clinical microscopy Flashcards
color change due to drugs: orange
PIR
Phenazopyridine
Isoniazid
Rifampicin
color change due to drugs: blue
MIA
Methylene blue
Indomethacin
Amitriptyline
color change due to drugs: purple
Rifampicin
color change due to drugs: brown
CLMN Chloroquine Levodopa Metronidazole Nitrofurantoin
color change due to drugs: black
MPM (many pa mention)
Metronidazole
Methyl dopa
Phenol derivatives
color change due to drugs: white
Propofol
color change due to drugs: green
Vitamin B12
color change due to drugs: red/pink
CTR
Cloropromazine
Thioridazine
Rifampin
color change due to drugs: blue green
Propofol
Rifampicin
food that affects urine color: bright yellow
riboflavin
the different clarity of urine:
hazy, cloudy, turbid, milky
little particulates but urine print is seen
hazy
many particulates and urine is blurred
cloudy
urine print cannot be seen
turbid
many particulates and clotted
milky
turbidity: nonpathological
mucus spermatozoa contrast media fecal contamination squamous epithelial cell amorphous urates, phosphates & carbonates
turbidity: pathological
bacteria yeast rbc wbc lymphatic fluid and lipids abnormal crystals
soluble in dilute acetic acid
RAC
RBCS
Amorphous urates
Carbonates
insoluble in dilute acetic acid
SBYW Sperm Bacte Yeast WBCs
soluble in alkaline urine
Amorphous phosphate and carbonates
soluble in acid urine
Amorphous urates & contrast media
soluble in ether
LCL
lipid
chyle
lymphatic fluid
soluble with heat
amorphous urates & uric acid crystals
normal urine odor
nutty/aromatic
ammonia is the odor when keeping urine due to _________?
breakdown of urea
sweet fruity odor
ketones (DM, vomitting, starvation)
mousy odor
phenylketonuria
pungent odor
asparagus, onion, garlic (food)
bad, unpleasant odor/ foul, ammonial-like
UTI
bacterial contamination
maple syrup
maple syrup urine disease: where body cannot breakdown amino acids
bleach odor
contamination
cabbage like odor
methionine malabsorption
sweaty feet odor
isovaleric acidemia
ranch
cystine disorder
rancid
tyrosinemia
urine volume at night and its specific gravity
more than 700 ml ; 1.018
specific gravity of first-morning urine/specimen
> 1.020
normal range of specific gravity
1.005 to 1.030
normal sample range SG
1.010 to 1.025
differentiate isothenuric, hyposthenuric, hypersthenuric
iso: 1.010
hypo: <1.010
hyper: >1.010
sg for neonates
1.012
SG for infants
1.002 - 1.006
sg for adults
1.003-1.030
tool used for measuring specific gravity
urinometer
tool that measures the refractive index of the solution
urine refractometer
principle of refractometer
RI can be compared to the velocity of a light in air to the velocity of light in the solution; velocity of light in the sol. is dependent on the amount of particles dissolved in the concentration
advantage of refractometer
only 2-3 drops of urine is needed
causes of isosthenuria
chronic renal diseases
impairment of renal function
sg of urine is like plasma infiltrate
causes of hyposthenuria
DI drinking too much fluids kidney diseases glomerulonephritis pyelonephritis (umakyat bacteria from bladder to kidney)
causes of hypersthenuria
loss of fluid less fluid intake (water) adrenal insufficiency particles in the urine hepatic disease congestive heart failure
pH of urine/average person pH
4.6-8.0
5-6
pH is useful for ______ and _______
acid base status and crystal identification
in acid base balance, the lungs are responsible for excreting _______ while kidneys are for _________
lungs: volatile waste - CO2
kidneys: non-volatile acid - uric acid
if blood pH is too acidic
more acids are secreted in urine; this is done by the secretion NH4, hydrogen phosphate and weak oganic acids
if blood pH is too alkaline
less acid is secreted in the urine; this is done by reabsorbing bicarbonate from convoluted tubes then attach to H ions to have carbonic acid therefore regulating pH levels
what makes urine acidic
a. high protein diet
b. accumulation of CO2 in the body
c. diabetes mellitus where ketones decrease pH
what makes urine alkaline
a. uti
b. bacterial contamination
c. hyperventilation / loss of CO2
d. use of NaHCO3 and K citrate in treating bacterial contamination
e. diet high in veg., citrus fruits and dairy products
abnormal alkaline urine is caused by
SKUAd Severe vomitting Kidney disease UTI Asthma
abnormal acidic urine
severe lung disease (emphysema) uncontrolled DM high protein diet dehydration starvation diarrhea
which fruit is a good remedy for UTI
cranberry (the only fruit that can produce acidic urine)
alkaline urine patients with renal calculi (kidney stones) are made up of _____
calcium PHOSPHATE
magnesium ammonium PHOSPHATE
pH is measured by
pH reagent strip (5-9)
indicators used in pH strip
methyl red - 4-6 (red to yellow)
bromthymol blue 6-9 (yellow to blue)
major protein found in the urine; also reabsorbed by tubules
albumin
this happens due to excess/vigorous exercise, dehydration or fever
proteinuria
does not indicate kidney disease
prerenal proteinuria
increase levels of low molecular weight plasma filtrates such as
hemoglobin, myoglobin and acute-phase proteins
conditions associated with prerenal proteinuria
hemoglobinuria
myoglobinuria
acute phase proteinuria
damage in the glomerulus or tubules which increases the amount of albumin, rbcs and wbcs in urine
renal proteinuria
diseases associated with renal proteinura
SLE Streptococcal glomerulonep Toxic heavy metals Viral infection Pre-eclampsia & hypertension Strenuous exercise Microalbuminuria
Microalbuminuria is seen where?
Seen in diabetic nephropathy when kidneys are damaged due to a patient with DM
proteins are added in the urine when passed through vagina prostate, urethra and such
postrenal proteinuria
conditions associated with postrenal
bacterial and fungal infection - produce exudate containing proteins
menstruation, injury, prostatic fluid, spermatozoa - contributes to proteins
benign proteinuria seen in young patients
orthostatic or postural proteinuria
microalbuminuria also increases the _______
risk of cardiovascular diseases
the significant level of microalbum is
20-200microgram/min or 30-300 mg/24hr
albumin creatinine ratio in microalbuminuria is
> 3.4mg/mmol
are monoclonal LIGHT CHAIN IMMUNOGLOBULINS; seen in patient w/ multiple myeloma
bence jones proteins
how to detect BJP?
turbid urine at 40-60C then clear at 100C = positive
causes of prerenal proteinuria
MuSIM
Multiply myeloma
Severe infection
Intravascular hemolysis
Muscular injury
renal proteinuria: glomerular disorders
amyloidosis hypertension pre-eclampsia dehydration diabetic nephropathy
renal proteinuria: tubular
toxic agents
heavy metal
fanconi’s syndrome
viral infections
postrenal proteinuria
vaginal secretions SPERMATOZOA menstrual contamination prostatic fluid infections and inflammation trauma and injury
detects urine protein
urine dipstick
trace positive reaction
15-30mg/dL
4+ positive reaction
2g/dL
Trace proteinuria
10-30 mg/dL
what type of urine specimen is required for microalbuminuria?
first morning specimen
report of proteinuria: 1+ 2+ 3+ 4+
1+ = 30 mg/dl 2+ = 100 mg/dl 3+ = 300 mg/dl 4+ = >1000 mg/dl
precipitation method of detecting proteinuria
sulfosalicylic acid
another precipitation method applied in automation
TCA (trichloroacetic acid)
normal range in TCA test
0.05-0.1g/24 hr
buffer used in heat coagulatoin test
5M acetate buffer which is composed of anhydrous sodium acetate & glacial acetic acid
orthostatic/postural proteinuria reporting
negative: first specimen
positive: second specimen
heat and acid: positive, negative, false positives and false negatives
positive: albumin, globulins, bence jones
false negatives: highly alkaline urine
false positives: confused with PO4 and urates, drug metabolites (s, t, p)
reagent strip: positive, negative, false positives and false negatives
positive: albumin only
false negative: highly diluted urine, high salt concentration
false positive: skin disinfectants
sulfosalicylic: positive, negative, false positives and false negatives
positive: globulins, glycoproteins, albumin, bence jones
false negatives: highly alkaline urine
false positives: confused with PO4 and urates, drug metabolites (s, t, p, c, c)
used to differentiate glomerular and tubular dysfunction
beta-2-microglobulin
normal level of glucose in a healthy individual
100 mg/dl or less
what is the value of the renal threshold
160-180mg/dl
convoluted tubule responsible for reabsorbing glucose filtered by glomerulus
proximal convoluted tubule
which convoluted tubule is responsible for releasing the excess glucose not absorbed by the proximal CT?
distal CT
hormone responsible for converting glucose to glycogen? aka glycogenesis
insulin
refers to the breakdown of glycogen to glucose
glycogenolysis
inhibitor of insulin secretion
epinephrine
epinephrine is secreted during
myocardial infarction, cerebrovascular diseases, stress
renal glycosuria may be seen in patients with
RG-FOE
end-stage renal disease
fanconi’s syndrome
osteomalacia
copper sulfate is reduced by alkaline and heat to cuprous oxide; this detects every reducing substances in the urine (general)
copper reduction method
blue: negative
green, yellow, orange/red: positive
this detects specific glucose in the urine
glucose-oxidase method
chromogens added to H2O2 (when oxidized so glucose to gluconic acid)
KI - green to brown
Tetramethylbenzidine - yellow to green
copper reduction method is also known as
benedicts reaction :D
false positive in benedict’s reaction
vit c salicylates homogentisic acid antibiotics levodopa contrast media
glucose oxidase false negative
homogentisic acid
many amount of salicylate
vit c
conditions associated with renal glycosuria
diabetes iv fluids adrenal gland diseases liver damage kidney diseases pregnant woman (normal)
condition where hormones act against insulin
hyperglycemia
conditions where hyperglycemia is seen
pancreatitis pancreatic disorder acromegaly cushings syndrome pheochromocytoma
3 intermediate products of ketones from lipolysis
acetone 2&
acetoacetate 20%
B-hydroxybutyric acid 78%
READ & UNDERSTAND WAG MO TO KAKALIMUNTAN
for patients with diabetes, if their kidneys are damaged (diabetic nephropathy), they won’t be able to use glucose and so fats are broken down (lipolysis) this leads to DECREASE REESTERIFICATION and INCREASES PLASMA FREE FATTY ACIDS which INCREASES KETONE BODIES
what happens when re-esterification happens?
plasma free fatty acids undergo esterification to form triglycerides to be converted to LDL
LDL is stored in the liver
ketones arent measurable in the urine since …..
they broke down into CO2 and H2O
fat metabolism where fats are broken down instead of carbohydrates are seen in patients with
DM
Vomitting
Starvation
deficiency in insulin
ketonuria
ketonuria excretes ____, ____, and ______ to have ketoacidosis
Na
K
Ca
If DM is not treated to the point where ketonuria exists, he/she may have
acidosis
diabetic coma
patient with DM has ________ odor in their breath
fruity odor due to acetone from the lungs
ketone strip test is reported as?
negative - 0
small amounts - 10
moderate amounts - 30
large amounts - 80
test where ketone bodies are measured through sodium nitroprusside reaction
ketone strip test
what can we measure in ketone strip test?
acetoacetate+ acetone since hindi reactive si b-hydroxybutyric acid
in ketone strip test, the color changes from what?
lavender to maroon (purple)
in rothera’s test, what composes the powder being used
sodium nitroprusside
sodium carbonate
ammonium sulfate
explain rothera’s test
add 0.5g of powder to the slide and add 2 drops of urine
positive: change color from lavender to purple
abnormal ketonuria happens when ______
uncontrolled diabetes
low carbo diet
starvation
alcoholism
ketones are seen in fasting after ____ hours
after 18 hours
high glucose in pregnant woman and low ketone in pregnant woman
T or F
T
what indicates when urine is colorless?
kidney disease or diabetes mellitus
what indicates when urine is amber/orange
bilirubin
which is responsible for the dark yellow color when dehydrated?
bilirubin or urobilin
responsible for the pink color of urine when at lower temperature
uroerythrin