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AUBF > Clinical Significance of Chemical composition > Flashcards

Clinical Significance of Chemical composition Flashcards

1
Q

What is the normal pH range of urine?

A

4.5 to 8.0

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2
Q

What is the typical pH of 1st morning urine?

A

5.0 - 6.0

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3
Q

What is the pH of unpreserved urine?

A

≥ 9.0

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4
Q

What occurs after meals due to withdrawal of H* ions for HCL secretion?

A

Alkaline tide

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5
Q

What contains quinic acid that causes urinary excretion of hippuric acid?

A

Cranberry juice

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6
Q

What is most indicative of renal disease?

A

Protein

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7
Q

What does protein produce in shaken urine?

A

White foam

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8
Q

What is the normal urinary protein level?

A

<10mg/dL or <100 mg/day; 150 mg/day

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9
Q

What is considered mild/minimal proteinuria?

A

<1g/day

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10
Q

What is considered moderate proteinuria?

A

1 to 3 or 4 g/day

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11
Q

What is considered large/heavy proteinuria?

A

> 3 or 4 g/day

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12
Q

What does protein in normal urine consist of?

A

1/3 albumin and 2/3 globulin

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13
Q

What is the major serum protein found in urine?

A

Albumin

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14
Q

What percentage of filtered protein is reabsorbed?

A

95-99%

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15
Q

What is the most abundant protein in normal urine?

A

Tamm-Horsfall protein (uromodulin)

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16
Q

What conditions are categorized as pre-renal proteinuria?

A

Intravascular hemolysis, Muscle injury, Severe infection and inflammation, Multiple myeloma

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17
Q

What is Multiple Myeloma characterized by?

A

Ig-producing plasma cells

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18
Q

What protein is produced in Multiple Myeloma?

A

Bence Jones proteins (BJP)

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19
Q

BJP is identical to what?

A

Immunoglobulin light chains (identical kappa and lambda)

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20
Q

What tests are used for detecting BJP?

A

Serum electrophoresis, Immunofixation electrophoresis

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21
Q

Urine precipitates at ____ and dissolves at ___

A

40-60 deg C (cloudy); 100 deg C (clear)

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22
Q

Glomerular proteinuria is indicated in

A

Diabetic nephropathy, Orthostatic/Cadet/Postural/Cyclic proteinuria, Tubular proteinuria

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23
Q

Diabetic nephropathy is characterized by

A

Decreased glomerular filtration; microalbuminuria is present

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24
Q

Albumin excretion rate in ug/min or mg/24 hrs: Normal

A

0-20 ug/min (negative in strip)

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25
Q

Albumin excretion rate in ug/min or mg/24 hrs: Microalbuminuria

A

20-200 ug/min or 30-300 mg/24 hrs (negative protein strip)

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26
Q

Albumin excretion rate in ug/min or mg/24 hrs: Clinical albuminuria

A

> 200ug/min (positive protein reagent strip)

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27
Q

Orthostatic proteinuria is due to

A

Increased pressure to renal veins when standing

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28
Q

In testing cadet proteinuria, what should be done?

A

Patient must empty bladder before going to bed and collect specimen immediately upon waking and another one 2 hours after standing

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29
Q

Orthostatic proteinuria result in first morning and after 2 hrs standing

A

First morning - negative; 2 hrs after standing - positive

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30
Q

Clinical proteinuria result in first morning and 2 hrs after standing

A

Positive in first morning and 2 hrs standing

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31
Q

Nephrotic syndrome, toxic agents, dehydration, strenuous exercise, hypertension, amyloidosis, pre-eclampsia is a type of what proteinuria

A

Renal proteinuria

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32
Q

Originally discovered in workers exposed to cadmium dust (a heavy metal)

A

Tubular proteinuria

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33
Q

Causes of tubular proteinuria

A

Fanconi’s syndrome, toxic agents/heavy metals, viral infections

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34
Q

Post renal proteinuria is caused by

A

Lower UTI/inflammation, menstrual contamination, injury/trauma, vaginal secretions, prostatic fluid/spermatozoa

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35
Q

Most frequently tested in urine

A

Glucose

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36
Q

Other sugars in urine caused by fruits, honey, syrups, fructose intolerance

A

Fructose (levulose)

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37
Q

Infants with galactosemia secrete in urine

A

Galactose

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38
Q

Increased sugar during pregnancy, lactation, strict milk diet, lactose intolerance

A

Lactose (Glucose + Galactose)

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39
Q

Increased sugar in fruits, benign essential pentosuria (xylulose, arabinose)

40
Q

Increased sugar found in intestinal disorders, sucrose intolerance

A

Sucrose (Glucose + Fructose) non-reducing sugar

41
Q

Clinical significance of urine glucose: hyperglycemia associated

A

Increased blood and urine glucose

42
Q

Clinical significance of urine glucose: Renal associated glycosuria

A

Normal blood glucose, increased urine glucose

43
Q

Causes of hyperglycemia in blood and urine

A

Diabetes mellitus, Cushing syndrome (increased cortisol), Pheochromocytoma (increased catecholamine), Acromegaly (increased growth hormone), Hyperthyroidism (increased T3 and T4)

44
Q

Causes of Renal glycosuria

A

Impaired tubular secretion of glucose, Fanconi syndrome (defective tubular reabsorption of glucose and amino acid)

45
Q

Nonspecific test for reducing sugars (glucose, galactose, lactose, fructose, but not sucrose)

A

Copper reduction test

46
Q

Reporting of Benedict’s test color bluish green

47
Q

Reporting of Benedict’s test color green color, green or yellow precipitate

48
Q

Reporting of Benedict’s test color yellow to green color, yellow precipitate

49
Q

Reporting of Benedict’s test color yellow-orange color, yellow-orange precipitate

50
Q

Reporting of Benedict’s test color reddish yellow color, brick red or red precipitate

51
Q

False positive of Benedict’s test

A

Reducing agents (ascorbic acid, uric acid)

52
Q

False negative of Benedict’s test

A

Oxidizing agents (detergents)

53
Q

Clinitest tablet uses how much urine

54
Q

Reaction from Clinitest tablet should be read at

A

15 seconds after bubbling stops

55
Q

Occurs when >2g/dL sugar is present

A

Pass-through phenomenon

56
Q

Clinitest tablet contains

A

CuSO4 - main reacting agent, Na Citrate - heat production, NaCO3 - eliminates interfering room air, NaOH - heat production

57
Q

To prevent pass-through reaction, what is used

A

2 drops of urine (use separate color chart)

58
Q

Pass-through reaction color

A

Blue > Green > Yellow > Brick red&raquo_space;»> blue or green-brown

59
Q

Pass-through reaction occurs due to

A

Reoxidation of cuprous oxide to cupric oxide and other cupric complexes

60
Q

Glucose oxidase 1+ positive; Clinitest Negative interpretation

A

Small amount of glucose is present

61
Q

4+ glucose oxidase; negative Clinitest

A

Possible oxidizing agent interference on reagent strip

62
Q

Glucose oxidase negative; Clinitest positive

A

Non-glucose reducing substance is present; possible interfering substance for reagent strip (e.g., ascorbic acid)

63
Q

Result of incomplete fat metabolism due to inability to metabolize carbohydrates

64
Q

Renal threshold for ketones

65
Q

Ketones are seen in

A

Type 1 DM, Vomiting, Starvation, Malabsorption

66
Q

Cloudy red urine; sensitive indicator of renal disease

67
Q

Hematuria is seen in

A

Glomerulonephritis, renal calculi, tumors, strenuous exercise, trauma

68
Q

Microscopic hematuria shows

A

Intact RBCs (>5 RBCs/uL is significant)

69
Q

Hemoglobinuria is characterized as __ in urine

70
Q

Hemoglobinuria is seen in

A

Intravascular hemolysis, transfusion reactions, hemolytic anemia, severe burns, brown recluse spider bites

71
Q

Microscopic hemoglobinuria

A

No RBCs seen

72
Q

Portion of hemoglobin that is toxic to renal tubules

73
Q

Myoglobinuria is seen in

A

Rhabdomyolysis, muscular trauma, crush syndromes, extensive exertion, cholesterol-lowering statin medications

74
Q

Amount of myoglobin that produces red urine

A

> 25 mg/dL

75
Q

> 1.5 myoglobin of urine is indicative of

A

Renal failure risk

76
Q

Lysis of RBCs in the urine usually shows

A

Mixture of hemoglobin and hematuria

77
Q

Plasma examination of hemoglobin result

A

Red or pink; decreased haptoglobin levels

78
Q

Plasma examination of myoglobin

A

Pale yellow plasma; increased aldolase activity

79
Q

Blondheim’s test (ammonium sulfate test) hemoglobin

A

Precipitated (reagent is negative)

80
Q

Blondheim’s test (ammonium sulfate test) myoglobin

A

No precipitate (reagent strip is positive)

81
Q

Early indicator of liver disease in urine

82
Q

Clinical significance of urine bilirubin

A

Hepatitis, cirrhosis, biliary obstruction (gallstones, carcinoma)

83
Q

Bile pigment resulted from hemoglobin degradation

A

Urobilinogen

84
Q

Normal value of urobilinogen (UBG)

A

<1 mg/dL or Erlich unit

85
Q

Specimen for urobilinogen

A

Afternoon urine 2-4 pm

86
Q

Watson Schwartz test is used for

A

Differentiating urobilinogen and porphobilinogen (PBG) and other Erlich reactive compounds

87
Q

Watson Schwartz test for urobilinogen

A

Soluble in chloroform; soluble in butanol

88
Q

Watson Schwartz test for porphobilinogen (PBG)

A

Insoluble in chloroform and butanol

89
Q

Watson Schwartz test for other Erlich reactive compounds

A

Insoluble in chloroform; soluble in butanol

90
Q

Hoesch Test: rapid screening test for porphobilinogen procedure

A

2 drops urine + 2 mL Hoesch reagent (Erlich reagent 6M or 6N HCl) = red color

91
Q

Condition with increased B1, negative urine bilirubin, 3+ urine urobilinogen

A

Extravascular hemolytic disease (pre-hepatic jaundice)

92
Q

Condition with increased blood B1/B2, +/- CB in urine, 2+ urine urobilinogen

A

Liver damage

93
Q

Condition with increased CB in blood, 3+ urine bilirubin (B2), decreased or normal urobilinogen

A

Bile duct obstruction (post-hepatic/obstructive jaundice)

94
Q

Rapid screening test for UTI or bacteriuria

95
Q

Nitrate converters are generally

A

Gram-negative such as Enterobacteriaceae

96
Q

Specimen for nitrite determination

A

4-hour collection or first morning urine (preferred)

97
Q

Significant in UTI or inflammation; screening of urine culture specimen

A

Leukocytes

AUBF (26 decks)

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