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CLINICAL MICROSCOPY > Introduction to Urinalysis > Flashcards

Introduction to Urinalysis Flashcards

1
Q

References to the study of urine can be found in the

A

Drawings of cavemen and in Egyptian hieroglyphics, such as the Edwin Smith Surgical Papyrus

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2
Q

He wrote a book on “uroscopy” in the 5th century BCE

A

Hippocrates

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3
Q

He discovered albuminuria in 1694

A

Frederik Dekkers

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4
Q

How did Frederik Dekkers discovered albuminuria?

A

By boiling urine

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5
Q

Charlatans without medical credentials that offer predictions to the public for a healthy fee

A

Pisse prophets

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6
Q

Author of the book where pisse prophets are the subjects

A

Thomas Bryant, 1627

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7
Q

This inspired the passing of the first medical licensure laws in England

A

Book of Thomas Bryant

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8
Q

This milestone led to the examination of urinary sediment

A

Invention of the microscope in the 17th century

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9
Q

He developed the methods for quantitating the microscopic sediment

A

Thomas Addis

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10
Q

He introduced the concept of urinalysis as part of a doctor’s routine patient examination in 1827

A

Richard Bright

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11
Q

Two unique characteristics of a urine specimen

A
  1. Urine is a readily available and easily collected specimen
  2. Urine contains information, which can be obtained by inexpensive laboratory tests, about many of the body’s major metabolic functions
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12
Q

How does the Clinical and Laboratory Standards Institute (CLSI) define urinalysis?

A

“The testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner.”

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13
Q

Reasons for performing urinalysis identified by CLSI

A

Aiding in the diagnosis of disease
Screening asymptomatic populations for undetected disorders
Monitoring the progress of disease and the effectiveness of therapy

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14
Q

Organ that continuously form urine

A

Kidney

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15
Q

Average daily urine output

A

1200mL

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16
Q

The amount of filtered plasma converted by the kidney into average daily urine output

A

170,000mL

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17
Q

General composition of urine

A

95% water
5% solutes (urea, organic and inorganic chemicals)

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18
Q

Metabolic waste product produced in the liver from the breakdown of protein and amino acids

A

Urea

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19
Q

This metabolic product accounts for nearly half of the total dissolved solids in urine

A

Urea

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20
Q

Primary organic substances in urine

A

Urea
Creatinine
Uric acid

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21
Q

The major inorganic solid dissolved in urine

A

Chloride
Sodium
Potassium

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22
Q

Other substances found in urine include

A

Hormones
Vitamins
Medications

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23
Q

Formed elements that may be found in urine

A

Cells
Casts
Crystals
Mucus
Bacteria

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24
Q

Increased amounts of formed elements in urine are often indicative of

A

Disease

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25
Q

This factor determines the amount of urine to be excreted by the body

A

State of hydration

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26
Q

Substances that can identify a body fluid as urine

A

Creatinine
Urea

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27
Q

Primary organic component. Product of protein and amino acid metabolism

A

Urea

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28
Q

Product of creatine metabolism by muscles

A

Creatinine

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29
Q

Product of nucleic acid breakdown in food and cells

A

Uric acid

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30
Q

Primary inorganic component. Found in combination with sodium (table salt) and many other inorganic substances

A

Chloride

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31
Q

Primarily from salt, varies by intake

A

Sodium

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32
Q

Combined with chloride and other salts

A

Potassium

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33
Q

Combines with sodium to buffer the blood

A

Phosphate

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34
Q

Regulates blood and tissue fluid acidity

A

Ammonium

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35
Q

Combines with chloride, sulfate, and phosphate

A

Calcium

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36
Q

Factors that influence urine volume

A

Fluid intake
Fluid loss from nonrenal sources
Variations in the secretion of antidiuretic hormone
The need to excrete increased amounts of dissolved solids, such as glucose or salts

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37
Q

Normal daily urine output

A

1200 to 1500 mL, a range of 600 to 2000 mL is considered normal

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38
Q

A decrease in urine output (which is less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 400 mL/day in adults)

A

Oliguria

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39
Q

Oliguria is commonly seen when:

A

The body enters a state of dehydration as a result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns

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40
Q

Cessation of urine flow

A

Anuria

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41
Q

Cause of anuria

A

Any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys

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42
Q

Comparison of urine output during day and night

A

The kidneys excrete two to three times more urine during the day than during the night

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43
Q

An increase in the nocturnal excretion of urine

A

Nocturia

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44
Q

An increase in daily urine volume (greater than 2.5 L/day in adults and 2.5 to 3 mL/kg/day in children)

A

Polyuria

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45
Q

Diseases and factors associated with polyuria

A

Diabetes mellitus
Diabetes insipidus
Artificial diuretics
Caffeine
Alcohol

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46
Q

Disease caused by a defect either in the pancreatic production of insulin or in the function of insulin, which results in an increased body glucose concentration

A

Diabetes mellitus

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47
Q

Level of specific gravity of urine specimen from patient with diabetes mellitus

A

Increased

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48
Q

Disease that results from a decrease in the production or function of antidiuretic hormone (ADH); thus, the water necessary for adequate body hydration is not reabsorbed from the plasma filtrate

A

Diabetes insipidus

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49
Q

Concentration and specific gravity of urine specimen from patient with diabetes insipidus

A

Urine is dilute and has a low specific gravity

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50
Q

Compensatory mechanism for polyuria

A

Ingestion of water

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51
Q

An increased ingestion of water

A

Polydipsia

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52
Q

Container for urine specimen collection must be

A

Clean
Dry
Leak-proof

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53
Q

Reason for using disposable urine containers for collection

A

it eliminates the chance of contamination owing to improper washing

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54
Q

The recommended capacity of the urine specimen container

A

50mL

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55
Q

Amount of urine specimen needed for microscopic analysis

A

12mL

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56
Q

Suggested urine specimen container if more than 2 hours elapse between specimen collection and analysis is expected

A

Sterile urine containers

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57
Q

Why do we attach the label on the urine container and not on the lid?

A

Labels on the lid may lead to swapping, thus misidentification occurs

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58
Q

Criteria of specimen rejection

A
  1. Specimens in unlabeled containers
  2. Nonmatching labels and requisition forms
  3. Specimens contaminated with feces or toilet paper
  4. Containers with contaminated exteriors
  5. Specimens of insufficient quantity
  6. Specimens that have been improperly transported
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59
Q

Can we discard reject specimen even without consultation with a supervisor?

A

No

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60
Q

Following collection, specimens should be delivered to the laboratory promptly and tested within

A

2 hours

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61
Q

A specimen that cannot be delivered and tested within 2 hours should be

A

Refrigerated or have an appropriate chemical preservative added

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62
Q

The most routinely used method of urine preservation

A

Refrigeration at 2°C to 8°C

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63
Q

Purpose of refrigerating urine specimen

A

To reduce bacterial growth and metabolism

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64
Q

What are the requirements if the urine is to be cultured

A

It should be refrigerated during transit and kept refrigerated until cultured up to 24 hours

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65
Q

When refrigerated urine sample is to be chemically tested by reagent strips, the specimen must be:

A

The specimen must return to room temperature before chemical testing by reagent strips

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66
Q

Mode of specimen preservation when a specimen must be transported over a long distance and refrigeration is impossible

A

Addition of chemical preservatives

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67
Q

Ideal chemical preservative should be

A

Bactericidal
Inhibit urease
Preserve formed elements in the sediment
Must not interfere with chemical test

68
Q

The reason why specimens must be returned to room temperature before chemical testing by reagent strips

A

The enzyme reactions on the strips perform best at room temperature

69
Q

This is the most commonly received specimen because of its ease of collection and convenience for the patient

A

Random specimen

70
Q

Purpose of random specimen

A

Routine screening

71
Q

The ideal screening specimen

A

First morning specimen

72
Q

Purpose of first morning specimen

A

Routine screening
Essential for preventing false-negative pregnancy tests
Evaluating orthostatic proteinuria

73
Q

Specimen collected to correspond with the blood samples drawn during a glucose tolerance test (GTT)

A

Glucose tolerance specimens

74
Q

Purpose of Glucose tolerance specimens

A

To assess patient’s ability to metabolize a measured amount of glucose and are correlated with the renal threshold for glucose

75
Q

Specimen used to produce accurate quantitative results

A

Carefully timed specimen

76
Q

Principle of 24-Hour (or Timed) Specimen

A

Patient must begin and end the collection period with an empty bladder

77
Q

What to do if 24-hour urine specimen is collected using two separate containers

A

Contents should be combined and mixed thoroughly

78
Q

Storage requirements for 24-hour specimen during collection

A

Must be refrigerated or kept on ice during the collection period

79
Q

Purpose of 24-hour (or timed) specimen

A

Quantitative chemical tests

80
Q

This specimen is collected under sterile conditions by passing a hollow tube (catheter) through urethra into the bladder

A

Catheterized specimen

81
Q

The most commonly requested test on a catheterized specimen

A

Bacterial culture

82
Q

Purpose of catheterized specimen

A

Bacterial culture

83
Q

Alternative to the catheterized specimen that provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis

A

Midstream clean-catch specimen

84
Q

Purpose of Midstream clean-catch

A

Routine screening
Bacterial culture

85
Q

It provides a specimen that is less contaminated by epithelial cells and bacteria and, therefore, is more representative of the actual urine than the routinely voided specimen

A

Midstream clean-catch specimen

86
Q

Provides a sample for bacterial culture that is completely free of extraneous contamination

A

Suprapubic aspiration

87
Q

Purpose of Suprapubic aspiration

A

Bladder urine for bacterial culture
Cytology

88
Q

Purpose of Three-glass collection

A

Prostatic infection

89
Q

Specimens using three-glass collection

A

Container 1 – first urine passed
Container 2 – midstream urine
Container 3 – remaining urine and prostatic fluid (post-massage urine)

90
Q

Specimens in pre-and post-massage test (PPMT)

A

Specimen 1: midstream clean-catch specimen
Specimen: post-massage specimen

91
Q

Positive result of pre- and post-massage test (PPMT) indicates

A

Bacteriuria in the post-massage specimen of greater than 10 times the premassage count

92
Q

Most challenging specimen to collect

A

Pediatric specimens

93
Q

Stamey-Mears 4-glass collection

A

Initial voided (VB1)
Midstream (VB2)
Massaged prostate excretions (EPS)
Post-massage urine (VB3)

94
Q

What to do when both a routine urinalysis and a culture are requested on a catheterized or midstream collection

A

Culture should be performed first to prevent contamination of the specimen

95
Q

How often do we need to check the applied bags when collecting pediatric specimen?

A

Every 15 minutes

96
Q

The most vulnerable part of a drug-testing program

A

Urine specimen collection

97
Q

In drug-testing program, this process provides the documentation of proper sample identification from the time of collection to the receipt of laboratory results

A

Chain of custody (COC)

98
Q

Standardized form that must document and accompany every step of drug testing, from collector to courier to laboratory to medical review officer to employer

A

Chain of custody (COC)

99
Q

During drug testing, urine specimen collections may be “witnessed” or “un-witnessed.” True or false

A

True

100
Q

The decision to obtain a witnessed collection is indicated when

A

It is suspected that the donor may alter or substitute the specimen or it is the policy of the client ordering the test

101
Q

Amount of urine specimen needed for drug testing

A

30-45mL

102
Q

According to COC, urine temperature must be taken within

A

4 minutes from the time of collection

103
Q

Why do we need to take the temperature of urine specimen during drug testing?

A

To confirm the specimen has not been adulterated

104
Q

Ideal temperature of urine specimen for drug testing

A

32.5°C to 37.7°C

105
Q

What to do if temperature of urine specimen is not within acceptable range?

A

Record the temperature
Report to supervisor
Recollect second specimen

106
Q

A patient presenting with polyuria, nocturia, polydipsia, and a low urine specific gravity is exhibiting symptoms of:

A

Diabetes insipidus

107
Q

A patient with oliguria might progress to having:

A

Anuria

108
Q

Labels for urine containers are:

A

Attached to the container
Not detachable

109
Q

A cloudy specimen received in the laboratory may have been preserved using:

A

Refrigeration

110
Q

The primary advantage of a first morning specimen over a random specimen is that it:

A

More concentrated

111
Q

If a routine urinalysis and a culture are requested on a catheterized specimen, then:

A

The culture is performed first

112
Q

What will happen if a patient fails to discard the first specimen when collecting a timed specimen?

A

Results will be falsely elevated

113
Q

What will happen if a patient fails to add the last specimen when collecting a timed specimen?

A

Results will be falsely decreased

114
Q

The primary cause of unsatisfactory results in an unpreserved routine specimen not tested for 8 hours is:

A

Bacterial growth

115
Q

Prolonged exposure of a preserved urine specimen to light will cause:

A

Decreased bilirubin

116
Q

The most sterile specimen collected is a:

A

Suprapubic aspiration

117
Q

Recommended cleansing materials/agents when collecting midstream clean-catch specimen

A

Mild antiseptic towelettes

118
Q

Who discovered CSF

A

Domenico Cotugno

119
Q

Who discovered Phenylketonuria

A

Ivan Folling

120
Q

Who discovered Alkaptonuria

A

Archibald Garrod

121
Q

Who discovered Cystine calculi

A

William Wollaston

122
Q

Oliguria in infants

A

<1mL/kg/hour

123
Q

Oliguria in children

A

<0.5 mL/kg/hour

124
Q

Oliguria in adult

A

<400 mL/day

125
Q

Polyuria in children

A

> 2.5-3 mL/kg/day

126
Q

Polyuria in adult

A

> 2.5 L/day

127
Q

Increased excretion of urine at night

A

Nocturia

128
Q

Nocturia value

A

> 500 mL

129
Q

SG of nocturnal urine

A

<1.018

130
Q

Anuria value

A

<100 mL/24 hour

131
Q

Urine specimen must be tested within

A

2 hours

132
Q

What to do if urine specimen cannot be tested within 2 hours

A

Refrigerate at 2°C-8°C

133
Q

What to do if urine specimen cannot be tested within 2 hours and refrigeration is not possible

A

Add preservatives

134
Q

Cause of increased pH in unpreserved urine

A

Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2

135
Q

Cause of increased bacteria in unpreserved urine

A

Bacterial multiplication

136
Q

Cause of increased odor in unpreserved urine

A

Bacterial multiplication causing breakdown of urea to ammonia

137
Q

Cause of increased nitrite in unpreserved urine

A

Multiplication of nitrate-reducing bacteria

138
Q

Cause of darkened color of unpreserved urine

A

Oxidation or reduction of metabolites

139
Q

Cause of decreased clarity in unpreserved urine

A

Bacterial multiplication, precipitation of amorphous material

140
Q

Cause of decreased glucose in unpreserved urine

A

Glycolysis and bacterial use

141
Q

Cause of decreased ketones in unpreserved urine

A

Volatilization and bacterial metabolism

142
Q

Cause of decreased bilirubin in unpreserved urine

A

Exposure to light/photo oxidation to biliverdin

143
Q

Cause of decreased urobilinogen in unpreserved urine

A

Oxidation to urobilin

144
Q

Cause of decreased RBC/WBC/Casts in unpreserved urine

A

Disintegration in dilute alkaline urine

145
Q

The least affected parameter affected in unpreserved urine

A

Protein

145
Q

Disadvantage of refrigeration

A

Precipitates amorphous phosphates and urates

146
Q

Advantage of thymol

A

Preserves glucose and sediments well

147
Q

Disadvantage of thymol

A

Interfere with acid precipitation test for protein

148
Q

Advantage of boric acid

A

Prevents bacterial growth and metabolism

149
Q

Disadvantage of boric acid

A

Interferes with drug and hormone analyses

150
Q

Preservative that keeps pH at about 6.0 and can be used for urine culture transport

A

boric acid

151
Q

Rinsing the specimen container with formalin helps to preserve cells and casts. True or False?

A

True

152
Q

Advantage of formalin

A

Excellent sediment preservative

153
Q

Disadvantage of formalin

A

Acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction

154
Q

Advantage of toluene

A

Does not interfere with routine test

155
Q

Disadvantage of toluene

A

Floats on surface of specimens and clings to pipette and testing materials

156
Q

Advantage of sodium fluoride

A

Is a good preservative for drug analyses

157
Q

Disadvantage of sodium fluoride

A

Inhibits reagent strip tests for glucose, blood, and leukocytes

158
Q

Urine preservative that causes a change in urine odor

A

Phenol

159
Q

The second specimen voided

A

Fasting specimen

160
Q

Use of fasting specimen

A

Recommended for glucose monitoring

161
Q

Specimen collected 2 hours after eating

A

2 hour postprandial specimen

162
Q

Use of 2 hour postprandial specimen

A

Monitors insulin therapy
Used for diabetic patients

163
Q

Preferred urine specimen for urobilinigen measurements

A

Afternoon urine (2pm-4pm)

164
Q

Ideal specimen for screening microalbuminuria

A

12 hours urine specimen

CLINICAL MICROSCOPY (20 decks)

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