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Renal Week 2 > ICL 1.9: Urinalysis > Flashcards

ICL 1.9: Urinalysis Flashcards

1
Q

what is the normal color of urine?

A

straw colored

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2
Q

what does it mean if urine is colorless?

A
  1. dilute urine
  2. low specific gravity
  3. tubular diseases
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3
Q

what does it mean if urine is milky?

A

infections = PMNs

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4
Q

what does it mean if urine is yellow-green?

A

bilirubin

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5
Q

what does it mean if urine is red?

A
  1. vitamins/food items (beets)
  2. Hb
  3. myoglobin (rhabdomyalsis or crush injury)
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6
Q

what does it mean if urine is black?

A
  1. melanin (melanoma)
  2. homogentistic acid
  3. alkaptonuria = spill homogentistic acid in the urine which is black
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7
Q

what kind of urine sample do you want for screening?

A

the specimen that was voided 1st thing in the morning is the best

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8
Q

what are you looking for in a screening urine?

A
  1. protein
  2. specific gravity
  3. nitrites (infection)
  4. leukocyte esterase (infection)

for screening, the specimen that was voided 1st thing in the morning is the best for these things

BUT for glucose a post-prandial specimen is better

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9
Q

what kind of urine sample do you want for a quantitative analysis?

A

a 24 hour urine specimen is needed

preservatives needed will depend on substances to be tested

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10
Q

how is urine stored?

A

urine should be examined fresh or refrigerated

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11
Q

what kind of urine sample do you want for cultures?

A
  1. straight cath

2. clean catch midstream

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12
Q

what is a normal volume of urine?

A

1200-1500 mL/24 hrs

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13
Q

what is oliguria?

A

<500 mL of urine daily

this signifies dehydration, renal disease, or obstruction

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14
Q

what is polyuria?

A

2000+ mL/24 hrs

occurs in diabetes mellitus and diabetes insipidus and tubular renal diseases

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15
Q

what are the 2 types of diabetes?

A
  1. diabetes mellitus

2. diabetes insipidus

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16
Q

what is a normal specific gravity?

A

1.015-1.025

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17
Q

what does low vs. high specific gravity signify?

A

low specific gravity:
1. diabetes inspidius

  1. tubular diseases

high specific gravity
1. diabetes mellitus

  1. dehydration
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18
Q

what is the pH of urine? what precipitates at low vs high pH?

A

pH varies with diet

uric acid precipitates in acidic urine

phosphate crystals precipitate in alkaline urine

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19
Q

what do you look for in a urine chemistry?

A
  1. nitrites*
  2. urobilinogen*
  3. blood*
  4. bilirubin*
  5. ketones
  6. glucose
  7. protein*
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20
Q

how do you score how much protein is in the urine?

A

1+ = 250-500 mgm (24 hrs)

2+ = 500-1000 mgm (24 hrs)

3+ = 1000-2000 mgm (24 hrs)

4+ = >2000 mgm (24 hrs)

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21
Q

if there’s glucose in the urine, which conditions could it signify?

A
  1. diabetes
  2. tubular defects
  3. decreased renal threshold
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22
Q

if there’s ketones in the urine, which conditions could it signify?

A
  1. starvation
  2. diabetes
  3. gastroenteritis in children*
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23
Q

if there’s blood in the urine, which conditions could it signify?

A
  1. hemoglobinuria
  2. UTI
  3. glomerular diseases
  4. interstitial nephritis
  5. tumors
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24
Q

if there’s bilirubin in the urine, which conditions could it signify?

A

obstructive jaundice

green urine

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25
Q

if there’s urobilinogen in the urine, which conditions could it signify?

A
  1. hemolysis
  2. hepatitis

brown urine

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26
Q

if there’s nitrite in the urine, which conditions could it signify?

A

bacteruria = infection

leukocyte esterase also means infection

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27
Q

what shows up in the microscopic examination of urine?

A
  1. cells

RBC, WBC, tubular cells, squamous malignant cells

  1. crystals (not clinically significant)
  2. casts

RBC, WBC, granular, hyaline, tubular

  1. oval fat bodies
  2. bacteria
  3. yeast
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28
Q

what do RBCs in the microscopic examination of urine indicate?

A

hematuria

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29
Q

what do WBCs in the microscopic examination of urine indicate?

A

pyuria

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30
Q

what do tubular cells in the microscopic examination of urine indicate?

A

tubular necrosis

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31
Q

what do RBC casts in the microscopic examination of urine indicate?

A

acute nephritic syndrome

32
Q

what do WBC casts in the microscopic examination of urine indicate?

A

acute pyelonephritis

33
Q

what do granular casts in the microscopic examination of urine indicate?

A

acute nephritic syndrome

34
Q

what do hyaline casts in the microscopic examination of urine indicate?

A

chronic renal disease

35
Q

what do tubular casts in the microscopic examination of urine indicate?

A

acute tubular necrosis cells

they’re muddy brown

36
Q

what are oval fat bodies?

A

tubular cells loaded with lipid droplets

associated with nephrotic syndromes

37
Q

are the kidneys, ureters and bladder normally sterile or non-sterile?

A

they are all normally sterile

38
Q

how do people get UTIs?

A

the urethra is really close to the perineal area so organisms from that area can find their way to the urethra and once they’re there they flourish since the urine has lots of nutrients in it!

there will be bacterial multiplication and infection

ex. placing a catheter

39
Q

what can cause a UTI?

A
  1. infection

2. obstruction

40
Q

how can obstruction cause a UTI?

A

residual urine can lead to stagnation of the urine in the bladder and distention

the urine is a broth for the bacteria to flourish

also the dilated bladder means there’s also compromise of blood supply which leads to ischemic changes that enhance the infection

ex. prostatic hypertrophy in older men

41
Q

what are the 2 mechanisms that cause UTIs?

A
  1. ascending via vesicoureteral reflux (common)

usually acquired due to repeated infection of the bladder and end of the ureter so the sphincter that controls one-direction urine flow is impaired and back flow of urine from bladder to kidney causes pyelonephritis

  1. hematogenous (rare)
42
Q

what are ether most common organisms that cause UTIs?

A

e coli is the most common!

other gram negative are common too

43
Q

what are the normal protective mechanisms against UTIs?

A
  1. urethra acts as a natural anatomic barrier

that’s why UTI are more common in women because we have a short urethra

  1. mucosal IgA
  2. bactericidal substances in the prostatic secretions in males (also another reason we get more UTIs)
44
Q

what part of the kidney are UTIs most common in? why?

A

medulla

  1. low blood supply
  2. hypertonicity of the medulla which interferes with and decreases phagocytosis
  3. high concentration of ammonia which decreases bactericidal actions of the serum
45
Q

24 year old lady present with dysuria, urgency, hematuria

UA: + ve esterase
+ nitrite
many leukocytes

diagnosis?
tests?

A

lower UTI infection that isn’t involving the kidney

tests = microscopic exam of urine and cultures

46
Q

24 year old lady present with dysuria, urgency, hematuria, turbid urine, flank pain and a temperature of 102.

UA: + ve esterase
+ nitrite
many leukocytes
WBC casts

diagnosis?
tests?

A

acute pyelonephritis

turbid urine = lots of neutrophils and bacteria

flank pain = kidney infected

47
Q

what is the clinical presentation of acute pyelonephritis?

A

it’s an infection of the renal pelvis and parenchyma that is usually associated with an ascending bacterial infection of the bladder

systemic = fever, chills, vomiting

local = urgency, frequency, dysuria, back pain

48
Q

what is in the urine analysis of acute pyelonephritis?

A
  1. bacteria
  2. WBC casts = renal involvement**
  3. RBCs
49
Q

what test do you need to do for acute pyelonephritis?

A

urine culture with a calibrated loop

if you see more than 10ˆ6 microorganisms/mL of one type of bacteria, it indicates an infection

if you have multiple bacteria it’s probably contaminated

50
Q

what is the course of acute pyelonephritis?

A
  1. acute pyelonephritis that heals with small scars if no obstruction
  2. high recurrence due to vesicoureteral reflux
  3. chronic pyelonephritis if there’s multiple scars due to recurrence
  4. papillary necrosis (flank pain going to the groin and WBCs in the urine with necrotic tissue because the kidney tries to expel them which causes a lot of pain)
51
Q

what are the complications of pyelonephritis?

A
  1. papillary necrosis

patient present with severe flank pain radiating to the groin and necrotic tissue and WBCs in the urine due to coaulative necrosis of the papillae = necrosis caused by tissue ischemia, which denatures proteolytic enzymes –> if the papillary necrosis is due to pyelonephritis you’ll also see WBCs but if it’s being caused by any other etiology like NSAIDs or sickle cell it’ll be sterile pyuria

this is a special hazard in patients with DM because they already have ischemic kidneys so if you add an infection or NSAID use it gets worse because you increase the blood flow compromise

  1. death
  2. stone formation
52
Q

what are the causes of papillary necrosis?

A
  1. acute pyelonephritis
  2. analgesic abuse (NSAIDs)
  3. sickle cell disease = sickle cells lodge in vessels and obstruct them which leads to ischemic damage of papilla
  4. DM
53
Q

how are stones associated with UTIs?

A

stones can lead to infection and infection can lead to stones = chicken and the egg

stones lead to infection because they cause obstructions which is a predisposing factor for UTIs because of stagnation of the urine

repeated infections can lead to stone formation especially when the infection is due to urea splitting organisms –> they split urea into ammonia which raises pH of the urine and in alkaline urine magnesium ammonium phosphate and calcium phosphate crystals can attain large sizes which impacts the calyces and eventually in the pelvis which eventually leads to a staghorn stone** (super large stones that fill the entire renal pelvis and calyces)

54
Q

what is a staghorn stone?

A

a very large stone obstructing the pelvis and calices of the kidney

common in alkaline conditions like UTIs caused by urea-splitting organisms

proximal to the stone the kidney will enlarge = hydronephrosis –> dilated calyces means urine stagnates and infection sets in which leads to pyonephrosis = large kidney filled with pus

55
Q

what are the gross changes seen with chronic pyelonephritis?

A
  1. multiple wedge shaped scars on the surface of the kidneys

2. U-shaped or geographic scars

56
Q

what are the microscopic changes seen with chronic pyelonephritis?

A
  1. heavy interstitial lymphocytic infiltrates
  2. interstitial fibrosis
  3. arteriolar sclerosis
  4. hyaline casts in tubules
  5. thyroid-like arrangement of tubules = tubules become atrophic and are filled with proteinaceous casts and look like mini thyroid particles
  6. periglomerular fibrosis
  7. hyalinized glomeruli
57
Q

RBCs casts

A

nephritic syndromes

58
Q

muddy brown casts

A

acute tubular necrosis

59
Q

WBC casts

A

acute pyelonephritis

60
Q

hyaline casts

A

chronic kidney problems

occasionally you might just be spilling a few hyaline casts and they don’t mean anything

61
Q

eosinophils in the urine

A

acute interstitial nephritis

62
Q

sterile pyuria

A

sterile pyuria = WBCs and necrotic tissue without bacteria

papillary necrosis = coagulative necrosis of the renal medullary pyramids and papillae = type of necrosis caused by tissue ischemia, which denatures proteolytic enzymes

63
Q

tubulorrhexis

A

ischemic tubular injury

64
Q

tubular cell casts

A

acute tubular necrosis

65
Q

analgesics

A

chronic interstitial nephritis

66
Q

tubular damage and oxalate crystals

A

ethylene glycol toxic tubular necrosis

67
Q

staghorn stones

A
  1. hydronephrosis

2. pylonephrosis

68
Q

A 58 year old lady with rheumatoid arthritis for 25 years presents with renal colic and turbid urine

UA reveals many neutrophils but no organisms

what is your DX?

what would you like to ask the patient?

A

sterile pyuria = chronic interstitial nephritis with papillary necrosis (flank pain)

ask about NSAID use

69
Q 
70 year old male with constipation for 4 weeks presents to the ER with back pain and renal failure

diagnosis?
Tests
Renal changes
A

multiple myeloma

run serum protein electrophoresis and bone marrow biopsy

changes = obstructive uropathy, amyloidosis, calcinosis, interstitial plasma cells, light chain glomerulonephritis, tubular damage from light chains

70
Q

cholesterol crystals in urine?

A

hyperlipidemia

nephrotic syndrome became you’re spilling lipid into the urine

71
Q

muddy brown cast

A

tubular necrosis

72
Q

oval fat body

A

nephrotic syndrome

73
Q

2+ protein

A

500-1000

74
Q

luekocyte estase

A

UTI

75
Q

acidic pH precipitate

A

uric acid

76
Q

alkaline pH precipitate

A

phosphate crystals

77
Q

black urine

A
  1. melanoma

2. alkaptonuria

Renal Week 2 (10 decks)

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