Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GU: Clin Med IIA > Hematuria & UA > Flashcards

Hematuria & UA Flashcards

1
Q

Rapid semiquantitative analysis for several urine parameters
what is this test?

A

Urine Reagent Strip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what do most Urine Reagent Strip measure?

A

RBC (heme), leukocyte esterase, nitrite, albumin, pH, specific gravity, glucose, bilirubin, urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ideal sample for a urine reagent strip?

A

clean catch urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

translucent, “straw yellow” urine indicates what?

A

normal urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cloudy urine indicates what?

A

pyuria, bacteriuria, diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

red urine indicates ?

A

blood, beets, phenazopyridine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red-orange urine indicates ?

A

phenazopyridine, rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

orange urine indicates ?

A

phenazopyridine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

an intense yellow urine indicates ?

A

vit B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

green urine indicates ?

A

pseudomonas, amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

brown urine indicates ?

A

rhubarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

purple urine indicates ?

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

the color of urine reflects what?

A

concentration, pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Urinous odor urine indicates ?

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

“Ammonia” odor indicates ?

A

Bladder retention, long-standing urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

“Fishy” or “pungent” odor urine indicates ?

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

“Strong” urine odor indicates

A

concentrated urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

“Fecal” odor urine indicates ?

A

bladder-intestinal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

“Sweet” or “fruity” odor, “acetone” odor urine indicates ?

A

DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

“maple syrup” odor urine indicates ?

A

maple syrup urine dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

“musty: odor urine indicates ?

A

PKU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what other foods/vitamins may cause abnormal urine odor?

A

asparagus, vit B6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

normal pH range of urine?

A

4.5-8
avg - 5-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what pathogen can alkalize urine?

A

bacteria (proteus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how can diet change urine pH?

A

Acidic - High-protein diet, cranberries
Alkaline - Vegetarian diet, low-carb diet, citrus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

___ ____ (such as those associated with urinary stone disease) can also cause pH to change

A

Metabolic errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Dipstick tests for ____
+ if intact RBCs, hemoglobin, or myoglobin in the urine

A

heme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

causes for heme on dipstick tests

A

Kidney injury or disease, GU tumor, GU tract trauma or inflammation (including catheterization), nephrolithiasis, UTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

false positive for heme in dipstick

A

Menstrual blood contamination
Semen in urine
Vigorous exercise
Concentrated urine (normal - 1,000 RBCs/mL in urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

false negatives for heme in dipstick

A

High ascorbic acid levels in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cannot diagnose as true “hematuria” without _____ to confirm the presence of RBCs

A

microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Enzyme produced by WBCs - indicates presence of WBCs

A

Leukocyte Esterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Leukocyte Esterase was found in a UA, does this indicate UTI?

A

suggestive, but NOT diagnostic for UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

other causes for Leukocyte Esterase in a dipstick

A

renal disease, asymptomatic bacteriuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

false positives for leukocyte esterase

A

contamination

36
Q

false negatives for leukocyte esterase

A

high specific gravity
glycosuria
urobilinogen
medications (rifampin, phenazopyridine)
ascorbic acid

37
Q

level of nitrites in urine?

A

none!

38
Q

what produces nitrites?

A

G- bacteria
Requires at least 105/mL organism count and adequate contact time with urine (>4 hrs)

39
Q

false positives for nitrites

A

contamination
in sample but not in urinary tract

40
Q

false negatives for nitrites

A

non-nitrite producing organisms, frequent urination, dilute or acidic urine, urobilinogen

41
Q

what is Urobilinogen vs bilirubin?
normal ranges (urobilinogen)?

A
  • 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
Q

what causes the changes in urobilinogen

A

Increased - hemolysis, hepatocellular disease
Decreased - biliary obstruction, altered gut flora

41
Q

cause of bilirubin in urine?

A

increased serum conjugated bilirubin

41
Q

causes of false results of Bilirubin / Urobilinogen

A

False positive - phenazopyridine
False negative - ascorbic acid

41
Q

causes for results of glucose in urine?

A
  • Any positive - suspect DM
  • Does not cross-react with other sugars
  • False negative - ketones, ascorbic acid
42
Q

how much glucose is found in normal urine?

A

Only very small amounts normally secreted
Too low to be detected by urine dip

43
Q

Not normally found in urine
Causes - post-exercise, fasting, pregnancy
May see elevated in DM pts before serum ketosis occurs

what is this agent?

A

ketones

44
Q

causes of ketones in urine?

A

dehydration, levodopa metabolites

45
Q

urine protein measures how much?

A
  • Measures 10 mg/dL or greater
  • Microalbuminuria (30-300 mg/d) usually is not detected
46
Q

urine dipstick is only sensitive to this protein only

A

albumin

47
Q

causes of false results of urine protein

A

False positive - WBCs, epithelial cells, bacteria
False negative - dilute urine, lower proteinuria levels

48
Q

Weight of urine compared with weight of water
Gives estimate of urine concentration and osmolality
what part of the urine dipstick is this?

A

specific gravity

49
Q

what measures number of particles in the urine

A

urine osmolality

50
Q

what measures number and size of particles in urine

A

SG

51
Q

urine concentration and osmolality may not match if what?

A

very large particles in urine (i.e. protein, contrast)

52
Q

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

A

urine microscopy

53
Q

what is considered significant for RBC in urine microscopy?

A

> 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
Q

causes for RBC in urine microscopy

A
  1. glomerular damage, tumors, trauma, nephrolithiasis, infection, inflammation, nephrotoxins, AKI
    - Dysmorphic - glomerular disease
    - Round (normal) - urinary tract epithelial disease or damage
55
Q

what is considered significant for WBC in urine microscopy?
what does that indicate?

A
  • > 5 WBC per HPF
  • injury to urinary tract - Infection, stones, strictures, cancer, glomerulonephritis, interstitial cystitis, AKI
56
Q

Mucoprotein with RBCs inside or stuck together
what is this? causes?

A

RBC casts
glomerulonephritis, vasculitis
Low urine flow promotes formation

57
Q

WBCs inside or stuck together by mucoprotein

what is this? causes?

A
  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
Q

Common in urine due to microbial flora of vagina, external genitalia

what is this finding on urine microscopy

A

bacteria

59
Q

bacteria in urine is most likely to rapidly multiple if kept at ?

A

room temp

60
Q

difference between single vs multiple organisms in urine?

A

single = infection
multiple - contamination

61
Q

what must be done if UTI is suspected?

A

do cx
>100,000 colony count/mL - UTI or bacteriuria
Treat if symptomatic or high-risk for infection

62
Q

what makes you more susceptible to any bacteria in urine?

A

catheterized or suprapubic tap = significant

63
Q

MC species for yeast infection/contaminant?

A

Candida albicans

64
Q

how are tubular epithelial cells seen/caused in urine microscopy?

A

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
Q

what other epithelial cells are seen in urine microscopy? (besides tubular)

A

Squamous Epithelial
- Skin surface or outer urethra
- Suggest urine contamination
Transitional Epithelial
- If present in high numbers, concerning for neoplasm

66
Q

other common urine casts

A

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
Q

PE factors to consider for hematuria

A

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
Q

how to diagnose hematuria

A

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
Q

The visible sign of (gross) hematuria is what color?

A

pink, red or cola-colored urine
the result of the presence of red blood cells.

70
Q

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.

A

Urinalysis (UA)

71
Q

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.

A

infection

72
Q

Proteinuria and red cell casts indicate _____ origin – labs and renal imaging along with a nephrology consult are indicated

A

renal

73
Q

Urinary cytology and/or cystoscopy with biopsy can assist in the dx of _____

A

bladder neoplasm

74
Q

Additional blood tests in the work up of hematuria may include:

A

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
Q

imaging for hematuria

A
  • 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
Q

An x ray of the urinary tract using contrast medium to visualize urine and possible blockage in the urinary tract.

A

IV pyelogram (IVP)

77
Q

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

A

cystoscopy

78
Q

Using US or CT to guide biopsy needle into the kidney.
Caution should be used in patients with ?

A

coagulopathy

79
Q

management for hematuria

A

Treatment of underlying cause
Rule out possibility of cancer or serious underlying disease with potential for harmful long-term sequelae

80
Q

follow up for hematuria

A
  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
Q

when to refer for hematuria

A

If no infection is present, persistent/recurrent hematuria requires evaluation with urology or nephrology as appropriate

GU: Clin Med IIA (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions