Introduction to Urinalysis Flashcards
1
Q
“The testing of urine with procedures commonly
performed in an expeditious, reliable, accurate, safe,
and cost-effective manner.” (CLSI)
A
URINALYSIS
2
Q
they continuously form urine as an ultrafiltrate
of plasma.
A
KIDNEYS
3
Q
Ultrafiltration of plasma takes place in the?
A
glomerular capillaries
4
Q
Reabsorption of water and filtered substances
essential to body function converts approximately
150,000 mL of filtered plasma
TRUE OR FALSE
A
FALSE
It reabsorbs 170,000mL not 150,000mL
5
Q
the average daily urine output is?
A
1,200 mL
6
Q
consists of urea and other organic and inorganic
chemicals dissolved in water.
A
Urine
7
Q
Urine is normally 95% water and 5% solutes.
TRUE OR FALSE
A
TRUE
8
Q
Urine is normally 95% water and 5% solutes.
These 5% solutes include:
A
Organic components;
Inorganic components.
9
Q
(most abundant organic component), a metabolic
waste product produced in the liver from the
breakdown of protein and amino acids, accounts for
nearly half of the total dissolved solids in urine.
A
Urea
10
Q
Aside from Urea other organic substances include primarily creatinine and uric acid, and other nitrogen-containing
compounds.
TRUE OR FALSE
A
TRUE
These are your main organic substances:
Urea
Creatinine
Uric Acid
Nitrogen-containing compounds
11
Q
The major inorganic solid dissolved in urine is?
A
Chloride
12
Q
principal salt in urine
A
sodium chloride salt
13
Q
The major inorganic solid dissolved in urine is chloride followed by?
A
sodium and potassium
usually in the form of sodium chloride salt
14
Q
excreted in the form of di-hydrogen phosphate
A
Calcium, phosphate
15
Q
Small or trace amounts of many additional inorganic
chemicals are also present in the urine
TRUE OR FALSE
A
TRUE
Because other substances found in urine include
hormones, vitamins, and medications; may also contain formed elements such as cells, casts, crystals, mucus, and bacteria.
16
Q
Primary organic component; product
of metabolism of protein and amino
acids
A
UREA
17
Q
Product of metabolism of creatine by
muscles.
A
CREATININE
18
Q
Product of breakdown of nucleic acid
in food and cells
A
URIC ACID
19
Q
Primary inorganic component; found
in combination with sodium and many
other inorganic substances.
A
CHLORIDE
20
Q
Primarily from salt, varies by intake.
A
SODIUM
21
Q
Combined with chloride and other
salts.
A
POTASSIUM
22
Q
Combines with sodium to buffer the
blood.
A
PHOSPHATE
23
Q
Regulates blood and tissue fluid
acidity.
A
AMMONIUM
24
Q
Combines with chloride, sulfate, and
phosphate.
A
CALCIUM
25
Refers to the 24-hr or Daily Output; the amount of urine
voided or excreted over a period of 24 hours
URINE VOLUME
26
Urine volume depends on the amount of _____ that the
kidneys excrete.
Water
27
is a major body constituent; therefore,
the amount excreted is usually determined by
the body’s state of hydration
Water
28
D/N (Day-to-Night) Ratio
2:3:1
29
Night output is 2 – 3x larger than the
Day output.
TRUE OR FALSE
FALSE
Day output is 2 – 3x larger than the
night output.
30
NORMAL DAILY URINE OUTPUT
RANDOM
600 – 2000 mL/day
31
NORMAL DAILY URINE OUTPUT
AVERAGE
1200 – 1500 mL/day (1.2 – 1.5 L/day)
32
Persistent production of large volumes of urine; an
abnormal increase in daily urine volume
Polyuria
2.5 L/day in adults;
2.5 – 3 mL/kg/day in children
33
Seen in cases of diabetes mellitus and diabetes
insipidus; differ in terms of specific gravity.
Polyuria
34
↑SG (hypersthenuria; due to
osmotic diuresis).
DIABETES MELLITUS
35
↓SG (hyposthenuria;
consistently within 1.002 –
1.003)
DIABETES INSIPIDUS
36
Failure in ADH secretion
(produces large amounts of
dilute urine).
DIABETES INSIPIDUS
37
Caused by a defect either in the pancreatic production of insulin or in the function of insulin, which results in an increased concentration of body glucose.
DIABETES MELLITUS
38
Results from a decrease in the production or function of ADH; thus, the water necessary for adequate body hydration is not reabsorbed from the plasma filtrate.
DIABETES INSIPIDUS
39
Fluid loss in both diabetes (Mellitus and Insipidus) diseases is compensated by increased ingestion of water (polydipsia), producing an even greater volume of urine. Polyuria is accompanied by increased fluid intake is often the first symptom of either disease.
TRUE OR FALSE
TRUE
40
increased ingestion of water
polydipsia
41
Persistent production of low volumes of urine; abnormal decrease in urine output
OLIGURIA
<400 mL/day in adults,
<1 mL/kg/hr in infants,
<0.5 mL/kg/hr in children
42
Identify this condition
Clinical Significance: Dehydration, renal insufficiency, poorly compensated heart disease, renal calculi (kidney stones), and kidney tumors
Characterized either by decreased renal blood flow or obstruction
OLIGURIA
43
Complete cessation of urine production; one of the main findings or manifestations of renal failure.
ANURIA
44
Almost all glomerular and tubulointerstitial disorders terminate in renal failure.
TRUE OR FALSE
TRUE
45
Identify this condition
Clinical Significance: Severe acute nephritis, tubular necrosis, Hg poisoning, obstructive uropathy, kidney failure.
May result from any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys.
ANURIA
46
Increase in the nocturnal excretion of urine. Excretion of more than 500 mL urine at night with a specific gravity of less than 1.018.
If S.G. = 1.010, it is usually associated with impairment of tubular function or renal failure/necrosis.
NOCTURIA
47
“Transient polyuria;” may be due to the intake of substances with a diuretic effect, such as alcohol, coffee, or diuretic drugs
Transitory increase in urine volume
DIURESIS
48
A SMALL volume of urine is produced, as long as the diuretic substances are in one’s system.
TRUE OR FALSE
FALSE
A large volume of urine is produced by diuretic substances
49
PREFERRED SPECIMEN FOR URINE
First Morning
50
(most concentrated specimen of the day) collected using midstream clean-catch technique.
First Morning
51
The most common indication of routine urinalysis is?
the diagnosis of urinary tract infection (UTI).
52
One way to collect sterile urine suitable for bacterial culture, which will also be in conjunction with urinalysis
First Morning
53
Specimens must be collected in STERILE, dry, leakproof, and clear containers.
TRUE OR FALSE
FALSE
For first morning routine urinalysis CLEAN is enough
54
Disposable containers should be used because?
they eliminate the chance of contamination due to improper washing
55
Properly applied screw-top lids are less likely to leak than are snap-on lids.
TRUE OR FALSE
TRUE
56
Containers for routine urinalysis should have a NARROW mouth to facilitate collections from female patients and a wide, flat bottom to prevent overturning.
They should also be made of a IMPERMEABLE material to allow for determination of color and clarity.
TRUE OR FALSE
FALSE
Containers for routine urinalysis exhibit WIDE mouths and are made of CLEAR material
57
For routine urinalysis, we only need how much urine?
10 – 15 mL (avg. of 12 mL).
58
Containers must be large enough to allow room for mixing.
TRUE OR FALSE
TRUE
The recommended capacity of the container is 50 mL, which allows 12 mL of specimen needed for microscopic analysis, additional specimen for repeat analysis, and enough room for the specimen to be mixed by swirling the container.
59
used for microbiological studies of urine.
Individually packaged STERILE containers with secure closures
60
Labels must be attached to the LID of the container, not to the BODY, and should not become detached if the container is refrigerated or frozen.
TRUE OR FALSE
FALSE
Labels must be attached to the BODY
61
All specimens must be labeled immediately after collection
What are the minimum requirements for urine specimens?
o (1) Patient’s full name;
o (2) Date and time of collection;
o (3) Identification number (if present);
o (4) Additional information such as the patient’s age and location, the health care provider’s name, and the preservative used.
62
the form that must accompany specimens delivered to the laboratory.
Requisition Form
63
This form may include additional information such as method of collection or type of specimen, possible interfering medications, and the patient’s clinical information
The time the specimen is received in the laboratory should be recorded on the form. So that the staff will have a basis for determining the acceptability of the specimen
Requisition form
64
THE CRITERIA FOR URINE SPECIMEN REJECTION
* (1) Specimens in containers that are unlabeled or improperly labeled;
* (2) Labels and requisition forms that do not match;
* (3) Specimens contaminated with feces or toilet paper;
* (4) Containers with contaminated exteriors;
* (5) Specimens of insufficient quantity;
* (6) Specimens that have been transported improperly;
* (7) Specimens that have not been preserved correctly during a time delay
* (8) Specimens for urine culture collected in a nonsterile container;
* (9) Inappropriate collection for the type of testing needed (ex. midstream clean-catch specimen for bacterial culture).
65
After collection, specimens should be delivered to the laboratory promptly and tested within ___ hours
2hrs to preserve specimen integrity
66
A specimen that cannot be delivered and tested within 2 hours should be?
refrigerated or have an appropriate chemical preservative added.
67
Identify the analyte of changes in unpreserved urine
Oxidation or reduction of metabolites
Color
Modified/Darkened
68
Identify the analyte of changes in unpreserved urine
Bacterial growth and precipitation of amorphous material
Clarity
Decreased
69
Identify the analyte of changes in unpreserved urine
Bacterial multiplication causing breakdown of urea to ammonia
Odor
Increased ammonia smell
70
Identify the analyte of changes in unpreserved urine
Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2.
pH
Increased
71
Identify the analyte of changes in unpreserved urine
Glycolysis and bacterial use.
Glucose
Decreased
72
Identify the analyte of changes in unpreserved urine
Volatilization and bacterial metabolism.
Ketones
Decreased
73
Identify the analyte of changes in unpreserved urine
Exposure to light/photo oxidation to biliverdin.
Bilirubin
Decreased
74
Identify the analyte of changes in unpreserved urine
Oxidation to urobilin.
Urobilinogen
Decreased
75
Identify the analyte of changes in unpreserved urine
Multiplication of nitrate-reducing bacteria
Nitrite
Increased
76
Identify the analyte of changes in unpreserved urine
Disintegration/lyse in dilute alkaline urine
Red and white blood cells and casts
Decreased
77
Identify the analyte of changes in unpreserved urine
Multiplication
Bacteria
Increased
78
Identify the analyte of changes in unpreserved urine
Loss of motility, death.
Trichomonas
Decreased
79
Most commonly used method of preservation; does not interfere with routine tests. Done at 2°C – 8°C which decreases bacterial growth and metabolism.
Refrigeration
80
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured, up to ___ hours
24hrs
81
If a technique prevents bacterial growth, the term “________” is used
“bacteriostatic”
82
Maintains an acid pH for up to 8 hours
REFRIGERATION
83
This is the disadvantage of what specimen preservation
Disadvantage: Can cause precipitation of amorphous urate and phosphate crystals, which would make the specimen turbid and increase its’ specific gravity
REFRIGERATION
84
When a specimen must be transported over a long distance and refrigeration is impossible, what is added as a substitute?
chemical preservatives may be added
85
The ideal specimen should be BACTERICIDAL, inhibit urease, and preserve formed elements in the sediment. The preservative should not interfere with chemical tests.
TRUE OR FALSE
TRUE
86
Urine preservative that does not interfere with chemical tests (Advantage)
Refrigeration
87
Urine preservative that precipitates amorphous phosphates and urates (Disadvantage)
Refrigeration
88
Urine preservative that prevents bacterial growth for 24 hours
Refrigeration
89
Urine preservative that prevents bacterial growth and metabolism. (advantage)
Acids (boric acid*, HCL, acetic acid, tartaric acid)
90
Urine preservative that Interferes with analysis of drugs and hormones (disadvantage)
Acids (boric acid*, HCL, acetic acid, tartaric acid)
91
Urine preservative that Keeps pH at about 6.0 (may be considered as a disadvantage; may interfere with pH reading); can be used for transport of urine cultures.
Acids (boric acid*, HCL, acetic acid, tartaric acid)
92
Urine preservative that is an Excellent sediment preservative (advantage)
Formalin (formaldehyde)
93
Urine preservative that Acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction. (disadvantage)
Formalin (formaldehyde)
94
Urine preservative that is a Good preservative for drug analyses. (advantage)
Sodium fluoride
95
Urine preservative that Inhibits reagent strip tests for glucose, blood, and leukocytes (disadvantage)
Sodium fluoride
96
Urine preservative that is 50% alcohol and 2% carbowax 1540; prevents cell collapse.(advantage)
Saccomanno’s fixative (acellular/sediment preservative)
97
Urine preservative that May contain dehydrating agents. (disadvantage)
Saccomanno’s fixative (acellular/sediment preservative)
98
Urine preservative that is Commercially available preservative for cytology studies
Saccomanno’s fixative (acellular/sediment preservative)
99
Urine preservative that is Convenient when refrigeration not possible. Have controlled concentration to minimize interference (advantage)
Commercial preservative tablets
100
Urine preservative that Check tablet composition to determine possible effects on desired tests (disadvantage)
Commercial preservative tablets
101
Urine preservatives that Does not interfere with routine tests. (advantage)
PHENOL AND TOLUENE
102
Urine preservative that Causes odor change (disadvantage)
PHENOL
103
Urine preservative that Floats and clings to pipettes and other instruments.(disadvantage)
TOLUENE
104
Urine preservative that Acts as a physical barrier to air and bacteria.
TOLUENE
105
Urine preservative that Preserves glucose and sediments.(advantage)
Thymol
106
Urine preservative that Interferes with protein precipitation test (disadvantage)
Thymol
107
Urine preservative that is Effective against bacteria and molds.
Thymol
108
Contains collection cup, transfer straw, culture and sensitivity (C&S) preservative tube, or UA tube
URINE COLLECTION KITS (BECTON, DICKINSON, RUTHERFORD, NJ)
109
URINE COLLECTION KITS (BECTON, DICKINSON, RUTHERFORD, NJ)
Needle that mimics the vacutainer system in blood collection.
Transfer Device
110
Rinse specimen container with formalin to preserve cells and casts.
TRUE OR FALSE
TRUE
111
Identify this tube
* Culture and sensitivity.
* Preservative is boric acid, sodium borate, and sodium formate.
* Keeps pH at about 6.0.
Light Gray and Gray C&S Tube
112
Identify this tube
Use on automated instruments.
Yellow UA Plus Tube (Plain)
113
Identify this tube
* Preservative is sodium proprionate, ethyl paraben, and chlorhexidine.
* Round or conical bottoms.
Cherry Red/Yellow Preservatuve Plus Tube
114
This is an advantage of what tube?
Specimen is stable at room temperature (RT) for 48 hours; prevents bacterial growth and metabolism
Light Gray and Gray C&S Tube
115
This is an advantage of what tube?
Must refrigerate within 2 hours
Yellow UA Plus Tube (Plain)
116
This is an advantage of what tube?
Specimen stable at 72 hours at RT; instrument-compatible.
Cherry Red/Yellow Preservatuve Plus Tube
117
This is an disadvantage of what tube?
Do not use if urine is below minimum fill line.
Light Gray and Gray C&S Tube
118
This is an disadvantage of what tube?
Round or conical bottom; no preservative.
Yellow UA Plus Tube (Plain)
119
This is an disadvantage of what tube?
Must be filled to minimum fill line. Bilirubin and urobilinogen may be decreased if specimen is exposed to light and left at RT.
Cherry Red/Yellow Preservatuve Plus Tube
120
If the specimen stands for more than 2 hours and no preservative has been added, the color will change; usually LIGHTENS upon standing due to oxidation and reduction of metabolites.
TRUE OR FALSE
FALSE
The color DARKENS
121
The goal of preservation is either to prevent bacterial growth (bacteriostatic) or kill bacteria (bactericidal).
TRUE OR FALSE
TRUE
122
becomes alkaline; due to ammonia from the breakdown of urea by urease-producing bacteria
urine pH in unpreserved urine
123
These all increase in urine
Odor
pH
Nitrite (NO2)
Bacteria Crystals
124
These all decrease in urine
Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
Cells and casts
T. Vaginalis
125
reduction of nitrate is done by?
nitrate-reducing bacteria.
126
decreased glucose is due to?
Glycolysis
127
Decreased ketones are due to?
due to volatilization or bacterial metabolism
128
Identify the type of specimen based on the given purpose
Routine screening
RANDOM
129
Identify the type of specimen based on the given purpose
Routine screening
Pregnancy tests
Orthostatic protein
FIRST MORNING
130
Identify the type of specimen based on the given purpose
Quantitative chemical tests
24-HOUR (OR TIMED)
131
Identify the type of specimen based on the given purpose
Bacterial culture
CATHETERIZED (sterile)
132
Identify the type of specimen based on the given purpose
Routine screening
Bacterial culture
MIDSTREAM CLEAN-CATCH
133
Identify the type of specimen based on the given purpose
Bladder urine for bacterial culture
Cytology
SUPRAPUBIC ASPIRATION
134
Identify the type of specimen based on the given purpose
Prostatic Infection
THREE-GLASS COLLECTION AND FOUR-GLASS COLLECTION
135
A RANDOM specimen can be accepted for analysis if it is not to DILUTE.
TRUE OR FALSE
TRUE
It must not be DILUTE, otherwise, it can lead to falsely low counts and concentrations of chemical components. It also may show erroneous results resulting from dietary intake or physical activity just before collection.
136
This is the specimen received most commonly because of its’ ease of collection and convenience for the patient. Can be collected at any time, but the actual time of voiding should be recorded on the container
Random Specimen
137
Preferred specimen for routine urinalysis, pregnancy testing, and for evaluating (orthostatic proteinuria)
FIRST MORNING SPECIMEN
138
a benign type of proteinuria, which is only due to the gravitational pull (that is, if you stand for 2 hours or so).
Orthostatic (Postural) Proteinuria
139
▪ Common among young adults; there is a significant excretion of protein in urine.
▪ This disappears once the patient assumes a recumbent or lying position.
▪ Results should be negative; otherwise, it indicates true proteinuria
Orthostatic (Postural) Proteinuria
140
The most concentrated specimen of the day; thereby, assuring detection of chemicals and formed elements that may not be present in a dilute random specimen.
FIRST MORNING SPECIMEN
141
Successive voidings within a specific period are combined in a single container
Rule: Begin and end the collection with an empty bladder. Then void or discard the first urine (time zero); should not be collected at the container.
24-HOUR (OR TIMED) SPECIMEN
142
When the concentration of the substance to be measured changes with DIURNAL VARIATIONS and with daily activities, such as exercise, meals, and body metabolism, 12-HOUR collection is required.
TRUE OR FALSE
FALSE
24-HOUR
143
Preferred specimen for clearance tests (tests used to estimate the glomerular filtration rate).
24-HOUR (OR TIMED) SPECIMEN
144
Addis count
* Sediments constituents are enumerated using a hemocytometer.
* Preservative: Formalin (excellent sediment preservative).
12-HOUR SPECIMEN
145
Urobilinogen is subjected to photooxidation; container must be protected from light (wrapped in aluminum foil or an amber container is used).
o Period of the day where urobilinogen concentration is at
its’ peak. (2:00 – 4:00).
2-HOUR SPECIMEN
146
SPECIMENS FOR DIABETIC SCREENING/MONITORING
* Second morning specimen (as to not get false positive results for glucose and ketones).
* The first morning specimen, after a period of fasting, must be discarded
o It is expected to contain food metabolites prior to the
beginning of period
FASTING SPECIMEN
147
SPECIMENS FOR DIABETIC SCREENING/MONITORING
* Best for detecting glucosuria (Renal threshold for glucose is exceeded or met)
2-H POST-PRANDIAL
148
SPECIMENS FOR DIABETIC SCREENING/MONITORING
Used to accompany blood specimen in a routine oral GTT (Glucose Tolerance Test).
GTT URINE
149
Renal threshold for glucose is exceeded or met.
glucosuria
150
is the most vulnerable part of a drug-testing program; requires the most stringent protocol due to the possibility of legal implications
Urine specimen collection
151
the process that provides this documentation of proper specimen identification from the time of collection to the receipt of laboratory results.
Chain of Custody (COC)
152
Urine specimen collections may be “witnessed” or “unwitnessed.”
TRUE OR FALSE
TRUE
153
Volume of urine observed by a same-gender collector under witnessed collection for a drug testing specimen
30 – 45 mL of urine;
154
Temperature range for urine drug testing specimen
32.5°C to 37.7°C.
The urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated.
155
A specific gravity of less than 1.005 could indicate dilution of the urine specimen and requires re-collection for drug testing specimens.
TRUE OR FALSE
TRUE
156
This technique provides a safer, less traumatic method for obtaining urine for bacterial culture and routine analysis.
MIDSTREAM CLEAN-CATCH TECHNIQUE
157
Patients must be provided with appropriate cleansing materials, a sterile container, and instructions for cleansing and voiding in what collection technique
MIDSTREAM CLEAN-CATCH TECHNIQUE
158
Strong bacterial agents, such as hexachlorophene or povidone-iodine, should NOT be used as cleansing agents in performing MIDSTREAM CLEAN-CATCH TECHNIQUE
TRUE OR FALSE
TRUE
Mild antiseptic towelettes are recommended.
159
Collected under STERILE conditions by passing a hollow tube (catheter) through the urethra into the bladder
CATHETERIZATION
160
Occasionally, urine may be collected by external introduction of a needle through the abdomen into the bladder; traumatic procedure
SUPRAPUBIC ASPIRATION
161
the bladder is STERILE under normal conditions, this provides a specimen for bacterial culture that is completely free of extraneous contamination, particularly in infants or children. The specimen also can be used for cytology studies.
TRUE OR FALSE
TRUE
162
In 3 glass collection WBC and bacterial counts in tube 3 is 10x of those of tube 1.
TRUE OR FALSE
TRUE
163
Also known as the (FOUR-GLASS TECHNIQUE)
STAMEY-MEARES TEST
164
These are observed in what specimen collection?
* Soft, clear plastic bags are available for collecting routine specimens.
o These bags have hypoallergenic skin adhesive to attach to the cleaned genital area of both boys and girls.
o Sterile specimens may be obtained by catheterization or by suprapubic aspiratio
PEDIATRIC SPECIMEN COLLECTION
