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MLS 415 Urinalysis & B.F. > Chemical Examination of Urine - Protein, Glucose, Ketone, and Leukocyte Esterase > Flashcards

Chemical Examination of Urine - Protein, Glucose, Ketone, and Leukocyte Esterase Flashcards

1
Q

Normal urine will have up to how much protein per day?

A

150 mg.

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2
Q

Which test in the testing strip is most indicative of renal disease?

A

Protein.

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3
Q

Albumin makes up what percentage of the protein content in urine?

A

33%

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4
Q

Globulins make up what percentage of the protein content in urine?

A

67%

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5
Q

What are the 3 true urinary proteins?

A
  • Uromodulin (Tamm-Horsfall protein).
  • Urokinase.
  • Secretory immunoglobulin A.
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6
Q

Uromodulin (Tamm-Horsfall protein) is made by?

A

The distal convoluted tubular cells.

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7
Q

Urokinase is made by?

A

Tubular cells.

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8
Q

Secretory immunoglobulin A is made by?

A

Renal tubular epithelial cells.

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9
Q

What is Proteinuria?

A

Increased levels of protein in the urine.

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10
Q

What is often first indicator of renal disease?

A

Proteinuria.

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11
Q

What are the 4 categories of Proteinuria?

A
  • Prerenal: Overflow proteinuria.
  • Renal: Glomerular proteinuria.
  • Renal: Tubular proteinuria.
  • Postrenal: proteinuria.
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12
Q

What is overflow proteinuria?

A

Increased amount of low-molecular weight plasma proteins spilling through the glomerular filtration barrier from the plasma.

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13
Q

What causes overflow proteinuria?

A
  • Acute phase reactants: infection or inflammation.
  • Hemoglobin: Muscle injury or intravascular hemolysis.
  • Bence-Jones proteins.
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14
Q

What are Bence-Jones proteins?

A

Myeloma tumor cells that produce only light chains. Must be confirmed by electrophoresis.

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15
Q

Acute phase reactants: infection or inflammation causes what type of proteinuria?

A

Overflow proteinuria.

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16
Q

Hemoglobin: Muscle injury or intravascular hemolysis causes what type of proteinuria?

A

Overflow proteinuria.

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17
Q

Bence-Jones proteins causes what type of proteinuria?

A

Overflow proteinuria.

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18
Q

What is glomerular proteinuria?

A

Increased amount of plasma proteins (albumin) pass into the ultrafiltrate.

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19
Q

What form of proteinuria is the most serious/common?

A

Glomerular Proteinuria.

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20
Q

In Glomerular Proteinuria, what proteins are elevated?

A
  • Albumin.
  • Transferrin.
  • Alpha 1 antitrypsin.
  • Alpha acid glycoprotein.
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21
Q

What causes Glomerular Proteinuria?

A
  • Nephrotic syndrome.
  • Glomerular damage.
  • Transitory glomerular changes.
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22
Q

Nephrotic syndrome causes what type of Proteinuria?

A

Glomerular Proteinuria.

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23
Q

Glomerular damage causes what type of Proteinuria?

A

Glomerular Proteinuria.

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24
Q

Transitory glomerular causes what type of Proteinuria?

A

Glomerular Proteinuria.

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25
Q

What is tubular defect Proteinuria?

A

Normal tubular function is altered.

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26
Q

What proteins are elevated tubular defect Proteinuria?

A
  • Albumin.
  • Beta2 microglobulin.
  • Retinol binding protein.
  • Alpha 1 microglobulin.
  • Alpha 2 microglobulin.
  • Lysozyme.
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27
Q

What causes tubular defect Proteinuria?

A
  • Acute/chronic pyelonephritis.
  • Fanconi’s syndrome.
  • Hereditary.
  • Heavy metal poisoning.
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28
Q

Which proteinuria will actually test negative on the protein strip?

A

Tubular defect (Proteinuria). Will need SSA-screen.

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29
Q

Acute/chronic pyelonephritis can cause what type of Proteinuria

A

Tubular defect Proteinuria.

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30
Q

Fanconi’s syndrome can cause what type of Proteinuria?

A

Tubular defect Proteinuria.

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31
Q

Heavy metal poisoning can cause what type of Proteinuria?

A

Tubular defect Proteinuria.

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32
Q

What is posternal proteinuria?

A

It is an inflammation anywhere in the urinary tract. The protein enters the urine after the urine left the kidney.

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33
Q

What causes posternal proteinuria?

A
  • Inflammation.
  • Malignancy.
  • Injury/trauma.
  • Contamination.
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34
Q

Inflammation causes what type of proteinuria?

A

Posternal proteinuria.

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35
Q

What is the principle behind the protein test?

A

Protein “error of indicators”.

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36
Q

What is the key reagent when testing for protein?

A

Tetrabromophenol blue.

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37
Q

The specificity for the protein reagent strip is most specific for which protein?

A

Albumin.

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38
Q

What is the sensitivity for the protein test on a chemstrip?

A

6.0 mg/dL.

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39
Q

What is the sensitivity for the protein test on a multistix?

A

15-30 mg/dL.

40
Q

What causes false positives for a protein test?

A

Highly alkaline urine.

41
Q

What are the expected results for a protein test?

42
Q

How is the protein test reported?

A

Trace, 30(1+), 100(2+), 300(3+), 2000 or more (4+).

43
Q

Where should glucose be reabsorbed if it gets passed the glomerulus?

A

The proximal convoluted tubular.

44
Q

Glucosuria is:

A

The presence of just glucose in the urine.

45
Q

Glycosuria is:

A

The presence of any form of sugar.

46
Q

What allows glucose to be in the urine?

A

Ultrafiltrate concentration exceeds the kidneys ability to reabsorb.

47
Q

What is the renal threshold for glucose?

A

160-180 mg/dL.

48
Q

What are some examples of pre-renal conditions?

A
  • Diabetes mellitus.
  • Hormonal disorders.
  • Liver disease.
  • Pancreatic disease.
  • Strokes.
  • Drugs.
  • Pregnancy.
49
Q

What are some examples of renal conditions?

A
  • Fanconi’s syndrome.
  • End stage renal disease.
  • Cystinosis.
  • Heavy metal poisoning.
50
Q

Diabetes mellitus is an example of what condition?

A

Pre-renal.

51
Q

Fanconi’s syndrome is an example of what condition?

52
Q

End stage renal disease is an example of what condition?

53
Q

Cystinosisis an example of what condition?

54
Q

Galactosemia is:

A

Is a rare, hereditary disorder of carbohydrate metabolism that affects the body’s ability to convert galactose (a sugar contained in milk, including human mother’s milk) to glucose (a different type of sugar).

55
Q

What enzyme is the child lacking when they have Galactosemia?

A

Galactose 1-phosphate uridyl transferase(GALT)

56
Q

How are patients under two diagnosed with Galactosemia?

A
  • Negative glucose on reagent strip.

- Do clinitest. Tests for the presence of reducing sugars such as galactose.

57
Q

What are 3 complications of Galactosemia:

A
  • Cataracts.
  • Hepatic problems.
  • Severe mental retardation.
58
Q

What is the principle of the the glucose test?

A

Glucose oxidase peroxidase reaction. It is a double sequential enzyme test that is specific only for glucose.

59
Q

What are the key reagents for a glucose test?

A

Glucose oxidase and chromogens.

60
Q

What chromogen is present for a glucose test on the Chemstrip?

A

Tetramethylbenzidine

61
Q

What chromogen is present for a glucose test on the multistix?

A

Potassium iodine.

62
Q

What causes a false positive glucose test?

A

Strong oxidizing agents and peroxide contaminates.

63
Q

What are the results reportable for a glucose test?

A
  • Negative.

- Positive: mg/dL (100, 250, 500, 1000, 2000 or more) or % (trace, 1/4, 1/2, 1, 2 or more).

64
Q

What causes a false negative glucose test?

A

Ascorbic acid/ improperly stored samples.

65
Q

What brand of test strips is more sensitive for glucose?

66
Q

What is the sensitivity of the chemstrip for glucose?

67
Q

What is the sensitivity of the multistix for glucose?

A

75-125 mg/dL.

68
Q

What are the 3 main ketones?

A
  • Acetoacetate.
  • Acetone.
  • Beta-hydroxybutyrate.
69
Q

Which ketone is the most abundant?

A

B-hydroxybutyrate.

70
Q

What causes an inability to use carbohydrates?

A

Diabetes mellitus.

71
Q

What causes an inadequate carbohydrate intake?

A
  • Starvation.
  • Diet.
  • Alcoholism.
  • Severe exercise.
  • Extreme temperatures.
  • High fevers.
72
Q

What causes a loss of carbohydrates?

A
  • Vomiting.

- Digestive disturbances.

73
Q

What is the principle of the ketone test?

A

Acetoacetate + sodium nitroprusside = color change on strip.

74
Q

What are the key reagents for a ketone test?

A
  • Sodium nitroprusside.

- Chemstrip: Glysine.

75
Q

How are the ketone results reported?

A
  • Negative.

- Positive: Trace (5), small (15), moderate (40), large (80 - 100 mg/dL).

76
Q

The ketone test has a specificity for?

A

Acetoacetic acid.

77
Q

Which ketone test strip is more sensitivity?

A

Both are just as great:

  • The chemstrip can detect acetoacetate (9.0 mg/dL) and acetone (70 mg/dL).
  • The multistix can detect acetoacetate at 5-10 mg/dL.
78
Q

What causes false positives for a ketone test?

A
  • Free sulfhydryl groups.

- Highly pigmented urine.

79
Q

What causes false negatives for a ketone test?

A

Improperly stored urine.

80
Q

What is considered an abnormal level of WBC’s?

81
Q

Leukocyte esterase tests for?

A
  • Intact WBC’s.

- Lysed WBC’s.

82
Q

Leukocyte Esterase is the test to detect:

A

Esterase that is found in the granulocytes or the cells of the myeloid linage.

83
Q

What are the 3 types of Leukocyturia with bacteriuria?

A
  • Pyelonephritis.
  • Cystitis.
  • Urethritis.
84
Q

What are 3 causes of Leukocyturia without bacteriuria?

A
  • Trichomonads.
  • Yeast.
  • Chlamydia.
85
Q

A type of UTI that generally begins in the urethras or bladder and travels to one or both of the kidneys:

A

Pyelonephritis

86
Q

Infection of the bladder:

87
Q

Infection of the urethra.

A

Urethritis.

88
Q

What are the key reagents for a leukocyte esterase chemistrip?

A

Indoxyl carbonic acid ester.

89
Q

What are the key reagents for a leukocyte esterase multistix?

A

Derivatize pyrrole amino acid ester.

90
Q

What is the specificity for the leukocyte esterase test?

A

It is testing for Leukocytes with granules. Therefor the lymphocytes won’t be directed.

91
Q

What is the sensitivity of a leukocyte esterase chemstrip?

A

10 WBC/uL.

92
Q

What is the sensitivity of a leukocyte esterase multistix?

A

10-25 WBC/uL.

93
Q

What causes a false positive leukocyte esterase test?

A
  • Vaginal discharge.
  • Drug and food that color the urine.
  • Formalin.
94
Q

What causes a false negative leukocyte esterase test?

A
  • WBC present that are not granulocytes (lymphocytes).
  • High specific gravity.
  • Increased glucose or protein.
  • Strong oxidizing agents.
  • Some antibiotics.
95
Q

What are the expected results leukocyte esterase test?

96
Q

What are the reportable results leukocyte esterase test?

A
  • Negative.

- Positive: Trace, small (1+), mod (2+), Large (3+).

97
Q

Which WBCs are undetectable by the reagent pad?

A

Lymphocyte.

MLS 415 Urinalysis & B.F. (37 decks)

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