Gary's copy - Urinalysis - A&P II - Lab ex 8 Flashcards
Urochrome
A chemical that is also commonly known as Urobilin that gives pee its yellow color. Urochrome is a byproduct of hemoglobin metabolism by the liver and is eliminated through urine. Later on this page we will discuss that it means if the shade of yellow in pee is too strong on a consistent basis, and the kinds of dietary and lifestyle changes that have to be made to maintain a healthier lifestyle and your urinary system.
Pyuria
is the condition of urine containing white blood cells or pus. Defined as the presence of 6-10 or more neutrophils per high power field of unspun, voided mid-stream urine. It can be a sign of a bacterial urinary tract infection. Pyuria may be present in the people with sepsis, or in an older people with pneumonia.
Sterile pyuria,[1] is urine which contains white blood cells while appearing sterile by standard culturing techniques. It is often caused by sexually transmitted infections, such as gonorrhea, or viruses which will not grow in bacterial cultures. Sterile pyuria is listed as a side effect from some medications such as paracetamol (acetaminophen). Its occurrence is also associated with certain disease processes, such as Kawasaki disease and genitourinary tuberculosis.[2] However, there are many known causes, including systemic or infectious disease, structural and physiological reasons, intrinsic kidney pathology, or drugs.[2]
Hematuria
Hematuria is the presence of blood in a person’s urine. The two types of hematuria are:
gross hematuria—when a person can see the blood in his or her urine
microscopic hematuria—when a person cannot see the blood in his or her urine, yet it is seen under a microscope
Urea
A nitrogen-containing substance normally cleared from the blood by the kidney into the urine. Diseases that compromise the function of the kidney often lead to increased blood levels of urea, as measured by the blood urea nitrogen (BUN) test.
Urea is of major historical significance. It was the first organic chemical compound ever synthesized. The German chemist Friedrich Wohler in 1828 attempted to make ammonium cyanate from silver cyanide and ammonium chloride and, in the process, accidentally made urea. Wohler wrote his mentor Jons Berzelius, “I must tell you that I can make urea without the use of kidneys, either man or dog. Ammonium cyanate is urea.”
This pioneering experiment disproved the theory of vitalism, the concept that organic chemicals could only be modified chemically, but that living plants or animals were needed to produce them.
Wohler had also discovered that urea and ammonium cyanate had the same chemical formula but very different chemical properties. This was due to isomerism, the phenomenon in which two or more chemical compounds have the same number and type of atoms but, because those atoms are arranged differently, each compound has different chemical properties.
Osmolality
Urine osmolality is a measure of urine concentration,[1] in which large values indicate concentrated urine and small values indicate diluted urine. Consumption of water (including water contained in food) affects the osmolality of urine.[2]
In healthy humans with restricted fluid intake, urine osmolality should be greater than 800 mOsm/kg, while a 24-hour urine osmolality should average between 500 and 800 mOsm/kg.
Urine osmolality in humans can range from approximately 50 to 1200 mOsm/kg, depending on whether the person has recently drunk a large quantity of water (the lower number) or has gone without water for a long time (the higher number).[2] Plasma osmolality with typical fluid intake often averages approximately 290 mOsm/kg H2O in humans.[2]
Creatinine
Creatinine is a chemical waste product produced by muscle metabolism. When your kidneys are functioning normally, they filter creatinine and other waste products out of your blood. These waste products are removed from your body through urination.
A creatinine urine test measures the amount of creatinine in your urine. The test can help your doctor evaluate how well your kidneys are functioning. This is useful for diagnosing or ruling out kidney disease and other conditions affecting the kidneys.
A chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Approximately 2% of the body’s creatine is converted to creatinine every day. Creatinine is transported through the bloodstream to the kidneys. The kidneys filter out most of the creatinine and dispose of it in the urine.
Although it is a waste, creatinine serves a vital diagnostic function. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine will rise. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys, sometimes even before a patient reports any symptoms. It is for this reason that standard blood and urine tests routinely check the amount of creatinine in the blood.
Normal levels of creatinine in the blood are approximately 0.6 to 1.2 milligrams (mg) per deciliter (dl) in adult males and 0.5 to 1.1 milligrams per deciliter in adult females. (In the metric system, a milligram is a unit of weight equal to one-thousandth of a gram, and a deciliter is a unit of volume equal to one-tenth of a liter.) Muscular young or middle-aged adults may have more creatinine in their blood than the norm for the general population. Elderly persons, on the other hand, may have less creatinine in their blood than the norm. Infants have normal levels of about 0.2 or more, depending on their muscle development. A person with only one kidney may have a normal level of about 1.8 or 1.9. Creatinine levels that reach 2.0 or more in babies and 10.0 or more in adults may indicate the need for a dialysis machine to remove wastes from the blood.
Certain drugs can sometimes cause abnormally elevated creatinine levels.
Uric Acid
Uric Acid Test (Blood Analysis)
Uses Preparation Procedure Test results Risks Conclusions
Uric acid and the uric acid blood test
A uric acid blood test, also known as a serum uric acid measurement, determines how much uric acid is present in your blood. The test can help determine how well your body produces and removes uric acid.
Uric acid is a chemical produced when your body breaks down foods that contain organic compounds called purines. Foods and beverages with a high purine content include:
liver anchovies mackerel dried beans beer wine
Purines are also created through the natural process of cell breakdown in the body.
Most uric acid is dissolved in the blood, filtered through the kidneys, and expelled in the urine. Sometimes the body produces too much uric acid or doesn’t filter out enough of it. Hyperuricemia is the name of the disorder that occurs when you have too much uric acid in your body.
High levels of uric acid are associated with a condition called gout. Gout is a form of arthritis that causes swelling of the joints, especially in the feet and big toes. Another cause of hyperuricemia is increased cell death, due to cancer or cancer treatments. This can lead to an accumulation of uric acid in the body.
It’s also possible to have too little uric acid in your blood, which is a symptom of liver or kidney disease. It’s also a symptom of Fanconi syndrome, a disorder of the kidney tubules that prevents the absorption of substances such as glucose and uric acid. These substances are then passed in the urine instead.
Uric Acid Test (Blood Analysis)
Uses Preparation Procedure Test results Risks Conclusions
Uric acid and the uric acid blood test
A uric acid blood test, also known as a serum uric acid measurement, determines how much uric acid is present in your blood. The test can help determine how well your body produces and removes uric acid.
Uric acid is a chemical produced when your body breaks down foods that contain organic compounds called purines. Foods and beverages with a high purine content include:
liver anchovies mackerel dried beans beer wine
Purines are also created through the natural process of cell breakdown in the body.
Most uric acid is dissolved in the blood, filtered through the kidneys, and expelled in the urine. Sometimes the body produces too much uric acid or doesn’t filter out enough of it. Hyperuricemia is the name of the disorder that occurs when you have too much uric acid in your body.
High levels of uric acid are associated with a condition called gout. Gout is a form of arthritis that causes swelling of the joints, especially in the feet and big toes. Another cause of hyperuricemia is increased cell death, due to cancer or cancer treatments. This can lead to an accumulation of uric acid in the body.
It’s also possible to have too little uric acid in your blood, which is a symptom of liver or kidney disease. It’s also a symptom of Fanconi syndrome, a disorder of the kidney tubules that prevents the absorption of substances such as glucose and uric acid. These substances are then passed in the urine instead.
Uses
Purposes of a uric acid blood test
Most commonly, the test is used to:
diagnose and monitor people with gout monitor people who are undergoing chemotherapy or radiation treatment check kidney function after an injury find the cause of kidney stones diagnose kidney disorders
You may need a uric acid test if:
you have joint pain or swelling that may be related to gout
you’re currently undergoing chemotherapy
you’re about to start chemotherapy
you have frequent kidney stones
you’ve been diagnosed with gout in the past
Another option for uric acid testing is to test your urine over a 24-hour period. Sometimes your doctor will recommend both to confirm a diagnosis.
Preparation
Preparing for a uric acid blood test
The following may interfere with your uric acid test results:
alcohol
certain medications, such as aspirin (Bufferin) and ibuprofen (Motrin IB)
high levels of vitamin C
dyes used in X-ray tests
Tell your doctor about any prescription or over-the-counter medications or supplements you’re taking.
You may need to fast (refrain from eating or drinking) for four hours before the test.
Procedure
How a uric acid blood test is done
The process of obtaining a blood sample for testing is called venipuncture.
Your doctor or another healthcare provider takes blood from a vein, usually from your inner elbow or the back of your hand. First, they sterilize the area with an antiseptic. They then wrap an elastic band around your arm to allow blood to fill the veins.
They next insert a needle into your vein. The blood is collected in an attached vial. Once the blood has been collected, the plastic band is untied and the needle removed from the vein. Pressure is applied to the site of the needle entry and a bandage applied if necessary.
For infants and young children, a small cut may be made on the arm and a test strip or slide used to collect a small sample of blood. The area is then cleaned and bandaged if necessary.
Once collected, the blood is sent to a laboratory for analysis.
Test results
What the test results mean
Uric acid levels can vary based on sex. Normal values for women are 2.5 to 7.5 milligrams/deciliter (mg/dL) and for men 4.0 to 8.5 mg/dL. However, the values may vary based on the lab doing the testing.
According to the American College of Rheumatology (ACR), your target level if you have gout is a blood uric acid level of less than 6.0 mg/dL. Low levels of uric acid are less common than high levels and are less of a health concern.
High levels of uric acid in your blood typically indicate that your body is making too much uric acid or that your kidneys aren’t removing enough uric acid from your body. Having cancer or undergoing cancer treatment can also raise your uric acid levels.
High uric acid levels in your blood can also indicate of a variety of conditions, including:
diabetes
gout, which involves recurring attacks of acute arthritis
chemotherapy
bone marrow disorders, such as leukemia
a diet high in purines
hypoparathyroidism, which is a decrease in your parathyroid function
kidney disorders, such as acute kidney failure
kidney stones
multiple myeloma, which is cancer of the plasma cells in your bone marrow
metastasized cancer, which is cancer that has spread from its original site
The blood uric acid test isn’t considered a definitive test for gout. Only testing a person’s joint fluid for monosodium urate can absolutely confirm the presence of gout. However, your doctor can make an educated guess based on high blood levels and your gout symptoms.
Also, it’s possible to have high uric acid levels without the symptoms of gout. This is known as asymptomatic hyperuricemia.
Low levels of uric acid in the blood may suggest:
Wilson’s disease, which is an inherited disorder that causes copper to build up in your body tissues
Fanconi syndrome, which is a kidney disorder most commonly caused by cystinosis
alcoholism
liver or kidney disease
a diet low in purines
Ammonia
Ammonia is a waste product formed primarily by bacteria in the intestines during the digestion of protein. If not processed and cleared from the body appropriately, excess ammonia can accumulate in the blood. This test measures the amount of ammonia in the blood.
Ammonia is normally transported in the blood to the liver, where it is converted into two substances called urea and glutamine. The urea is then carried to the kidneys, where it is eliminated in the urine. If this “urea cycle” does not complete the breakdown of ammonia, ammonia builds up in the blood and can pass from the blood into the brain.
Ammonia is toxic to the brain. For example, when liver function is significantly reduced due to disorders such as cirrhosis or hepatitis, ammonia and other compounds processed by the liver can accumulate in the brain and cause a condition called hepatic encephalopathy.
Hepatic encephalopathy causes mental and neurological changes that can lead to confusion, disorientation, sleepiness, and eventually to coma and even death.
Infants and children with increased ammonia levels may vomit frequently, be irritable, and be increasingly lethargic. Left untreated, they may experience seizures, have difficulty breathing, and may lapse into a coma.
Problems with ammonia processing can arise from conditions such as:
Severe liver disease - damage limits the ability of the liver to process ammonia; spikes in ammonia blood levels may be seen in people with stable liver disease, especially following a triggering event such as gastrointestinal bleeding or an electrolyte imbalance.
Decreased blood flow to the liver - ammonia is less able to get to the liver to be processed.
Reye syndrome - a rare condition that affects the blood, brain, and liver; it is characterized by a rise in ammonia levels and a fall in glucose. It affects primarily children and young adults. In most cases, it follows and appears to be triggered by a viral infection, such as the flu or chickenpox. Children who are given aspirin are at an increased risk.
Renal failure - the kidneys are unable to effectively rid the body of urea, leading to a build-up of ammonia in the blood.
Rare inherited defects in the urea cycle - a deficiency or defect in one or more of the enzymes necessary to complete the conversion of ammonia to urea.
Albumin
If you are at risk for kidney disease, your provider may check your urine for albumin.
Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Having albumin in the urine is called albuminuria.
A diagram showing a healthy kidney with albumin only found in blood, and a damaged kidney that has albumin in both blood and urine.
A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.
A health care provider can check for albumin in your urine in two ways:
Dipstick test for albumin. A provider uses a urine sample to look for albumin in your urine. You collect the urine sample in a container in a health care provider’s office or lab. For the test, a provider places a strip of chemically treated paper, called a dipstick, into the urine. The dipstick changes color if albumin is present in the urine.
Urine albumin-to-creatinine ratio (UACR). This test measures and compares the amount of albumin with the amount of creatinine in your urine sample. Providers use your UACR to estimate how much albumin would pass into your urine over 24 hours. A urine albumin result of
30 mg/g or less is normal
more than 30 mg/g may be a sign of kidney disease
If you have albumin in your urine, your provider may want you to repeat the urine test one or two more times to confirm the results. Talk with your provider about what your specific numbers mean for you.
If you have kidney disease, measuring the albumin in your urine helps your provider know which treatment is best for you. A urine albumin level that stays the same or goes down may mean that treatments are working.
Glucose
A urine glucose test is a quick and simple way to check for abnormally high levels of glucose in the urine. Glucose is a type of sugar that your body requires and uses for energy. Your body converts the carbohydrates you eat into glucose. Having too much glucose in your body can be a sign of a health problem. If you don’t receive treatment and your glucose levels remain high, you can develop serious complications.
The test involves taking a sample of urine. Once you provide your sample, a small cardboard device known as a dipstick will measure your glucose levels. The dipstick will change color depending on the amount of glucose in your urine. If you have a moderate or high amount of glucose in your urine, your doctor will perform further testing to determine the underlying cause.
The most common cause of elevated glucose levels is diabetes, a condition that affects the body’s ability to manage glucose levels. It’s important to monitor your glucose levels if you have already been diagnosed with diabetes, or if you show symptoms of prediabetes. These symptoms include excessive thirst, blurred vision, and fatigue. When left untreated, diabetes can lead to long-term complications, including kidney failure and nerve damage.
Glycosuria
Renal glucosuria is the excretion of glucose in the urine in detectable amounts at normal blood glucose concentrations in the absence of any signs of generalized proximal renal tubular dysfunction due to a reduction in the renal tubular reabsorption of glucose. The revised criteria for diagnosis of this condition includes: a normal oral glucose tolerance test in regard to plasma glucose concentration, normal plasma levels of insulin, free fatty acids, glycosylated hemoglobin, and relatively stable urinary glucose levels (10 to 100 g/d; except during pregnancy, when it may increase) with glucose present in all urine samples. The urine should contain glucose as the only source of carbohydrate, and individuals should have normal carbohydrate storage and use.
Erythrocytes
Red blood cells (erythrocytes) may be a sign of kidney disease, a blood disorder or another underlying medical condition, such as bladder cancer. Bacteria or yeasts may indicate an infection. Casts — tube-shaped proteins — may form as a result of kidney disorders.
Leukocytes
A complete blood cell (CBC) test often includes a measurement of the level of leukocytes, or white blood cells (WBCs). Higher levels of leukocytes in the bloodstream may indicate an infection. This is because WBCs are part of the immune system, and they help fight off disease and infection.
Leukocytes may also be found in a urinalysis, or a urine test. High levels of WBCs in your urine also suggest that you have an infection. In this case, your body is trying to fight off an infection somewhere in your urinary tract. Usually, that means the bladder or the urethra, which is the tube that carries urine from the bladder. Leukocytes in the urine could also suggest a kidney infection.
Ketone Bodies/Acetone Bodies
Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat instead of the sugar glucose for energy. The ketone bodies – acetone, acetoacetate, and beta-hydroxybutyrate – are toxic acidic chemicals. They build up in the blood and then spill over into the urine. The body can also rid itself of acetone through the lungs. This gives the breath a fruity odor.
The presence of ketone bodies in the blood is termed ketosis and the presence of ketone bodies in the urine is called ketonuria.
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a state of uncontrolled diabetes and it is characterized by hyperglycemia, a high anion gap acidosis, and the presence of ketonemia and ketonuria (ketone bodies in the blood and urine). Although it can occur in patients with type 2 diabetes (during periods of severe stress), DKA primarily occurs in patients with type 1. Type 1 diabetes is caused by the (usually autoimmune) destruction of the pancreatic beta cells ,which leads to an absolute insulin deficiency. Thus, patients with type 1 have an absolute requirement for insulin and will develop DKA if they do not receive it.
