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Urinalysis > Chemical Examination > Flashcards

Chemical Examination Flashcards

1
Q

What are some of the medically significant tests reagent strips perform? (10)

A
  1. pH
  2. protein
  3. glucose
  4. ketones
  5. blood
  6. bilirubin
  7. urobilinogen
  8. nitrite
  9. leukocytes
  10. Specific gravity
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2
Q

Two major type of reagent strips are manufactured under the trade names?

A
  • Multistix
  • Chemstrip
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3
Q

Describe Improper Technique Errors with reagent strips? (5)

A
  • Unmixed specimen: form elements like RBCs & WBCs sink to bottom, not moxed remain undetected
  • Refridgerated samples must return to room temp; enzymatic reactions temp. dependent on strips.
  • Excess urine remaining on strip after removal can cause chemical run over between pads and distort colors.
  • Not following manufacturers stated timing. (Leukocyte eserase reaction is 2 mins (120s))
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4
Q

How are reagent strips stored and protected? (4)

A
  • Opaque container (light)
  • stored at room temp (<30 degrees)
  • Not touch chemical pads when removing strips
  • visually inspect each time for detoriation.
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5
Q

Quality control of reagent strips: When are reagent strips checked? (4)

A
  • with positive and negative controls every 24 hrs
    • beginning of each shift in labs
  • New bottle opened
  • questionable results
  • strip integrtity concern
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6
Q

Why is distilled water not recommended as a negative control?

A

Because strip chemical reations are desined to perform at ionic concentrations similar to urine.

Basically it will react with water

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7
Q

T/F all negative controls must be negative and all positive controls must agree with published value +/- 1 color block.

A
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8
Q

Give an example of reagent strip interference?

A
  • orange pigment in urine caused by medication phenazopyridine masks color reactions.
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9
Q

What is secondary testing?

A

Test using different reagents / methods to detect same substances by reagent strip with similar or greater sensitivity and specificity.

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10
Q

What is the secondary test for protein?

A

Sulfosalycylic Acid (SSA)

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11
Q

What is the secondary test for Galactose, Glucose?

A

Clintest

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12
Q

What is the secondary test for ketones?

A

Acetest

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13
Q

This is the secondary test and primary confirmatory test for Bilirubin?

A

Ictotest

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14
Q

What is the pH of the first morning specimen? When is it alkaline?

A
  • slightly acidic 5.0 - 6.0
  • more alkaline (alkaline tide) after meals
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15
Q

What is the pH range of normal random samples?

A

4.5 - 8.0

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16
Q

No normal values are assigned to urine pH, what other patient information must be considered in conjuction with pH?

A
  • acid-base content of blood
  • renal funtion
  • prescence of a UTI
  • dietary intake
  • age of specimen
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17
Q

Above what pH is considered improperly preserved?

A

8.5

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18
Q

Persons with high protein and high meat diets tend to produce what urine pH?

and vegetarians?

What is an exception to the above?

A
  • Acidic
  • Alkaline
  • cranberry juice - home remedy to treat UTI as it inhibits colonization of some urinary pathogens.
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19
Q

Maintaining acidic urine can be vaulable in treating?

A

UTI

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20
Q

Reagent strip reactions

  • Methly red produces what color change at what pH?
  • Bromothymol blue produces what color change at what pH?
A
  • red to yellow at 4 - 6 pH
  • green to blue at 5 - 9 pH
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21
Q
A
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22
Q

How much protein is in normal urine?

A

<10 mg/dL or 100 mg per 24hrs excreted

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23
Q

Uromodulin also known as what is produced where?

A

Tamm-Horsfall protien is produced in the distal convoluted tubule

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24
Q

Proteinuria is a common early indicator of what?

Clinical protienuria is indicated at? (#)

A
  • early renal disease
  • 30 mg/dL or 300 mg per 24hrs
25
Q

What are the three major categories of protienuria?

A
  • prerenal
  • renal
  • postrenal
26
Q

What causes prerenal proteinuria?

A
  • conditions affecting plasma before it reaches the kidney, not indicative of renal disease.
  • usually transient condition
  • caused by increases in lmw plasma proteins like Hgb and acute phase reactants associated with infection and inflammation.
  • this in NOT discovered in routine urinalysis
27
Q

A primiary example of protienuria is?

A

Bence Jones Protein due to multiple myloma.

28
Q

How is BJP tested?

A
  • Boil Piss
    • BJP coagulates between 40 - 60 oC
    • dissolves at 100oC
29
Q

Protienuria associated with true renal disease may be the result of? (3)

A
  • glomerular damage
  • tubular damage
  • diabetic nephropathy
30
Q

What are two major causes of proteinuria due to glomerular damage?

A
  • erythmatosus
  • streptococcal glomerularnephritis
31
Q

Protienuria in the latter months of pregnancy may indicate?

A

pre-eclampsia

32
Q

Microabumminuria is an early preductor of renal complications and common in people with? and also indicative of?

A

type 2 and type 2 diabetes mellitus and is also indicative of carsiovascular disease.

33
Q

What is a benign proteinuria that occurs in young adults?

A

Orthostatic proteinuria occurs when too much time spent in verticle position

34
Q

Causes of postrenal protienuria? (3)

A
  • protein can be added to urine as it passes through lower urinary tract structures (bladder, ureters, urethra, prostate, vag)
  • bacterial and fungal infectiond produce exudates contaning protein
  • Blood from injury or mentral contamination or prostatic fluis and large amounts of spermatozoa
35
Q

reagent strip (multistix) test for protein contains tetrabromophenol blue color turns from yellow to blue.

A
36
Q

reagent strip (multistix) test for protein

causes of interference?

A
  • alkaline urine ovveriding acis-buffer system cause unrelated color change
  • false positive if not done under acidic conditions
  • highly pigmented urine, ammonium compunds, detergents and antiseptics cause false positives
  • false positive with high specific gravity
37
Q

What is the Sulfosalycylic Acid (SSA) Test?

A

A cold precipitation test that reacts with all forms of protein.

38
Q

What is the clinical significance of an SSA test?

A

Renal Diseases

39
Q

What is the most frequently performed checmical analysis on urine?

A

Glucose Test

40
Q

What is the level at which tubular reabsorbtion of glucose stops?

A

160 - 180 mg/dL

41
Q

The glucose oxidase test is specific to glucose.

What is the first and second step of this reaction?

A
  1. glucose oxidase catalyses reaction between glucose + air ==> gluconic acid
  2. perosidase catalyses reaction between peroxise+chromogen ===> oxidized color compound proportional to glucose concentration.
42
Q

Interfering substance: glucose oxidase test

A
  • False +ve - peroxide and strong oxidizing agents
  • False -ve - Enzyme reaction interference - asorbic acid
  • High ketones at low glucose concentrations affect test
  • High specific gravity can reduce sensitivity
43
Q

What is the Copper reduction method (Clinitest)?

What do clinitest tablets contain?

What is the color change? and what is ‘pass through’

A
  • glucouse reduce copper sulphate to cuprous oxide in the prescence of alkali and heat.
  • copper sulphate, sodium carbonate, sodium citrate, and sodium hydroxide
  • Orange/brown
    • color change to orange brown and back to green-brown, if not observed can be reported as negative
44
Q

What can interfere with Clinitest?

A
  • other reducing sugars - galactose, fructose, lactose, pentose etc.
  • drug metabolites
  • antibiotics
45
Q

What is the clinical significance of clinitest?

A
  • inborn error of metabolism in neborns
  • Diabetes mellitus
46
Q

Ketones represent what intermediates of fat products?

A
  • acetone 2%
  • acetoacetic acid 20%
  • beta-hydroxybutyrate 78%
47
Q
A
48
Q

Clinical significance of Keytones in urine?

A
  • Diabetes mellitus
  • inability to metabolize carbs
  • carb loss from vomiting
  • inadequate carb intake
  • malabsorbtion
49
Q

Reagent strip: Ketones

What is the reaction and color change?

A

Acetoacetic acid + sodium nitroprusside ===> purple color change

50
Q

What is the clinical significance of hematuria (RBC in pee)?

A
  • renal or genitourinary bleeding
    • renal calculi
    • glomerula diseases
    • trauma
    • pyelonephritis
    • toxic chemicals
    • anticoag therapy
51
Q

What is the clinical significance of hemoglobinuria (Hgb in pee)? (7)

A
  • lysis of RBCs in urianary tract from alkaline pee
  • intravascular hemolysis
  • hemolytic anemias
  • severe burns
  • brown recluse spider bites
  • infections
  • strenuous exercise
52
Q

What is the clinical significance of myeoglobinuria (RBC in pee)?

A
  • muscle destruction (rhabdomyolysis)
  • high conc of myeglobin toxic to renal tubules and can cause acute renal failure
53
Q

Appearance of bilirubin in urine is an early indicator of?

What type of bilirubin can appear in urine?

A
  • liver disease
  • conjugated bilirubin causing bilirubinuria due to hepatitis / cirrhosis
54
Q

Reagent strip reaction for bilirubin?

color change?

A
  • Diazo ===> azodye
  • pink to voilet
55
Q

What is the confirmatory test for bilirubin?

A

Ictotest

56
Q

reagent strip reaction for urobilniogen?

A
  • Erlich reaction (multistix)
    • Normal 0.2 - 1.0 EU
    • Abnormal 2. 4. 8 EU
  • Diazo reaction(Chemstrip)
    • more specific than erlich reaction
57
Q

Nitrite tests indicate?

A

UTI

58
Q

Clinical significance of Nitrite? (3)

A
  • Initial bladder infection (cystitis)
  • Pyelonephritis
  • evaluate success of antibiotic therapy
59
Q

Nitrite is detected by what reaction?

A

Greiss reaction, nitrite at acidic pH reacts w/ aromatic amine to make diazonium compund ====> pink azodye

Urinalysis (4 decks)

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