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CHEM Urinalysis Flashcards

1
Q

Ref: urine pH

A

4.5 - 8.0

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2
Q

Sources of Error: Falsely Alkaline and Acidic urine

A

Falsely Alkaline: bacterial growth

Falsely Acidic: improper reagent strip dipping

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3
Q

Source of Error: Leukocyte False Pos vs Neg

A

False Pos: coloured urine, contamination

False Neg: high [protein], [glucose], [ascorbic acid]; not mixing before dipping reagent strip

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4
Q

Nitrite False Pos vs Neg

A

False Pos: coloured urine, improper storage

False Neg: urine not held in bladder for long, high [ascorbic acid], high SG

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5
Q

Nitrite Significance

A

Gram negative bacteria infection

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6
Q

Leukocyte Significance

A

Infection/ inflammation

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7
Q

Protein False Pos vs Neg

A

False Pos: coloured urine, highly buffered alkaline urine, high SG, prolonged dipping of reagent strip

False Neg: proteins other than albumin

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8
Q

Glucose False Pos vs Neg

A

False Pos: contamination

False Neg: low temperature, high SG, high [ketones], high [ascorbic acid], bacteria

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9
Q

Protein Significance

A

Renal disease

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10
Q

Glucose Significance

A

Uncontrolled diabetes mellitus, renal disease, pregnancy

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11
Q

Ketones False Pos vs Neg

A

False Pos: coloured urine, bacteria, MESNA or captopril

False Neg: bacteria

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12
Q

Ketones Significance

A

Uncontrolled diabetes mellitus, inherited metabolic disorder, dieting, starvation

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13
Q

Blood False Pos vs Neg

A

False Pos: contamination, bacterial peroxidase, myoglobin

False Neg: high SG, high [ascorbic acid], not mixing before dipping reagent strip

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14
Q

Blood Significance

A
  1. Hematuria = renal stones, glomerulonephritis, pyelonephritis
  2. Hemoglobinuria = IVH, transfusion rxn, severe burns, infection
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15
Q

Urobilinogen Normal Range

A

< 16 μmol/L

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16
Q

Urobilinogen False Pos vs Neg

A

False Pos: coloured urine, porphobilinogen

False Neg: acidic urine, light exposure, RT storage

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17
Q

Urobilinogen Significance

A

Hemolytic disorders, liver disease (EXCEPT HEPATOBILIARY OBSTRUCTION)

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18
Q

Bilirubin Sources of Error

A

False Pos: coloured urine

False Neg: light exposure, 4°C storage, high [ascorbic acid], high nitrites

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19
Q

Bilirubin Significance

A
  • HEPATOBILIARY OBSTRUCTION
  • liver disease (hepatitis, cirrhosis)
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20
Q

Ref: SG

A

1.005 - 1.030

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21
Q

SG Sources of Error

A

False Increase: high [proteins]

False Decrease: highly buffered alkaline urine

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22
Q

SG Significance

A
  • hydration status
  • increased SG = ketones
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23
Q

Which positive macroscopic results require microscopic analyis ?

A

Blood, protein, nitrites, leukocytes

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24
Q

Stain used for urine sediments

A

Sternheimer-Malbin; supravital stain composed of safranin O and crystal violet

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25
Q

Hyaline casts are caused by __ or __.

A

Hyaline casts are casued by STRESS or EXERCISE (dehydration)

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26
Q

Granular casts can be seen due to both __ and __.

A

Granular casts can be seen due to both EXERCISE and RENAL DISEASE.

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27
Q

Red blood cell casts indicate __, and is most commonly observed in __.

A

Red blood cell casts indicate BLEEDING IN THE NEPHRON, and is most commonly observed in GLOMERULONEPHRITIS.

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28
Q

White blood cell casts indicate __.

A

White blood cell casts indicate INFECTION/ INFLAMMATION WITHIN THE NEPHRON

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29
Q

White blood cell casts are observed in __.

A

White blood cell casts are observed in PYELONEPHRITIS, ACUTE INTERSTITIAL NEPHRITIS, and GLOMERULONEPHRITIS

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30
Q

Epithelial cell casts contain what kind of epithelial cells ?

A

Mostly RENAL TUBULAR epithelial cells

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31
Q

When are epithelial cell casts observed ?

A
  • advanced renal tubular disease
  • ingestion of heavy metals, drugs
  • transplant rejection
  • infection (pyelonephritis)
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32
Q

When are fatty casts observed ?

A
  • NEPHROTIC SYNDROME
  • toxic tubular necrosis, diabetes mellitus, CRUSH INJURIES
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33
Q

Waxy casts are observed with __.

A

Waxy casts are observed with CHRONIC RENAL FAILURE.

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34
Q

What does cholesterol look like under polarizing light ?

A

Cholesterol has a “Maltese-cross”

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35
Q

T or F: Squamous epithelial cells are clinically significant and should be reported.

A

T or F: Squamous epithelial cells are NOT clinically significant, but should STILL BE REPORTED.
- originate from skin

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36
Q

Where do renal tubular cells originate from ?

A

Originate from the convoluted tubules and collecting ducts of nephron

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37
Q

The presence of __ indicates renal tubular damage.

A

The presence of RENAL TUBULAR EPITHELIAL CELLS indicates renal tubular damage.

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38
Q

What are oval fat bodies ?

A

Renal tubular epithelial cells that have absorbed lipids

39
Q

How do oval fat bodies appear under polarized light ?

A
  • highly refractive
  • eccentric nucleus
  • fatty droplets composed of cholesterol appear as “Maltese-crosses”
40
Q

Confirmation of fatty droplets in oval bodies can be done using __ or __.

A

Confirmation of fatty droplets in oval bodies can be done using the stains SUDAN III or OIL RED O.

41
Q

Which crystal is associated with ethylene glycol poisoning ?

A

Calcium oxalate - monohydrate form (oval/ dumbbell-shaped)

42
Q

Uric acid is associated with __ and __.

A

Uric acid is associated with cytotoxic drugs and gout.

43
Q

What crystal is described as colorless “dumb-bells” ?

A

Calcium carbonate

44
Q

What causes cystinuria ?

A

An inherited metabolic disorder

45
Q

Which 3 crystals are associated with severe liver disease ?

A

Tyrosine, leucine, and bilirubin

46
Q

Besides liver disease, leucinuria can also be observed in __.

A

Besides liver disease, leucinuria can also be observed in INHERITED METABOLIC DISORDERS.

47
Q

T or F: Bilirubin crystals in the urine may be associated with newborn jaundice.

A

FALSE; Newborn jaundice is associated with UNCONJUGATED bilirubin. Only unconjugated bilirubin is water soluble/ found in urine.

48
Q

Trichomonas vaginalis is associated with a __.

A

Trichomonas vaginalis is associated with a SEXUALLY TRANSMITTED INFECTION.

49
Q

List the steps when cleaning up a minor urine spill (<10 mL)

A
  1. Cover the spilled material with paper towel to avoid splashing
  2. Pour disinfect onto paper towels, working outside to the center
  3. Wait 30 minutes
  4. Remove soiled towels with forceps
  5. Repeat
50
Q

What causes green, pink, and white urine ?

A

Green: hepatitis, improper storage

Pink: myoglobin

White: chyle

51
Q

Mnemonic: Colored urine = False Pos

A

“broke LPNs” have (+) colored urine

B - bilirubin
Uro - uro bilinogen
K - ketones

L - leukocytes
P - proteins
N - nitrite

52
Q

Mnemonic: High SG = False Neg

A

“sweet, bloody nitrites!” I hate (-) it when my drink is too dense

Glucose, Blood, Nitrites

53
Q

Mnemonic: High [ascorbate] = False Neg

A

“luke glues bloody bills at night” when he drinks too much orange juice; it’s a bad (-) habit

Leuk - ocytes
Glu - cose
Blood - y
Bil - irubin
Nit - rites

54
Q

Which 2 urine reagent strip tests can be falsely negative with insufficient sample mixing ?

A

Leukocytes (WBCs) and Blood (RBCs); cells

55
Q

__ is produced in tubular epithelial cells in loop of Henle and is ALWAYS PRESENT

A

UROMODULIN is produced in tubular epithelial cells in loop of Henle and is ALWAYS PRESENT

56
Q

Which substance interferes with the urine reagent strip glucose test?

a.
elevated levels of urobilinogen

b.
elevated levels of ascorbic acid

c.
elevated levels of protein

d.
L-dopa metabolites

A

b.
elevated levels of ascorbic acid

57
Q

Using a urine reagent strip, an elevated pH (≥8.5) result may

a.
falsely increase specific gravity

b.
falsely decrease glucose results

c.
falsely elevate protein results

d.
falsely decreased ketone result

A

c.
falsely elevate protein results

58
Q

Urobilinogen is useful in the evaluation of

a.
Pyelonephritis

b.
Renal calculi

c.
Glomerular nephritis

d.
Hemolytic anemia

A

d.
Hemolytic anemia

  • Urobilinogen is an indicator of IVH and liver disease EXCLUDING HEPATOBILIARY OBSTRUCTION
59
Q

False positive hemoglobin results may be caused by

a.
Microbial peroxides

b.
Ascorbic acid

c.
Hypochlorite

d.
A and C

e.
All of the above.

60
Q

T or F: Myoglobinuria may be associated with long distance running.

A

FALSE; Myoglobinuria is associated with CRUSH INJURIES, surgery, and contact sports.

  • Hemoglobinuria is associated with long distance running.
61
Q

T or F: β2 micro globulin and α2 micro globulin concentration in urine are increased in tubular proteinuria.

A

TRUE: β2 micro globulin and α2 micro globulin concentration in urine are increased in tubular proteinuria

  • same with albumin, retinol binding protein and lysozyme.
62
Q

T or F: Proteinuria is often the first indicator of renal disease.

A

TRUE: Proteinuria is often the first indicator of renal disease.

63
Q

T or F: In the presence of high concentrations of ketones the sensitivity of the urine glucose test decreases.

A

TRUE: In the presence of high concentrations of ketones the sensitivity of the urine glucose test decreases.

64
Q

T or F: Measurement of specific gravity by the reagent strip is falsely increased in the presence of radiographic media.

A

FALSE; The urine reagent strip SG test ONLY DETECTS IONIC solutes and is not affected by glucose, protein or radiographic media.

65
Q

T or F: False positive urine hemoglobin results may be caused by extremely high concentrations of ascorbic acid.

A

FALSE; High Ascorbic acid concentrations cause FALSE NEGATIVE hemoglobin results.

66
Q

T or F: The detection of hemoglobin is based on hemoglobin’s peroxidase activity which can catalyze the reaction of a peroxide and a chromagen.

A

TRUE: The detection of hemoglobin is based on HEMOGLOBIN’S PEROXIDASE activity which can catalyze the reaction of a peroxide and a chromagen.

67
Q

T or F: Highly buffered acidic urines may falsely decrease specific gravity using a urine reagent strip.

A

FALSE; highly buffered ALKALINE urines (>=6.5) FALSELY DECREASE specific gravity readings using urine reagent strips.

68
Q

T or F: In the presence of glucose, the specific gravity measured by a urine reagent strip increases.

A

FALSE; the specific gravity urine reagent strip test responds to ionic concentration. GLUCOSE DOES NOT FORM IONS.

69
Q

T or F: High concentrations of nitrites can cause false positive urine reagent strip tests for bilirubin.

A

FALSE; High concentrations of nitrites can cause FALSE NEGATIVE urine reagent strip tests for bilirubin.

70
Q

T or F: Allowing the urine to run down the strip after dipping a urine reagent strip may cause false increase in pH.

A

FALSE; IMPROPER REAGENT STRIP TECHNIQUE causes the acid buffer from the protein test to contaminate the pH pad and cause a FALSE DECREASE in pH.

71
Q

T or F: Free hemoglobin only appears in the urine when haptoglobin is saturated.

A

TRUE: Free hemoglobin only appears in the urine when haptoglobin is saturated.

72
Q

T or F: The ketone test on urine reagent strips detects the predominant ketone found in urine.

A

FALSE; The predominant ketone in urine and blood is β-hydroxybutyrate BUT ACETOACETIC ACID is detected by the urine reagent strip test.

73
Q

T or F: The urine reagent strip test pad for leukocytes is impregnated with an ester that is hydrolyzed in the presence of leukocytes esterase and subsequently reacts with a diazonium compound to produce an azo dye.

A

TRUE; The urine reagent strip test pad for leukocytes is impregnated with an ester that is hydrolyzed in the presence of leukocytes esterase and subsequently reacts with a diazonium compound to produce an azo dye.

74
Q

T or F: The urine reagent strip test pad for leukocytes can only detect intact neutrophils

A

FALSE; The chemical detection of leukocytes esterase provides a means to detect INTACT AND LYZED GRANULOCYTES AND MONOCYTES, not only neutrophils

75
Q

Which urine reagent strip test is the only one affected by increased ketones ?

A

FALSE NEGATIVE GLUCOSE RESULTS due to increased ketones

76
Q

T or F: The sensitivity of the urine reagent strip test for leukocytes is decreased in the presence of increased glucose.

A

TRUE: The sensitivity of the urine reagent strip test for leukocytes is decreased in the presence of increased glucose.

77
Q

T or F: Falsely increased urine reagent strip test for protein may be the results of extremely acidic urine.

A

FALSE; Falsely increased urine reagent strip test for protein may be the results of highly buffered ALKALINE urine (>pH 9).

78
Q

T or F: Urobilinogen concentrations in urine are normal in pre-hepatic jaundice.

A

FALSE; Urobilinogen concentrations in urine are INCREASED in pre-hepatic jaundice.

79
Q

Urobilinogen and bilirubin urine reagent strip results for hemolytic disorders

A

Urobilinogen positive, bilirubin negative
- bilirubin is not water soluble

80
Q

Which microscopic urine results can differentiate pyelonephritis from UTIs ?

A
  • both have increased WBC, bacteria, and RBCs
  • pyelonephritis will have WBC (clumps), granular, and waxy casts
81
Q

Which microscopic urine results are indicative of nephrotic syndrome ?

A
  • increased proteins and lipids
  • fatty casts and oval fat bodies
82
Q

Acidic urine cystals (5)

A
  • bilirubin
  • cholesterol
  • cystine
  • tyrosine
  • uric acid
83
Q

Basic urine crystals (4)

A
  • calcium oxalate
  • calcium carbonate
  • amorphous phosphate
  • triple phosphate
84
Q

Describe Bilirubin crystals

A
  • acidic urine
  • brown clump of needles
85
Q

Describe Calcium oxalate crystals

A
  • basic/ neutral urine
  • colorless “envelopes”
86
Q

Describe Cholesterol crystals

A
  • acidic/ neutral urine
  • colorless rhomboid with notched corners
  • birefringent
87
Q

Describe Cystine crystals

A
  • acidic urine
  • colorless hexagons
88
Q

Describe Leucine crystals

A
  • acidic/ basic urine
  • brown “tree-trunk” (concentric rings)
89
Q

Describe Amorphous phosphate crystals

A
  • basic/ neutral urine
  • fine, junky
  • birefringent
90
Q

Describe Triple phosphate crystals

A
  • basic/ neutral urine
  • colorless, “coffin-lid”
  • birefringent
91
Q

Describe Tyrosine crystals

A
  • acidic urine
  • colorless, clumps of needles
92
Q

Describe Uric acid crystals

A
  • acidic urine
  • variable “sea glass”
  • birefringent
93
Q

Describe Calcium carbonate crystals

A
  • basic urine
  • variable ovoids and “dumb-bells”
94
Q

Describe Calcium phosphate crystals

A
  • basic urine
  • colorless, clumps of wedges

CSMLS (46 decks)

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