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CLINICAL MICROSCOPY > Chemical Examination of Urine > Flashcards

Chemical Examination of Urine Flashcards

1
Q

Provide, simple, rapid means for performing medically significant analysis of urine

A

Reagent strips

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2
Q

Reagent strips consist of _____ absorbent pads attached to a plastic strip

A

Chemical-impregnated

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3
Q

Specimen required for chemical testing of urine

A

A fresh, well-mixed, uncentrifuged specimen

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4
Q

10 parameters for chemical examination of urine

A

pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen
Nitrite
Leukocytes
Specific gravity

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5
Q

11th parameter for chemical examination of urine

A

Ascorbic acid or Vitamin C

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6
Q

Two major types of reagent strip are manufactured under

A

Multistix & Chemstrip

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7
Q

Dipping time of reagent strips

A

No longer than 1 second

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8
Q

Major regulators of the acid–base content in the body

A

Kidneys

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9
Q

Importance of pH determination

A

Identification of urinary crystals
Determination of unsatisfactory specimens

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10
Q

Normal random urine pH

A

4.5-8.0

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11
Q

First morning urine pH

A

5.0-6.0

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12
Q

Freshly voided urine pH

A

Not >8.5 in normal or abnormal conditions

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13
Q

pH of improperly preserved specimen

A

> 9 or >8.5

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14
Q

Presence of _____ in urine container can cause alkalization of urine

A

Detergent

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15
Q

Home remedy for minor bladder infections

A

Cranberry juice or pills

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16
Q

Principle of reagent strip reaction for pH

A

Double Indicator System

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17
Q

Reading time of reagent strip reaction for pH

A

60 seconds

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18
Q

Reagents for pH testing

A

Methyl Red
Bromthymol Blue

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19
Q

Density of a solution compared with density of similar volume of distilled water at a similar temperature

A

Specific gravity

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20
Q

S.G. is influenced by

A

Number and size of particles on a solution

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21
Q

What does the reagent strip S.G. test measure?

A

Only ionic solutes

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22
Q

Normal random S.G.

A

1.002-1.035

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23
Q

Radiographic Contrast dye S.G.:

A

> 1.040

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24
Q

Not a urine S.G

A

<1.002

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25
Q

Principle of reagent strip reaction for S.G.

A

Change in the pKa (dissociation constant) of a polyelectrolyte

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26
Q

Reading time of reagent strip reaction for S.G.

A

45 seconds

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27
Q

Reagents for S.G. testing

A

Multistix: Poly (methyl vinyl ether/ maleic anhydride) bromthymol blue

Chemstrip: Ethylene glycol diaminoethyl ether tetraacetic acid, bromthymol blue

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28
Q

Parameter that is most indicative of renal disease

A

Protein

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29
Q

Normal urine protein

A

<10 mg/dL or 100 mg/24 hours (Strasinger)

<150mg/24 hours (Henry’s)

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30
Q

Major protein found in normal urine

A

Albumin

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31
Q

Protein produces a yellow foam in urine. True or False?

A

False; white foam

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32
Q

Other Proteins normally found in urine

A

Serum and tubular microglobulins
Tamm-Horsfall protein (Uromodulin)
Protein derived from prostatic and vaginal secretion

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33
Q

Result that indicates clinical proteinuria

A

≥30mg/dL or ≥300mg/L

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34
Q

Three categories of proteinuria

A

Prerenal
Renal
Postrenal

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35
Q

Proteinuria caused by conditions that affect the plasma prior to it reaching the kidney

A

Prerenal proteinuria/Overflow proteinuria

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36
Q

A monoclonal immunoglobulin light chains (kappa and lambda) found in cases of Multiple myeloma

A

Bence Jones protein

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37
Q

Bence Jones protein in heat reactivity test

A

Coagulates/Precipitates at 40-60C and dissolves at 100C

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38
Q

Confirmatory Test for Bence Jones protein

A

Serum electrophoresis

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39
Q

Proteinuria associated with true renal disease may be the result of either glomerular or tubular damage

A

Renal proteinuria/True renal disease

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40
Q

Amount of protein following glomerular damage

A

Slightly above normal to 4 g/day

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41
Q

The presence of albumin in urine above the normal level but below the detectable range of conventional urine dipstick methods

A

Microalbuminuria

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42
Q

Diabetic Nephropathy is also known as

A

Kimmelstiel-Wilson’s disease

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43
Q

Indicator of Kimmelstiel-Wilson’s disease

A

Microalbuminuria

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44
Q

Normal Albumin Excretion Rate (AER)

A

0-20 µg/min

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45
Q

AER corresponding to microalbuminuria

A

0-300 mg of albumin is excreted in 24 hours or the AER is 20-200 µg/min

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46
Q

Immunochemical assays for microalbuminuria

A

Micral-Test
ImmunoDip

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47
Q

Principle of Micral-Test

A

Enzyme immunoassay

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48
Q

Reagents for Micral-Test

A

Gold-labeled antibody
B-galactosidase
Chlorophenol red galactoside

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49
Q

Dipping time of strips in Micral-Test

A

5 seconds

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50
Q

Reading time of Micral-Test

A

1 minute

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51
Q

(+) Micral-Test

A

Red

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52
Q

(-) Micral-Test

A

White

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53
Q

Principle of ImmunoDip

A

Immunochromographic technique

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54
Q

Reagents for ImmunoDip

A

Antibody-coated blue latex particles

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55
Q

Dipping time of strips in ImmunoDip

A

3 minutes

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56
Q

(+) ImmunoDip

A

Darker top band; 2 -8

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57
Q

Borderline ImmunoDip

A

Equal band colors; 1.2-1.8

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58
Q

(-) ImmunoDip

A

Darker bottom band; <1.2

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59
Q

Normal creatinine value

A

10-300 mg/dL

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60
Q

Abnormal A:C Ratio

A

30-300 mg/g or 3.4-33.9 mg/mmol

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61
Q

Principle of A:C ratio

A

Sensitive albumin tests related to creatine concentration to correct for patient hydration

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62
Q

Reagent of albumin strip

A

dye bis (3’,3”-diiodo-4’,4”-dihydroxy-5’,5” dinitrophenyl)-3,4,5,6-tetrabromo sulphonphthalein (DIDNTB)

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63
Q

Principle of creatinine strip test

A

Pseudoperoxidase activity of copper-creatinine complexes

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64
Q

Reagent of creatinine strip

A

Copper sulfate (CuSO4), 3,3’,5,5’-tetramethylbenzidine (TMB),
Diisopropyl benzene dihydroperoxide (DBDH)

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65
Q

Occurs following periods spent in a vertical posture and disappears when a horizontal position is assumed

A

Orthostatic / Cadet / Postural proteinuria

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66
Q

Disease where normally filtered albumin can no longer be reabsorbed

A

Tubular proteinuria

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67
Q

Principle of reagent strip reaction for protein

A

Protein (Sorensen’s) error of indicator

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68
Q

Reagents for protein strip testing

A

Multistix: Tetrabromphenol blue

Chemstrip: 3’,3’’,5’,5’’-tetrachlorophenol 3,4,5,6-tetrabromosulfophthalein

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69
Q

Reading time of reagent strip reaction for protein

A

60 seconds

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70
Q

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

A

Sulfosalicylic acid precipitation test

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71
Q

(+) SSA & (+) RGT STRP

A

Presence of ALBUMIN

72
Q

(+) SSA & (-) RGT STRP

A

Presence of proteins OTHER THAN ALBUMIN

73
Q

Microscopically, what is the SSA pattern if proteins cause a positive reaction?

A

Amorphous

74
Q

Microscopically, what is the SSA pattern if drugs and radiographic contrast dye cause a positive reaction?

A

Crystalline

75
Q

Most frequently performed chemical analysis on urine (due to detection and monitoring of DM)

A

Glucose test

76
Q

Renal threshold for glucose

A

160-180 mg/dL

77
Q

Specimen used for diabetes monitoring

A

2-hour postprandial

78
Q

Glucose and insulin can cross the placenta. True or False?

A

False; glucose crosses the placenta whereas insulin does not

79
Q

Effect of GDM to the baby

A

Large baby (macrosomia) at risk for obesity and later type 2 diabetes

80
Q

Effect of GDM to the mother

A

Prone to developing type 2 diabetes mellitus in later years

81
Q

Hyperglycemia – Associated urine glucose

A

Increased blood glucose, Increased Urine glucose

82
Q

Renal – Associated urine glucose

A

Normal blood glucose, Increased Urine glucose

83
Q

Principle of reagent strip reaction for glucose

A

Double sequential enzyme reaction

84
Q

Reading time of reagent strip reaction for glucose

A

30 seconds

85
Q

Reagents for glucose strip testing

A

Multistix: glucose oxidase, peroxidase, Potassium iodide (blue to green to brown)

Chemstrip: glucose oxidase, peroxidase, tetramethylbenzidine (yellow to green)

86
Q

Principle of Copper Reduction Test (Clinitest/Benedict’s Test)

A

Copper Reduction

87
Q

Component of the Tablet (Copper Reduction Test) and their function

A

Copper sulfate: main reacting agent
Sodium carbonate: eliminates interfering O2 (room air)
Sodium citrate /citric acid: for heat production
Sodium hydroxide: for heat production

88
Q

(+) glucose oxidase (+) clinitest

A

Presence of glucose

89
Q

(-) glucose oxidase (+) clinitest

A

Presence of non-glucose reducing substance

90
Q

(1+) glucose oxidase (-) clinitest

A

Small amount of glucose

91
Q

(4+) glucose oxidase (-) clinitest

A

False-positive reagent strip
False negative Clinitest
Defective Clinitest tablets (outdated)

92
Q

Result from increased fat metabolism. They are formed from beta oxidation of fats

A

Ketones

93
Q

Most valuable in the management and monitoring of insulin-dependent (type 1) diabetes mellitus

A

Testing for urinary ketones

94
Q

Ketone Renal Threshold

A

70 mg/dL

95
Q

Ketone Bodies

A

78% Beta Hydroxybutyric acid
20% Acetoacetic acid (AAA) / Diacetic acid
2 % Acetone

96
Q

Early indicator of insufficient insulin dosage in type 1 diabetes

A

Ketonuria

97
Q

Principle of reagent strip reaction for ketones

A

Legal’s Test (Sodium Nitroprusside)

98
Q

Reading time of reagent strip reaction for ketones

A

40 seconds

99
Q

Reagents for ketone strip testing

A

Sodium nitroprusside (nitroferricyanide),
Glycine (Chemstrip)

100
Q

Components of the acetest tablet

A

Sodium nitroprusside
Glycine
Disodium phosphate
Lactose

101
Q

Reading time of acetest

A

30 seconds

102
Q

The finding of a positive reagent strip test result for blood indicates the presence of

A

Red blood cells
Hemoglobin
Myoglobin

103
Q

Clarity of urine with hematuria

A

Cloudy red urine

104
Q

Clarity of urine with hemoglobinuria

A

Clear red urine

105
Q

Clarity of urine with myoglobinuria

A

Clear red urine

106
Q

Amount of blood that is clinically significant

A

> 5 cells/µL of urine

107
Q

Why is it that chemical tests for hemoglobin provide the most accurate means for determining the presence of blood?

A

Because microscopic examination of the urinary sediment shows intact red blood cells, but free hemoglobin produced either by hemolytic disorders or lysis of red blood cells is not detected

108
Q

The heme portion of myoglobin is toxic to the renal tubules, and high concentrations can cause acute renal failure. True or False?

A

True

109
Q

The massive hemoglobinuria seen in hemolytic transfusion reactions also is associated with

A

Acute renal failure

110
Q

Appearance of plasma when hemoglobin is present

A

Red/ pink plasma

111
Q

Appearance of plasma when myoglobin is present

A

Pale yellow plasma

112
Q

Precipitation test used to differentiate hemoglobin from myoglobin

A

Blondheim’s precipitation test (ammonium sulfate)

113
Q

Blondheim’s precipitation test result of hemoglobin

A

Precipitated by ammonium sulfate

Produce a clear supernatant that is negative for blood reagent strip

114
Q

Blondheim’s precipitation test result of myoglobin

A

Not precipitated by ammonium sulfate

Produce a red supernatant that is positive for blood reagent strip

115
Q

Principle of reagent strip reaction for blood

A

Pseudoperoxidase activity of Hemoglobin

116
Q

Reading time of reagent strip reaction for blood

A

60 seconds

117
Q

Reagents for blood strip testing

A

Multistix: diisopropylbenzene dihydroperoxide and 3,3’,5,5’-tetramethylbenzidine

Chemstrip: dimethyldihydroperoxyhexane and tetramethylbenzidine

118
Q

Pattern of of pads when hemoglobin/myoglobin is detected

A

Uniform

119
Q

Pattern of of pads when RBC is detected

A

Speckled

120
Q

A highly pigmented yellow compound, is a degradation product of hemoglobin

A

Bilirubin

121
Q

The appearance of bilirubin in the urine indicates

A

Early indication of liver disease

122
Q

Why does jaundice due to increased destruction of red blood cells does not produce bilirubinuria?

A

Because the serum bilirubin is present in the unconjugated form and the kidneys cannot excrete it

123
Q

Jaundice associated with hemolytic disorders results from the increased amount of circulating unconjugated bilirubin. True or False?

A

True

124
Q

Form of bilirubin that is water soluble and can be seen in urine

A

B2 or conjugated bilirubin

125
Q

Bilirubin produces an amber urine with white foam. True or False?

A

False; yellow foam

126
Q

Amount of bilirubin normal adult urine

A

0.02 mg/dL

127
Q

Principle of reagent strip reaction for bilirubin

A

Diazo Reaction

128
Q

Reading time of reagent strip reaction for bilirubin

A

30 seconds

129
Q

Reagents for bilirubin strip testing

A

Multistix: 2,4-dichloroaniline diazonium salt

Chemstrip: 2,6-dichlorobenze diazonium salt/tetrafluoroborate

130
Q

A confirmatory test for bilirubin

A

Ictotest

131
Q

Positive reaction
of Ictotest

A

Blue to purple color

132
Q

Negative reaction of Ictotest

A

Colors other than blue or purple

133
Q

How to remove interferences in Ictotest?

A

Add water

134
Q

Reading time of Ictotest

A

30 seconds

135
Q

A bile pigment that results from hemoglobin degradation

A

Urobilinogen

136
Q

Amount of urobilinogen normally found in urine

A

<1 mg/dL or Ehrlich unit

137
Q

> 1 mg/dL of urobilinogen indicates

A

Liver disease and hemolytic disorders

138
Q

Absence of urobilinogen in the urine and feces indicates

A

Bile duct obstruction

139
Q

Stool color when there is a lack of urobilin

A

Pale

140
Q

Principle of reagent strip reaction for urobilinogen

A

Ehrlich‘s reaction

141
Q

Reading time of reagent strip reaction for urobilinogen

A

60 seconds

142
Q

Reagents for urobilinogen strip testing

A

Multistix: p-dimethylaminobenzaldehyde

Chemstrip: 4-methoxybenzene diazonium tetrafluroborate

143
Q

What would be the result of urobilinogen measurements if the reagent strip is performed at a higher temperature?

A

Falsely increased

144
Q

What would be the result of urobilinogen measurements after following a meal?

A

Normally highest after meal

145
Q

Used to differentiate urobilinogen, porphobilinogen, and other Ehrlich reactive compounds

A

Watson-Schwartz Test

146
Q

Review Watson-Schwartz Test

A

REVIEWHIN MO SA NOTES

147
Q

Rapid screening and monitoring test for urine porphobilinogen (>2mg/dL)

A

Hoesch Test (Inverse Ehrlich Reaction)

148
Q

Provides a rapid screening test for the presence of UTI and bacteriuria

A

Nitrite

149
Q

The nitrite test also can be used to:

A

Evaluate the success of antibiotic therapy
Periodically screen persons with recurrent infections, patients with diabetes
Pregnant women

150
Q

Nitrite test is intended to replace the urine culture as the primary test for diagnosing and monitoring bacterial infection. True or False?

A

False; not intended

151
Q

Specimens used for nitrite test

A

1st morning or 4 hours urine

152
Q

The chemical basis of the nitrite test

A

The ability of certain bacteria to reduce nitrate, a normal constituent of urine, to nitrite, which does not normally appear in the urine

153
Q

Principle of reagent strip reaction for nitrite

A

Greiss reaction

154
Q

Reading time of reagent strip reaction for nitrite

A

60 seconds

155
Q

Reagents for nitrite strip testing

A

Multistix: p-arsanilic acid, tehtrahydrobenzoquinolin-3-ol

Chemstrip: sulfanilamide, hydroxytetrahydro benzoquinoline

156
Q

Positive result of nitrite strip testing

A

Uniform/Homogenous pink

157
Q

Pink spots/edge result of nitrite strip testing is considered

A

Negative

158
Q

Positive nitrite corresponds to

A

> 100,000 organisms/mL

159
Q

Significance of leukocyte testing

A

UTI/inflammation
Screening of urine culture specimen
Bacterial and non-bacterial infection

160
Q

LE test detects esterase found in:

A

Granulocytic WBCs (Neutrophil, Eosinophil, Basophil)
Monocytes
Trichomonas
Chlamydia
Yeast
Histiocytes

161
Q

Esterase negative constituents

A

Lymphocytes
Erythrocytes
Bacteria
Renal tissue cells

162
Q

Infections involving trichomonads, mycoses (yeast), chlamydia, mycoplasmas, viruses, or tuberculosis cause

A

Leukocyturia or pyuria without bacteriuria

163
Q

Screening urine specimens using LE test should be correlated with

A

Nitrite chemical reactions

164
Q

Principle of reagent strip reaction for leukocyte

A

Leukocyte Esterase

165
Q

Reading time of reagent strip reaction for leukocyte

A

120 seconds

166
Q

Reagents for lekocyte strip testing

A

Multistix: Diazonium salt, derivatized pyrrole amino acid ester

Chemstrip: Diazonium salt, Indoxylcarbonic acid ester

167
Q

11th parameter

A

Ascorbic acid

168
Q

Ascorbic acid causes False Negative result to

A

BBLNG (Blood, Bilirubin, Leukocyte, Nitrite, Glucose)

169
Q

Ascorbic acid causes False Positive result to

A

Clinitest

170
Q

Ascorbic acid level that causes a negative reaction to Bilirubin and Nitrite

A

≥25 mg/dL

171
Q

Ascorbic acid level that causes a negative reaction to glucose

A

≥50 mg/dL

172
Q

Reading time of Stix

A

60 seconds

173
Q

Reading time of C-stix

A

10 seconds

174
Q

Positive result of Stix

A

Blue color

175
Q

Positive result of C-stix

A

Blue color

CLINICAL MICROSCOPY (20 decks)

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