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General Medicine & Family Medicine > Chemical Pathology/ Abnormal Urinalysis Results > Flashcards

Chemical Pathology/ Abnormal Urinalysis Results Flashcards

1
Q

What component of a urinalysis helps assess a patient’s hydration status as well as the concentrating ability of the kidneys?

A

Urine specific gravity

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2
Q

When patients develop the following conditions, does their urine specific gravity increase or decrease from baseline?

—> Dehydration

—> Diabetes insipidus

—> Syndrome of inappropriate antidiuretic hormone

A
  • Dehydration —> Increases
  • Diabetes insipidus —> Decreases
  • Syndrome of inappropriate antidiuretic hormone —> Increases
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3
Q

Urinary pH generally reflects the serum pH except in patients with what renal disease?

A

Renal tubular acidosis

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4
Q

What is hematuria?

A

The presence of red blood cells in the urine (according to the American Urological Association this equals three or more red blood cells per high-powered field in two out of three, clean catch, midstream urine samples)

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5
Q

When a dipstick test for hematuria is positive, why is it important to subsequently confirm hematuria microscopically?

A

Some conditions (myoglobinuria, hemoglobinuria) produce a false positive test for blood on dipstick. In true hematuria, microscopic analysis reveals intact erythrocytes in the urinary sediment.

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6
Q

Exercise-induced hematuria is a self-limited and benign condition that should resolve within how many hours?

A

48 to 72 hrs

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7
Q

In general, hematuria accompanied by proteinuria usually indicates that the blood loss is originating from the renal glomeruli. True or false?

A

True (glomerular hematuria often also presents with erythrocyte casts and dysmorphic RBCs).

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8
Q

What is the most common cause of glomerular hematuria?

A

IgA nephropathy (Berger disease)

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9
Q

In general, hematuria in the absence of proteinuria and RBC casts usually indicates a urologic or nonglomerular renal source of bleeding. True or false?

A

True

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10
Q

Give some examples of renal causes of bleeding that present this way(with hematuria in the absence of proteinuria and RBC casts).

A
  • tumors
  • cysts
  • arteriovenous malformations
  • infarctions of the kidney
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11
Q

When blood clots are present in urine, is the blood most likely glomerular or urologic in origin?

A

Urologic

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12
Q

What is the next step in management following a positive urine cytology test?

A

Referral for cystoscopy to rule out malignancy

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13
Q

Visualization of the upper urinary tract in a patient being evaluated for urologic bleeding is accomplished through what tests?

A

CT without contrast or intravenous (IV) pyelogram

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14
Q

What environmental exposures are associated with urologic malignancy?

A
  • Smoking
  • recreational
  • work-related chemical exposure (eg, benzene)
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15
Q

A patient with hematuria and the following characteristics would make you suspect what disease?

–> Family history of renal failure and cerebral aneurysms

A

Polycystic kidney disease

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16
Q

A patient with hematuria and the following characteristics would make you suspect what disease?

Family history of male renal failure and hearing loss

A

Alport syndrome

17
Q

A patient with hematuria and the following characteristics would make you suspect what disease?

–> Fever, weight loss, rash, arthritis

A

Connective tissue disease (eg, lupus)

18
Q

A patient with hematuria and the following characteristics would make you suspect what disease?—-> Severe flank pain radiating to the groin

A

Urethral distention most likely from stones

19
Q

A patient with hematuria and the following characteristics would make you suspect what disease?

—-> Palpable purpura of the skin, nausea, vomiting, diarrhea, blood in stool

A

Henoch-Schonlein purpura

20
Q

What is the definition of proteinuria?

A

Abnormal urinary protein excretion (borderline proteinuria equals 150-300 mg/day, clinical proteinuria is >300 mg/day)

21
Q

What is the difference between proteinuria and albuminuria and why is it important to make this distinction?

A

Proteinuria and albuminuria are abnormally high protein and albumin excretion in the urine, respectively. Albumin is a small protein and often the first to leak when there is kidney damage. However, not all patients with proteinuria have albuminuria (such as with light chain proteinuria [Bence-Jones]).

22
Q

Urine dipsticks, which are often used in a clinical setting, offer a method to screen for proteinuria but may give false negative results under what conditions?

A

Dipstick analysis measures protein concentration so it can miss proteinuria if the urine is dilute. Also, the reagent on the test strips is highly specific for albumin and may miss nonalbumin proteins.

23
Q

What are some causes of transient proteinuria?

A
  • Dehydration
  • exercise
  • emotional stress
  • fever
  • seizures
  • orthostatic proteinuria
24
Q

What is the workup of asymptomatic transient proteinuria?

A

None, since it is rarely indicative of significant disease

25
Q

What are the first follow-up tests in the workup of persistent proteinuria?

A

Spot urine protein to creatinine ratio (often preferred over 24-hour urinary protein excretion), microscopic examination of the urinary sediment, urinary protein electrophoresis (UPEP helps identify nonalbumin proteins), creatinine, and electrolytes

26
Q

Nephrotic syndrome is indicative of glomerular disease. True or false?

A

True

27
Q

What are the clinical signs that characterize nephrotic syndrome?

A
  • Proteinuria exceeding 3.5 g/day
  • hypoalbuminemia
  • edema
  • hypercholesterolemia
28
Q

Light chain proteinuria (often nephrotic range) with or without renal failure presenting with malignant plasma cells, renal failure, hypercalcemia, anemia, lytic bone lesions, and pathologic fractures suggest the presence of what disease?

A

Multiple myeloma

29
Q

Light chain proteinuria (often nephrotic range) with or without renal failure presenting with restrictive cardiomyopathy, peripheral neuropathy, hepatomegaly, swelling of extremities suggest the presence of what disease?

A

Amyloidosis

30
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

31
Q

What is the treatment for minimal change disease?

A

Steroids

32
Q

Glucosuria occurs when the amount of glucose filtered by the glomerulus exceeds the ability of the proximal tubule to reabsorb it. Usually, this indicates that serum glucose is at least how high?

A

200 mg/dL (very often an indication of uncontrolled diabetes mellitus)

33
Q

What kind of cells in a urine specimen suggest contamination?

A

Epithelial cells

34
Q

What is the most common cause of pyuria (>10 leukocytes/mL)?

A

Infection

35
Q

What are some causes of pyuria not associated with infection?

A
  • Tumors
  • nephrolithiasis
  • trauma
  • glomerulonephritis
  • drugs (corticosteroids, cyclophosphamide)
  • balanitis of noninfectious origin
  • urethritis of noninfectious origin

General Medicine & Family Medicine (150 decks)

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