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Visceral Disorder and Lab Interpretation > Introduction and UA Notes > Flashcards

Introduction and UA Notes Flashcards

1
Q

For a typical chiropractic practice, a chiropractor must develop a chiropractic case management plan, which ___ consist of concurrent care by another health care provider

A

May

-Also include report of findings and informed consent

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2
Q

If indications of an underlying disease exist, then a second opinion from another health care provider _____ necessary for concurrent care

A

Maybe

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3
Q

Patient presents with mid back pain. History includes polyuria, dolydipsia, and family members with onset diabetes. Nervoscope shows subluxations at C1, T6, and the pelvis. What does the patient now need?

A

Concurrent care with endocrinologist as patients is showing signs of diabetes that also correlate with family history.

-Also order a fasting glucose test for Lab to help confirm/check for a Dx of diabetes

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4
Q

You suspect a patient of having diabetes so you order a UA and FBS. Lab work shows the following:

  • UA = +3 glucose with ketones
  • FBS = 325 mg/dL

What is your clinical impression?

A

Both the UA and FBS are higher than normal and indicate diabetes and ketosis in addition to multiple subluxations.. Comanage the patient with an endocrinologist

-Scope of practice would mandate a second opinion for Dx, treatment, and concurrent care with endocrinologist.

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5
Q

Governing body for lab facilities

A

CLIA

-Clinical Laboratory Improvement Amendments

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6
Q

How do chiropractors use lab tests?

A
  • Establish baseline data
  • Screening (general or target)
  • To determine Dx and prognosis
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7
Q

S/S to order a UA

A
  • Low back pain
  • Painful urination
  • Hematuria
  • Suprapubic pain
  • Urethral or vaginal discharge
  • Frequent urination
  • Inability to urinate
  • Polydipsia
  • Polyphagia
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8
Q

Routine UA consists of what 3 reports

A

1) Physical properties
2) Chemical properties
3) Microscopic properties (not on every report)

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9
Q

Functional unit of the kidney

A

Nephron

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10
Q

The oldest clinical lab procedure. What people use to gaze into the body fluid for fortune telling purposes?

A

Urinalysis

-Urine gazers a.k.a. Pisse Prophets

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11
Q

What chemical makes up 1/2 of the urine filtrate?

A

Urea

  • Glomeular filtrate becomes urine after it leaves the distal convoluted tubules.
  • Principle solutes of urine = urea, Na, K, Cl, Creatinine, uric acid, NH3
  • Body excretes 60 grams of dissolved material/24 hr
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12
Q

Urine is composed of __% water and __% dissolved solids

A

95% water 5% dissolved solids

-Daily average urine volume is 1,200-1,500 mL (normal range = 600-2,000 mL)

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13
Q

>2,000 mL of urine output per 24 hours. What conditions could cause this?

A

Polyuria

  • Diabetes mellitus
  • Diabetes insipidus
  • Large fluid intake
  • Diuretics
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14
Q

<500 mL of urine output per 24 hours. What conditions may cause this?

A

Oliguria

  • Renal tubule dysfunction
  • End stage renal disease
  • Obstruction
  • Edema
  • Dehydration
  • Diarrhea
  • Vomiting
  • Shock
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15
Q

Absence of urine. What conditions may cause this?

A

Anuria

  • Renal failure
  • Obstruction
  • Heart attack
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16
Q

Excessive water intake

A

Polydipsia

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17
Q

What time of day is best for a UA specimen?

A

Early morning

  • Midstream clean catch on rising (urine has been in the bladder for hours)
  • Most concentrated
  • Decomp begins withing 30 mins. at room temp (4 hours in fridge)
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18
Q

Most common and convenient type of urine specimen

A

Random sample

  • Testing should be performed immediately or at least within 2 hours at room temperature
  • Could do 24 hours sample with a preservative
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19
Q

What changes does the urine undergo if unpreserved?

A
  • Color becomes darker
  • Turbidity increases
  • Odor is more foul
  • pH increases
  • Glucose, ketones, bilirubin, and urobilinogen decrease
  • Nitrites and bacteria increase
  • RBC’s, WBC’s, and casts disintegrate (may lead to erroneous findings)
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20
Q

Straw to amber colored urine indicates what?

A

Considered normal

  • Light yellow to dark yellow
  • early morning urine is darker, more concentrated
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21
Q

Red, dark brown urine indicates what?

A

Excessive hemoglobin, RBC, or myoglobin associated with many things:

  • Menses
  • UTI
  • Malignancy
  • Prostate

etc.

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22
Q

T/F Urine color roughly indicates the degree of hydration and concentration

A

True

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23
Q

What can cause orange urine?

A

Found with dehydration from fever, vomiting, certain foods (rhubarb, Vit C., carrots), medications, etc.

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24
Q

Bright yellow urine indicates what?

A

Excessive B vitamins

-Energy drinks

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25
Q

Black urine indicates what?

A
  • Alkaptonuria (urine turns black as it sits)
  • Melanin problems like malignant melanoma
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26
Q

Colorless urine indicates what?

A
  • Diabetes insipidus associated with decreased pituitary ADH (head trauma)
  • Overhydration associated with low specific gravity
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27
Q

X-ray finding of homogentric oxidase deficiency that mimics DJD/DDD everywhere in the spine and patient also has black urine

A

Ochronosis

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28
Q

Brownish yellow/green urine indicates what?

A

Liver problems

  • Check bilirubin and urobilinogen (may also be referred to as dark yellow)
  • May see jaundice of skin and sclera and other findings possible for hepatitis/liver disease
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29
Q

Milky urine is associated with what pathology?

A

Hyperlipidemia

-Risk factor for heart disease

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30
Q

Technician holds the urine up to the light and notices it is clear. What pathology is present?

A

None = Clear is normal

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31
Q

Urine that appears slightly hazy, but the sediment check is negative indicates what?

A

Normal urine

-If it appears hazy, but sediment check is negative = insignificant

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32
Q

Cloudy urine indicates what?

A

If associated with crystals, insignificant

-May also be pus, bacteria, RBC’s, or spermatozoa

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33
Q

Hazy, cloudy urine is usually due to __________

A

Infection

  • Milky = hyperlipidemia (need lipid profile to confirm)
  • White frothy = proteins
  • Yellow frothy = bile/billirubin in the urine
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34
Q

Evaluates the kidneys ability to concentrate urine. Inability to do so is an early sign of disease. What is the normal range for an adult?

A

Specific gravity

-Weight or urine compared to distilled water (SpG H2O = 1.000) 1.015 - 1.035 is normal range for adults

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35
Q

Low specific gravity

A

Hyposthenuria

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36
Q

High specific gravity

A

Hyperosthenuria

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37
Q

Fixed SpG of 1.010

-What does this indicate?

A

Isosthenuria

-Same value as protein free plasma and signifies end stage of renal failure

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38
Q

If someone has a SpG of 1.010, does this indicate a Dx of renal failure?

A

NO!!!

-Multiple SpG values of 1.010 indicates possible renal failure. If only one reading shows 1.010, that does not indicate renal failure, only hyposthenuria. Only when multiple tests show a constant hyposethenuria of 1.010, does that indicate Isosthenuria

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39
Q

You notice your patient has yellow urine, so you order a UA. Results show:

  • pH = 5
  • Urobilinogen = 0.01
  • Sugar = +2
  • SpG = 1.060

What is causing the hypersthenuria?

A

Lots of heavy sugar and protein molecules in the urine (urobilinogen and sugar) cause the SpG to increase

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40
Q

What can cause an increased SpG?

A

Anything that increases concentration in urine:

  • Proteinuria or Glucosuria
  • Dehydration
  • Decreased renal blood flow (heart failure, renal artery stenosis)
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41
Q

Low SpG indicates what?

A

Dilute urine

  • Decreased concentration
  • Overhydration (polyuria)
  • Glomerulonephritis (hematuria, blood casts)
  • Pyleonephritis
  • Diabetes insipidus
  • Renal failure Anything that would prevent the kidney from being able to concentrate urine
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42
Q

Urine odor matching:

__ Diabetes mellitus/ketosis

__ Normal

__ UTI

__ Asparagus, enterobladder fistula

a) Feces odor
b) Foul, fishy
c) Aromatic
d) Fruity, sweet

A

d) Fruity, sweet = Diabetes mellitus/ketosis
c) Aromatic = Normal
b) Foul, Fishy = UTI
a) Feces odor = Asparagus, enterobladder fistula

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43
Q

Reagent strips utilized to detect excess amounts of substances in the urine

A

Dipsticks

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44
Q

pH is used to indicate the _______________ of the patient. What are the normal ranges?

A

Acid-Base Balance

Normal pH = 4.5 to 7.5

  • Acidic pH = < 7
  • Neutral pH = 7
  • Alkaline pH = >7
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45
Q

Which of the following is NOT true with pH or urine?

a) Becomes acidic as it stands due to bacterial growth (like E. coli) and breakdown of urea
b) Changes in pH may first appear in the urine
c) Blood pH is 7.35 - 7.45 (more critical)
d) Normal pH is maintained primarily through reabsorption of Na and secretion of H and NH4

A

a) Becomes acidic as it stands due to bacterial growth and breakdown of urea

With E.coli, it becomes ALKALINE as it stands due to growth and breakdown of urea

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46
Q

What kinds of diets will typically produce acidic and alkaline urine?

A
  • Diets high in animal products = typically acidic urine
  • Diets high in citrus fruits and vegetables = typically alkaline
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47
Q

What conditions cause acidic urine?

A

Acidic urine = pH > 7

  • Respiratory acidosis =COPD, aasthma
  • Metabolic acidosis
  • Diabetes mellitus
  • Large amounts of meats and cranberries
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48
Q

What conditions cause alkaline urine?

A

Alkaline pH = >7

  • Respiratory alkalosis = Hyperventilation
  • Metabolic alkalosis
  • UTI (E. coli, Bacillus proteus both love alkaline urine)
  • Diets high in vegetables
  • MC in females
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49
Q

What is the recommendation for someone with UTI’s due to E. coli or B. proteus?

A

Drink cranberry or blueberry juice to increase the pH of the urine (preventative measure)

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50
Q

If a patient is complaining of dysuria and the UA shows:

pH = 8

Bacteria = +2

SSA = +1

WBC = Leukocytosis

-Would concurrent care be appropriate?

A

YES!

  • Leukocytosis and SSA + indicates there is protein in the urine which points to a possible upper UTI that needs concurrent care with a nephrologist
  • If no protein in the urine, could be handled conservatively
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51
Q

Acidic urine is associated with what types of stones?

A

Xanthine, cysteine, and uric acid stones

-Keep the urine alkaline

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52
Q

Alkaline urine is associated with what types of stone formation?

A

Calcium carbonate, calcium, and magnesium phosphate stones

-Keep the urine acidic

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53
Q

Dipsticks are maninly sensitive to what protein?

A

Albumin

  • 1/3 of proteins in urine are albumin
  • Reported as negative(ideal), trace, +1, +2, +3, +4 (worst)
  • Some albumin is excreted, but normal is immeasurable
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54
Q

T/F Albuminuria is synonymous with proteinuria

A

True

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55
Q

Normally the glomerulus prevents _______ entering the glomerular filtrate.

A

Protein

-ALWAYS investigate proteinuria since it maybe the primary indicator of renal disease

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56
Q

T/F The dipstick test is used to confirm proteinuria

A

FALSE.

  • Dipstick test is used to SCREEN for proteinuria
  • SSA test is used to CONFIRM proteinuria from a positive Dipstick test
  • SSA Test is + if Tech notices turbidity following SSA and centrifuge
  • SSA Test = 3% sulfasalicyclic acid test used to confirm results from + Dipstick test
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57
Q

T/F Following a centrifuge of the urine, the protein remains in the supernatant

A

True

-WBC, RBC, etc. settle to the bottom as the precipitate

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58
Q

Proteinuria because of kidney disease usually indicates an ____________

A

Upper UTI

Other causes of proteinuria:

-Diabetes, glomerulonephritis, nephrotic syndrome, preclampsia, trauma, strenuous exercise, exposure to cold, large abdomen, dehydration, pregnancy, febrile illness.

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59
Q

Female athlete, 13 year old sports physical

-Abnormal Findings:

pH 5

Protein +1

What are some possible explanations for her abnormal findings?

A

Could be a renal disease, strenuous exercise, or cold induced

  • Correlate history with suspicions
  • Worked out a lot? Don’t exercise for 2 days and rerun UA
  • Goes skiing a lot? Don’t ski for 2 days and rerun UA
  • If UA is still abnormal after eliminating other factors, do concurrent care with urologist or nephrologist

KEY POINT: There many causes of proteinuria, so DO NOT take it lightly and do due diligence to find what the etiology is!

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60
Q

Patient displays normal urine when supine and displays proteinuria when standing.

A

Orthostatic proteinuria

  • Lie down for 1 hour and recheck urine
  • MAYBE associated with exaggerated lumbar lordosis causing renal congestion
  • MC in adolescents
  • Likely caused by altered hemodynamic (still idiopathic)
61
Q

Toxemia associated with 3rd trimester pregnancy that causes increased blood pressure and proteinuria if mild. May lead to seizures and/or coma if severe.

A

Preeclampsia

62
Q

+2 protein, chest pain, and cardiac enzymes indicated what pathology has occured?

A

Heart condition (MI)

63
Q

Massive proteinuria (protein +4). Urine appears very white and frothy. Patient has severe edema, especially around the eyes.

A

Nephrotic Syndrome

-Associated with toxins, bee stings, severe infections, and polycystic kidney

64
Q

Should be run on all patients with 4+ protein. Should be considered if patient has back pain and X-ray shows large lytic changes, Rain Drop Skull, and/or pathologic fractures

A

Bence Jones Test

-To look for Bence Jones Proteins that may indicate multiple myeloma (50-80%)

65
Q

Proliferating malignancy of plasma cells that produces monoclonal antibodies

A

Multiple Myeloma

66
Q

DDx for a Pathologic Fracture

A

1) Osteoporosis (MC)
2) Lytic Metastasis (MC cancer)
3) Multiple Myeloma (MC primary cancer)

67
Q

What should we do first to help DDx a pathologic fracture?

A

Obtain old films (from > 2 years ago)

  • Lesions is on old films = leave it alone/Osteoporosis
  • Lesions are not on old films = NOT osteoporosis; need lab/history/imaging to DDx lytic mets from MM
68
Q

Light chain portion of immunoglobulin that appears in the urine of someone with multiple myeloma. What test(s) is/are used to find these proteins?

A

Bence Jones Protein

  • Urine protein electrophoresis (PEP) to find monoclonal immunoglobulin
  • Immunofixation to find what specific type of Ig is present (A, E, G, M, etc.)
69
Q

T/F Routine UA will be able to detect Bence Jones proteins

A

FALSE.

Need either Bence Jones Test (non-preferred) or Urine and/or Serum Protein Electrophoresis (preferred)

70
Q

Which of the following is NOT associated with multiple myeloma?

a) Renal insufficiency
b) Thrombocytopenia
c) Pathologic Fractures
d) Immune deficiency
e) all are associated with MM

A

e) all are associated with MM

Nausea, fatigue, confusion, polyuria, hypercalcemia, renal insufficiency, anemia, bone lysis, dizziness, blurred vision, hyperviscosity

Usually Fatal From:

  • Pulmonary infections/problems
  • Anemia
  • Kidney dysfunction
71
Q

___________ more common in older populations and of course are at risk of fractures from weakened bones. Patients should have PEP done to confirm.

A

Multiple Myeloma

72
Q

For multiple myeloma, dipstick is negative for Bence Jones. _______ test is SSA which is positive. _________ by urine electrophoresis. Why would the dipstick test be negative for multiple myeloma?

A

Screening test = SSA test (looks for proteins)

Confirmatory test = PEP (or Immunofixation)

Dipstick is negative for MM because Dipstick is looking for albumin protein and NOT globulin proteins that makes up Bence Jones Proteins.

73
Q

Patients with suspected multiple myeloma need a 24-hour urinalysis with PEP to determine presence of ______________

A

Bence Jones Proteinuria

74
Q

CRAB for Multiple Myeloma

A

C = Calcium (elevated)

R = Renal dysfunction

A = Anemia

B = Bone loss (pathologic fractures)

75
Q

For patients who may have Lytic Mets or Multiple myeloma, what is the algorithm for each?

A

Lytic Mets = Bone scan (find Hot Spots) –> MRI “Hot Spots” –> Biopsy (Dx type of cancer)

MM = PEP serum and urine (look for M-spike) –> Skeletal survey (where else is it?) –> MRI abnormal spots from survey –> biopsy suspected spots from MRI

(May add PET scan at anytime for either)

76
Q

T/F Bone scans are one of the key types of imaging to confirm presence of multiple myeloma

A

FALSE

-Bone scans usually do not contribute significantly because they rely on blastic activity while multiple myeloma is primarily a lytic activity pathology

77
Q

What other test can be used to confirm Multiple Myeloma in patients who are negative for serum and urine M-spike?

A

Serum free light chain assay

-also good for monitoring patients response to treatment

78
Q

Serum M protein < 3 g/dL

Bone marrow plasma cells < 10%

No CRAB

What is the Dx?

A

Monoclonal Gammopathy of Undetermined Significance (MGUS)

79
Q

Serum M protein >3g/dL

Bone marrow plasma cells >10%

No CRAB

Dx:_______________

A

Smoldering Multiple Myeloma

If patient presents with CRAB = Dx for Multiple Myeloma

80
Q

What is the normal finding for sugar/glucose in the urine?

A

Negative

-If +, need a fasting blood sugar (FBS) and correlate to family history.

81
Q

Normal RTV

A

RTV = Renal Threshold Value a.k.a. blood threshold value (beyond this causes glucose to spill into the urine)

Normal = 140-180 mg/dL

>180 = may indicate diabetes

82
Q

Classic association with glucosuria is __________. May also be seen with ________ which lowers the RTV

A

Diabetes mellitus (#1)

Renal disease may lower RTV causing glycosuria

83
Q

What causes ketones to form?

A

Due to lack of available sugar getting to the cells due to lack of Insulin

-Byproduct of fat metabolism as a way for the body to make energy when glucose levels are inadequate

84
Q

Normal value for ketones in the urine

A

Negative

-Abnormal = reported as trace, small, moderate, +1, +2, +3, +4

85
Q

Ketones

A
  • Acetone
  • Beta-hydroxybutric acid
  • Acetoacetic acid
86
Q

What does ketonuria suggest in diabetic and nondiabetic patients?

A

1) Diabetic patients = poorly controlled disease (may warn of diabetic coma)
2) Non-diabetic patients = reduced carbohydrate metabolism and excessive fat metabolism

87
Q

Normal value for bilirubin in the urine

A

Negative

-Billirubin is a breakdown product of RBC hemoglobin release. Needs to be processed by the liver before it can be released into the urine.

88
Q

________ billirubin is unable to pass the golmerular filter and can not be excreted in the urine (NOT water soluble).

A

Nonconjugated bilirubin binded to albumin in the blood stream from RBC hemoglobin

-Needs to be conjugated in the liver (adds glucuronic acid) before it can be excreted in the bile and small intestine

89
Q

Bilirubin is acted on by bacteria to form _________ which is further reduced to _________ to give feces its brown color?

A

Bilirubin –> Urobilinogen(some is handled by the kidneys and excreted) –> Stercobiligen

90
Q

Conjugated bilirubin in the urine indicates what?

A

Obstruction of bile flow from the liver (gall stones, tumor, pancreatic cancer, liver inflammation/infection, etc.)

91
Q

What are possible s/s of bilirubin in the urine?

A
  • Dark urine with a yellow foam (if shaken)
  • Jaundice
  • Pale colored feces (all point to bilirubinuria)
92
Q

What does pre-hepatic abnormal bilirubin indicate?

A
  • Anemia’s
  • Excessive breakdown of RBCs
93
Q

What does hepatic abnormal bilirubin indicate?

A
  • Hepatitis
  • Cirrhosis
  • Obstruction of biliary duct
  • Toxic liver damage

etc.

94
Q

What does post-hepatic abnormal bilirubin indicate?

A

Biliary tree obstruction etc.

95
Q

Normal range for urobilinogen

A

0.1 - 1 mg/dL (Ehrlich units)

96
Q

What protein gives the yellow color of urine and brown color of feces?

A

Stercobilinogen

97
Q

How would liver disease and hemolytic conditions effect urobilinogen?

A

Urobilinogen is not re-excreted in the bile and increased levels accumulate in the urine

98
Q

Liver/biliary dysfunction have what effect on urobilinogen and bilirubin?

A

Increases urobilinogen

Bilirubin will be found in the urine (+)

99
Q

Biliary tract obstruction will have what effect on urobilinogen and bilirubin?

A

Decreased/absent urobilinogen

Bilirubin will be found in the urine (+)

100
Q

Prehepatic disease or hemolytic anemia will have what effect on urobilinogen and bilirubin?

A

Increased urobilinogen

Bilirubin will be negative (can’t conjugate it)

101
Q

Dark yellow/brown/green colored urine indicates what?

A

Bilirubin is in the urine

Urobilinogen is in the urine

Think liver/biliary tract problem (gallstones)

-also look for jaundice, mid back discomfort, increased liver enzymes

102
Q

Correct follow ups for gallstones

A

1) Expectant management (“wait and see”)
2) Nonsurgical removal
3) Surgical removal

103
Q

Normal range for occult blood present in the urine. What color will the urine be if occult blood is present?

A

Negative (none)

-Smoky colored

104
Q

3 causes of occult blood seen from a Dipstick test

A

1) Hematuria
2) Hemoglobinuria
3) Myoglobinuria Lab:
- Increased RBC = hematuria
- Normal RBC = hemoglobinuria or myoglobinuria

105
Q

Normal RBC and yellow urine that test + for occult blood indicates what?

A

Microhemogobinuria or Micromyogloninuria

-if RBC was normal and urine was red colored = hemoglobinuria or myoglobinuria

106
Q

Causes of hematuria

A
  • Malignancy
  • Infection
  • Stones
  • Menses
  • Trauma
  • Exercise

etc.

107
Q

35 year old female

  • Color = smoky
  • Character = Cloudy
  • pH = 5
  • Occult blood = +
  • Urobilinogen = 0.8
  • Nitrites (-)
  • SpG = 1.020
  • WBC/HPF = 2
  • RBC/HPF = 15-20

What is the Dx?

A

Hematuria die to menses

  • Color = smoky = occult blood
  • Character = cloudy = take a look under a microscope
  • WBC = 2 = within 1-3, NOT infection
  • RBC = 15-20 = over 1-3, blood in urine (true hematuria)

Since it’s a 35 year old female with no history to indicate trauma, menses is most likely

108
Q

5 year old female

  • Color = smoky
  • Character = Cloudy
  • pH = 5
  • Occult blood = +
  • Urobilinogen = 0.8
  • Nitrites (-)
  • SpG = 1.020
  • RBC/HPF = 15-20

What is the Dx?

A

Hematuria due to either

  • Sexual abuse
  • Trauma (too young for menses)
109
Q

T/F If sperm cells are found in the urine of a female, it should always be reported in the lab report

A

FALSE

  • Adult female with no history of rape = no report
  • Adult female who was raped = Report
  • Child = REPORT (mandatory)
110
Q

35 year old female

  • Color = yellow
  • Character = clear
  • pH = 5
  • Urobilinogen = 0.1
  • Occult blood = +
  • Nitrites (-)
  • SpG = 1.018
  • WBC/HPF = 2
  • RBC/HPF = 2

What is the Dx?

A

Blood in urine due to either hemoglobin or myoglobin (microhemoglobinuria or micromyoglobinuria)

111
Q

Causes of hemoglobinuria

A

Anything that increases RBC destruction

  • Drugs
  • Crushing injuries
  • Transfusion reactions
  • Burns
  • Hemolytic anemia
112
Q

Causes of myoglobinuria

A

Anything that causes muscle trauma/destruction

  • Crushing injuries
  • Myocardial infarction
113
Q

Screening test used to detect WBC in the urine. What does a positive test suggest pathologically?

A

Leukocyte Esterase

-Suggest a UTI

>5 WBC’s = 50% (+) for UTI

>10 WBC’s = 90% (+) for UTI

114
Q

Screening test for UTI. Normal is negative. Indicates the pH of the urine is changing due to the bacteria

A

Nitrites

-Gram (-) bacteria convert/reduce nitrates to nitrites which increases the pH of the urine (more alkaline) which favors most bacterial growth (E.coli MC)

115
Q

T/F UA is negative for nitrites meaning that a UTI is not present

A

FALSE

  • Negative for nitrites does not mean negative for bacteriuria
  • Not all UTI’s are caused by bacteria able to convert nitrates to nitrites
116
Q

What 2 bacteria can cause a UTI and a negative test for nitrites?

A

Strep

Staph

117
Q

What is the difference between LPF and HPF when testing for UA sediments?

A

LPF = Low Powered Field = used to screen

HPF = High Powered Field = used to confirm

118
Q

Normal ranges for WBC/HPF and RBC/HPF

A

Both are 0-3

  • Increased WBC = inflammation/infection
  • Increased RBC = GMN, trauma, systemic or renal disease
119
Q

TNTC

A

Too Numerous To Count

-Never a good sign

120
Q

25 year old with 20-30 WBC/HPF, +2 bacteria, + nitrites

What does this indicate?

A

Lower UTI

  • Self limiting usually; adjust, flush the system, monitor.
  • If +1 protein, think upper UTI, need concurrent care
121
Q

67 year old with TNTC WBC/HPF, cloudy, + nitrites, +2 bacteria, Diabetic. What does this indicate?

A

Severe UTI (WBC TNTC)

-Need concurrent care because her diabetes is also a complicating factor along with her age

122
Q

Which of the following is most likely to develop a urolithiasis?

a) 25 year old female
b) 35 year old male
c) 35 year old female
d) 25 year old male

A

d) 25 year old male
- 5 to 10% of Americans develop urolithiasis (renal calculi, kidney stone)
- Peak age = 20-30
- Familial and hereditary tendencies as well as dietary

123
Q

MC type of kidney stone

A

Calcium oxalate

  • 15% are triple phosphate
  • 6% are uric acid (Gout)
  • Supersaturation, decreased urine volume, pH factors, foreign body seed to foster stone formation (crystals, debris, clot, etc.)
124
Q

T/F Kidney stone can present with or without pain. Often discovered due to obstruction, ulceration, or bleeding (hematuria).

A

True

125
Q

X-ray findings for a huge kidney stone that fills up most of the kidney

A

Staghorn Calculus

126
Q

Special type of imaging used to appreciate the kidney

A

Intervenous Pyelogram (IVP)

127
Q

What amino acid levels may be elevated in the urine in someone with liver disease?

A
  • Tyrosine
  • Leucine
  • Cysteine
128
Q

What type of crystals are seen in someone with Gout?

A

Uric acid crystals

-Correlate with high serum uric acid levels.

Phosphate crystals = parathyroid problems and malabsorption states

129
Q

___________ epithelium cells are found in the lower 1/2 of the bladder and urethra and may end up in the urine sample. Least serious and most common type of epithelial cell found in the urine sample

A

Squamous epithelium

-if lab report just says “epithelial cells”, assume it’s squamous unless reported different

130
Q

_________ epithelium cells are found in the upper 1/2 of the bladder and ureters while ________ epithelium is found in the kidney and indicates a more serious condition

A

Transitional epithelium = upper 1/2 of the bladder and ureters

Renal cell epithelium = kidneys

131
Q

If you have bacteria and epithelial cells with no other bacterial findings (normal WBC, mucous, nitrites, etc.) it may indicate ____________

A

Contamination (particularly vaginal)

132
Q

26 year old female

  • Color = yellow
  • Appearance = cloudy
  • Nitrites = None
  • WBC = 2-3/HPF
  • Epithelial cells = Frequent
  • Bacteria = +2

What is the Dx?

A

Contamination or Infection

-+2 bacteria with no other obvious signs of infection or pathology indicate its probably contamination.

Need to rerun the UA and explain proper technique (wipe around first and catch the urine midstream, etc.).

Be aware it still may be infection, which is why we need to redo the UA

133
Q

Normal report for mucus in the urine. What does it indicate if abnormal?

A

Negative.

Abnormal amount points to infection

134
Q

Urinary sediments/casts are able to give us a picture/condition of what kidney structure?

A

The nephron

135
Q

Kidney specific proteins (________________) are produced in the tubules and may start to get primarily in the DCT and slough into the system causing it to appear in the urine. What are these proteins associated with?

A

Tamm-Horsfall proteins

-If found in the urine, indicates possible upper UTI, which is very serious (concurrent care)

136
Q

T/F Only granular and hyaline casts can normally be found in the urine (0-2/LPF). With no other findings, they are considered insignificant

A

True

-With other findings, may become significant

137
Q

T/F Casts come from the nephron and no where else.

A

True

138
Q

What do RBC and WBC casts indicate?

A

RBC Cast = upper UTI bleeding

WBC Cast = upper UTI infection

139
Q

With RBC casts, this indicates bleeding in the nephron as seen in conditions like _________________ where the renal filter becomes inflammed (upper UTI) usually _____________ related

A

Glomerulonephritis

Immune related (no organism is present)

140
Q

What are some s/s seen with glomerulonephritis?

A
  • RBC Casts
  • Lots of RBC
  • Lots of WBC
  • Oliguria
  • Red/smoky, cloudy urine
  • Low SpG (kidney is not functioning properly)
141
Q

6 year old male

  • Color = smoky
  • Character = cloudy
  • pH = 5
  • Protein = +2
  • Urobilinogen = 0.15
  • Occult blood = moderate
  • SpG = 1.004
  • WBC/HPF = 4-6
  • RBC/HPF = 30-40
  • Casts = 1-2 RBC
  • What is the Dx?
A

Glomeurlonephritis

Red Casts is almost always indicative of Glomerulonephritis

-Also correlate history

142
Q

What pathology complications may lead to someone developing GMN?

A

Kid (MC 6-10) with Strep throat that lasted >2 weeks may lead to an immune response causing GMN

Adult with SLE may cause an immune response that leads to GMN

143
Q

Besides blood casts, what other lab finding may lead to the diagnosis of GMN? What is the prognosis?

A

HTN and elevated Antistreptolysin O titer

  • Need to maintain electrolyte and water balance
  • 95% of children recover totally
  • Chronic GTN progresses slowly to death of the patient unless dialysis or transplant intervention
144
Q

WBC cast indicate _____________, primarily of the kidney interstitium known as _____________

A

Infection/Inflammation a.k.a. Pyelonephritis (upper UTI)

145
Q

What are some s/s that correlate with Pyelonephritis?

A
  • Flank pain
    • Punch test
  • Low grade fever, malaise, dysuria, burning sensation, urgency, frequency
  • LAB: bacteria present, WBC’s, WBC casts
146
Q

28 year old female

  • Color = yellow
  • Character = cloudy
  • pH = 5
  • Protein = +2
  • Urobilinogen = 0.25
  • Leukocyte esterase = +
  • Nitrites = +
  • SpG = 1.018
  • WBC/HPF = 30-40
  • RBC/HPF = 1-2
  • Bacteria = +2
  • Casts = WBC 1-2, Hyaline 0-1

What is the Dx?

A

Pyelonephritis (upper UTI)

-Bacteria, WBC casts, and + protein all point to a upper UTI (especially with WBC casts)

NOTE: Hyaline casts are normally if 0-2 with NO OTHER signs of kidney problems

147
Q

Casts correlations:

  • Bacteria indicate _________________
  • Clusters of WBC indicate ______________
  • Glitter cells (WBC’s undergoing phagocytosis) indicates__________
  • Waxy, broad, and fatty casts indicate _____
  • Yeast cells indicate ___________
  • Granular casts indicate ______
A
  • Bacteria = UTI
  • WBC = UTI
  • Glitter cells = UTI
  • Waxy = Chronic Renal Failure
  • Yeast = Candida
  • Granular = by product of metabolism, fine or course, increase with renal disease
148
Q

T/F Lower UTI will show up as casts, protein, cloudy, hazy urine possibly with blood, flank pain, and WBC’s

A

FALSE

-These are all associated with Upper UTI (blood and protein = upper UTI)

Lower UTI = increase WBC’s, mucous, blood, no casts, no protein, lower back/pubic pain (no casts and no protein = lower UTI)

Visceral Disorder and Lab Interpretation (7 decks)

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