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Urinalysis > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the physical properties of urine?

A

Color, Clarity, Foam (not reported), Odor, Concentration, Volume

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2
Q

What is urochrome and what is its color?

A

It is a normal product of metabolism and it is yellow.

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3
Q

What is urobilin and what color is it?

A

Normal urine constituent; orange-brown pigment

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4
Q

What is uroerythrin? What color is it?

A

Normal urine constituent that has a brick dust appearance; pink pigment

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5
Q

What may cause a urine sample to be orange?

A

phenazopyridine, warfarin/rifampin, or consumption of carotene

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6
Q

What may cause a urine sample to be bright yellow?

A

riboflavin or b-vitamins

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7
Q

What may cause a urine sample to be yellow-brown?

A

nitrofurantoin (antibiotic)

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8
Q

What may cause a urine sample to be pink?

A

Blood in urine, presence of porphobilin

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9
Q

What may cause urine samples to be red?

A

RBCs or HGB, beet ingestion, senna (laxative)

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10
Q

What may cause a urine sample to be red-purple?

A

oxidation of phorphobilinogen to colored compounds or improper storage

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11
Q

What may cause a urine sample to be brown?

A

myoglobin in the urine, methemoglobin, or metronidazole

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12
Q

What may cause a urine sample to be dark brown to black?

A

malignant melanoma, homogentistic acid (alkaline urine)

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13
Q

What may cause a urine sample to be blue or green?

A

Pseudomonas infection, methylene blue, chlorophyll, amitriptyline, or indomethacin

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14
Q

What may cause a urine sample to be dark yellow-green?

A

biliverdin

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15
Q

What may cause a urine sample to be dark yellow or amber?

A

concentrated, excessive urobilin, or bilirubin

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16
Q

Is foam reported on a urinalysis?

A

No

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17
Q

What does large amounts of foam indicate after a urine sample is shaken up?

A

Presence of protein or bilirubin

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18
Q

What does thick, large volume of white foam in urine indicate?

A

Large amounts of protein (albumin) in the urine

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19
Q

What does yellow foam in urine indicate?

A

Bilirubin in the urine

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20
Q

Describe “clear” urine

A

No particles present, transparent

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21
Q

Describe “hazy/slightly cloudy” urine

A

Visible particles are present, newsprint can be read when viewed through urine tube

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22
Q

Describe “cloudy” urine

A

Significant particulate matter, newsprint is blurred/difficult to read

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23
Q

Describe “turbid” urine

A

Opaque - newsprint cannot be seen when viewed through urine tube

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24
Q

Is urine odor reported?

A

No

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25
Q

What is the cause of mousy/barny urine odor?

A

Phenylketonuria

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26
Q

What is the cause of sweet/fruity urine odor?

A

Ketone production due to diabetes mellitus

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27
Q

What is the cause of bleach-smelling urine?

A

Adulteration of specimen (I.e. drug testing)

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28
Q

What is the cause of ammoniacal smelling urine?

A

“old” urine/improperly stored

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29
Q

What is the smell of normal urine?

A

Faintly aromatic

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30
Q

What foods can change the smell of urine?

A

Asparagus, garlic, onions

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31
Q

What is the cause of menthol-smelling urine?

A

Phenol-containing medications

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32
Q

What two tests are used to indicate urine concentration?

A

Specific Gravity or Osmolality

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33
Q

Specific gravity

A

the mass of solutes present in urine

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34
Q

Osmolality

A

the number of solutes present in a solution

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35
Q

Is specific gravity or osmolality more specific when it comes to measuring urine concentration?

A

osmolality

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36
Q

What is the physiological possible range of specific gravity of urine?

A

1.002 - 1.040

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37
Q

Specific gravity is a measure of urine _______.

A

density

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38
Q

Refractometry

A

used to measure SG based on refractive index of light

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39
Q

T/F: Refractometry measures ALL solutes in a solution, as opposed to only ionic solutions on a dipstick SG test.

A

True

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40
Q

What factors affect the refractive index of a solution?

A

Wavelength of light used
Temperature of the solution
Concentration of the solution

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41
Q

Each g/dL of protein present increases SG by ____.

A

0.003

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42
Q

Each g/dL of glucose present increases SG by ____.

A

0.002

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43
Q

What may cause physiological impossible SG results?

A

Presence of radiographic contrast media

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44
Q

What limitation does the reagent strip method for SG have?

A

It only measures ionic specific gravity (charged solutes). It disregards protein, glucose, urea, and radiographic media.

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45
Q

Acidic urine causes SG to falsely ______.

A

increase

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46
Q

Alkaline urine causes SG to falsely ______.

A

decrease

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47
Q

What is normal urine osmolality?

A

275-900 mOsm/kg

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48
Q

Does molecular weight have an affect on specific gravity or osmolality?

A

It has an affect on SG. It does not have an affect on osmolality because osmolality measures # of solutes, not mass.

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49
Q

Would NaCl (MW 58) or Glucose (MW 180) have a higher osmolality?

A

NaCl would have a higher osmolality because it dissociates in solution into 2 osmoles. Glucose does not dissociate in solution.

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50
Q

What are the 4 colligative properties?

A

Freezing point depression
Vapor pressure depression
Osmotic pressure elevation
Boiling point elevation

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51
Q

If you were given a sample’s freezing point, how would you determine osmolality? (calculation)

A

1000 X CROSS MULTIPLY :)
____ = ____
-1.86 C freezing point

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52
Q

nocturia

A

when an individual excretes >500mL urine at night

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53
Q

anuria

A

complete lack of urine excretion

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54
Q

oliguria

A

decrease in urine excretion (<400 mL/day)

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55
Q

polyuria

A

excretion of >3L of water daily (excess)

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56
Q

diuresis

A

increase in urine excretion (>1800mL/day)

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57
Q

List the 11 possible tests included on a reagent strip for chemical testing.

A

pH, protein, glucose, blood, leukocyte esterase, specific gravity, bilirubin, urobilinogen, nitrite, ascorbic acid, ketones

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58
Q

Reagent strips must be protected from:

A

moisture, chemicals, heat, and light

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59
Q

hyposthenuric

A

urine with a SG <1.010

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60
Q

hypersthenuric

A

urine with a SG >1.010

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61
Q

Normal urine SG range

A

1.010-1.025

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62
Q

isosthenuria

A

SG of 1.010

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63
Q

principle of specific gravity reagent strip test

A

reagent strip test that only measures ionic (charged) solutes

64
Q

urine pH range

A

4.5-8.0

65
Q

principle of pH reagent strip test

A

a double-indicator system using bromothymol blue and methyl red

66
Q

alkaline tide

A

urine is more alkaline following a meal

67
Q

common reasons for pH over 8.0 (impossible)

A

improper storage, highly alkaline substance ingested, or adulterated specimen

68
Q

What tests should be negative in urine?

A

protein, glucose, nitrite, leukocyte esterase, ketones, bilirubin, and blood

69
Q

proteinuria (what is it and what is it caused by)

A

increased amount of protein in the urine, caused by increased levels of albumin (first indicator of renal disease)

70
Q

Cause of Prerenal proteinuria

A

caused by increased quantities of plasma proteins

71
Q

glomerular proteinuria

A

tubular capacity for reabsorption (Tm) is exceeded

72
Q

tubular proteinuria

A

tubular reabsorptive function is altered or impaired; plasma proteins that are normally reabsorbed will be increased in urine

73
Q

what is the most common type of proteinuria AND the most serious clinically?

A

glomerular proteinuria

74
Q

cause of renal proteinuria

A

gomerular or tubular proteinuria

75
Q

postrenal proteinuria

A

inflammation in the urinary tract (normal kidney function, something after kidneys is introducing proteins)

76
Q

conditions resulting in prerenal proteinuria

A

septicemia, hemoglobinuria, myoglobinuria, or multiple myeloma and macroglobulinemia

77
Q

postural (orthostatic) proteinuria

A

type of functional proteinuria characterized by urinary excretion of proteins only when the individual is in an upright position

78
Q

SSA precipitation test - to which reagent strip test does it relate to? what does a positive result look like?

A

Protein (ALL protein) - positive result is white/turbid, the more turbid the higher + value

79
Q

What is the principle of protein reagent strip test?

A

the protein error of indicators

80
Q

limitation of protein reagent strip test

A

only detects albumin; does not detect other proteins

81
Q

What reagent strip test does Sensitive Albumin Tests relate to?

A

Protein - tests for small amounts of albumin <2.0 mg/dL that strip test may not detect.

82
Q

hematuria

A

abnormal amount of RBCs in urine (cloudy sample)

83
Q

hemoglobinuria

A

presence of hemoglobin in the urine (clear sample)

84
Q

myoglobinuria

A

muscle damage that causes release of myoglobin in the blood

85
Q

hemosiderin

A

a storage form of iron

86
Q

principle of the blood reagent strip test

A

pseudoperoxidase activity of the heme moiety

87
Q

T/F: <2.0 mg/dL of albumin the urine is considered abnormal.

A

False. It is normal to have very small amounts of albumin in the urine.

88
Q

What is the normal level of WBC in the urine?

A

10 WBC/uL

89
Q

What does increased number of WBC/leukocyte esterase in the urine indicate?

A

inflammation

90
Q

When are WBC susceptible to lysis in the urine?

A

hypotonic and alkaline urine

91
Q

Limitations of leukocyte esterase reagent strip test

A

Does not detect lymphocytes

92
Q

Principle of nitrite reagent strip test

A

formation of diazonium salt and an azo coupling reaction

93
Q

What does nitrite in the urine indicate? Why?

A

Bacterial infection (UTI). Bacteria (such as E. coli) can reduce nitrate to nitrite.

94
Q

Glucosuria

A

presence of glucose in the urine

95
Q

Glycosuria

A

presence of non-glucose sugars in the urine

96
Q

What is the renal threshold level of glucose? What happens if this is exceeded?

A

160-180 mg/dL. If it is exceeded, glucose will be excreted in the urine.

97
Q

The most common disease that causes hyperglycemia and glucosuria

A

Diabetes mellitus

98
Q

principle of glucose reagent strip test

A

double sequential enzyme reaction that detects only glucose

99
Q

what is considered normal excretion of glucose in the urine?

A

<20 mg/dL

100
Q

Clinitest - what is it? what reagent strip test does this relate to? What does a positive result look like?

A

Copper reduction test to look for any reducing sugar in the urine. Relates to glucose test but is less limiting. A positive result will be orange.

101
Q

Normal amount of ketones in urine?

A

No ketones in urine should be present

102
Q

What are the 3 types of ketones? Which is the most common found in serum/urine?

A

Acetoacetate
Beta-hydroxybutyrate (MOST COMMON)
Acetone

103
Q

What is the first ketone formed by the liver cells?

A

Acetoacetate. It can form into acetone or beta-hydroxybutyrate (most common).

104
Q

Which ketones are detected in testing?

A

Only acetoacetate or acetone. There are no methods of detection for beta-hydroxybutyrate.

105
Q

Principle of the ketone reagent strip test

A

Nitroprusside reaction

106
Q

What reagent strip test does Acetest relate to? What does a positive reaction look like?

A

Acetest detects ketones in the urine. A positive result is a purple color.

107
Q

T/F: ANY amount of bilirubin in the urine is clinically significant

A

True

108
Q

What is ascorbic acid? What reagent strip tests are vulnerable to ascorbic acid interference? Does it cause a false negative or a false positive for these tests?

A

Vitamin C.

It may interfere with blood, bilirubin, glucose, and nitrite strip tests by causing a false NEGATIVE.

109
Q

principle of bilirubin reagent strip test

A

coupling reaction of a diazonium salt to form an azo dye

110
Q

Bilirubin vs urobilinogen

A

Bilirubin comes from breakdown of hemoglobin; Urobilinogen comes from breakdown of bilirubin

111
Q

What reagent strip test does the icotest relate to? What does a positive result look like?

A

Bilirubin - must more sensitive than than reagent strip test. positive result will be a purple/bruise color

112
Q

principle for urobilinogen strip test

A

Ehrlich’s reaction or azo coupling reaction

113
Q

Normal urobilinogen in urine

A

<1 mg/dL

114
Q

What is the only component that is normal to find small amounts of in urine?

A

Urobilinogen

115
Q

Sternheimer-Malbin stain

A

supravital stain (stains live parts of cells) consisiting of crystal violet and safranin

116
Q

2% acetic acid for use in microscopy

A

can help ID WBC cause it lyses RBC

117
Q

0.5% Toluidine blue stain

A

helps to distinguish cells of similar size

118
Q

Sudan III stain or oil red O stain

A

Stains fats or lipids orange/red

119
Q

Prussian Blue stain

A

helps to visualize hemosiderin (iron aggregates)

120
Q

Hansel stain

A

used to ID eosinophils in urine

121
Q

Most common type of microscopy

A

brightfield

122
Q

What produces a maltese cross pattern with polarized light under a microscope?

A

Cholesterol

123
Q

Normal reference range for RBC in urine microscopy

A

0-3 per HPF

124
Q

Normal reference range for WBC in urine microscopy

A

0-8 per HPF

125
Q

Normal reference range for casts in urine microscopy

A

0-2 hyaline casts per LPF

126
Q

Normal reference range for squamous/transitional/renal cells in urine microscopy

A

squamous: few per LPF

transitional/renal: few per HPF

127
Q

Normal reference range for bacteria and yeast in urine microscopy

A

none

128
Q

Normal reference range for abnormal crystals in urine microscopy

A

none

129
Q

What does eosinophiluria indicate?

A

acute interstitial nephritis (AIN)

130
Q

Oval fat bodies

A

monocyte/macrophage that ingested lipoproteins and fat

131
Q

Presence of many renal tubular epithelial cells indicates what?

A

intrinsic renal disease

132
Q

What are casts made of?

A

uromodulin AKA Tam-Horsfall protein

133
Q

What promotes disintegration of casts?

A

Hypotonic and alkaline urine

134
Q

What enhances cast formation?

A

acidic urine, increased solute concentration (hypertonic), urine stasis, and increased plasma proteins

135
Q

most clinically significant crystals are found in ______ urine.

A

acidic

136
Q

Crystals ending in what are typically found in acidic urine?

A

“Urate”

137
Q

Where are amorphous urates commonly found? Are they normal?

A

In “brick dust” samples caused by uroerythrin deposits. Yes they are normal.

138
Q

What crystal is a small ball or sphere and yellow-brown?

A

acid urates

139
Q

What crystal is rhombic or diamond shape and ONLY found in acidic urine <5.7?

A

Uric acid

140
Q

What crystal is envelope shaped in dihydrate form and dumbbell shaped in monohydrate form, and can be found in any pH of urine?

A

Calcium oxalate

141
Q

Clinical significance of high levels of calcium oxalate in urine

A

ingestion of ethylene glycol (antifreeze)

142
Q

What is the most frequently observed crystal in urine?

A

Calcium oxalate

143
Q

What do crystals found in alkaline urine end with?

A

“Phosphate” + ammonium biurate

144
Q

What crystal looks like grains of sand and is found in white or gray macroscopic precipitate?

A

Amorphous phosphate

145
Q

What crystal looks like a coffin lid and can be associated with kidney stones?

A

Triple phosphate

146
Q

What crystal is found in alkaline urine, indicates dehydration, and has a thorny apple appearance?

A

Ammonium biurate

147
Q

What crystal can produce CO2 gas with acetic acid?

A

Calcium carbonate

148
Q

What crystal of metabolic origin appears as fine needles and is yellow-brown in color?

A

Bilirubin

149
Q

What metabolic crystal is hexagonal and can indicate hereditary cystinosis?

A

Cystine

150
Q

What crystals are fine, hairlike delicate needles? Which are concentric circles/radial striations? What is the clinical significance of finding these?

A

Tyrosine and Leucine

Found in patients that cannot metabolize certain amino acids

151
Q

What crystal appears as having notched corners, that must be accompanied by evidence of lipiduria and proteinuria?

A

Cholesterol

152
Q

What drug crystal can be found in the urine that looks like sheaves of wheat?

A

Sulfonamides

153
Q

What can cause flat, elongated parallelogram shaped plates in urine?

A

Radiographic contrast media

154
Q

What must be moving in order to report it out?

A

Trichomonads

155
Q

What stain is used to identify hemosiderin?

A

Prussian blue stain

Urinalysis (4 decks)

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