72 hours at RT;
instrument-compatible
Cherry red/yellow
Preservative Plus tube
Bilirubin and urobilinogen
may be decreased if specimen is exposed to light and left at RT
Cherry red/yellow
Preservative Plus tube
This has no preservative
Yellow UA Plus tube
Preservatives in Cherry red/yellow Preservative Plus tube
Sodium propionate, ethyl paraben, and chlorhexidine
The specimen received most commonly because of
its ease of collection and convenience for the patient
Random specimen
This specimen is essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria
First Morning Specimen
______ must be used to produce an accurate quantitative result
24-Hour (or Timed) Specimen
Solutes that exhibit diurnal variations. They lowest concentration is in the early morning and the highest concentration occurs in the afternoon.
catecholamines, 17-hydroxysteroids, and electrolytes
When the concentration of the substance to be measured
changes with diurnal variations and with daily activities,
such as exercise, meals, and body metabolism, __________ is required.
If the concentration of a particular substance remains constant, the specimen may be collected over a ________ period.
24-hour collection; shorter
Common Errors Associated with Timed Urine Collections
- Loss of urine specimen
- Inclusion of two first morning specimens
- Inaccurate measurement of total urine volume
- Inadequate urine preservation
- Transcription error
To obtain an accurate timed specimen, the patient must
begin and end the collection period with?
an empty bladder
In collecting 24-hour urine spx, it should be _______ or kept on _______ during the collection period and may require addition of a ___________
refrigerated; ice; chemical preservative
As an alternative to the catheterized specimen, the _____________ specimen provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
midstream clean-catch
Adding urine formed before the start of the collection period (24-hour collection) will falsely _______ the results, and failure to include the urine produced at the end of the collection period will falsely _______ the results
elevate; decrease
This specimen is collected under sterile conditions by passing
a hollow tube through the urethra into the bladder.
Catheterized Specimen
What should not be used as cleansing agents for midstream clean-catch?
Strong bacterial agents, such as
hexachlorophene or povidone-iodine
Cleansing agent used for midstream clean-catch
Mild antiseptic towelettes
This urine collection method may be collected by external introduction of a needle through the abdomen into the bladder
Suprapubic Aspiration
T/F: The bladder is sterile under normal conditions
True
This method is used for used for cytological examination and/or bacterial culture
Suprapubic Aspiration
This method is used for used for routine screening and/or bacterial culture
Midstream Clean-Catch Specimen
Methods used to detect the presence of prostatitis
Three-Glass Collection, Pre- and Postmassage Test, Stamey-Meares Test for Prostatitis
The test requested most commonly on a catheterized specimen is?
bacterial culture
The first urine passed for three-glass collection is collected in a?
sterile container
The first and third specimens for three-glass collection are?
examined microscopically
The midstream portion for three-glass collection is collected in?
another sterile container
In prostatic infection, the third specimen will have a ___________ and a ________ 10 times that of the first specimen
white blood cell/high power field count; bacterial count
The second specimen for three-glass collection is used as a control for __________. If it is positive, the results from the ________ are invalid because infected urine has contaminated the specimen.
bladder and kidney infection; third specimen
When both a routine urinalysis
and a culture are requested on a catheterized or midstream collection, what should be performed first?
The culture should be performed first to prevent contamination of the specimen.
A clean-catch midstream urine specimen is collected. A second urine sample is collected after the prostate is massaged
Pre- and Postmassage Test
Positive result for Pre- and Postmassage Test
Postmassage specimen of greater than 10 times the premassage count (bacteriuria).
What is used for collecting urine of pediatric patients?
Clear plastic bags, hypoallergenic skin adhesive to attach to the
cleaned genital area of both boys and girls
They describe the traditional four-glass urine collection technique
Meares and Stamey
In Stamey-Meares Test for Prostatitis, this represents the urethral spx
The first urine specimen, voided bladder (VB1), the first 10 mL of urine
In Stamey-Meares Test for Prostatitis, this represents the bladder spx
The second specimen, voided bladder 2 (VB2), another 10 mL of urine (after the px voids 100-150 mL of urine after the first 100 mL)
In Stamey-Meares Test for Prostatitis, this consists
of the first 10 mL of urine collected after EPS; it contains
any EPS trapped in the prostatic urethra
The fourth specimen
In Stamey-Meares Test for Prostatitis, this expressed prostatic specimen
(EPS), which is the fluid collected during prostatic massage
Third specimen
In Stamey-Meares Test for Prostatitis, Urethral infection or inflammation is tested for by the?
VB1
In Stamey-Meares Test for Prostatitis, The VB2 tests for?
urinary bladder infection
These are cultured and examined for white blood cells. Having more than 10 to 20 white blood cells per high-power field is considered abnormal
Prostatic secretions in Stamey-Meares Test for Prostatitis
