Hematuria & UA Flashcards
1
Q
Rapid semiquantitative analysis for several urine parameters
what is this test?
A
Urine Reagent Strip
2
Q
what do most Urine Reagent Strip measure?
A
RBC (heme), leukocyte esterase, nitrite, albumin, pH, specific gravity, glucose, bilirubin, urobilinogen
3
Q
ideal sample for a urine reagent strip?
A
clean catch urine
4
Q
translucent, “straw yellow” urine indicates what?
A
normal urine
5
Q
cloudy urine indicates what?
A
pyuria, bacteriuria, diet
6
Q
red urine indicates ?
A
blood, beets, phenazopyridine
7
Q
Red-orange urine indicates ?
A
phenazopyridine, rifampin
8
Q
orange urine indicates ?
A
phenazopyridine
9
Q
an intense yellow urine indicates ?
A
vit B
10
Q
green urine indicates ?
A
pseudomonas, amitriptyline
11
Q
brown urine indicates ?
A
rhubarb
12
Q
purple urine indicates ?
A
UTI
13
Q
the color of urine reflects what?
A
concentration, pathology
14
Q
Urinous odor urine indicates ?
A
normal
15
Q
“Ammonia” odor indicates ?
A
Bladder retention, long-standing urine
16
Q
“Fishy” or “pungent” odor urine indicates ?
A
UTI
17
Q
“Strong” urine odor indicates
A
concentrated urine
18
Q
“Fecal” odor urine indicates ?
A
bladder-intestinal fistula
19
Q
“Sweet” or “fruity” odor, “acetone” odor urine indicates ?
A
DKA
20
Q
“maple syrup” odor urine indicates ?
A
maple syrup urine dz
21
Q
“musty: odor urine indicates ?
A
PKU
22
Q
what other foods/vitamins may cause abnormal urine odor?
A
asparagus, vit B6
23
Q
normal pH range of urine?
A
4.5-8
avg - 5-6
24
Q
what pathogen can alkalize urine?
A
bacteria (proteus)
25
how can diet change urine pH?
Acidic - High-protein diet, cranberries
Alkaline - Vegetarian diet, low-carb diet, citrus
26
___ ____ (such as those associated with urinary stone disease) can also cause pH to change
Metabolic errors
27
Dipstick tests for ____
+ if intact RBCs, hemoglobin, or myoglobin in the urine
heme
28
causes for heme on dipstick tests
Kidney injury or disease, GU tumor, GU tract trauma or inflammation (including catheterization), nephrolithiasis, UTIs
29
false positive for heme in dipstick
Menstrual blood contamination
Semen in urine
Vigorous exercise
Concentrated urine (normal - 1,000 RBCs/mL in urine)
30
false negatives for heme in dipstick
High ascorbic acid levels in urine
31
Cannot diagnose as true “hematuria” without _____ to confirm the presence of RBCs
microscopy
32
Enzyme produced by WBCs - indicates presence of WBCs
Leukocyte Esterase
33
Leukocyte Esterase was found in a UA, does this indicate UTI?
suggestive, but NOT diagnostic for UTI
34
other causes for Leukocyte Esterase in a dipstick
renal disease, asymptomatic bacteriuria
35
false positives for leukocyte esterase
contamination
36
false negatives for leukocyte esterase
high specific gravity
glycosuria
urobilinogen
medications (rifampin, phenazopyridine)
ascorbic acid
37
level of nitrites in urine?
none!
38
what produces nitrites?
G- bacteria
Requires at least 105/mL organism count and adequate contact time with urine (>4 hrs)
39
false positives for nitrites
contamination
in sample but not in urinary tract
40
false negatives for nitrites
non-nitrite producing organisms, frequent urination, dilute or acidic urine, urobilinogen
41
what is Urobilinogen vs bilirubin?
normal ranges (urobilinogen)?
- urobilinogen - bilirubin metabolism by gut bacteria
- Bilirubin - unconjugated bilirubin not filtered by glomerulus; only 1% of conjugated bilirubin is filtered
1-4 mg/day urobilinogen excreted
41
what causes the changes in urobilinogen
Increased - hemolysis, hepatocellular disease
Decreased - biliary obstruction, altered gut flora
41
cause of bilirubin in urine?
increased serum conjugated bilirubin
41
causes of false results of Bilirubin / Urobilinogen
False positive - phenazopyridine
False negative - ascorbic acid
41
causes for results of glucose in urine?
- Any positive - suspect DM
- Does not cross-react with other sugars
- False negative - ketones, ascorbic acid
42
how much glucose is found in normal urine?
Only very small amounts normally secreted
Too low to be detected by urine dip
43
Not normally found in urine
Causes - post-exercise, fasting, pregnancy
May see elevated in DM pts before serum ketosis occurs
what is this agent?
ketones
44
causes of ketones in urine?
dehydration, levodopa metabolites
45
urine protein measures how much?
- Measures 10 mg/dL or greater
- Microalbuminuria (30-300 mg/d) usually is not detected
46
urine dipstick is only sensitive to this protein only
albumin
47
causes of false results of urine protein
False positive - WBCs, epithelial cells, bacteria
False negative - dilute urine, lower proteinuria levels
48
Weight of urine compared with weight of water
Gives estimate of urine concentration and osmolality
what part of the urine dipstick is this?
specific gravity
49
what measures number of particles in the urine
urine osmolality
50
what measures number and size of particles in urine
SG
51
urine concentration and osmolality may not match if what?
very large particles in urine (i.e. protein, contrast)
52
Urine is centrifuged to cause sediment to precipitate
This sediment is then resuspended in a small volume of urine and put onto a glass slide for analysis
what testing is this
urine microscopy
53
what is considered significant for RBC in urine microscopy?
>5 RBC per HPF on a single occasion OR >3 RBC per HPF on multiple occasions
All patients with hematuria require further work-up
54
causes for RBC in urine microscopy
1. glomerular damage, tumors, trauma, nephrolithiasis, infection, inflammation, nephrotoxins, AKI
- Dysmorphic - glomerular disease
- Round (normal) - urinary tract epithelial disease or damage
55
what is considered significant for WBC in urine microscopy?
what does that indicate?
- > 5 WBC per HPF
- injury to urinary tract - Infection, stones, strictures, cancer, glomerulonephritis, interstitial cystitis, AKI
56
Mucoprotein with RBCs inside or stuck together
what is this? causes?
RBC casts
glomerulonephritis, vasculitis
Low urine flow promotes formation
57
WBCs inside or stuck together by mucoprotein
what is this? causes?
1. WBC casts
2. Indicate inflammation of the kidney
- Only form in the kidney
- Acute pyelonephritis, interstitial nephritis
3. Low urine flow promotes formation
58
Common in urine due to microbial flora of vagina, external genitalia
what is this finding on urine microscopy
bacteria
59
bacteria in urine is most likely to rapidly multiple if kept at ?
room temp
60
difference between single vs multiple organisms in urine?
single = infection
multiple - contamination
61
what must be done if UTI is suspected?
do cx
>100,000 colony count/mL - UTI or bacteriuria
Treat if symptomatic or high-risk for infection
62
what makes you more susceptible to any bacteria in urine?
catheterized or suprapubic tap = significant
63
MC species for yeast infection/contaminant?
Candida albicans
64
how are tubular epithelial cells seen/caused in urine microscopy?
Normally slough in small numbers
Nephrotic syndrome or any tubular degeneration → increased shedding
If lipiduria occurs → endogenous fat droplets fill these cells
“oval fat bodies,” “Maltese crosses,” or “grape clusters”
65
what other epithelial cells are seen in urine microscopy? (besides tubular)
Squamous Epithelial
- Skin surface or outer urethra
- Suggest urine contamination
Transitional Epithelial
- If present in high numbers, concerning for neoplasm
66
other common urine casts
Hyaline Casts - Common - can be normal finding
Granular Casts
- Cellular casts which remain in urine long enough to degenerate
- Sign of renal damage
Waxy Casts
- Wide, bland-looking casts
- Shaped like wide, dilated nephrons - CKD
67
PE factors to consider for hematuria
General - Vitals, Weight loss
Cardiovascular - Edema, Volume status
GU
Urinary retention
DRE
External genitalia
Local lymphadenopathy
CVA tenderness
Suprapubic tenderness
Signs of recent instrumentation or procedures
68
how to diagnose hematuria
Both gross and microscopic hematuria require evaluation.
The upper urinary tract should be imaged, and cystoscopy should be performed if there is persistent hematuria in the absence of infection.
69
The visible sign of (gross) hematuria is what color?
pink, red or cola-colored urine
the result of the presence of red blood cells.
70
A critical component of the workup of gross hematuria and should be an initial test. A fresh, midstream, clean-catch or catheterized urine specimen should be collected.
Urinalysis (UA)
71
The presence of WBC and/or Leukocyte Esterase and/or Nitrites indicates possible ___ and may be confirmed by urine culture (if indicated) and treated appropriately.
infection
72
Proteinuria and red cell casts indicate _____ origin – labs and renal imaging along with a nephrology consult are indicated
renal
73
Urinary cytology and/or cystoscopy with biopsy can assist in the dx of _____
bladder neoplasm
74
Additional blood tests in the work up of hematuria may include:
Serum BUN/Cr and GFR to assess baseline renal function and suitability for radiographic studies that will require IV contrast
CBC for evaluating potential anemia and presence of infection
Coags if coagulopathy is suspected
75
imaging for hematuria
- **CT urography (imaging modality of choice)** and MRI - replaced IV urography when imaging the upper tracts for sources of hematuria.
- CT of abd/pelvis with and w/o contrast – may identify neoplasms of the kidney or ureter as well as benign conditions such as urolithiasis, obstructive uropathy, papillary necrosis, medullary sponge kidney, or polycystic kidney disease.
- US - if hematuria is unclear. Although it may provide adequate information for the kidney, its sensitivity in detecting ureteral disease is lower. In addition, its higher degree of operator dependence may further confound its utility.
76
An x ray of the urinary tract using contrast medium to visualize urine and possible blockage in the urinary tract.
IV pyelogram (IVP)
77
To rule out pathology of the lower urinary tract (bladder or urethral neoplasm, BPH, and radiation or chemical cystitis)
for gross hematuria, ideally performed while the patient is actively bleeding to allow better localization (ie, lateralize to one side of the upper tracts, bladder, or urethra).
what is this diagnostic modality
cystoscopy
78
Using US or CT to guide biopsy needle into the kidney.
Caution should be used in patients with ?
coagulopathy
79
management for hematuria
Treatment of underlying cause
Rule out possibility of cancer or serious underlying disease with potential for harmful long-term sequelae
80
follow up for hematuria
1. Cause may never be found
2. Negative evaluations - repeat eval may be needed to avoid a missed malignancy
- No set frequency for repeat evaluations
- Urinary cytology can be repeated in 3–6 months
- Cystoscopy and upper tract imaging can be repeated after a year
81
when to refer for hematuria
If no infection is present, persistent/recurrent hematuria requires evaluation with urology or nephrology as appropriate
