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Urinalysis > Chemical Analysis > Flashcards

Chemical Analysis Flashcards

1
Q

PH

Principle
Reagents
Misc Info

A

Principle: double indicator

Reagents: methyl red and bromthymol blue

Misc Info
Normal 5.0 – 8.0

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2
Q

Protein

Principle
False pos and neg interferences
Misc Info

A

Principle: protein error of indicators

Reagents: tetrabromphenol blue

False Pos: drugs, highly buffered or alkaline urine

False Neg: presence of protein other than albumin

Misc Info: Normal: Negative

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3
Q

Glucose

Principle
False pos and neg interferences
Misc Info

A

Principle: double sequential enzyme reaction

Reagents: Chemstrip tetramethylbenzidine
Multistix: Potassium iodide

False Pos: strong oxidizing agents; bleach
Peroxide contaminants

False Neg: ascorbic acid -improper storage

Misc Info: Normal: Negative

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4
Q

Ketones

Principle
False pos and neg interferences
Misc Info

A

Principle: Nitroprusside rxn

Reagents: Nitroferricyanide
Chemstrip-glycine

False Pos: Pigmented urine, levodopa metabolites

False Neg: improper storage

Misc Info: Normal: Negative

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5
Q

Blood

Principle
False pos and neg interferences
Misc Info

A

Principle: Pseudoperoxidase activity of heme moiety

Reagent: tetramethylbenzidine

False Pos: Peroxidase, menstruation

False Neg: ascorbic acid, nitrites, improperly mixed spec

Misc Info: Normal: Negative

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6
Q

Bilirubin

Principle
False pos and neg interferences
Misc Info

A

Principle: Diazo coupling rxn

Reagent: Chemstrip: dichlorobenzenediazonium tetrafluroboroate.
Multistix dichloroaniline diazonium salt

False Pos: Drugs

False Neg: ascorbic acid, high nitrite concentrations,
improper storage with exposure to light

Misc Info: Normal: Negative

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7
Q

Urobilinogen

Principle
False pos and neg interferences
Misc Info

A

Principle: azo coupling rxn - chemstrip
modified Ehrlich rxn - multistix

Reagent: 4 methoxybenzene diazonium fluorborate -
p-dimethylaminobenzaldine - multistix

False pos: Drugs, beets

False neg: formalin, improper storage, old specimen

Misc Info: Normal: < 1mg/dL

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8
Q

Nitrate

Reagent
False pos and neg interferences
Misc Info

A

Reagents: Chemstrip: sulfanialamide
aromatic compound
Multistix: p-arsanilic acid aromatic compound

False pos: drugs, beet ingestion, improper storage

False Neg: ascorbic acid,

Misc Info: Normal: Negative

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9
Q

Leukocyte Esterase

Principle
False pos and neg interferences
Misc Info

A

Principle: esterase activity
Chemstrip: indoxylcorbonic acid ester
Multistix: pyrroleaminoacid ester

False Pos: drugs, beet ingestion, vaginal contamination. formalin

False Neg: increase conc of glucose, oxidizing agents, tetracyclines

Normal: Negative

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10
Q

Specific gravity

Principle
False pos and neg interferences
Misc Info

A

Principle: Polyelectrolyte on strip

Reagent: Chemstrip: ethylenglycol-bistetra acetic acid
Multistix: polymethylvinul ether malic acid

False Pos: High conc. Of protein, ketoacidosis

False Neg: Glucose and urea

Misc Info: Normal: 1.000 – 1.030

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11
Q

Ictotest

Principle and Purpose

A

Principle: Bilirubin glucoronide (aromatic compound) plus a Diazonium salt gives a azobilirubin (azodye brown/purple)

Purpose: Bilirubin

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12
Q

SSA

Principle and Purpose

A

Principle: Proteins denature in SSA, turbidity is observed

Purpose: Low molecular weight proteins

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13
Q

Microalbumin

Principle and Purpose

A

Principle: Immunodip, Micral tests strips, CLINITEK Microalbumin test strips, Creatinine, Multistix PRO test strips

Purpose: Minute amounts of albumin

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14
Q

Hoesch Test

Principle and Purpose

A

Principle: 10 parts (2 mL) Ehrlich’sreagent and 1 part (2 drops) urine in acidic urine, will develop red/pink if porphobilinogen is present

Purpose: Porphobilinogen

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15
Q

Benedicts Test

Principle and Purpose

A

Principle: Reducing substance + cupric sulfate cuprous oxide (colored)

Purpose: Tests for reducing carbohydrates such as galactose, lactose, fructose, glucose.

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16
Q

Acetest Test

Principle and Purpose

A

Principle: Reagent:nitroprusside

Purpose: Ketones

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17
Q

Discuss the care and storage of reagent strip and how often QC is performed.

A

Store reagent strip in the original container at room temperature, keep out of light, once opened they can only be used for six months.

QC needs to be performed daily on both a positive (usually purchased) and negative(can either be purchased or DI water) control

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18
Q

Explain isothenuria and what this diagnosis indicates for the patient.

A

Isothenuria is a urine that has a fixed specific gravity of 1.010. It is the result of the kidneys inability to concentrate urine. The urine has the same specific gravity as plasma. Meaning the urine is an indication of end stage renal disease and is often associated with nocturia.

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19
Q

Discuss the clinical significance of urine specific gravity results.

A

1.000 - water, impossible
1.001-1.009 - associated with increase water intake considered dilute urine
1.010-1.025 - normal specific gravity
1.025-1.035 - assocaited with decreased water intake, dehydration, or profuse sweating
>1.040 - indicated iatrogenic substances, impossible

20
Q

Correlate the clinical significance with pH results seen on the reagent strip.

A

<4.5 impossible

  1. 5-6.9 Acidic urine-diet high in proteins, metabolic and respiratory acidosis, UTI, and medications.
  2. 0-7.9 Alkaline or basic urine-diet rich in fruits and vegetables, metabolic and respiratory alkalosis, UTI, and medications.

> 8.0 impossible indicates iatrogenic substances

21
Q

List two other methods of testing the urine pH.

A

The pH meter and pH test paper

22
Q

What term best describes Red Blood Cells present in the urine?

A

Hematuria. The term hemoglobinuria is the presence of hemoglobin in the urine. The term myoglobinuria is the presences of the protein that carries oxygen to the muscles

23
Q

Hematuria

A

Pink/Red/Brown /Cloudy
Yellow
Spotted positive

24
Q

Hemoglobinuria

A

Pink/Red/Brown clear
Red
Positive

25
Q

Myoglobinuria

A

Pink/Red/Brown clear
Yellow
positive

26
Q

Describe why it is important to differentiate hemoglobinuria from myoglobinuria?

A

Myoglobinuria is toxic to kidney

27
Q

What is the clinical significance of hemosiderin in a urine specimen

A

Indicates increase heme processing, present in paroxysmal nocturnal hemoglobinuria

28
Q

Explain the methodology of the leukocyte esterase reagent pad and describe why lymphocytes are not detected by this methodology

A

Leukocyte esterase is an enzyme found in the azurophilic granules of the granulocytes. Lymphocytes do not contain any granules therefore are not detected by the reagent pad.

29
Q

A positive nitrite test and a positive leukocyte esterase test is usually indicative of a urinary tract infection. List the organisms that most commonly cause UTI’s from the least common to the most common.

A

Klebsiella > Enterobacter > Proteus > E.coli

30
Q

True or false a negative nitrite test will always indicate that no bacteria are present in the urine.

A

False there are some bacteria that do not produce the nitrate reductase enzyme and there are times when the organism has reduced the nitrates to nitrites

31
Q

Pre renal: Overflow proteinuria

Proteins Present
Causes
Tests

A

Proteins present: Myoglobin, Hgb, Acute phase reactants, Bence Jones proteins

Causes: Muscle injury, Intravascular hemolysis, infection, MM

Tests: Reagent strip, microalbumin, SSA(Bence Jones)

32
Q

Renal: Glomerular proteinuria

Proteins Present
Causes
Tests

A

Proteins Present: Albumin, transferrin, α-Antitrypsin, α1-
Acid glycoprotein

Causes: Primary glomerular disease, Glomerular damage secondary to other conditions, Transitory glomerular changes

Tests: Reagent Strip, Total Protein

33
Q

Renal: Tubular proteinuria

Proteins Present
Causes
Tests

A

Proteins Present: Albumin, α2-microglobulin, α1-microglobulin,
Retinol-binding protein, β2-microglobulin, Lysozyme

Causes: Acute/chronic pyelonephritis, interstitial nephritis, Renal tubular acidosis, renal tuberculosis, Fanconi’s syndrome

Tests: Total Protein, reagent strip

34
Q

Post renal: Produced by the urine or is present as a result of contamination

Proteins Present
Causes
Tests

A

Proteins Present: Pus, menstrual proteins, vaginal secretions

Causes: Inflammation, injury, tumor, contamination

Tests: negative

35
Q

What is the normal range for protein in the urine? What is happening in the kidney if excess protein is being excreted

A

150 mg/24 hrs

Proteinuria is a result of increased amounts of protein being filtered and not reabsorbed or a reduction in the tubules= reabsorptive ability.

36
Q

Describe how elevated levels of glucose appear in the urine?

A

Glucose is normally reabsorbed by the proximal renal tubules. Glucose presents in the urine as either a pre renal condition or as a result of renal damage specifically the tubules. Pre-renal conditions consist of conditions such as Diabetes Mellitus, hormonal disorders, liver disease, pancreatic disease, drugs. In these conditions plasma glucose levels exceed the renal plasma threshold of 160-180 mg/dL

37
Q

Interpretation of clinitest versus dipstick glucose results:

A

Dipstick Clinitest Interpretation
Negative Negative -No glucose or reducing substance

Negative Positive -Reducing substance other than glucose present

Positive Positive -Glucose and possibly other reducing substance

Positive Negative -Only glucose is present

38
Q

When do ketone bodies appear in urine? What are they?

A

Ketones are present because of increased fatty acid metabolism as a result of a person being unable to utilize carbohydrates(diabetes mellitus), insufficient consumption: starvation, alcoholism, exercise, or as a result of a loss of carbohydrates. The three ketone bodies are acetone, acetoacetic acid(AAA), beta-hydroxybutyric acid

39
Q

Identify one advantage of acetest.

A

Can be used on samples other than urine.

40
Q

Describe in detail hemoglobin catabolism. Include how the heme is broken and where the breakdown takes place

A

Peripheral tissue - Heme to Biliverdin to Bilirubin

Blood - Bilirubin reversibly binds to albumin forming a large soluble complex

Liver - Albumin removed and Bilirubin conjugated with glucuronic acid
Normally: All conjugated bili excreted into bile duct and go to small intestine
Abnormal: Excreted by kidneys into the urine

Intestine - reconverted to unconjugated form and reduced by bacteria to colorless urobilinogen

41
Q

Classify the type of jaundice present what caused the condition and the results of the bilirubin and urobilinogen on the reagent strip.

Prehepatic
Hepatic Disorder
Posthepatic

A

Prehepatic - Transfusion reactions, sickle cell disease, hereditary spherocytosis, HDN, thalassemia, PA Negative Elevated

Hepatic disorder - Hepatitis, cirrhosis, genetic disorders Positive normal

Posthepatic - Gallstones, tumors, fiborosis Positive Decrease or absent

42
Q

Describe the physical examination of a urine with elevated bilirubin results.

A

Dark yellow to amber with a yellow foam.

43
Q

Can bilirubin results be reported directly from the dipstick–why or why not:

A

Depends upon the sensitivity of the reagent strip. The reagent strips are usually sensitive to approximately 0.5 mg/dL. The Ictotest is sensitive to approximately 0.05 – 0.1 mg/dL.

Most laboratories do not perform confirmatory tests if the reagent strip is positive, however, the Ictotest should be performed if the practitioner has specifically ordered

44
Q

True or False Urobilinogen is reported as positive or negative?

A

False in normal hemoglobin catabolism there is always about 1mg/dL of urobilinogen present in the urine

45
Q

Describe two tests used for the detection of prophobilinogen.

A

Hoesch test and the Watson-Schwartz test both of which use the Ehrlich reaction methodology .

46
Q

Discuss the sensitivity and specificity in the identification of porphyria.

A

Hoesch test is sensitive to prophobilinogen levels as low as 2 mg/dL and is specific to prophobilinogen.

Watson-Schwartz can detect levels as low as 0.6mg/dL and is not specific to just prophobilinogen it also detects urobilinogen.

Urinalysis (3 decks)

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