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Urinalysis Test 3 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Identify drawings of microscopic structures in urine sediment

A

Know ammonium biurate, mucus, tyrosine, hyaline, uric acid, cholesterol, calcium oxalate, triple phosphate, cystine, waxy cast.

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2
Q

Calculate the magnification of urine sediment under the microscope

A

400x

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3
Q

How may TNTC RBCs be dispersed so other sediment may be evaluated?

A

2% acetic acid will lyse the RBCs

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4
Q

Casts and _______ go hand-in-hand in a urine specimen

A

protein

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5
Q

Identify possible causes of a false negative dipstick test for blood.

A

ascorbic acid
high specific gravity
high nitrite

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6
Q

Which crystals appear in acid and which in alkaline urine?

A 
ampicillin
amorphous urate
aspirin
bilirubin
cholesterol
calcium phosphate
calcium oxalate
cysteine
hemosiderin
hippuric acid
leucine
sulfonamide
tyrosine
uric acid
x-ray media
ALKALINE URINE:
ammonium biurate
amorphous phosphate
calcium carbonate
calcium phosphate
calcium oxalate
triple phosphate
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7
Q

List the principles of the reactions on the N-Multistix

A

Hydrogen peroxide (H2O2) reacts with tetramethylbenzidine (chromogen) in presence of hemoglobin or myoglobin to produce oxidized chromogen and water

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8
Q

How may amorphous be dispersed so other sediment may be evaluated?

A

2% acetic acid gets rid of amorph phosphate.

Heat to 60C gets rid of amorph urates.

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9
Q

What organism may be found in the urine of diabetics?

A

Yeast

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10
Q

What type of urine specimen provides an overall picture of the patient’s health?

A

Random Specimen

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11
Q

List the various types of preservatives and their usage

A

1) Refrigeration: routine analysis up to 24 hours.
2) Commercial transport tubes (boric acid): preserves urine for longer time at RT; routine analysis.
3) Thymol: preserves sediments, inhibits bacteria & yeast.
4) KNOW Formalin: cellular preservation, will cause false-negative in blood & urobili reagent tests; used in cytology.
5) Saccomanno’s fixative: cellular preservation; used in cytology.
6) Acids (HCl, glacial acetic acid): UNACCEPTABLE for urinalysis!
7) Sodium carbonate: UNACCEPTABLE for urinalysis!

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12
Q

What is the clinical significance of bilirubin &/or urobilinogen in a urine specimen?

A

Any bilirubin in urine is not normal; can indicate hepatitis, cirrhosis or biliary obstruction. But negative in chronic liver disease.
Small amount of urobilinogen is normal in urine. Increased amount can indicate hepatitis, cirrhosis or hemolytic states (pernicious anemia). Decreased in chronic liver disease (remember, cannot report negative Uro).

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13
Q

What is the SG of normal urine?

A

1.002 to 1.030

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14
Q

What is the significance of ketone bodies in the urine?

A

Indicates fat metabolism resulting from starvation or deficiency in carbohydrate metabolism.

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15
Q

How is the urine osmolality determined?

A

Measured by freezing point depression or vapor pressure osmometer. Unaffected by heavy molecules, all solutes contribute equally. Normal value is 275-900 mOsm/kg of water

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16
Q

What are the findings on the dipstick with a UTI and with a HTR?

A

Protein: small (

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17
Q

What urinary crystal appears in more forms that any other crystal

A

Uric Acid Crystals

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18
Q

How may RBCs and yeast plus WBCs and renal epithelial cells be differentiated?

A

Acetic acid lyses RBCs but not yeast, WBC or RE and it will accentuate nuclei of WBC. Toluidine blue will also accentuate WBC nuclei. RE have large, dense nuclei and polygonal shape where WBCs and RBCs are spherical. Yeast vary in size, are not biconcave and usually are budding

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19
Q

What sugar is a non-reducing sugar?

A

Sucrose

any sugar that has an aldehyde group or can form one

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20
Q

How may myoglobin and hemoglobin be differentiated

A

80% Ammonium sulfate precipitation: Hb precipitates out of solution but myoglobin remains soluble.

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21
Q

What is the best way to find urinary casts in a microscopic exam of urine?

A

Low power, dim light

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22
Q

What is the most common constituent of renal calculi?

A

Calcium oxalate

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23
Q

What is the reason for a negative dipstick for glucose and a positive Clinitest?

A

A reducing substance is present (e.g. sucrose)

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24
Q

Clinical Sig & Causes of CELLS:

RBC’s

A

1) Increased # indicates renal bleed, either glomerular or tubular. Assoc. with casts and proteinuria.
2) Indicates glomerulonephritis, pyelonephritis, cystitis, calculi, tumors or trauma. If no casts or proteinuria, bleed is below the kidney or may be contamination.

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25
Q

Clinical Sig & Causes of CELLS :

WBC

A

1) Increased # indicates inflammation of urinary tract.
2) Indicates bacterial/parasitic infections or renal diseases (glomerulonephritis, chlamydia, mycoplasmosis, TB, trichomonas, mycoses).

26
Q

Clinical Sig & Causes of CELLS:

Eosinophils

A

1) Discrimination of eos from WBCs often impossible.

2) Indicates acute interstitial nephritis (AIN) or chronic UTIs.

27
Q

Clinical Sig & Causes of CELLS:

Lymphocytes

A

1) Normally present in urine in small #. Not normally distinguished from WBCs but large # is significant.
2) Present in inflammatory conditions such as acute pyelonephritis or in renal rejection transplant.

28
Q

Clinical Sig & Causes of CELLS:

Monocytes & Macrophages

A

1) Increased in viral conditions

2) Drawn to site of inflammation resulting from renal infection or immune reactions.

29
Q

Clinical Sig & Causes of CELLS:

Transitional Epithelial

A

1) Indicates inflammation or renal damage if large #.
2) Can be UTI. Clusters/sheets seen after catheritization but if no instrumentation used, indicates a pathologic process.

30
Q

Clinical Sig & Causes of CELLS:

Squamous Epithelial

A

1) Not clinically significant.

2) Indicates specimen contamination.

31
Q

Clinical Sig & Causes of CELLS:

Convoluted Renal Tubular Epithelial

A

1) Increased in acute ischemic or toxic renal tubular disease.
2) Indicates heavy metal or drug toxicity.

32
Q

Clinical Sig & Causes of CELLS :

Collecting Duct Renal Epithelial

A

1) Very significant

2) All types of renal disease (nephritis, acute tubular necrosis, kidney transplant rejection, salicylic poisoning).

33
Q

Clinical Sig & Causes of CELLS:

Oval Fat Bodies

A

1) Indicates glomerular dysfunction with renal tubular cell death & leakage of plasma into urine. Assoc. with proteinuria & casts.
2) Renal tubular cells become engorged with fats from tubular lumen or own degenerating intracellular lipids.

34
Q

Clinical Sig & Causes of CELLS:

Cytomegalic Inclusion Bodies

A

1) Indicates viral infection affecting newborns with liver, spleen & blood disorders and adults with Hodgkins, leukemia & aplastic anemia.
2) Viral inclusions found in nucleus of renal tubular epithelial cells.

35
Q

Clinical Sig & Causes of CRYSTALS:

Cystine

A

1) Can indicate congenital cystinosis or cystinuria, tend to deposit in tubules as calculi resulting in renal damage.
2) Can be caused by pyelonephritis, diet high in animal fat and protein

36
Q

Clinical Sig & Causes of CRYSTALS:

Bilirubin

A

1) Indicates liver disease.

2) Formed when large amount of bilirubin is present in urine.

37
Q

Clinical Sig & Causes of CRYSTALS:

Leucine

A

1) Indicates aminoaciduria or severe liver disease.

2) Very water soluble so rarely seen.

38
Q

Clinical Sig & Causes of CRYSTALS:

Tyrosine

A

1) Indicates aminoaciduria or severe liver disease.

2) Water soluble so rarely seen but found more often than leucine.

39
Q

Clinical Sig & Causes of CRYSTALS:

Cholesterol

A

1) Rare; always accompanied by large amount of protein & other fats.
2) Seen in nephrotic syndrome & conditions resulting in chyluria (rupture of lymphatic vessels into renal tubules).

40
Q

Clinical Sig & Causes of CRYSTALS:

Uric Acid

A

1) Can be non-pathologic but large numbers seen in gout & conditions of increased purine metabolism (cytotoxic drugs used in leukemia).
2) Crystals form as body tries to rid itself of excessive uric acid in the blood possibly caused by overweight, rich diet, exposure to lead or genetic predisposition.

41
Q

Clinical Sig & Causes of CRYSTALS:

Calcium Oxalate

A

1) Non-pathologic with ingestion of high oxalate foods but also seen in ingestion of antifreeze and severe chronic renal disease.
2) Oxalic acid (metabolite of ascorbic acid) will combine with Ca2+ in urine to form calcium oxalate.

42
Q

Clinical Sig & Causes of CRYSTALS:

Ampicillin

A

1) Rare.

2) Indicates large doses of ampicillin (antibiotic).

43
Q

Clinical Sig & Causes of CRYSTALS:

Calcium Phosphate

A

1) Not clinically significant

2) Calcium and phosphate combine in urine to form an insoluble complex.

44
Q

Clinical Sig & Causes of CRYSTALS:

Hippuric Acid

A

1) No clinical significance.

2) Might be seen in ethylene glycol (antifreeze) intoxication or exposure to toluene in atmosphere.

45
Q

Clinical Sig & Causes of CRYSTALS:

Asprin

A

1) Extremely rare; if seen indicates overdose of aspirin (salicylic acid poisoning).
2) Excess aspirin in body excreted in urine where it may crystalize in acid urine.

46
Q

Clinical Sig & Causes of CRYSTALS:

Sulfonamide

A

1) Rare; renal damage uncommon
2) Original drug was insoluble & formed crystals in renal tubules causing damage. Current drugs do not have solubility problems.

47
Q

Clinical Sig & Causes of CRYSTALS:

X-Ray media

A

1) Not clinically significant but may be mistaken for cholesterol.
2) Crystals can form in acid urine as body excretes the dye.

48
Q

Clinical Sig & Causes of CRYSTALS:

Triple Phosphate

A

1) No clinical significance but can be associated with UTI in alkaline pH.
2) Ammonium combines with magnesium and phosphate in alkaline urine to form “coffin lid” crystals.

49
Q

Clinical Sig & Causes of CRYSTALS:

Ammonium Biurate

A

1) Not clinically significant unless found in fresh urine (extremely rare). Can be mistaken for sulfonamide.
2) Forms as urine ages. If seen, must check collection time of specimen.

50
Q

Clinical Sig & Causes of CRYSTALS:

Amorphous urate & Amorphous phosphate

A

1) No clinical significance. Can be mistaken for bacteria.

2) Can be seen after large consumption of vegetables.

51
Q

Clinical Sig & Causes of CASTS:

Hyaline

A

1) Normal in low numbers. High numbers can indicate strenuous exercise, dehydration, fever, stress, renal disease or congestive heart failure (CHF).
2) Composed of homogenous Tamm-Horsfall (T-H) protein matrix and formed within tubules.

52
Q

Clinical Sig & Causes of CASTS:

Waxy

A

1) Indicates urinary stasis

2) Formed when granular cast degenerates as it sits in the renal tubule.

53
Q

Clinical Sig & Causes of CASTS:

Granular

A

1) Finely granular in low numbers can be normal. Coarse granular and broad granular indicates poor prognosis. Assoc. with renal tubular epithelial cell casts and proteinuria.
2) Coarse granular results from degeneration of renal cells and other casts. Broad granular indicates renal damage.

54
Q

Clinical Sig & Causes of CASTS:

Broad

A

1) Renal Failure, increase # is poor prognosis.

2) Cast forms in dilated convoluted tubules or collecting ducts indicating severe urinary stasis.

55
Q

Clinical Sig & Causes of CASTS:

Renal Tubular Epithelial Cast

A

1) Indicates renal tubular disease. Assoc with proteinuria and granular casts.
2) Renal epithelial cells become incorporated into the T-H matrix as it sits in the tubule (urinary stasis).

56
Q

Clinical Sig & Causes of CASTS:

Red Blood Cell Cast

A

1) Diagnostic of intrinsic renal disease. Assoc with proteinuria. Occasionally found in healthy people 24-48 hrs after contact sports.
2) RBCs from glomerulus or tubular damage.

57
Q

Clinical Sig & Causes of CASTS:

Leukocyte (WBC) Cast

A

1) Indicates renal inflammation or infection.

2) Glomerulonephritis will also have RBC casts; Pyelonephritis will also have proteinuria and hematuria.

58
Q

Clinical Sig & Causes of CASTS:

Bacterial Cast

A

1) Not often IDed because difficult to see, diagnostic of pyelonephritis.
2) Usually contains WBCs so often reported as WBC cast.

59
Q

Clinical Sig & Causes of CASTS:

Fatty Cast

A

1) Significant renal pathology: nephrotic syndrome or severe crush injury.
2) Usually contained with hyaline or granular matrix and assoc. with proteinuria.

60
Q

Clinical Sig & Causes of CASTS:

Hemosiderin & crystals

A

1) Sulfonamide & Ca oxalate most common. Assoc with hematuria.
2) Any substance present in tubular lumen can be in casts.

61
Q

Clinical Sig & Causes of CASTS:

Pigmented casts

A

Hb & Myoglobin: yellow to brown with hematuria
Bilirubin: all urine sediment will be yellow-golden brown
Urobili: yellow-golden but will not color sediment
Phenazopyridine (urinary pain killer): brown to reddish brown

Urinalysis Test 3 (3 decks)

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