INTRODUCTION TO URINALYSIS Flashcards
Wrote the book of “uroscopy”
Hippocrates
Discovered albuminuria by boiling urine
Frederik Dekker
Published a book about “Pisse Prophets”
Thomas Bryant
Addis Count
Thomas Addis
Introduced the concept of urinalysis as part of a doctor’s routine patient examination
Richard Bright
Urochrome - the pigment that causes yellow color or urine
Thudichum
Reasons for performing urinalysis (CLSI): (4)
- Diagnosis of disease
- Screening asymptomatic populations for undetected disorder
- Monitoring the progress of disease
- Monitoring the effectiveness of therapy
Primary organic component. Product of protein and amino acid metabolism
Urea
Product of creatine metabolism by muscles
Creatinine
Product of nucleic acid breakdown in food and cells
Uric acid
Primary Inorganic component. round in combination with sodium and many other inorganic substances
Chloride
Primarily from salt, varies by intake
Sodium
Combined with chloride and other salts
Potassium
Combines with sodium to buffer the blood
Phosphates
Regulates blood and tissue acidity
Ammonium
Combines with chloride, sulfate, and phosphate
Calcium
A normal urine constituent
Nitrate
The single most useful substance that identifies a fluid as urine
uniquely high creatinine concentration (approximately 50 times that of plasma)
Factors that influence urine volume include: (4)
- Fluid intake
- Fluid loss from non-renal sources
- variations in the secretion of ADH
- need to excrete increased amounts dissolved solids such as glucose or salts
DM or DI:
- Due to defect in the pancreatic production of insulin
- Increase Urine Specific gravity
- Increase urine Glucose (glucosuria)
Diabetes mellitus
DM or DI:
- Due to decrease production or function of ADH
- Decreased Urine Specific gravity
Diabetes insipidus
Urine specimens should be delivered to the laboratory promptly and tested within 1 hour. Never discard a specimen before checking with a supervisor.
A. First statement is true, second statement is true.
B. First statement is false, second statement is true.
C. First statement is true, second statement is false.
D. First statement is false, second statement is false.
B. First statement is false, second statement is true.
- Within 2 hours
Characteristics of urine specimen container: (4)
- Clean, Dry, Leak-proof
- With Screw top lids - they are less likely to leak than snap-on lids
- Wide mouth, and wide flat bottom
- Made of sterile material
- Recommended container capacity
- Required specimen volume for microscopic analysis
- 50 mL
- 15 mL
This must accompany specimens delivered to the laboratory
Requisition form
When to reject specimen? (6)
- Specimen in unlabeled containers
- Non matching labels and requisition forms
- Specimens contaminated with feces or toilet papers
- Containers with contaminated exteriors
- Specimens of insufficient quantity
- Specimens that have improperly transported
Collect urine after 2 hours of meal. Measures the amount of glucose and correlated with the renal threshold.
2 hour post prandial
For quantitative measurement of analytes that shows
diurnal variation. Urine specimen for clearance test. Urine specimen evaluation of fistulas
Timed specimen
This specimen is collected under sterile conditions by passing a hollow tube through the urethra into the bladder
Catheterized specimen
Ideal for screening microalbuminuria (brunzel). For determination of urine albumin, creatinine, and the albumin-to creatinine ratio.
12 hours urine specimen
Preferred for urobilinogen measurements
Afternoon urine (20m to 40m)
Easy to collect and convenient. For Routine screening.
Random specimen
Urine specimen that is ideal for cytology
Random urine “clean catch” with prior hydration
Specimen that is ideal to test for substances that require concentration or incubation for detection. These specimens are often preferred for cytology studies because the number epithelial cells present can be significant.
First morning or 8-hour specimen
Specimen for glucose or diabetic monitoring and screening
Second morning/fasting specimen
Specimen for glucose or diabetic monitoring and screening
Second morning/fasting specimen
For bacterial culture (especially for anaerobic microbes). It is used for cytological examination.
Suprapubic aspiration
This specimen is safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
Midstream Clean catch
Urine specimen in soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genital area of both boys and girls
Pediatric specimen
If both urinalysis and culture are requested on a midstream or catheterized collection, which should be performed first and why?
Culture. This is to prevent contamination of the specimen
blank
Process that provides documentation or proper sample identification from the time of collection to the receipt of laboratory results
Chain of custody
This is added to the toilet water reservoir to prevent an adulterated specimen
Bluing agent (dye)
Most common adulterant
Water
Container capacity for drug testing
60 mL
Urine volume required for drug testing
30-45 mL
Urine temperature for drug testing
Within 4 mins, the temp should be 32.5-37.7°C
This is inspected to identify any signs of contaminants during drug testing
Urine color
Explain each container in the three-glass collection for prostatitis test
1st sterile container - contains the first urine passed
2nd sterile container - contains the midstream portion of urine
3rd sterile container - contains the urine with prostate fluid after massaging the prostate
Which of the specimens in 3-glass collection is/are examined microscopically?
1st and 3rd specimen
In 3-glass collection, what is the 2nd specimen used for?
Serves as control or bladder and kidney infections and should not be positive for bacteria. can be used for routine UA if additional testing is required
This is performed in all specimens of 3-glass collection
Qualitative culture
In Stamey-Mears, what are the types of four glass specimen
a) VB1 Initial voided urine, For bacterial cultures, Urethral infection or inflammation testing
b) VB2 Midstream urine and is used to tests for urinary bladder infection.
c) EPS Expressed prostatic secretion
d) V63 Post prostatic massage urine
Changes in unpreserved urine:
Which of the analytes are increased?
pH
Bacteria
Odor
Nitrite
Changes in unpreserved urine:
Which of the analytes are decreased?
Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
RBC, WBC, Casts
Trichomonas
Which of the analytes is the least or not affected by unpreserved urine?
Protein
Changes in unpreserved urine:
Cause of increase in Trichomonas
None.
Trichomonas is decreased in unpreserved urine due to loss of characteristic, motility and death.
Changes in unpreserved urine:
Cause decrease of RBC, WBC, and Cast
Disintegration in dilute alkaline urine
Changes in unpreserved urine:
Cause of decrease in Urobilinogen
Oxidation to urobilin
The decrease in bilirubin in unpreserved urine is due to photooxidation to urobilin.
A. True
B. False
B. False.
Bilirubin is photo oxidized to biliverdin.
This analyte is increased due to bacterial multiplication or breakdown of urea to ammonia
Odor
This analyte is affected due to oxidation or reduction of metabolites
Color (Modified/Darkened)
pH is _______ due to breakdown of urea to ammonia by urease-producing bacteria loss of CO2
A. Increased
B. Decreased
A. Increased
Why is Nitrite increased in an unpreserved specimen
Multiplication of nitrite reducing bacteria
Explain why clarity of unpreserved specimen decreases.
Due to bacterial growth and precipitation of amorphous material
This analyte is decreased due to glycolysis and bacterial consumption
Glucose
Urine preservative that can be used to preserve urine for catecholamines (e.g., epinephrine & norepinephrine) measurement
Concentrated HCl
Urine preservative that is Inexpensive, stabilizes porphyrins, porphobilinogen, etc. but unacceptable for urinalysis testing. Used for quantitative analysis of porphyrins, porphobilinogen, etc.
Sodium carbonate
Urine preservative that preserves cellular elements, and used for cytological examination.
Saccomanno fixative
Component of Saccomanno fixative
Ethanol + Carbowax
Urine preservative used for automated instrument with round or conical bottom. Must refrigerate within 2 hours.
Yellow plain UA
Urine preservative that is stable for 72 hours, which contains sodium propionate. This decreases bilirubin and urobilinogen when left exposed at room temperature and light.
Cherry red/Yellow top tube
Urine preservative that preserves bacteria using boric acid and is stable at room temperature for 48 hours. However, this decreases pH if urine is below minimum fill line.
Gray C and S tube
Urine preservative that does not interfere with routine test and uses 1 drop per ounce of specimen. This causes changes in odor.
Phenol
Urine preservative that is good for drug analysis and prevents glycolysis. It Inhibits reagent strip tests for glucose, blood, and leukocytes. May use sodium benzoate instead of fluoride for reagent strip testing.
Sodium fluoride
Urine preservative that does not interfere with routine test but floats on surface of specimens and clings to pipette and testing materials
Toluene
Excellent sediment preservative and can also be used for cytology (Brunzel). But act as reducing agent, interferes with chemical tests for glucose, blood, leukocyte esterase, and copper reduction, and gives false-negative reagent strip test for blood and urobilinogen
Formalin
Urine preservative that preserves protein and formed elements well, does not interfere with routine analysis other than pH, and prevents bacterial growth and metabolism. However, it may precipitate crystals when used in large amounts and interferes with drug and hormone analyses. Keeps pH at 6.0 and Bacteriostatic at 18 g/L
Boric Acid
Urine preservative that preserves glucose and sediments well but interferes with acid precipitation test for protein.
Thymol
Urine preservative that does not interfere with chemical test, but precipitates amorphous crystals and raises specific gravity by hydrometer. Prevents bacterial growth for 24 hours.
Refrigeration