GU #1 Flashcards
Reasons for obtaining urine specimens:
water“fluid biopsy” of the urinary tract
Quick
Economical
To diagnose renal or urinary tract disease
To monitor renal or urinary tract disease
To detect metabolic disease
**quick , noninvasive, cheap*
Solutes are end products of __________ and are filtered through the ________ to maintain _________ balance
metabolism
kidneys
acid-base - homeostasis
Urine collection methods?
Routine Void
Midstream and Clean-Catch Specimen
24-hour urine collection - big jug and collect all the urine within 24 hours
Urethral catheterization-infants
Suprapubic aspiration-surgery or prostate that is blocking urinary outlet
Pediatric collection-try not to cath them; collect it from the bag that is stuck to them in the diaper
What collection method is the most common?
Midstream and Clean-Catch Specimen
Indications for a UA?
Used as diagnosis or screening exam
screen for protein in pregnant women signifies kidney damage; looking for preeclampsia
UA is used to investigate?
Abdominal pain / flank pain Back pain Dysuria - painful urinaiton Hematuria - blood in urine Urinary frequency
Urine sampling/specimens
us only what specimens for testing for urinalysis?
fresh
Urine sampling/specimens
uses the ______ method for urinalysis?
Midstream clean catch
**this is the most common test - midstream clean catch *
For urinalysis the _______ _______ must be cleansed first with ______/_________ wipe
Uretheral meatus must be cleansed first with iodine/cleansing wipe
Urinalysis you void a small amount then ____ and then you void into ______ cup then send to lan
Void small amount then stop
Void into sterile specimen cup then send to lab
✪ best specimen for urine cultures: however they are not routinely done on everyone that you need a culture on
Catheterized specimen
Catheterized specimen
used in patients with ?
Dexterity issues
Bedridden
Post-op
Urinary retention
UA color is normally?
pale yellow
UA color: colorless means?
if they are very well hydrated - if kidney stone ( have them drink water until they pee clear
UA color: orange means?
pyridium
UA color: brown means?
Rhabdomyolysis
UA color: green means?
vitamins
pseudomonas
UA color: red means?
blood
hematuria
UA odor: fruity?
Diabetic (acetone)
uncontrolled Diabetes
UA odor: foul-smelling?
infections
fistulae from the intestines to the bladder
UA odor: fecal?
Enterovesicular fistula
UA appearance: cloudy/turbid?
Old specimen
Presence of pus
Ingestion of fats (large amounts)
**old or sitting around for a while it can be cloudy *
UA pH: alkaline causes?
Alkalemia
UTI
Diet high in citrus
more alkaline with infection
UA pH: acidic causes?
Acidemia
Starvation
Dehydration
Diet high in meats
**urine is normally more acidic,
more acidic if more acid in the serum, starvation, atkins diet ( ketoacidosis), paleodiet,*
UA: stones related to alkaline conditions?
Calcium carbonate,
Calcium phosphate, Magnesium phosphate
UA: stone related to acidic conditions?
Xanthine
cystine
uric acid
calcium oxalate
UA protein normal?
normally no protein present
**runner or you work out aggressively causing micro trauma to the kidney you can spill proteins *
** think inflammation, damage or infections if there is protein in the urnine*
if there is protein in the urine, then it is an indication of what ?
✪ indicator of renal disease
**glomerular capillary pores are to small to let protein through and if there is damage or inflammation then protein, mostly albumin, leaks through ( glomerular membrane is injured), when albumin leaks through you can decrease the oncotic pressure in the vascular system and cause interstitial edema
edema and proteinuria are conditions for nephrotic syndrome **
UA increased protein causes?
Glomerulonephritis
SLE
Kidney trauma
Multiple myeloma- Bence joyce
Preeclampsia
Polycystic kidney dz
Malignant HTN
Pyelonephritis
Goodpasture syndrome - AI condition where body attacks the kidneys and the fail
UA increased protein causes cont…?
CHF Orthostatic proteinuria Bladder tumors Urethritis Amyloidosis
Glucose is ___ normally found in the urine?
NOT
What is the number one cause of glucose in the urine?
diabetes
Other causes of glucose in the urine?
Renal glycosuria - lower threshold for secretion of glucose
Fanconi syndrome - transport defect in the proximal renal tubule
Nephrotoxic chemicals
If there is glucose in the urine then it indicates an ________ serum glucose , > ___.
elevated
> 180
Specific Gravity range?
1.005-1.030
Specific Gravity is a measurement of _____________.
concentration
SG compares with ?
water
**usually more solutes in urine than in water ( SG of urine is really close to the SG of water)*
SG is used to evaluate the _____________ and __________ power of the kidneys
concentrating and excretory power
**SG - how well our kidney can concentrate the urine *
Low specific gravity causes?
decreased conc.
over hydration - peeing clear
Diabetes insipidus
Renal failure - cause more water secretion
Diuretics
High specific gravity causes?
dehydration
SIADH
renal ischemia
fever
glycosuria
proteinuria
UA: leukocyte esterase normal ?
Normal: none
but we do see it with UTI so its positive
Leukocyte esterase is a screening test to detect what?
leukocytes
Leukocyte esterase positive with ?
Pyuria
UTI
Leukocyte esterase falsely increased with ?
WBC normal not in urine and it is false increase if sample has external inflammation or vaginal discharge ( got a special with external WBCs)
UA: nitrites normal urine level?
none
UA nitrites is an ________ test for detecting ________.
indirect
bacteria
**nitrites are made by bacteria so we can assume we having infection*
bacteria reduce ________ to _________ by producing _________
nitrates
nitrites
reductase
+nitrites and +leuks = ?
UTI
UA normal ketone level?
none
Causes of ketonuria?
Metabolic conditions
Dietary conditions
Increased metabolic states
anything that causes ketoacidosis
**what ever raises ketone is the serum with raise it in the urine *
conjugated bilirubin is ____________.
water soluble
Bilirubin in the urine suggests process affecting ____________________
excretion of bilirubin
** excreted through the kidney system into the urine so anything that raises conjugated bili it will raise urine bili*
Urobilinogen: means conjugated bilirubin is broken down in the bowel into ___________
Urobilinogen
Bilirubin has to be __________ to be in the kidneys so …..?
Infectious hepatocellular disease
Obstructive process
Urobilinogen is increased with ?
Hemolysis
Hemorrhage
Hepatic damage
Urobilinogen is decreased with ?
Obstructive disease
**obstructive process - high bilirubin but low urobilinogen ( cause it is not going though the bile duct and small intestine - it is going start to the vascular system),
Galls tone - high bili but uronbilinogen is not elevated cause there is obstruction
elevated bilirubin and a decreased to NL urobili = obstructive process*
Blood in the urine indicates some type of damage in the __ tract
GU
Hematuria causes?
UTI/Cystitis Stones Cancer Trauma (MVC, athletes) Blood thinners Menstruation - female Traumatic catheterization
Myoglobin- gives cherry red appearance without blood!
muscle damage - skeletal muscle
**kidney sensitive to an inflammation in the body or micro trauma so they will leak protein and blood in small amount - this is NL only larger amount we are worried about *
UA micro: WBCs: >5 per LPF = ?
infection
UA micro: epithelial cells in urine means?
Cells lining the hollow organs and the skin.
If present, can indicate contamination.
**microscopic analysis - looks for WBC and gives you a count, more then 5 per low power field - infection!, if there are many squamous epithelial cells then it means the sample is contaminated *
What frequently causes kidney stones?
Ca oxalate
Casts are what?
mold or renal tubules - slugging off of the inside of the renal tubule - different casts mean different things
RBC casts indicate?
infection
Hyaline casts indicate?
can be normal they are just hyaline cells
** not everyone makes casts - *
Hyaline casts indicate?
can be normal they are just hyaline cells
** not everyone makes casts*
Urine C & S indications?
+ dipstick or micro results
Urine C & S normal ?
no growth
Urine C & S abnormal?
single organism
multiple organism
Urine C & S >100,000 bacteria/ mL = ?
infection ( Klebsiella or E.coli)
Urine C&S 10,000-100,000 = ?
consider clinical presentation
Urine C&S <10,000 bacteria / mL = ?
no infection
(maybe if they are immunocompromised or something then yeah we want to treat this number)
Urine C&S: multiple organisms?
Probably contaminated
Urine stone analysis?
Strain urine of patient with stone
Urinary stone analysis: calcium oxalate / phosphate stones = ?
80%
Urinary stone analysis: Ammonium phosphate stones = ?
10%
Urinary stone analysis: Urice acid stones = ?
9%
Urinary stone analysis: Cystine stones = ?
1%
Urine cytology indications?
Gross or microscopic hematuria
Urine cytology is the initial screening test for?
✪ initial screening test for bladder cancer
**sometimes they will have negative cytology*
Urine cytology is a good test for screening for but a __ is diagnostic?
CA
CT is dx
Urine Microalbumin (MA) refers to protein not __________ by routine protein testing from __?
detectable
UA
**protein that is smaller ( smaller amount) then what we test for with UA*
Urine Microalbumin (MA) can ID _____________ 5 years prior to routine testing.
diabetic nephropathy
**why we looking for minute amount of protein? it is a good indication or early kidney disease or damage in DM patients before they start spilling over bigger proteins *
** order a UA and MA*
MA: Annual screening test for diabetics?
3 tests: If 2 or more are positive than 24-hour urine for microalbumin should be completed
Urine Microalbumin (MA) is a early indicators of what?
✪ early indicator of damage to renal system from diabetes ( so we can start duo do things to save them - like pt them on an ACE )
42 yo female with left flank pain radiating into the LLQ of the abdomen since this morning. Waxes and wanes. Rates it 10/10.
VS: HR 108 BP 165/76 T 37.0C SPO2 96%
UCG: negative
glucose, protein(idk), nitrite
if pilo - we will have WBC
run a serum glucose test, CT scan of kidneys
maybe some kidney inflammation ( looks a little larger)
stone down in the LLQ
right pic - level of the hips
UVJ is the most common place for a stone to get stuck ( uretevesticular junction)
HURTS LIKE THE DICKENS
21 yr old female presents with dysuria, frequency, and urgency x 2 days.
VS: all WNL
UCG: negative
UA: +leuks, +blood, +nitrites,
Micro: many epithelials, >25 WBC
Next test?
UTI!
epithelial - we should get another specimen
treat her empirically and send specimen for culture
3 days of bactrim or cipro for uncomplicated UTI for healthy immune system 1 tab BID x 3 days most common for UTI
( same ABS for pilo but we treat for 7 days )
but if they are pregnant then marcobid ( bacteriostatic) or nitrofurantoin
