Introduction to Urinalysis Flashcards
3 methods used in urinalysis?
- Disptick
- Basic (routine) urinalysis; Wet urinalysis
- Specialized cytopathogenic urine sediment exam
→ Commonly requested test
→ Urine contains many information
→ Inexpensive
Urinalysis
Screening test; also known as urine chemistry
Dipstick
also known as urine chemistry
Dipstick
Dipstick measures what urine components?
protein
glucose
pH
Basic (routine) urinalysis is also known as ?
Wet urinalysis
Whar are the 3 sections done in Basic (routine) urinalysis; Wet urinalysis?
Physical, Chemical, Microscopic
Basic (routine) urinalysis; Wet urinalysis
Physical section include observation of what 2 components?
Color, Transparency
Basic (routine) urinalysis; Wet urinalysis
In microscopic section, what components are nobserved?
Cells, casts
- Examination of abnormal cells with the latest technology
- Chemical, microscopic and new technologies like immunochemistry, molecular diagnostics, dNA, and cell cycle analysis
Specialized cytopathogenic urine sediment exam
T or F
Specialized cytopathogenic urine sediment exam is routinely performed
F (not routinely performed)
detects cancer, renal transplant rejection
Specialized cytopathogenic urine sediment exam
What is the composition of urine?
95% Water
5% Solute
Composition of Urine
How many percent of water is in urine?
95%
Composition of Urine
How many percent of solute is in urine?
5%
Urine composition factors because of what 4 factors?
- Dietary intake
- Physical activity
- Metabolism
- Endocrine functions
Main organic component of urine?
Urea
waste products of protein removed by kidney
Urea
T or F
Urea and creatinine are normal components of urine
T
Main inorganic components of the urine?
Chloride
What are the other organic components of urine
Creatinine, Uric acid, Ammonia, Nitrogen
What are the other inorganic components of urine
Sodium, Potassium, Phosphorus, Calcium, Magnesium, Iron
Other components of urine? (neither inorganic or organic)
Hormones, Vitamins, Medication, formed elements
T or F
Urine of volume depends on the volume of water the kidneys excrete
T
Normal average volume of urine of adults?
1,200 - 1,500 mL
Normal range of volume of urine of adults?
600 - 2,000 mL
Nigh urine is not excess of how many mL?
400 mL
T or F
Night urine in general is not in excess of 300 ml
F (not in excess of 400 ml)
When is the urine volume higher, day or night?
Day
Factors that influence urine volume?
- Fluid intake
- Fluid loss
- Variations in the secretions of ADH
- Necessity to excrete increased amounts of dissolved solids
This makes tubules permeable to water
ADH
High ADH indicates what in terms of volume of urine?
High ADH = low volume urine
Low ADH indicates what in terms of volume of urine?
Low ADH = High volume urine
Low ADH indicates what condition?
deficiency in ADH (diabetes insipidus)
Condition where urine is less than 400 mL/day in adults
Oliguria
Causes of Oliguria?
- Dehydration
- Renal ischemia
- Hemolytic transfusion reaction
- Uremia due to progressive renal disease
- Obstruction of urinary tract
Causes of Oliguria
Symptoms of dehydration include?
- Prolonged vomiting and diarrhea
- Excessive sweating
- Fever
Oliguria
Oligo means?
Decreased
Causes of Oliguria
narrowing of artery
Renal Ischemia
T or F
Narrowing of artery means more blood enters the kidney
F (narrowing of artery = less blood enters kidney)
Causes of Oliguria
red blood cells are damaged
Hemolytic Transfusion Reaction
- increase in urine volume
- more than 2,500 ml /24 hr
- 2.5 to 3 mL/kg/day in children
Polyuria
Polyuria
How many volume of urine excreted in polyuria?
2,500 ml /24 hr
Polyuria
How many volume of urine excreted in polyuria
In children
2.5 to 3 mL/kg/day
Polyuria
What conditions are associated with polyuria?
- diabetes mellitus
- diabetes insipidus
Polyuria
A condition in polyuria wherein there is defect either in pancreatic production of insulin or in insulin function
Diabetes mellitus
Polyuria
A condition in polyuria wherein there is decreased production or function of ADH causing decreased reabsorption of water from ultrafiltrate
Diabetes insipidus
Polyuria
High or Low Specific Gravity?
Diabetes mellitus
High SG
Polyuria
High or Low Specific Gravity?
Diabetes insipidus
Low SG
Causes of polyuria?
- Increased salt intake and high protein diet
- Drugs (caffeine, alcohol, thiazides and other diuretics)
- Intravenous saline or glucose solution
- Chronic progressive renal failure
more than 500 ml with a specific
gravity of less than 1.018 at night
Nocturia
Nocturia means having more than ____ mL with SG of less than ____ at night
500 mL, 1.018
complete or total suppression of urine formation
Anuria
urine that is left in the bladder after voluntary urination
Residual urine
Capcity of urine container
50 - 100 mL
Urine volume
10 - 15 mL
capacity container for 24 hour collection
3L
Light sensitive analytes
Bilirubin,
Urobilinogen
Porphyrins
Needed labels
Patient’s full name
Date of collection
Time of collection
Enumerate additional information written on requisition form
method of collection
type of specimen
interfering medications
patient’s clinical information
time the specimen is received
Urine must be tested within how many hours
2
Urine should be refrigerated if not tested within ___ mins after collection
30
Increase or Decrease in Unpreserved Urine
Bacteria
Increase
Increase or Decrease in Unpreserved Urine
Turbidity
Increase
Increase or Decrease in Unpreserved Urine
pH
Increase
Increase or Decrease in Unpreserved Urine
Nitrite
Increase
Increase or Decrease in Unpreserved Urine
Glucose
Decrease
Increase or Decrease in Unpreserved Urine
Ketones
Decrease
Increase or Decrease in Unpreserved Urine
Bilirubin
Decrease
Increase or Decrease in Unpreserved Urine
Urobilinogen
Decrease
Increase or Decrease in Unpreserved Urine
Cells and casts
Decrease
Increase or Decrease in Unpreserved Urine
Trichomonas
Decrease
Urease converts urea into what?
CO2 and ammonia
Nitrate is converted into what?
Nitrite
Bilirubin is converted into what?
Biliverdin
Urobilinogen is converted into what?
Urobilin
3 ways to preserve the specimen
Refrigeration 2°C to 8°C
Freezing
Chemical preservative
Characteristic of an ideal chem preservative
bactericidal - kills bacteria
inhibits urease
preserves formed elements in the specimen - WBCS stay the same
Preservative that does not iterfere with the chemical test
Refrigeration
Preservative used in C&S and maintains pH at 6.0
Boric acid
Bacteriostatic agent
Boric acid
Excellent sediment preservative
Formalin
Preservative used in glucose determination
Sodium Fluoride
Preservative used in cytologic studies
Saccomanno’s
Container that contains Boric acid, sodium borate, and sodium formate
Light gray tube (for C&S)
Urine in light dray tube is stable at RT for how many hours
48 hours
Light gray tube can preserve estriol and estrogen for how many days
7
Urine container;
With tube for automated instruments
No preservative
Yellow UA
Cherry red/yellow top container has which two components?
Na+ propionate and chlorhexidine
Urine in cherry red/yellow top is stable at RT for how many hours
72
Preservation for urea
Ref
Preservation for aldosterone and cortisol
Boric acid
Preservation for cathecolamines
6N HCl
Routine screening
Random specimen
Urine specimen
concentrated and acidic (Casts dissolve in dilute alkaline urine)
ideal for routine urinalysis and pregnancy testing
evaluation of orthostatic proteinuria
First morning
Urine specimen
Fasting patient
The next day patient will urinate, discard the first morning
Get the second morning
Fasting (2nd morning)
Urine specimen
Starting from time zero
Timed specimen
Timed specimen
Quantitative analysis, clearance tests
Diurnal variations
Mix specimen
Measure total volume collected
40 mL aliquot is submitted for
analysis
24-hour
Timed specimen
Formalin as preservative
12-hour specimen
Timed specimen
Monitoring insulin therapy in DM
2-hour post prandial
Timed specimen
used for “urobilinogen determination”
Urobilinogen is stable at alkaline ph
Afternoon specimen
Afternoon specimen is collected at which hours
2 - 4pm
Urine specimen
Bacterial culture/routine analysis
Cytology
Midstream
Urine specimen
3 glass collection
Prostatitis specimen
Urine specimen
Soft,clear plastic bags with hypoallergenic skin adhesive
Pediatric collection
T or F: First morning urine is alkaline
False
For bacterial culture, do not use strong bacterial agents such as __________ or ________ _______ as cleansing agents
hexachlorophene, povidone iodine
process that provides documentation of proper sample identification from the time of collection to the receipt of laboratory results.
Chain of custody
Required amount for drug specimen collection
30 - 45 mL (60mL)
Required temperature for drug specimen collection
32.5 - 37.7 within4 mins
yellow pigment in Urine;
most abundant
Urochrome
orange red; brown pigment in urine
Urobilin
Pink-red pigment in urine
Uroerythrin
White foam in urine is attributed to?
Protein
Yellow foam in urine is caused by?
Bilirubin
State the color
Conc specimen
B complex vitamins
Dehydration
Bilirubin
Acriflavine
Nitrofurantoin
Dark yellow
State the color
Phenazopyridine (Pyridium), azo gantrisin
Phenindione
Orange-yellow
State the color
Bilirubin oxidized to biliverdin
Yellow-green
State the color
Pseudomonas infection
Green
State the color
Clorets
Phenol
Amitriptyline
Methocarbamol
Methylene blue
Indican
Blue-green
State the color
RBCs
Hemoglobin
Myoglobin
Beets
Rifampin
Mens contamination
Pink Red
State the color
Porphyrins
Port wine
State the color
RBCs oxidized to methemoglobin
Myoglobin
Red-brown
State the color
Homogentistic acid
Malignant melanoma
Melanin or melanogen
Phenol derivatives
Argyrol
Methyldopa or Iovedopa
Metronidazole
Brown Black
Cloudy urine and has RBCs present
Hematuria
Clear urine and has clear blood plasma
Myoglobinuria
Clear urine and has red blood plasma
Hemoglobinuria
Clarity
No visible particulates; transparent
Clear
Clarity
Few particulates; print easilty seen through urine
Hazy
Clarity
Many particulates; print blurred through ruine
Cloudy
Clarity
Print cant be seen
Turbid
Clarity
May precipitate or clotted
Milky
Attributed for pink cloud seen in urine
Urates
Attributed for orange cloud seen in urine
Uric acid
Attributed for white cloud seen in urine
Leukocytes
Urine turbidity
Amorphous urates
Radiographic contrast media
Acid urine
Urine turbidity
Amorphous phosphates
carbonates
Alkaline urine
What are soluble with heat?
Urates and uric acid
What are soluble in dilute acetic acid?
RBCs, amorphous phosphates, carbonates
What are insoluble in dilute acetic acid?
WBCS, Bacteria, Yeast, Sperm
What are soluble in ether?
Lipids, lymphatic fluid, chyle
Pathologic or nonpathologic
Squamous epith cell
Mucus
Amorphous urates/phosphates
Semen
NOn
Pathologic or nonpathologic
Fecal contamination
Radiographic contrast media
Talcum, vaginal creams
Non
Pathologic or nonpathologic
RBC (>500 RBC/ul
WBC (>200 WBC/ul)
Pathologic
Pathologic or nonpathologic
Bacteria
Yeast
Non-squamous epithelial cells
Pathologic
Pathologic or nonpathologic
Abnormal crystals
Lymph fluid
Lipids
Pathologic
Density of a solution compared with the density of a similar volume of distilled water at a similar temperature
SG
indicates the relative proportion of dissolved solid components to total volume of the specimen
SG
Average SG
1.016 - 1.022
Range for SG
1.002 - 1.035
SG for Isosthenuric
1.010
SG for hypothenuric
below 1.010
SG for hypersthenuric
above 1.010
Execution of which three components will give a high SG in urine?
radiographic contrast media, mannitol, and dextran
Principle of urinometry
Water displacement or buoyancy
Disadvantage or urinometry
Needs 10 - 15 mL
Increased or decreased SG
Cold temp
Increased
Increased or decreased SG
High temp
Decreased SG
Principle for refractometry
Refractive index
Refers to change in direction of wave due to change in speed
Refraction
determines the concentration of dissolved particles in a specimen by measuring the refractive index
Refractometer
comparison of velocity of light
in air with velocity of light in a solution
Refractive index
Refractometer calibrated reading of 3% NaCl
1.015
Refractometer calibrated reading of 5% NaCl
1.022
Refractometer calibrated reading of 9% sucrose
1.034
T or F: Refractometer has temperature compensated bet 15 c and 28 c
False (15 - 38)
Principle of dipstick
pKa change of polyelectrolytes
Reagent strip contains which three components?
Polyelectrolytes
Indicator
Buffer
Polyelectrolytes used in dipstick
Multistix and chemstrip
Multistix or chemstrip
polymethylvinyl
ether/malei acid
Multistix
Multistix or chemstrip
ethylene glycol-bis
tetraacetic acid
Chemstrip
Interference in reagent strip that causes a falsely elevated result
High conc of protein
Interference in reagent strip that causes a falsely decreased result
Highly alkaline urine
A volume of urine is maintained in a U shaped tube and a sound wave of fixed frequency is transmitted to one end of the tube.
Specific gravity is directly related to the change in frequency recorded as the sound wave exits the other end of the tube
Harmonic Oscillation Densitometry
timing the fall of a drop of body fluid of known size, through a definite distance in a mixture
heavier drop will fall faster
there is column and water immiscible oil
Falling drop
Enumerate the direct methods for SG measurement
Urinometer
Harmonic oscillation densitometry (HOD)
Enumerate the indirect methods for SG measurement
Refractometer
Chemical reagent strips
the concentration of a solution in terms of osmoles of solute per kilogram of solvent
indicates the number of particles of solute per unit of solution
Osmolality
Normal value for serum osmolality
275 - 300 mOsm/kg
After period of dehydration, osmolality of urine should be how many times higher than that in the plasma?
3 - 4 times
Solute dissolved in solvent causes which 4 changes in colligative properties?
lower freezing point
lower vapor pressure
higher boiling point
higher osmotic pressure
T or F: Freezing point of a liquid is depressed when another compound is added
True
State the odor
faint, aromatic
(fresh specimen)
Normal odor
Substance responsible for odor of urine
Urinod
State the odor
Bacterial contamination
Ammoniacal
State the odor
Diabetic acidosis
Sweet/fruity
State the odor
Asparagus, Onions, Garlic
Pungent
State the odor
isovaleric & glutaric
Sweaty feet
State the odor
Maple syrup urine disease
Maple syrup
State the odor
methionine malabsorption
Cabbage
State the odor
phenylketonuria (for mentally retarded people
Mousy
State the odor
trimethylaminuria
Rotting fish
State the odor
Tyrosinemia
Rancid
State the odor
Contamination
Bleach
