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.
2
Q
Which test in the testing strip is most indicative of renal disease?
A
Protein.
3
Q
Albumin makes up what percentage of the protein content in urine?
A
33%
4
Q
Globulins make up what percentage of the protein content in urine?
A
67%
5
Q
What are the 3 true urinary proteins?
A
- Uromodulin (Tamm-Horsfall protein).
- Urokinase.
- Secretory immunoglobulin A.
6
Q
Uromodulin (Tamm-Horsfall protein) is made by?
A
The distal convoluted tubular cells.
7
Q
Urokinase is made by?
A
Tubular cells.
8
Q
Secretory immunoglobulin A is made by?
A
Renal tubular epithelial cells.
9
Q
What is Proteinuria?
A
Increased levels of protein in the urine.
10
Q
What is often first indicator of renal disease?
A
Proteinuria.
11
Q
What are the 4 categories of Proteinuria?
A
- Prerenal: Overflow proteinuria.
- Renal: Glomerular proteinuria.
- Renal: Tubular proteinuria.
- Postrenal: proteinuria.
12
Q
What is overflow proteinuria?
A
Increased amount of low-molecular weight plasma proteins spilling through the glomerular filtration barrier from the plasma.
13
Q
What causes overflow proteinuria?
A
- Acute phase reactants: infection or inflammation.
- Hemoglobin: Muscle injury or intravascular hemolysis.
- Bence-Jones proteins.
14
Q
What are Bence-Jones proteins?
A
Myeloma tumor cells that produce only light chains. Must be confirmed by electrophoresis.
15
Q
Acute phase reactants: infection or inflammation causes what type of proteinuria?
A
Overflow proteinuria.
16
Q
Hemoglobin: Muscle injury or intravascular hemolysis causes what type of proteinuria?
A
Overflow proteinuria.
17
Q
Bence-Jones proteins causes what type of proteinuria?
A
Overflow proteinuria.
18
Q
What is glomerular proteinuria?
A
Increased amount of plasma proteins (albumin) pass into the ultrafiltrate.
19
Q
What form of proteinuria is the most serious/common?
A
Glomerular Proteinuria.
20
Q
In Glomerular Proteinuria, what proteins are elevated?
A
- Albumin.
- Transferrin.
- Alpha 1 antitrypsin.
- Alpha acid glycoprotein.
21
Q
What causes Glomerular Proteinuria?
A
- Nephrotic syndrome.
- Glomerular damage.
- Transitory glomerular changes.
22
Q
Nephrotic syndrome causes what type of Proteinuria?
A
Glomerular Proteinuria.
23
Q
Glomerular damage causes what type of Proteinuria?
A
Glomerular Proteinuria.
24
Q
Transitory glomerular causes what type of Proteinuria?
A
Glomerular Proteinuria.
25
What is tubular defect Proteinuria?
Normal tubular function is altered.
26
What proteins are elevated tubular defect Proteinuria?
- Albumin.
- Beta2 microglobulin.
- Retinol binding protein.
- Alpha 1 microglobulin.
- Alpha 2 microglobulin.
- Lysozyme.
27
What causes tubular defect Proteinuria?
- Acute/chronic pyelonephritis.
- Fanconi's syndrome.
- Hereditary.
- Heavy metal poisoning.
28
Which proteinuria will actually test negative on the protein strip?
Tubular defect (Proteinuria). Will need SSA-screen.
29
Acute/chronic pyelonephritis can cause what type of Proteinuria
Tubular defect Proteinuria.
30
Fanconi's syndrome can cause what type of Proteinuria?
Tubular defect Proteinuria.
31
Heavy metal poisoning can cause what type of Proteinuria?
Tubular defect Proteinuria.
32
What is posternal proteinuria?
It is an inflammation anywhere in the urinary tract. The protein enters the urine after the urine left the kidney.
33
What causes posternal proteinuria?
- Inflammation.
- Malignancy.
- Injury/trauma.
- Contamination.
34
Inflammation causes what type of proteinuria?
Posternal proteinuria.
35
What is the principle behind the protein test?
Protein "error of indicators".
36
What is the key reagent when testing for protein?
Tetrabromophenol blue.
37
The specificity for the protein reagent strip is most specific for which protein?
Albumin.
38
What is the sensitivity for the protein test on a chemstrip?
6.0 mg/dL.
39
What is the sensitivity for the protein test on a multistix?
15-30 mg/dL.
40
What causes false positives for a protein test?
Highly alkaline urine.
41
What are the expected results for a protein test?
Negative
42
How is the protein test reported?
Trace, 30(1+), 100(2+), 300(3+), 2000 or more (4+).
43
Where should glucose be reabsorbed if it gets passed the glomerulus?
The proximal convoluted tubular.
44
Glucosuria is:
The presence of just glucose in the urine.
45
Glycosuria is:
The presence of any form of sugar.
46
What allows glucose to be in the urine?
Ultrafiltrate concentration exceeds the kidneys ability to reabsorb.
47
What is the renal threshold for glucose?
160-180 mg/dL.
48
What are some examples of pre-renal conditions?
- Diabetes mellitus.
- Hormonal disorders.
- Liver disease.
- Pancreatic disease.
- Strokes.
- Drugs.
- Pregnancy.
49
What are some examples of renal conditions?
- Fanconi's syndrome.
- End stage renal disease.
- Cystinosis.
- Heavy metal poisoning.
50
Diabetes mellitus is an example of what condition?
Pre-renal.
51
Fanconi's syndrome is an example of what condition?
Renal
52
End stage renal disease is an example of what condition?
Renal
53
Cystinosisis an example of what condition?
Renal
54
Galactosemia is:
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
What enzyme is the child lacking when they have Galactosemia?
Galactose 1-phosphate uridyl transferase(GALT)
56
How are patients under two diagnosed with Galactosemia?
- Negative glucose on reagent strip.
| - Do clinitest. Tests for the presence of reducing sugars such as galactose.
57
What are 3 complications of Galactosemia:
- Cataracts.
- Hepatic problems.
- Severe mental retardation.
58
What is the principle of the the glucose test?
Glucose oxidase peroxidase reaction. It is a double sequential enzyme test that is specific only for glucose.
59
What are the key reagents for a glucose test?
Glucose oxidase and chromogens.
60
What chromogen is present for a glucose test on the Chemstrip?
Tetramethylbenzidine
61
What chromogen is present for a glucose test on the multistix?
Potassium iodine.
62
What causes a false positive glucose test?
Strong oxidizing agents and peroxide contaminates.
63
What are the results reportable for a glucose test?
- Negative.
| - Positive: mg/dL (100, 250, 500, 1000, 2000 or more) or % (trace, 1/4, 1/2, 1, 2 or more).
64
What causes a false negative glucose test?
Ascorbic acid/ improperly stored samples.
65
What brand of test strips is more sensitive for glucose?
Chemstrip
66
What is the sensitivity of the chemstrip for glucose?
40 mg/dL.
67
What is the sensitivity of the multistix for glucose?
75-125 mg/dL.
68
What are the 3 main ketones?
- Acetoacetate.
- Acetone.
- Beta-hydroxybutyrate.
69
Which ketone is the most abundant?
B-hydroxybutyrate.
70
What causes an inability to use carbohydrates?
Diabetes mellitus.
71
What causes an inadequate carbohydrate intake?
- Starvation.
- Diet.
- Alcoholism.
- Severe exercise.
- Extreme temperatures.
- High fevers.
72
What causes a loss of carbohydrates?
- Vomiting.
| - Digestive disturbances.
73
What is the principle of the ketone test?
Acetoacetate + sodium nitroprusside = color change on strip.
74
What are the key reagents for a ketone test?
- Sodium nitroprusside.
| - Chemstrip: Glysine.
75
How are the ketone results reported?
- Negative.
| - Positive: Trace (5), small (15), moderate (40), large (80 - 100 mg/dL).
76
The ketone test has a specificity for?
Acetoacetic acid.
77
Which ketone test strip is more sensitivity?
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
What causes false positives for a ketone test?
- Free sulfhydryl groups.
| - Highly pigmented urine.
79
What causes false negatives for a ketone test?
Improperly stored urine.
80
What is considered an abnormal level of WBC's?
> 20
81
Leukocyte esterase tests for?
- Intact WBC's.
| - Lysed WBC's.
82
Leukocyte Esterase is the test to detect:
Esterase that is found in the granulocytes or the cells of the myeloid linage.
83
What are the 3 types of Leukocyturia with bacteriuria?
- Pyelonephritis.
- Cystitis.
- Urethritis.
84
What are 3 causes of Leukocyturia without bacteriuria?
- Trichomonads.
- Yeast.
- Chlamydia.
85
A type of UTI that generally begins in the urethras or bladder and travels to one or both of the kidneys:
Pyelonephritis
86
Infection of the bladder:
Cystitis
87
Infection of the urethra.
Urethritis.
88
What are the key reagents for a leukocyte esterase chemistrip?
Indoxyl carbonic acid ester.
89
What are the key reagents for a leukocyte esterase multistix?
Derivatize pyrrole amino acid ester.
90
What is the specificity for the leukocyte esterase test?
It is testing for Leukocytes with granules. Therefor the lymphocytes won't be directed.
91
What is the sensitivity of a leukocyte esterase chemstrip?
10 WBC/uL.
92
What is the sensitivity of a leukocyte esterase multistix?
10-25 WBC/uL.
93
What causes a false positive leukocyte esterase test?
- Vaginal discharge.
- Drug and food that color the urine.
- Formalin.
94
What causes a false negative leukocyte esterase test?
- WBC present that are not granulocytes (lymphocytes).
- High specific gravity.
- Increased glucose or protein.
- Strong oxidizing agents.
- Some antibiotics.
95
What are the expected results leukocyte esterase test?
Negative.
96
What are the reportable results leukocyte esterase test?
- Negative.
| - Positive: Trace, small (1+), mod (2+), Large (3+).
97
Which WBCs are undetectable by the reagent pad?
Lymphocyte.
