Exam #2: UA Flashcards
What three things are assessed with gross examination?
- Color
- Turbidity
- Odor
What urine color is normal? What two urine colors are abnormal?
Normal: pale straw/dark amber
Abnormal:
- Red/red brown
- Dark brown/black
What urine turbidity is considered abnormal?
Cloudy
What does foul/putrid smelling urine indicate?
What does fruity smelling urine indicate?
What does maple syrup smelling urine indicate?
- Foul/putrid: UTI
- Fruity: high ketones
- Maple syrup: AA disorders (PKU)
What pH range is indicative of acidic urine?
ACIDIC = 4.5-5.5
What pH range is indicative of basic urine?
ALKALINE = 6.5-8.0
What does specific gravity of urine measure, and what does this reflect?
Concentration of solutes in urine (more concentrated = higher number of solutes)
- Reflects kidneys ability to concentrate/dilute urine
What finding on specific gravity is indicative of renal disease?
Isosthenuria
- SG fixed due to inability to concentrate urine
Is glucose normally detectable in urine? What are two reasons as you might get false + for glucose in urine?
NO
False positives possible due to:
- Ascorbic acid (Vitamin C)
- ASA
What does + Ketones in urine indicate?
Acidosis (DKA)
- Also rapid weight loss, fasting, starvation, pregnancy
What is the most sensitive protein evaluated for in urine, and what is this a potentially early sign of?
Albumin
- Early sign of renal disease
What could possibly give a false + for proteins in urine?
Pyridium
What test can be used to determine staging/prognosis of renal disease, especially in high risk patients? Who is considered high risk (2)?
Albumin (Moderately increased Albumin)
- High risk is DM, HTN
What three things can be measured via blood in urine? How can you differentiate between the three?
- RBCs
- Hb
- Mb
WHICH one = centrifuge
What is produced by bacteria in urine (normally negative)?
Nitrites
What finding is a marker for presence of WBCs/infection?
Leukocyte Esterase
What two positive findings are likely indicative of UTI?
- Nitrites
- Leukocyte Esterase
What color does urine turn when Bilirubin/Urobilinogen is positive?
Brown
What three things might a positive Bilirubin/Urobilinogen indicate?
- Liver disease
- Hemolysis
- Biliary obstruction
If a patient has red/brown urine and the result is sediment red, what is the next step?
Hematuria = determine etiology
If a patient has red/brown urine and the result is supernatant red, what is the next step?
GET DIPSTICK HEME
If a patient has red/brown urine that is supernatant red, and dipstick heme is -, what does this indicate (3)?
What is the next step, if anything?
- Beeturia
- Pyridium (Phenazopyridine)
- Porphyria
NO NEXT STEP
If a patient has red/brown urine that is supernatant red, and dipstick heme is +, what does this indicate?
What is the next step, if anything?
Myoglobin vs. Hemoglobin
NEXT STEP: CENTRIFUGE blood sample to check plasma color
If a patient has red/brown urine that is supernatant red, and dipstick heme is + (Mb vs. Hb), what finding is indicative of Mb and which finding is indicative of Hb?
- Mb: clear plasma
- Hb: red plasma
When using microscopic evaluation of urine, what is found on high power field (2), and what is found on lower power field?
HIGH:
- RBCs
- WBCs
LOW: casts
What RBC finding on microscopic evaluation of urine is abnormal?
> 3 RBC/HPF
What WBC finding on microscopic evaluation of urine is suspicious for UTI? What is indicative of UTI?
- 10-20 WBC/HPF = suspicious for UTI
- 20+ WBC/HPF = UTI
What type of cast is normal and most common?
Hyaline casts
What type of cast is suggestive of glomerulonephritis?
Red Cell casts
What type of cast is suggestive of acute pyelonephritis?
White Cell casts
What type of cast is suggestive of acute tubular necrosis?
Renal Tubular Cell casts
What type of cast is nonspecific to any disease?
Granular casts
What finding do Oval Fat Bodies exhibit, and what is this indicative of?
“Maltese cross”
- Indicates nephrotic syndromes
What is associated with “Maltese cross”?
Oval Fat Bodies
What are large polygonal squamous cells with small nuclei? What are they indicative of?
Squamous Epithelial cells
- Indicates contaminated specimen of skin or external origin
What type of crystal is in acidic urine, secondary to hyperuricemia (gout)?
Uric Acid crystals
What type of crystal is in alkaline urine, secondary to infection by urease producing bacteria?
Struvite crystals
What type of crystals cause cause kidney stones? What other type of crystal is RARELY a cause of kidney stones (but still possible)?
Calcium Oxylate crystals
- RARE: Cystine crystals
What is the purpose of urine culture, and what finding is indicative of a UTI?
Confirm presence of bacteriuria
- >100,000 colonies/mL = UTI
What UA finding is seen in larger numbers if tubular degeneration is present (2)?
- Renal Tubular cells
- Transitional Epithelial cells
What is the major intracellular cation?
K+
What serum [K+] level is indicative of Hyperkalemia?
Above 6.0
- Sxs at around 7.0+
What are the four major etiologies of Hyperkalemia?
- Pseudohyperkalemia
- Inadequate excretion
- Redistribution from ICF → ECF
- Excess K+ administration
What is a false elevation of K+ from hemolysis due to poor venipuncture technique?
Pseudohyperkalemia
What is the most common cause of inadequate excretion by kidneys, and what are three possible causes behind this?
RAAS failure due to…
- Renal failure
- Medications that inhibit K+ excretion
- Hypoaldosteronism
What are the three most common reasons for redistribution of K+ from ICF → ECF?
- Tissue damage
- Acidosis
- Decreased insulin
What are the two most common reasons for excess K+ administration?
- Potassium supplements
- Potassium-containing salt substitutes
Which condition involves arrhythmias (T waves), conduction abnormalities?
Hyperkalemia
If RAPID correction of Hyperkalemia is needed, what treatment is recommended?
What other two treatments could be used to shift K+ from ECF → ICF?
IV calcium chloride
Maneuvers to shift K+ from ECF → ICF:
- IV sodium bicarbonate
- D50W + IV insulin
If SLOW correction of Hyperkalemia is needed, what treatment is recommended (2)?
Loop/Thiazide diuretics to increase K+ loss
What serum [K+] level is indicative of Hypokalemia?
Below 3.5
- Dangerous if <3.0
What are the four major etiologies of Hypokalemia? Which is most common?
- Inadequate intake
- GI tract loss = MOST common
- Renal loss
- Redistribution from ECF → ICF
What is the common cause of renal loss causing Hypokalemia?
Loop/Thiazide diuretics
What are three possible causes of redistribution from ECF → ICF (leads to Hypokalemia)?
- Metabolic alkalosis
- Insulin administration
- Beta agonists
What condition involves U waves, cramping, respiratory failure, rhabdomyolysis, anorexia, N/V?
Hypokalemia
If RAPID correction of Hypokalemia is needed, what treatment is recommended?
IV potassium chloride
If SLOW correction of Hypokalemia is needed, what treatment is recommended?
ORAL K+
IF a patient has Hypokalemia, what else should be checked for?
Hypomagnesemia
- Low K+ is difficult to correct if low Mg2+ is also not corrected
Is Hypokalemia or Hyperkalemia associated with T waves?
Hyperkalemia
Is Hypokalemia or Hyperkalemia associated with U waves?
Hypokalemia
Sx associated with hyper-K+ (mnemonic to remember this)
“It’s a FACT”
- flaccid paralysis
- ascending paralysis
- conduction abnormalities
- T waves peaked
Sx associated with hypo-K+ (mnemonic to remember this)
“YOU CRAMP”
- hYpOkalemia
- U waves
- Cramping (opposite of hyper-K flaccid paralysis)
- Respiratory failure & Rhabdomyolysis
- Anorexia (n/v)
- Muscle weakness ascending pattern (same as hyper-K)
- Paralysis
