Introduction to Urinalysis Flashcards
1
Q
____ is the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner (CLSI).
A
Urinalysis
2
Q
Duration of manual urinalysis
A
15 minutes
3
Q
Duration of automated urinalysis
A
6 minutes
4
Q
____ is the foundation (beginning) of laboratory medicine.
A
Urinalysis
5
Q
History of Urinalysis
5th BC
A
Hippocrates wrote a book on “Uroscopy”
6
Q
References to the study of urine can be found in the ____ and in ____.
A
- Drawings of cavemen
- Egyptian hieroglyphics, such as Edwin Smith Surgical Papyrus
7
Q
____ wrote a book on “Uroscopy”
A
Hippocrates
8
Q
Hippocrates wrote a book on ____.
A
Uroscopy
9
Q
History of Urinalysis
Middle Ages
A
Physicians were trained on the “Art of Uroscopy”
10
Q
During the Middle Ages, physicians were trained on the ____.
A
Art of Uroscopy
11
Q
History of Urinalysis
1140 AD
A
Color charts were developed
Describes the significance of 20 different colors
12
Q
Color charts were developed to describe the significance of ____.
A
20 different colors
13
Q
History of Urinalysis
1627
A
- Thomas Bryant published a book called “Pisse Prophets” which was about charlatans.
- The book inspired the passing of the first medical licensure laws in England
14
Q
____ published a book about charlatans.
A
Thomas Bryant
15
Q
Thomas Bryant published the book called ____.
A
Pisse Prophets
16
Q
____ are predictors about health without proper medical background.
A
Pisse prophets (quack doctors/charlatans)
17
Q
Pisse prophets are also called as ____.
A
Quack doctors or Charlatans
18
Q
History of Urinalysis
1694
A
Frederik Dekker discovered albuminuria (white precipitates)
19
Q
____ discovered albuminuria.
A
Frederik Dekker
20
Q
Frederik Dekker discovered ____.
A
albuminuria
21
Q
How did Dekker discovered albuminuria?
A
By boiling the urine
22
Q
History of Urinalysis
17th Century
A
- Discovery of Microscope by Anton van Leeuwenhoek
- Development of methods for quantitating microscopic sediment by Thomas Addis
23
Q
____ developed methods of quantitating microscopic sediments.
A
Thomas Addis
24
Q
History of Urinalysis
1827
A
Richard Bright introduced urinalysis as part of a doctor’s routine patient examination
25
____ introduced urinalysis as part of a doctor's routine patient examination.
Richard Bright
26
____ led to the passing of medical licensure laws in England.
The book "Pisse prophets"
27
The first medical licensure laws were passed in ____.
England
28
Importance of Urinalysis (Unique Characteristics)
* Readily available and easily collected
* Contains information which can be obtained by inexpensive lab tests
29
Reasons for performing Urinalysis
* Aids in diagnosing of disease
* Screen asymptomatic population
* Monitor disease progression and effectiveness of therapy
30
# **Situation**
A 2 year old patient submitted a 2 mL amount of urine. If the average amount of urine to be submitted is 10-15 mL, should you accept or reject the specimen?
**Accept** but take note in the result form
| For patients that are geriatric, pediatric, or with special case.
31
In-born errors were discovered due to the ____.
peculiar odor of urine
32
Four Parts of Routine Urinalysis
1. Specimen Evaluation
2. Physical Examination
3. Chemical Examination
4. Sediment/Microscopic Examination
33
# **Identify which part of Routine Urinalysis**
Checking for the following:
* Contamination
* Label
* Amount
Specimen Evaluation
34
What is the ideal amount when collecting a urine specimen?
10 - 15 mL
35
What is the average amount when collecting a urine specimen?
12 mL
36
In a 50 mL urine container, the specimen should be ____ full.
3/4
37
# **Identify which part of Routine Urinalysis**
Accepting or rejecting a specimen
Specimen Evaluation
38
# **Identify which part of Routine Urinalysis**
Checking for the following:
* Color
* Volume
* Clarity
Physical Examination
39
# **Identify which part of Routine Urinalysis**
Testing the soluble substances or dissolved solids
Chemical Examination
40
# **Identify which part of Routine Urinalysis**
Gold standard
Sediment/Microscopic Examination
41
# **Identify which part of Routine Urinalysis**
Confirms the result of the latter examinations
Sediment/Microscopic Examination
42
If the urine specimen is clear red, then it means that ____.
The specimen is hemolyzed
43
If If the urine specimen is cloudy red, then it means that ____.
The RBCs are intact
44
Ascorbic acid is a ____ which causes a false negative result.
reducer
45
The kidneys convert approximately ____ of filtered plasma to the average daily urine output.
170,000 mL (170 L)
46
The average daily urine output is ____.
1,200 - 1,500 mL
47
The kidneys form urine as an ultrafiltrate of ____.
Plasma
48
Patients who undergo dialysis usually suffer from ____.
heart attack
49
# **TRUE OR FALSE.**
Amino acids should be excreted out of the body.
False
50
Normal range of urine output
600 - 2,000 mL
51
Amount of glucose absorbed for patients with Diabetes Mellitus
160 - 180 mg/dL
52
If the amount of glucose reabsorbed exceeds the limit, what will happen?
The excess glucose will come out of the urine, therefore the patient will be positive for glucose
| **REMEMBER:** kapag may solute, ang kasunod ay water.
53
Urine % Composition
95% water + 5% solutes
54
Variation in urine concentration may be due to ____.
* Dietary intake
* Physical activity
* Body's metabolism
* Endocrine function
* Body's position
55
Dietary intake relationship to solute concentration
Directly proportional (the more we consume, the higher the solute concentration)
56
Physical metabolism relationship to solute concentration
Directly proportional (high physical activity = high metabolism = high concentration of solute)
57
What endocrine hormones affect the urine?
* Antidiuretic hormone (ADH)
* Aldosterone
58
Body Position relationship to solute concentration
Prolonged standing can cause increased protein
59
When urine is positive for protein it can be an indication of ____.
kidney problem
60
Organic Solutes in Urine
* Urea
* Creatinine
* Uric acid
* Hippuric acid
61
When will the urine be unsterile?
When it passes the urethra
62
____ is the primary organic component of urine.
Urea
63
Urea is produced in the ____.
liver
64
Urea is produced due to the ____.
Metabolism of protein and amino acids
65
____ is the solute that is predominant in urine.
Urea
66
Creatinine is a product of ____.
Metabolism of creatine by muscles
67
Uric acid is a product of ____.
Purine metabolism
68
____ is the product of creatine metabolism in the muscles.
Creatinine
69
____ is the product of purine metabolism.
Uric acid
70
Amount of urea in a 24 hour urine
25 - 35 g
71
Amount of creatinine in a 24 hour urine
1.5 g
72
Amount of uric acid in a 24 hour urine
0.4 - 1 g
73
Amount of hippuric acid in a 24 hour urine
0.7 g
74
Amount of other substances in a 24 hour urine
2.9 g
75
Inorganic Solutes in Urine
* Chloride
* Sodium
* Pottasium
* Sulfate
* Phosphate
* Ammonium
* Magnesium
* Calcium
76
____ is the primary inorganic component of urine.
Chloride
77
____ is the principal salt in urine.
Sodium Chloride
78
Amount of sodium chloride in a 24 hour urine
15 g
79
Amount of pottasium in a 24 hour urine
3.3 g
80
Amount of sulfate in a 24 hour urine
2.5 g
81
Amount of phosphate in a 24 hour urine
2.5 g
82
Amount of ammonium in a 24 hour urine
0.7 g
83
Amount of magnesium in a 24 hour urine
0.1 g
84
Amount of calcium in a 24 hour urine
0.3 g
85
Other substances in the urine
* Hormones
* Vitamins
* Medications
86
Formed elements in the urine
* Cells
* Casts
* Crystals
* Mucus
* Bacteria
87
Some changes in urine specimen are caused by ____.
viable cells
88
Specimens should be tested within ____.
2 hours
89
A specimen that cannot be delivered and tested within 2 hours should be ____.
refrigerated or have a chemical preservative added
90
Most of the changes in the urine specimen are related to the ____.
presence and growth of bacteria
91
# **Changes in Upreserved Urine**
**Analyte:** Color
**Change:**
Modified/Darkened
| **Cause:** Oxidation or Reduction of metabolites
92
Why does the color of our urine darken overtime?
Due to the oxidation of Urobilinogen which turns into Urobilin (gives brown pigment)
93
Which component is responsible for the brown pigment of urine?
Urobilin
94
Color of urobilinogen
colorless
95
# **Changes in Upreserved Urine**
**Analyte:** Clarity
**Change:**
Decrease
| **Cause:** Bacterial growth and precipitation of material
96
Why does the clarity of a urine specimen decreases when left unpreserved?
Due to the growth of bacteria and precipitation of amorphous material
97
If the specimen clarity decreases, what will happen to the turbidity?
Increase
98
If the specimen clarity decreases, what will happen to the transparency?
Decrease
99
As the cells increase, the turbidity will ____.
also increase
100
# **Changes in Upreserved Urine**
**Analyte:** Odor
**Change:**
Increased ammonia smell (ammoniacal)
| **Cause:** Breakdown of urea to ammonia via urease-producing bacteria
101
What is the normal odor of urine?
Aromatic or Fragrance
102
Why does the odor of a urine specimen increases when left unpreserved?
Due to the growth of urease-producing bacteria, which converts urea to ammonia
103
A chlorine-like smell of urine can be a possible indication of ____.
in-born error
104
# **Changes in Upreserved Urine**
**Analyte:** pH
**Change:**
Increased (alkaline)
| **Cause:** Breakdown of urea to ammonia via urease-producing bacteria +
## Footnote
loss of CO2
105
Why does the pH of a urine specimen increases when left unpreserved?
Due to the growth of urease-producing bacteria, which converts urea to ammonia, and leads to the loss of CO2
106
# **Changes in Upreserved Urine**
**Analyte:** Glucose
**Change:**
Decreased
| **Cause:** Glycolysis and bacterial use
107
Why does the glucose of a urine specimen decreases when left unpreserved?
Due to glycolysis and bacterial use
108
# **Changes in Upreserved Urine**
**Analyte:** Ketones
**Change:**
Decreased
| **Cause:** Votalization and bacterial metabolism
109
Why does the ketones of a urine specimen decrease when left unpreserved?
Due to votalization and bacterial metabolism
110
Ketones are a product of ____ metabolism.
lipid
111
# **Changes in Upreserved Urine**
**Analyte:** Bilirubin
**Change:**
Decreased
| **Cause:** Exposure to light/photo oxidation to biliverdin
112
Bilirubin came from ____.
Heme of hemoglobin (via hemolysis)
113
Heme is converted in the ____ to become bilirubin.
liver
114
Bilirubin is converted in the intestine to become ____.
Urobilinogen
115
____ is the only analyte that will NEVER become negative.
Urobilinogen
116
Urobilinogen travels to the intestine via ____.
Bile duct
117
Why does bilirubin increase in urine?
Because it is not converted into urobilinogen
118
Why does bilirubin not convert to urobilinogen?
Because there might be a blockage or tumor in the bile duct
| Iikot sa blood, pupunta sa kidneys, lalabas sa urine.
119
# **Changes in Upreserved Urine**
**Analyte:** Urobilinogen
**Change:**
Decreased
| **Cause:** Oxidation to urobilin
120
# **Changes in Upreserved Urine**
Why does urobilinogen of a urine specimen decrease when left unpreserved?
Because it undergoes oxidation to urobilin
121
# **Changes in Upreserved Urine**
**Analyte:** Nitrite
**Change:**
Increased
| **Cause:** Multiplication of nitrate-reducing bacteria
122
Why does nitrite of a urine specimen increase when left unpreserved?
Due to the multiplication of nitrate-reducing bacteria
123
A positive result in nitrite can indicate the possibility of ____.
UTI
124
# **Changes in Upreserved Urine**
**Analyte:** RBCs, WBCs and casts
**Change:**
Decreased
| **Cause:** Disintegration/lyse due to alkalinity
125
Why does RBCs, WBCs, and casts of a urine specimen decrease when left unpreserved?
Because they disintegrate or lyse due to the alkalinity of urine
126
# **Changes in Upreserved Urine**
**Analyte:** Bacteria
**Change:**
Increased
| **Cause:** Multiplication
127
# **Changes in Upreserved Urine**
**Analyte:** Trichomonas
**Change:**
Decreased
| **Cause:** Loss of motility, death
128
The most routinely used method of preservation is ____.
Refrigeration
129
Temperature for refrigeration to preserve specimen
2 - 8 C
130
Why is refrigeration commonly used as a method of preservation?
* Decreases bacterial growth
* Stops bacterial metabolism (bacteriostatic)
131
Is sterile container required for routine urinalysis?
No (as long as the container is clean)
132
Sterile container is only used in ____.
Culture and Sensitivity
133
How do we mix urine?
By swirling
134
All body fluids are considered biohazardous except ____.
Sweat
135
Characteristics of an ideal urine container
* Clean, dry, leak-proof, disposable
* Screw-top lid
* Wide mouth and flat bottom
* Clear plastic
136
Specimen label contents
* Name
* Age
* Gender
* Date and Time of Collection
137
____ causes a yellow foam in the urine.
Phenazopyridine
138
Additional information on the requisition form
* Method of collection
* Type of Specimen
* Interfering medications
* Patient's clinical information
* Time specimen is received
139
Criteria for specimen rejection
* Unlabeled containers
* Non-matching labels and requisition form
* Contaminated
* Insufficient quantity (depends on the situation)
140
The ____ tells about the amount of solute present in urine.
Specific Gravity
141
Specific gravity of urine
1.003 - 1.035
142
Specific gravity of distilled water
1.000
143
Specific gravity of a patient with diabetes insipidus
1.002
144
Normal pH of urine
4.0 - 8.0
145
Normal temperature of urine
32.5 - 37.5
146
Creatinine of urine
50x that of plasma
147
# **Types of Urine Specimen Collection**
Most commonly received specimen because of its ease of collection and convenience.
Random Urine
148
# **Types of Urine Specimen Collection**
May be collected at any time
Random Urine
149
# **Types of Urine Specimen Collection**
Useful for routine screening tests to detect obvious abnormalities
Random Urine
150
# **Types of Urine Specimen Collection**
May show erroneous results resulting from dietary intake and physical activity.
Random Urine
151
# **Types of Urine Specimen Collection**
Ideal screening specimen
First Morning Urine
152
# **Types of Urine Specimen Collection**
Prevents false-negative pregnancy tests and for evaluating orthostatic proteinuria
First Morning Urine
153
# **Types of Urine Specimen Collection**
Most concentrated (acidic) urine
First Morning Urine
154
# **Types of Urine Specimen Collection**
The second voided specimen after a period of fasting
Fasting Specimen (Second Morning Urine)
155
# **Types of Urine Specimen Collection**
The specimen will not contain any of the metabolites from food ingested before the beginning of the fasting period.
Fasting Specimen (Second Morning Urine)
156
# **Types of Urine Specimen Collection**
Recommended for glucose monitoring
Fasting Specimen (Second Morning Urine)
157
# **Types of Urine Specimen Collection**
Used for monitoring insulin resistance
Two-Hour Postprandial Specimen
158
# **Types of Urine Specimen Collection**
Collected 2 hours after eating
Two Hour Postprandial Specimen
159
# **Types of Urine Specimen Collection**
The urine is tested for glucose and ketones, and the results are reported along with the blood test results as an aid to interpreting the patient’s ability to metabolize a measured amount of glucose and are correlated with the renal threshold for glucose.
Glucose Tolerance Specimens
160
# **Types of Urine Specimen Collection**
Usually performed for pregnant women
Glucose Tolerance Specimens
161
# **Types of Urine Specimen Collection**
Used to quantitate amount of solute in urine
**Timed Specimen:** 24 hour
162
# **Types of Urine Specimen Collection**
Used for Addi's count or to quantitate amount of formed elements in the urine
**Timed Specimen:** 12 hour
163
# **Types of Urine Specimen Collection**
Used for nitrite determination
**Timed Specimen:** 4 hour
164
# **Types of Urine Specimen Collection**
Used for urobilinogen
**Timed Specimen:** Afternoon urine (2-4 pm)
165
When is the best time to collect an afternoon urine specimen?
2 - 4 pm
166
# **Types of Urine Specimen Collection**
The most commonly requested specimen for culture and sensitivity
Catheterized Specimen
167
# **Types of Urine Specimen Collection**
Collected under sterile conditions by passing a hollow tube through the urethra into the bladder.
Catheterized Specimen
168
2 Types of Catheterized Specimen
* Urethral
* Ureteral
169
# **Determine which type of Catheterized Specimen**
Collects urine specimen up to the urinary bladder
Urethral
170
# **Determine which type of Catheterized Specimen**
Used to check if the patient has cystitis, UTI, etc.
Urethral
171
# **Determine which type of Catheterized Specimen**
Collect urine specimen up to the ureter
Ureteral
172
# **Determine which type of Catheterized Specimen**
Used to check if the patient has pyelonephritis
Ureteral
173
# **Determine which type of Catheterized Specimen**
To locate whether the infection is on the left, right, or both kidneys.
Ureteral
174
If the infection progressed up to the urethra and bladder, then it could lead to ____.
* Lower UTI
* Cystitis
175
If the infection progressed up to the ureter and kidneys, then it could lead to ____.
* Upper UTI
* Pyelonephritis
176
# **Types of Urine Specimen Collection**
A safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis.
Midstream Clean-Catch Specimen
177
# **Types of Urine Specimen Collection**
The most invasive among all methods of urine specimen collection
Suprapubic Aspiration
178
# **Types of Urine Specimen Collection**
Introduction of a needle through the abdomen into the bladder.
Suprapubic Aspiration
179
# **Types of Urine Specimen Collection**
The most sterile method of urine specimen collection, guided by an ultrasound.
Suprapubic Aspiration
180
# **Types of Urine Specimen Collection**
Performed to check if there is infection in the prostate gland
Prostatitis Specimen
181
Individuals who undergo drug testing are called ____.
clients
182
Volume of urine for drug specimen
30 - 45 mL
183
The container for drug specimen is ____.
translucent
