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clin med GU > intro to labs > Flashcards

intro to labs Flashcards

1
Q

what is a urinalysis comprised of?

A

macroscopic/microscopic, examination, dipstick and specialty testing

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2
Q

what must every label collection container have?

A

at least 2 patient identifiers with a sterile container

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3
Q

what is the preferred method for collecting a urine sample?

A

clean catch technique (necessary for UTI) , mid stream preferable

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4
Q

when is the best time to collect urine?

A

in the morning because its when it is most concentrated, preferred particularly for protein and specific gravity

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5
Q

A urine sample should be tested with in how many hours?

A

2 hour otherwise results will not be accurate

up to 4 hours if refrigerated

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6
Q

when do you send a urine for culture

A

Only send if patient has signs and symptoms of infection or an abnormal U/A

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7
Q

A urinary infection is classified as a bacterial count of?

A

> 100,00 colonies
or
10,000 colonies if symptomatic, immunosuppressed or antibiotic treated

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8
Q

what happens if you get back a mixed bacterial count <10,000

A

would be contaminated

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9
Q

when would it be normal to see RBC on microscopic U/A?

A

after exertion, trauma, fever, menstruation

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10
Q

when would RBC be abnormal on microscopic U/A?

A

UTI, glomerulonephritis, necrosis, tumors, stones, coagulopathies

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11
Q

when would you see WBC on a U/A

A

UTI or inflammation

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12
Q

when would you see squamous cells on U/A?

A

contamination

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13
Q

when would you see renal tubular cells?

A

acute tubular necrosis, nephrotic syndrome

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14
Q

When would you see bacteria in a U/A

A

UTI

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15
Q

what do fat bodies on a U/A tell you?

A

Nephrotic syndrome, you will see maltese cross appearance

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16
Q

what are casts?

A
  • Unique to kidneys – formed in lumen of DCT and collecting duct
  • The shape represents molds of the renal tubule from which they arise
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17
Q

what are hyaline casts?

A
  • Tamm-Horsfall protein (small amt is normal)

* Multiple casts-assoc w/ all renal dz, essential HTN, nephrotic syndrome

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18
Q

WBC casts

A

renal parenchymal infx, MC pyelonephritis

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19
Q

RBC casts

A

Hydronephrosis, infections

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20
Q

granular casts

A
  • Formed by breakdown products of cellular casts and immunoglobulins
  • Deeply pigmented (muddy brown) = acute tubular necrosis
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21
Q

Fatty casts

A

•Leakage of lipoproteins through glomerular filter (nephrotic syndrome)

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22
Q

When there is protein in the urine what is that indicative of?

A

renal disease
proteins can be either albumin or globulins (bence-jones are associated with multiple myeloma)
small amounts in DM and HTN may be first sign of CKD

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23
Q

what does the presence of bilirubin in the urine tell you?

A

early sign of biliary obstruction

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24
Q

Urobilinogen?

A

formed by bacterial conversion of conjugated bilirubin in intestine
Most sensitive test to determine impaired liver function
One of the earliest signs of liver disease and hemolytic disorders

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25
Q

what causes hemoglobinuria?

A

burns, transfusions rxns, chemical agents, malaria, post-op hemolysis

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26
Q

what causes hematuria?

A

UTI, stones, tumor, glomerulo/pyelonephritis, kidney, trauma, PCKD, leukimia

27
Q

What is cherry red blood with out RBC and blood serum levels of muscle destruction?

A

myoglobinuria

28
Q

glucose in urine?

A

should be non, present when serum glucose is 160-180mg/dl (renal threshold)
increased in diabetes, cushings, brain injury

29
Q

what causes ketones in the Urine?

A

there should be none but they result from the metabolism of fatty acids
used to screen for DKA
Increased in starvation, fasting, high fat diets, prolonged vomiting

30
Q

What does the presence of leukocyte esterases in urine tell you

A

marker of infection

needs to be verified with microscope for WBC

31
Q

what does nitirites in urine tell us?

A

detects bacteria
present in setting of UTI’s- needs culture
Azo dye and bilirubin will result in false positive
neg. test does not rule out UTI

32
Q

what is the range of urine pH?

A

5-9, usually around 6

33
Q

what is the cause acidic urine?

A

E. coli which is also MCC of UTI

respiratory acidosis, K deficiency

34
Q

what is the cause of alkaline urine?

A

Klebsiella causing UTI, renal tubular acidosis, chronic renal failure, metabolic acidosis, respiratory alkalosis

35
Q

what is specific gravity?

A

kidney’s ability to concentrate urine
measures the density of dissolved chemicals
Osmolality

36
Q

what causes red urine

A

hematuria, porphyrins, pyridium, food color, beets

37
Q

what causes yellow brown urine

A

bilirubin

38
Q

what causes brown black urine

A

melanin, methyldopa

39
Q

what causes bright orange urine

A

rifampin

40
Q

what causes blue or green urine?

A

dyes or meds

41
Q

what is microalbumin in urine?

A

small increase in urinary excretion of albumin that is too small to be detected in conventional U/A
screening tool to assess risk of early diabetic/HTN nephropathy

42
Q

why is a 24 hour urine useful and what are its indications?

A

more accurate information on measurement

Indicated for: CrCl, stone analysis, hormonal dz of adrenal glands, quantify proteinuria

43
Q

what is BUN

A

urea is formed in the liver as an end product of protein metabolism and digestion
As kidney function decreases BUN level rises
Its an indirect measurement of renal/liver function and GFR

44
Q

what is creatinine

A

More specific and sensitive indicator of kidney function than BUN alone
production is constant as long as muscle mass remain constant
not affected by BUN
As Kidney function decreases Creatinine levels rise

45
Q

what is KUB used as a diagnostic test for?

A

demonstrates size, shape, location and malformation of kidneys and bladder
Initial study to dx intra-abdominal gas patterns, soft tissue mass, ruptured bowel

46
Q

what is IV pyelography?

A

radioopaque contrast to visualize kidneys, pelvis, ureters, bladder

47
Q

what are the indications for IV pyelography?

A

persistent pain, hematuria, trauma, obstruction tumor

Images will be obtained over 30min showing passage of dye through renal system

48
Q

How can you tell if renal artery is blocked with IV pyelography?

A

dye will not enter the renal system, if there is a partial block will take longer to pass

49
Q

what is cystoscopy and what are the benefits of it

A

endoscope used to assess urethra, bladder and lower ureters and it allows you to take biopsies.

50
Q

what is urea

A

Major nitrogen containing product of protein metabolism

51
Q

what is creatinine

A

spontaneous breakdown product of muscle energy metabolism

52
Q

what is creatinine clearance?

A

measures the rate at which the kidney clear creatinine from the blood

53
Q

what is anuria?

A

lack of urine output <50ml per day

54
Q

what are casts?

A

Protein aggregates, outlined in the shape of renal tubules and excreted into the urine; the matrix is the Tamm-Horsfall protein (seen under the microscope)

55
Q

what is oligouria?

A

decreased urine output <400ml per day

56
Q

what is albuminuria?

A

albumin in urine but there should not be any

57
Q

what is uremia?

A

High BUN used interchangeably with Azotemia

58
Q

what is Nephritis?

A

Inflammation of the kidney with focal or diffuse proliferation or destructive processes that may involve the glomerulus, tubule, or interstitial renal tissue. Hematuria

59
Q

what is glomerulonephritis

A

nephritis accompanied by inflammation of the capillary loops in the glomeruli of the kidney.
Occurs in the acute, sub acute and chronic forms

60
Q

what is nephrotic syndrome?

A

general name for a group of disease involving increased glomerular permeability characterized by massive proteinuria, lipiduria, edema, hypoalbuminemia, hyperlipidemia

61
Q

what is hemodialysis

A

The exogenous removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semi-permeable membrane (for example, by means of a hemodialysis filter) → for kidney failure

62
Q

How is hemodialysis done?

A

done through IV or Fistula-MC

3x/week for 3-4 hours

63
Q

what is peritoneal dialysis?

A

Hemodialysis through the peritoneum, the dialyzing solution being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure

64
Q

How is peritoneal dialysis done?

A
  • Can be done at home; noninvasive; not as effective as hemodialysis
  • 4-5 times/ day

clin med GU (6 decks)

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