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AUBF - Lec > Chemical Examination - Kulang > Flashcards

Chemical Examination - Kulang Flashcards

1
Q

are used to perform the routine chemical tests on urine

A

Reagent Strips

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2
Q

consist of chemical-impregnated absorbent
pads on a plastic strip

○ each test has a specific chemical that is
impregnated on the pad

A

Reagent Strips

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3
Q

Test performed for Reagent Strips

A

pH
protein
glucose
ketones
blood
bilirubin
urobilinogen
nitrite
leukocyte esterase
specific gravity (SG)

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4
Q

What parameters are in the 2 Parameters Reagent Strips?

A

Protein
Glucose

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5
Q

What parameters are in the 11 parameters Reagent Strips?

A

pH
protein
glucose
ketones
blood
bilirubin
urobilinogen
nitrite
leukocyte esterase
specific gravity (SG)
+ Creatinine

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6
Q

Major Types of Reagent Strips

A

○ Multistix (Siemens)
○ Chemstrip (Roche)

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7
Q

Reagent strips are also used with _________

A

automated instruments

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8
Q

Some VARIATIONS occur between the strips with regard to ________ and _________ and _____________

A

sensitivity; specificity; interfering substances

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9
Q

are supplied by the manufacturer → located at the bottle

A

Color Comparison Charts

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10
Q

Reagent Strip Technique

A
  • Dip strip
  • Remove excess urine
  • Blot edge of strip
  • Wait
  • Compare color of reaction
  • Hold horizontally
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11
Q

results of Reagent Strip can be read from (time)

A

30-120 secs

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12
Q

Dip strip briefly into well-mixed specimen at (temperature)

A

room temperature

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13
Q

RBCs and WBCs sink to the bottom of an unmixed specimen → can cause

A

false negative results

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14
Q

Enzyme reactions on strip are based on (readings)

A

room temperature readings

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15
Q

leukocyte esterase amount of time for reactions to occur

A

the LONGEST at 2 minutes

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16
Q

strips are stored with

A

DESICANT in an opaque, tightly closed
container

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17
Q

What is generated when strips are refrigerated?

A

Freezing can generate moist

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18
Q

HANDLING AND STORAGE OF STRIPS

A

● Store with DESICANT in an opaque, tightly closed container
● Store below 30C, DO NOT FREEZE
● Do not expose to volatile fumes
● Do not use past the expiration date
● Do not use if pads are discolored
● Remove strips immediately prior to use

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19
Q

characteristics of pads

A

hydroscopic

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20
Q

QC for Protein

A

sulfosalycilic acid / acidify specimen

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21
Q

QC for Galactose

A

Clinitest

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22
Q

QC for Ketones

A

Acetest

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23
Q

QC for Bilirubin

A

Ictotest (primary confirmatory test)

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24
Q

are major regulator of acid-base balance
○ Make sure that blood pH is maintained

A

kidneys

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25
Q

specimen that is normally acidic (5-6)

A

First Morning Specimen

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26
Q

specimen that is more alkaline

A

Postprandial specimen

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27
Q

Normal Range of Urine pH

A

4.5-8.0

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28
Q

cannot reach pH 9→ indicates old
bacteria-contaminated urine (highly alkaline urine; recollect)

A

Normal fresh urine

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29
Q

DIET AND MEDICATION REGULATION

Meat = ?
Vegetables = ?
Medications for URINARY TRACT INFECTION = ?

A

● MEAT = acid pH
● VEGETABLES = alkaline pH
● Medications for URINARY TRACT INFECTION = acid pH

30
Q

exception for alkaline pH for vegetables

A

cranberry juice

31
Q

Causes Acid Urine

A

Emphysema
Diabetes mellitus
Starvation
Dehydration
Diarrhea
Presence of acid-producing bacteria (E. coli)
High Protein diet
Cranberry Juice
Medication

32
Q

Example of Medications that can cause Acidic Urine

A

methenamine mandelate [Mandelamine],
fosfomycin tromethamine [Monurol]

33
Q

Causes Alkaline Urine

A

Hyperventilation
Vomiting
Renal Tubular Acidosis
Presence of urease-producing bacteria
Vegetarian diet
Old specimens

34
Q

Double Indicator Reaction

A

Methyl Red
Bromthymol blue

35
Q

4–6 red/orange to yellow (DIR)

A

Methyl Red

36
Q

6–9 green to blue (DIR)

A

Bromthymol blue

37
Q

(DIR)
Interference:
Only runover between acid from protein pad →

A

False Positive Results

38
Q

Most indicative of renal disease

A

Protein

39
Q

seen in early renal disease

A

Proteinuria

40
Q

Normal protein of Urine

A

NORMAL = <10 mg/dL or 100 mg/24 hr

41
Q

is primary protein of concern

A

Albumin

42
Q

● Conditions affecting the PLASMA, not the kidney
○ Inflammation can cause proteinuria; overrides the reabsorptive capacity of the kidneys

A

Prerenal Proteinuria

43
Q

● Transient, increase levels of low molecular weight plasma proteins, acute phase reactants, exceed reabsorptive capacity
● Rarely seen on reagent strip (not albumin)

A

Prerenal Proteinuria

44
Q

urine test is used most often to diagnose and check on multiple myeloma, a type of cancer.

A

Bence Jones Protein (BJP)

45
Q

○ Proliferative disorder of plasma cells
○ Excessive division of plasma cells results to
the immunoglobulin light chains in the urine
(BJP)

A

Multiple Myeloma

46
Q

Immunoglobulin light chains

A

Bence Jones Protein

47
Q

Screening Test for BJP

A

BJP coagulates between 40-60°C and dissolves at 100 degrees (solubility property)
○ Proteins other than BJP remain uncoagulated

48
Q

Confirmatory Test for BJP

A

serum electrophoresis

49
Q

Prerenal Tubular Disorders

A
  1. Intravascular hemolysis
  2. Muscle Injury
  3. Acute phase reactants
  4. Multiple Myeloma
50
Q

Clinical proteinuria range

A

= 30 mg/dL, 300 mg/24 hr

○ Higher results → pathologic cause

51
Q

Proteinuria - Variety of Causes

A

Prerenal
Renal
Postrenal

52
Q

Renal Proteinuria

A
  1. Glomerular proteinuria
  2. Tubular proteinuria
53
Q

Glomerular Proteinuria is caused by what factors?

A

● Damage to glomerular membrane
● Impaired selective filtration causes increased protein filtration
● Abnormal substances deposit on the membrane
● Increased pressure on the filtration mechanism
● Benign proteinuria (transient

54
Q

Primarily immune disorders result in immune
complex formation

A

■ Lupus erythematosus
■ Streptococcal glomerulonephritis

55
Q

Increased pressure on the filtration mechanism can caused of

A

○ Hypertension
○ Strenuous exercise (physiologic cause)
○ Dehydration
○ Pregnancy (Preeclampsia)

56
Q

↑ blood flow in kidneys = ?

A

↑ pressure at glomerular basement membrane
= CAUSES DAMAGE IN THE GBM

57
Q

○ Exposure to cold, exercise, dehydration, high
fever
○ Observed in young adults
○ Long hours of standing/sitting (in vertical position) → detection of protein in urine

A

Orthostatic Proteinuria

58
Q

ORTHOSTATIC (POSTURAL) PROTEINURIA

A

● Benign (increased pressure on renal vein)
● Occurs in vertical position, disappears in horizontal position
● Frequently picked up on random specimen
● Empty bladder before bed
● Collect specimen immediately on arising
● Specimen will be NEGATIVE for protein

59
Q

Glomerular Disorders

A

1) Immune complex disorders
2) Amyloidosis
3) Toxic agents
4) Diabetic nephropathy
5) Strenuous exercise
6) Dehydration
7) Hypertension
8) Preeclampsia
9) Orthostatic or postural proteinuria

60
Q

Tubular Proteinuria is caused by what factors?

A

● Tubular damage affecting reabsorptive ability
● AMOUNT OF PROTEIN

61
Q

■ Toxic substances, heavy metals,
viral infections, Fanconi syndrome
(generalized proximal convoluted
tubule defect)

A

○ ACUTE TUBULAR NECROSIS

62
Q

Patients (children) with cystinuria
may develop ___________________

A

Fanconi syndrome

63
Q

disorder where the reabsorptive capacity of kidney tubules are impaired

A

Fanconi syndrome

64
Q

Amount of Protein in Glomerular

A

up to 4 g/day (directly from
circulation)

65
Q

Amount of Protein in Tubular

A

much lower levels (from damaged tubules)

66
Q

Factors that causes Postrenal Proteinuria

A

● Protein added in the lower urinary and genitourinary tract
● Microbial infections causing inflammations and release (leakage) of interstitial fluid protein
● Menstrual contamination
● Semen / Prostatic fluid
● Vaginal secretions
● Traumatic injury

67
Q

TRADITIONAL PRINCIPLE of Protein Reagent Strip Reactions

A

○ Protein error of indicators
○ Certain indicators change color in the
presence of protein at a constant pH
○ Protein, primarily ALBUMIN, accepts H+ from
the indicator
○ Most sensitive to albumin because albumin
has more amino groups to accept H+ than
other proteins
○ Color change is directly proportional to the
amount of protein present in the urine

68
Q

Indicator of Reaction in Protein

A

Tetrabromophenol blue or tetrachlorophenol
tetrabromsulfonphthalein and an acid buffer

69
Q

pH Level for Protein

A

3

70
Q

In protein strip reaction, color progresses through ____ to ______

A

green to blue

71
Q

trace values of protein are

A

<30 mg/dL

AUBF - Lec (4 decks)

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