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Chemical Analysis of Urine Flashcards

1
Q

pH of urine is reflection of:

A

ability of kidneys to maintain normal hydrogen ion concentration in plasma and extracellular fluid

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2
Q

urine pH has 2 main objectives

A

diagnostic

therapeutic

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3
Q

pH range of urine

A

5.0-8.5

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4
Q

vegetable diet results in urine pH of

A

higher than 6

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5
Q

diet high in protein results in urine pH that is more

A

acidic

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6
Q

factors resulting in persistent acidic diet

A 
dehydration
diarrhea
fever
diabetes ketoacidosis
gout
pulmonary emphysema
high protein diet or cranberries
renal tubular acidosis
acidifying drugs
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7
Q

factors resulting in persistent alkalinity

A 
acute and chronic renal failure
UTI
bacterial continuation of urine sample
alkaline drugs
diuretics
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8
Q

small amounts of low-molecular weight protein could be found in urine – from _______ tract

A

genito-urinary tract

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9
Q

mucoprotein Tamm-Horsfall (T-H) is secreted by _______ and is NOT derived from ______

A

renal tubules

blood plasma

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10
Q

less than ______ mg/24 hour of T-H protein is excreted and is the matrix for ______

A

150 mg/24 hour period

formation of calculi or casts

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11
Q

testing for protein in urine is based off of principle called _________, which is the ability of protein to alter the color of some acid-base indicators without altering pH

A

Protein Error of pH indicators

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12
Q

in a solution void of protein, pH =

A

3 (yellow)

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13
Q

in the presence of protein, color on dipstick changes to ____, then ____ based on concentration; this method is more sensitive to ______ than _____

A

green then blue

albumin than globulin

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14
Q

false positive of protein in urine may come from:

A 
highly buffered alkaline urine
prolonged exposure to sample
container cleaning compounds
some skin cleaners
blood in urine
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15
Q

false negative of protein in urine may come from:

A

diluted urines

elevated amounts of protein other than albumin

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16
Q

factors that could contribute to temporary proteinuria

A 
strenuous exercise
postural proteinuria
dehydration
exposure to heat or cold
fever
emotional stress
pregnancy
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17
Q

(3) diseases causing consistent proteinuria

A

glomerulonephritis
pyelonephritis
malignant HTN

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18
Q

100% of glucose is reabsorbed in _______; usually not present in urine unless _______ mg/dl in blood

A

proximal tubules

160-180 mg/dl

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19
Q

urine glucose false positive may come from: (3)

A

oxidizing cleaning agents for urine containers (hydrogen peroxide)
patients taking Levodopa (parkinson’s disease)
high levels of ketones in urine

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20
Q

urine glucose false negative may come from (4)

A

cool urine
urine with high specific gravity due to uricosuria
alkaline urine due to bacterial contamination of old urine
ascorbic acid (vit C) in high doses can inhibit enzymatic reaction

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21
Q

when glucose concentration is present in urine 2 hours after eating sweet foods

A

transient glucosuria

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22
Q

glucosuria depends on:

A

blood glucose levels
glomerular filtration rates
tubular reabsorption

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23
Q

glucosuria is seen in (2) diseases

A

diabetes mellitus

congenital forms of glucosuria

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24
Q

PERSISTENT glucosuria develops in: (6)

A 
diabetes mellitus
CNS problem
kidney problems
endocrine problems
liver disorders
pharmaceutical agents
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25
second method for measurement of glucose in urine; detects ALL _____ sugars except _____
Clinitest aka Benedict's Test | reducing sugars except glucose
26
Clinitest (benedict's test) is predominately used for diagnosing ______
galactosemia
27
false positives for Clinitest (4)
ascorbic acid cephalosphorins probenecid (treating gout and hyperuricemia) urinary preservatives (formalin and formaldehyde)
28
false negatives for Clinitest (1)
technique errors
29
urine reducing sugar test is screening for GENETIC disorders of _______ metabolism; routinely performed in ______; early detection of ______
carbohydrate newborns galactosemia
30
ketones are normally produced by ______, as part of fatty acid metabolism
liver
31
if body cannot get enough _____ for energy, it will switch to using it's body fats --> increase _____ production making them detectable in urine and blood
glucose | ketone
32
ketone bodies that commonly appear in urine when fats burned for energy (3)
acetoacetic acid beta-hydroxybutyric acid acetone
33
dipsticks test determine ______ for protein, but never ____ for protein
``` acetoacetic acid (sometimes acetone) never beta-hydroxybutyric acid ```
34
false positive for urine ketone with atypical color (6)
``` highly pigmented urine combination of high specific gravity and low pH dehydration phenylketones some meds ascorbic acid ```
35
(2) reasons for false negatives for urine ketons
delay in testing | loss of reagent activity
36
ketone bodies can signify: (9)
``` diabetes mellitus malabsorption syndrome exposure to cold fasting fever insufficient carb intake malnutrition strenuous exercise vomiting ```
37
positive dipstick for blood in urine
hematuria hemoglobinuria myoglobinuria
38
blood in urine may be released from any organ of GENITO-URINARY tract
hematuria
39
blood in urine due to intravascular distraction of RBC - Glomerular filtrate
hemoglobinuria
40
blood in urine due to muscle damage - Glomerular filtrate
myoglobinuria
41
(3) reasons for false positive for blood in urine
cleanser- oxidizing contaminant bacterial peroxidase menstrual blood
42
(6) reasons for false negative for blood in urine
``` technique errors inadequate mixing of urine sample formalin preservative high conc. of ascorbic acid (vit C) high specific gravity nitrates proteins ```
43
Hematuria is the presence of blood or intact ____ in the urine. A urine that is highly _____ or has a very low ______ can cause the red cells to lyse, thus releasing their hemoglobin into the urine.
RBCs alkaline specific gravity (1.007)
44
if RBCs lyse in urine, the microscopic exam may show empty RBC membranes called:
ghost cells
45
transient hematuria may result from:
strenuous exercise | menstrual contamination
46
persistent urine blood (hematuria) may develop with (2)
``` renal diseases (glomerular, tubular, interstitial, vascular) trauma to kidneys ```
47
persistent hematuria may be present in patients with
``` urolithiasis (kidney stones) UTI urinary tract tumor bleeding disorders related to anticoagulant therapy prostatic cancer gynecological disorders ebola ```
48
free hemoglobin(hemoglobinuria) may be found in urine if
``` (intravascular hemolysis) incompatible blood transfusion hemolytic anemias immunohemolytic anemias burns electric shock ```
49
myoglobinuria may be due to: (6)
``` rhabdomyolysis electric shock myocardial infarction heroin abuse alcoholism after strenuous activity ```
50
___ & ____ will both produce positive reagent strip blood results because both contain HEME
myoglobin | hemoglobin
51
red plasma cells plus red urine =
hemoglobin
52
clear plasma cells plus red urine =
myoglobin
53
chemical differentiation for myoglobin/hemoglobin in urine
based on ammonium sulfate precipitation test
54
amount of bilirubin present in serum in healthy subjects is _____
small (less than 10% of total bilirubin)
55
elevated amount of conjugated serum bilirubin implies: (2)
liver diseases | cholestatic diseases
56
Unconjugated bilirubin is tightly bound to _____, not filtered by the ____ and absent from urine even with raised serum levels of unconjugated bilirubin.
albumin | glomerulus
57
A positive test for urine bilirubin confirms that any raised plasma levels are from
conjugated hyperbilirubinemia
58
(2) reasons for false positive urine bilirubin
technique errors | atypical color reactions
59
(3) reasons for false negative urine bilirubin
large amounts of absorbic acid decrease sensitivity of dipstick high levels of nitrate exposure to light and room temperature
60
urine bilirubin confirmation test
ictotest
61
urine bilirubin may indicate:
gallbladder, blue duct obstruction or liver pathology
62
urobilirubin is ______ color and oxidizes to _____, ____ color
colorless | urobilin (brown)
63
10-15% of urobilinogen is ________ and returned to liver, then _____ in intestines
reabsorbed in bloodstream | re-excreted
64
normal level or urobilinogen
1-4 mg/24 hour period or less than 0.1 Herlich
65
false positive for urobilinogen
aspirin sulfunamides nitrites porphyria
66
false negative for urobilinogen
use of stale urine formalin antibiotics
67
significance of urobilinogen in urine
normally present in small amounts peaks btwn 2-4:00 pm elevated in liver disease, intestinal obstruction, hemolytic anemia
68
_____ test is a rapid, indirect method for the early detection of significant and asymptomatic bacteriuria
nitrate
69
nitrates are present in normal ____, and are _____ soluble and present in ____
diets water- soluble urine
70
Nitrates converted to nitrites by many bacteria, indicates presence of ____
UTI
71
common organisms that can cause UTIs
``` escherichia coli enterobacter citrobacter klebsiella proteus species ```
72
to test for UTI caused by NITRITES, urine must have incubated in the bladder for a minimum of ____ , If UTI is caused by only non-nitrate reducers, the reaction will be ___
``` 4 hours (usually first morning urine is specimen of choice) negative ```
73
false positive for urine nitrite
air exposure to dipstick
74
false negative for urine nitrites (6)
``` specimen containing non-nitrate reducers insufficient time in bladder low or no nitrate diet elevated specific gravity of urine high level of urobilinogen in urine ascorbic acid ```
75
significance for urine nitrite
screening method for UTI
76
leukocyte esterase is only present in _____ ; and few ______ seen in urine
neutrophils | neutrophils
77
increased # of neutrophils indicates presence of ____
UTI
78
screening for UTI includes:
neutrophils, pH, protein, nitrite
79
(3) reasons for leukocyte esterase false positive
trichomonas infxn contamination by vaginal discharge formalin used as preservative
80
(3) reasons for leukocyte esterase false negative
high level ascorbic acid high level protein or glucose some antibiotics

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