Infection and Immunity: Analysing urine

Question 1

What to look out before urine analysis?

Answer 1

• make sure patient doesn’t show sign of sepsis → if suspected take cultures and start on immediate antibiotics
• sex and age matter → urianalysis become more unreliable as you get older→ cut off is 0ver 65, or if pt has urine catheter →. due to already having bacteria in urine that sits there without causing infection → asymptomatic bacteriuria
• look out for conditions that could mimick a UTI e.g STI

Question 2

when to do urine analysis?

Answer 2

• suspected uti
• diabetes
• screening in pregnancy
• suspected renal disease

Question 3

What to do if the patient shows one of two:
- dysuria
-nocturia
-cloudy urine

Answer 3

urine culture, can go straight to antibiotics

Question 4

What to do if the patient shows one of these:
- dysuria
-nocturia
-cloudy urine

Answer 4

urinalaysis

Question 5

What is the patient shows none of these?:
dysuria
-nocturia
-cloudy urine

Answer 5

think if there is urgency to wee, freq urinating, visibility, haematuria, suprapubic tenderness?

if so urine analysis

Question 6

If they don’t have:?
dysuria
-nocturia
-cloudy urine
if there no urgency to wee, freq urinating, visibility, haematuria, suprapubic tenderness?

Answer 6

if none of the symptoms can predict not UTI urinalysis is not generally needed

Question 7

why no dipsticks on men?

Answer 7

dipsticks become unreliable when predicting UTI in men → urine culture done instead

Question 8

what to first look at for urine analysis?

Answer 8

look at colour, visibility and odour

Question 9

What to look out for Bilirubin in urine analysis?

Answer 9

• red blood cells die by-product produced is bilirubin → sent to the liver and processed into bile ie ending up in the intestine → gut bacteria turn into urobilinogen → small amount is reabsorbed by the liver and rest excreted in urine or stool
  
  • normally should not have Bilirubin in urine

Question 10

What to look out for Urobilinogen in urine analysis?

Answer 10

normal to have some in urine as is being excreted out BUT can still have abnormal amounts e.g if more red blood cells died or damaging liver e.g hepatitis

Question 11

What to look out for Ketones in urine analysis?

Answer 11

can be triggered if not eating properly or have diabetes → normal to have some

Question 12

What to look out for Ascorbic acid in urine analysis?

Answer 12

high levels can interfere with blood glucose and nirtile and bilirubin parts of urinalysis → if seen in results need to be cautious

Question 13

What to look out for glucose in urine analysis?

Answer 13

raises suspicion of diabetes but can be associated with pregnancy and kidney damage

Question 14

What to look out for protein in urine analysis?

Answer 14

kidney ideally want to keep proteins produced but most people have negative/trace amount detected. elevated levels can be a sign of kidney disease → with apperance of urine can make it frothy

Question 15

What to look out for Erythrocytes in urine analysis?

Answer 15

not always clear to see blood in urine, when dipstick can identify but not visible to eye = microscopic hematuria, → UTI can cause but also tumors, clotting issue or kidney disease

Question 16

What to look out for pH in urine analysis?

Answer 16

ranges from 4.5 to 8 with normal urine being slightly acidic at 5.5-6.5 → generally urine ph reflects blood ph e.g if pH is more acidic could be caused by conditions that make blood more acidic e.g sepsis → if goes outside 4.5-8 can suspect that its not acc urine or wasn’t stored properly

Question 17

What to look out for Nitrites in urine analysis?

Answer 17

to make nitrite must break down nitrates which doesn’t happen in normal urine but if have gram-negative bacteria, then breakdown can occur →. Raised can suggest UTI

Question 18

What to look out for Leucocytes in urine analysis?

Answer 18

detecting enzyme produced by white blood cells, raised suggest UTI, but contaminates (e.g discharge) can suggest otherwise

Question 19

What to look out for in Specific gravity in urine analysis?

Answer 19

• measures density of urine and kidneys ability to conc. or dilute it →
• The normal range for urine specific gravity is1.005 to 1.030.