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Clinical Microscopy > Chemical Examination of Urine (DJIP) > Flashcards

Chemical Examination of Urine (DJIP) Flashcards

1
Q

Major types of reagent strips

A
  • Multistix

- Chemstrip

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2
Q

Source of errors of using reagent strips

A 
-Unmixed specimen 
o Keeping strip in urine too long
o Excess urine on strip 
o Imprecise timing 
o Light source
o Reagents strips and color charts from different
manufacturers are not interchangeable
o Sample must be at room temperature
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3
Q

True or false. Enzymatic

reactions are temperature dependent

A

true

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4
Q

pH of first morning urine

A

pH 5.0-6.0

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5
Q

Defects in renal tubular secretion and reabsorption of

acids and bases

A

—renal tubular acidosis

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6
Q

Normal pH range

A

4.5-8.0

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7
Q

pH condition observed after meals

A

Alkaline tide

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8
Q

Chemical finding most indicative of renal disease

A

protein

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9
Q

Causes of acidic urine

A 
·Emphysema
· Diabetes mellitus
· Starvation
· Dehydration
· Diarrhea
· Acid producing bacteria
(E. coli)
· High protein diet
· Cranberry juice
· Medications:
Methenamine mandelate,
fosfomycin tromethamine
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10
Q

Causes of alkaline urine

A 
· Hyperventilation
· Vomiting
· Renal tubular disease
· Urease producing bacteria
· Vegetarian diet
· Old specimens
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11
Q

Clinical proteinuria level

A

≥ 30 mg/dL

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12
Q

3 major categories of proteinuria

A
  • prerenal
  • renal
  • postrenal
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13
Q

Kind of protein increased in Intravascular hemolysis

A

Hemoglobin

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14
Q

Kind of protein increased in muscle injury

A

myoglobin

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15
Q

Kind of protein increased in multiple myeloma

A

bence-jones protein

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16
Q

bence jones protein coagulate at what temp

A

40-60C

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17
Q

bence jones protein dissolve at what temp

A

100

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18
Q

kind of renal proteinuria when there are:

  • Fanconi syndrome
  • Toxic agents/heavy metals
  • Severe viral infections
A

Tubular proteinuria

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19
Q

Due to vertical posture

A

Orthostatic (Postural) proteinuria

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20
Q

Due to increased pressure on renal vein

A

Orthostatic (Postural) proteinuria

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21
Q

solution to postural proteinuria

A

empty bladder before going to bed
and obtain a first morning specimen, then
obtain a second specimen after a few hours in
vertical position

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22
Q

-Diabetic nephropathy
- Leads to reduced glomerular filtration and
renal failure

A

Microalbuminuria

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23
Q

kind of proteinuria in Bacterial and fungal infections (UTI) [produce
exudates]

A

Postrenal proteinuria

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24
Q

Reagent of Multistix (protein)

A

:tetrabromphenol blue

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25
Q

Reagent of chemstrip (protein)

A

3’,3’’,5’,5’’-tetrachlorophenol-

3,4,5,6-tetrabromosulfonphthalein

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26
Q

sources of false positive when using a reagent strip

A
  • Highly buffered alkaline urine
  • Pigmented sx (phenazopyridine)
  • 4° ammonium compounds (detergents)
  • Antiseptics, chlorhexidine
  • Loss of buffer due to prolonged exposure
  • High specific gravity
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27
Q

sources of false negative when using a reagent strip

A
  • Proteins other than albumin

- Microalbuminuria

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28
Q

Reagents of micral test

A

Gold-labeled antibody
· B-galactosidase
· Chlorophenol red galactoside

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29
Q

confirmatory test for albumin

A

Sulfosalicylic Acid Precipitation Test (SSA)

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30
Q

Most frequent chemical analysis

A

glucose

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31
Q

Reagent strip rxns for glucose

A

Blue-green to orange-red color

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32
Q

tablet used for glucose measurement

A

clinitest

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33
Q

true or false. Tablets are very hygroscopic

A

true

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34
Q

Intermediate products of fat metabolism

A

ketones

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35
Q

inadequate intake of carbohydrates

A

starvation

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36
Q

inadequate

absorption of carbohydrates

A

Malabsorption/pancreatic disorders

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37
Q

reagent strip reactions for ketones

A

purple

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38
Q

tablet used for ketone test

A

acetest

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39
Q 
give the Clinical significance:
- Due to trauma or damage of genitourinary organs
 Renal calculi
 Glomerulonephritis
 Pyelonephritis
 Tumors
 Trauma
 Exposure to toxic chemicals
 Anticoagulants
 Strenuous exercise
 Menstruation
A

hematuria

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40
Q

give the clinical signifance:
Heme-containing protein found in muscle tissue
- Clear red-brown urine
- Suspected in patients with conditions associated
with muscle destruction (eg. Rhabdomyolysis)

A

myoglobinuria

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41
Q

Reagent strip reactions (blood)

A

o Pseudoperoxidase activity of hemoglobin to catalyze
reaction with hydrogen peroxide and the chromogen
tetramethylbenzidene
o Green-blue color

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42
Q

o Early indicator of liver disease; detected before jaundice

A

bilirubin

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43
Q

tablet for bilirubin test

A

ictotest

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44
Q

ictotest reagent tablet composition

A

◦ P-nitrobenzene-diazonium-p-toluenesulfonate
◦ SSA
◦ Sodium carbonate
◦ Boric acid

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45
Q

positive result for bilirubin in ictotest

A

: blue to purple color

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46
Q

Found in urine because as it is filtered by the glomerulus en
route to the liver

A

Urobilinogen

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47
Q

Classic test for differentiating urobilinogen,

porphobilinogen and Ehrlich-reactive compounds

A

Watson-Schwartz test

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48
Q

read niyo nlng mga results about Watson-Schwartz test

A 
Interpretation
Tube #1:
◦ Upper layer = urine
If colorless: porphobilinogen or Ehrlich-reactive
compounds
◦ Bottom layer = chloroform
If red: urobilinogen3A – MT | 2013-2014 Page 14
◦ If both layers are red, reextract urine layer from
tube #1, place 2 mL chloroform and 4 mL sodium
acetate into a new tube and repeat!
- If upper layer (urine) is colorless and the
chloroform layer is red
= excess urobilinogen
- If both layers are red
 = porphobilinogen & urobilinogen
 Tube #2
◦ Upper layer = butanol
If red: urobilinogen or Ehrlich-reactive
compounds
◦ Bottom layer = urine
If colorless: porphobilinogen
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49
Q

Rapid screening or monitoring of urinary

porphobilinogen

A

Hoesch screening test

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50
Q

Sources of error in Hoesch screening test

A

◦ Methyldopa
◦ Indicant
◦ Highly-pigmented urines

51
Q

Rapid screening test for UT

52
Q

Reagent strip reactions (nitrite)

A
  • Greiss reaction

- Pink colored azodye

53
Q

true or false. nitrite reagent strip measures degree of bateuria

54
Q

Sensitivity reagent strip of nitrite is standardized to correspond with a
quantitative bacterial criterion of ________ organisms/mL

55
Q

(LE) causes of Inflammation of the urinary tract

A

 Trichomonas
 Chlamydia
 Yeast
 Inflammation of renal tissues

56
Q

true or false. LE catalyze hydrolysis of acid ester on reagent pad

57
Q

Based on the change in pKa of a polyelectrolyte in an

alkaline medium

A

Specific Gravity

58
Q

rgt strip rxn for sp gr

A

o Release of H+
directly proportional to number of ions
o pH is thus lowered
o blue to green to yellow

59
Q

source of false positive in specific gravity rgt strip

A

High concentrations of protein

60
Q

source of false negative in specific gravity rgt strip

A

Highly alkaline urine

61
Q

other term for macroscopic screening, being used to decide whether microscopic exam is needed

A

chemical sieving

62
Q

positive for nitrite may signify what in microscopic?

A

bacteria/WBCs

63
Q

positive for protein may signify what in microscopic?

64
Q

positive for glucose may signify what in microscopic?

65
Q

used to count number of RBCs, WBCs, casts, and epithelial cells present in a 12-hour urine sample

A

Addis count

66
Q

may cause precipitation of amorphous urates and phosphates and other nonpathologic crystals

A

refrigeration

67
Q

solution to crystals caused by refrigeration

A

warming to 37 degrees

68
Q

standard volume for urine sedimentation

69
Q

RBCs must be identified at

70
Q

RBCs in hypersthenuric urine appear

71
Q

large empty cells are called ________; lysed RBCs in hyposthenuric urine which released its hemoglobin content

A

ghost cells

72
Q

usually associated with glomerular bleeding

A

dysmorphic RBCs

73
Q

indicates damage to the glomerular membrane or vascular injury within the genitourinary tract

A

presence of RBCs

74
Q

urine in macroscopic hematuria appears

A

cloudy with red to brown color

75
Q

predominnt WBC in urine

A

neutrophil

76
Q

neutrophils may be called _______ due to the sparkling appearnce caused by brownian movement

A

glitter cells

77
Q

the presence of eosinophils in the urine is primarily associated with

A

drug induced interstitial nephritis

78
Q

preffered stain for eosinophil in urine

A

Hansel stain

79
Q

may resemble RBCs because of their size

A

lymphocytes

80
Q

___ are usually larger than WBCs and more polyhedral in shape, woth an eccentrically located nucleus

81
Q

increase in urine WBCs

82
Q

indicates presence of inflammation or infection in the genitourinary tract

83
Q

represents normal sloughing off of cells

A

epithelial cells

84
Q

largest found in a ruine sediment

A

squamous epithelial cells

85
Q

contains irregular, abundant cytoplasm, prominent nucleus about the size of a RBC

A

squamous epith cell

86
Q

indicative of bacterial infection by Gardnerella vaginalis

A

clue cells

87
Q

difference of a transitional epith cell from RTE cells

A

transitional has centrally located nucleus

88
Q

rectangular shape and reffered to as columnar or convoluted cells

89
Q

smaller than those from PCT and are round and oval

90
Q

cuboidal and never round

A

collecting duct RTE

91
Q

the presence of ________ RTE cells per hpf indicates ______

A

2

tubular injury

92
Q

RTE cells absorb lipids present in the glomerular filtrate, and then appear highly refractile

A

oval fat bodies

93
Q

stain for oval fat bodies

A

sudan III

oil red o

94
Q

most frequently associated with damage to the glomerulus caused by nephrotic syndrome

95
Q

RTE cells containing non-lipid filled vacuoles

A

bubble cells

96
Q

acidic crystals include

A 
cystine
cholesterol
leucine
tyrosine
bilirubin
sulfonamide
ampicillin
uric acid
amorphous urates
calcium oxalate
97
Q

color of cystine crystal

98
Q

color of bilirubin crystal

99
Q

color of leucine crystal

100
Q

most frequent parasite in urine

A

trichomonas vaginalis

101
Q

a major constituent of mucus in urine

A

Tamm-Horsfall protein

102
Q

formed within the lumens of the DCT and collecting tubes

103
Q

appearancce of cast

A

tubular with rounded ends

104
Q

presence of casts in urien is called

A

cylindruria

105
Q

hyaline cast is colored ___

106
Q

specific finding indicating bleeding in the nephron

107
Q

primary marker for distinguishing upper UTI from lower UTI

108
Q

indicates advanced tubular destructon

A

epithelial cell casts

109
Q

representative of extreme urine stasis indicating chronic renal failuer

A

waxy casts

110
Q

also called renal failure casts, similar to waxy casr

A

broad cast

111
Q

formed by the precipitation of urine solution

112
Q

most common crystal found in the urine

113
Q

alkaline crystals include

A 
amorphous phosphates
calcium phosphate
triple phosphate
ammonium biurate
calcium carbonate
114
Q

color of amorphous urates

A

brick dust or yellow brown

115
Q

appears like throny apple

A

ammonium biurate

116
Q

dumbbell shaped

A

calcium carbonate

117
Q

appears dumbbell shaped, oval and envelope

A

calcium oxalate

118
Q

appears like coffin lids

A

triple phosphate

119
Q

with notched corners

A

cholesterol crystals

120
Q

appears in fine needle clumps

121
Q

hexagonal shaped crystal

A

cystine crystal

122
Q

varies upon refrigeration

A

ampicillin crystals

123
Q

appears in rosette form

A

sulfa crystal

124
Q

artifacts may include

A

pollen grain
diaper fiber
fecal material
vegetable fiber

Clinical Microscopy (11 decks)

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