KLUBSY: INTRODUCTION TO URINALYSIS Flashcards
References of the study or urine can be found where?
in the drawings of cavemen and in Egyptian hieroglyphics, such as Edwin Smith surgical papyrus
Who wrote the book “uroscopy”
Hippocrates
Who discovered albuminuria by boiling urine?
Frederik Dekker
Who published a book about “Pisse prophets”?
Thomas Bryant
Addis count
Thomas Addis
Who introduced the concept of urinalysis as part of a doctor’s routine patient examination
Richard Bright
This is the pigment that causes yellow color of urine
Urochrome
Who discovered urochrome?
Thudicum
Reasons for performing urinalysis?
1 Diagnosis of disease
2 Screening asymptomatic populations for undetected disorder
3 monitoring the progress of disease
4 monitoring the effectiveness of therapy
Urine consists of what?
-urea
-other organic and inorganic chemicals dissolved in water
Urine is normally what percent of water?
95% water and 5% solutes
Primary organic component in the urine
Urea
*URganic
This is the 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 in the urine
chloride
this is found in combination with sodium and many other inorganic substances
chloride
Primarily from salt, varies by intake
sodium
combined with chloride and other salts
potsassium
combines with sodium to buffer the blood
phosphate
regulates blood and tissue acidity
ammonium
combines with chloride, sulfate, and phosphate
calcium
a normal urine constituent
nitrate
This is the major organic component of urine
UREA
*URganic
This is the major INorganic component of urine followed by sodium then potassium
chloride
What are the INORGANIC components of urine?
1 chlorde
2 Sodium (Na)
3 Potassium K
*ChaNaK
What are the most important analytes in order for fluid to be identified as urine?
high urea and creatinine
the single most useful substance that identifies a fluid as urine is what?
its uniquely high creatinine concentration
What is the volume or measurement of “HIGH CREATININE” to be considered as urine?
Approx. 50 TIMES that of plasma
Urine volume depends on what?
the amount of water that the kidneys excrete
this depends on the amount of water that the kidneys excrete
Urine volume
What is the NORMAL DAILY urine output?
usually 1200 to 1500 mL
*a range of 600 to 2000 mL is considered normal
This term refers to decrease in daily urine output
oliguria
This state might progress to anuria (complete absence of urine production)
Oliguria
What is the measurement of oliguria in infants?
< 1mL/kg/hr
what is the measurement of oliguria in children?
< 0.5mL/kg/hr
In oliguria, urine output is measured as how much in 24 hours?
< 400 mL/day
this term refers to increase in daily urine output
Polyuria
What is the polyuria measurement in children?
> 2.5 - 3mL/kg/day
How much is urinated in polyuria per day?
> 2000 mL per day
*other books: more than 2.5L/24 hours
this term refers to increase or excessive excretion of urine at night
Nocturia
What is the normal day to night urine volume ratio?
2-3:1
What is the measurement for nocturia conditions?
more than 500 mL urine
What is the urine specific gravitiy of those with nocturia?
Less than 1.018
this term refers to cessation of urine flow or NO URINE output
Anuria
Sometimes defined as being <100 mL/24 hr during 2 to 3 consecutive days, in spite of a high fluid intake
Anuria
This has a urine S.G of less than 1.018
Nocturia
This has more than 500 mL urine
Nocturia
It has a normal day to night urine volume ratio of 2-3:1
Nocturia
It has more than 2.5 to 3ml/kg/day in children
polyuria
this has more than 2000 mL urine per day
polyuria
This has less than 1ml/kg/hr in infants
Oliguria
this has LESS than 0. ml/kg/hr in children
oliguria
DM or DI: Due to defect in the pancreatic production of insulin
DM
DM or DI: increase urine S.G
DM
DM or DI: Increase urine glucose (glucosuria)
DM
DM or DI: Due to decrease production of function of ADH
DI
DM or DI: Decrease urine S.G
DI
Urine specimens should be delivered to the laboratory promptly and tested within ???
2 hours
What are the characteristics of a urine container?
- clean, dry, lea-proof
- with screw top lids
- wide mouth and wide flat bottom
- made of sterile material
the recommended urine container capacity is ???
50 mL
the required specimen volume for urine microscopic analysis is ???
10 tto 15 mL
what is the AVERAGE required specimen volume for urine microscopic analysis?
12 mL
What are the information to be included in the labelling?
- Px name
- Px identification number
- Date and time of collection
- additional info such as age, sex, etc.
Urine containers should stand upright and have an opening of how big?
at least 4 to 5 cm
T/F: Urine containers should have a capacity of 500 to 100 mL
T
Where must be the labels be attached or written?
BODY OF CONTAINER, not on the lid
Reject or accept specimen: Specimen in unlabeled containers
Reject
Reject or accept specimen: non matching labels and requisition forms
reject
Reject or accept specimen: specimens contaminated with feces or toilet paper
reject
Reject or accept specimen: containers with contaminated exteriors
reject
Reject or accept specimen: specimens of insufficient quantity
reject
Reject or accept specimen: specimens that are improperly transported
reject
What must be done if a specimen cannot be delivered and tested within 2 hours?
-should be refrigerated or have an appropriate chemical preservative added
When the urine cannot be delivered and tested within 2 hours AND is not refrigerated and without a chemical preservative,,, what analytes are increased?
-pH
- Bacteria
- Odor
- Nitrite
- Color (darkened)
*PBaON-C
T/F: Protein/Alubmin is least or not affected when the urine is not preserved
TRUE
Enumerate urine preservatives:
- Refrigeration (2-8C)
- thymol
-boric acid
-formalin
-toluene
-sodium fluoride
-phenol
-Gray C and S tube - Cherry red/yellow top tube
- Yellow plain UA
-Saccomanno fixative - Sodium carbonate
This is the easiest and most common way of preservation
Refrigeration
this is an excellent sediment preservative
formalin
this preservative is good for drug analysis
sodium fluoride
this preservative prevents glycolysis
sodium fluoride
Preservatives that do not interfere with routine test
-toluene
-phenol
this preservative is stable for 72 hours
cherry red/yellow top tube
this preservative is stable at RT for 48hrs
Gray C and S tube
This preservative is for automated instruments
yellow plain UA
What is the component of saccomanno fixative?
ethanol + carbowax
This preservative is inexpensive
Sodium carbonate
This preservative precipitates amorphous crystals
Refrigeration
this preservative is used for cytological examination
Saccomanno fixative
This preservative is unacceptable for urinalysis testing
Saodium carbonate
This can be used to preserve urine for catecholamines
Concentrated HCl
this preservative keeps pH at 6.0
boric acid
these preservatives can be used for culture and sensitivity
Refrigeration and boric acid
this preservative can also be used for cytology
formalin
this preservative is used for Addis counting
Formalin
What is the principle of automated reagent strip reader?
REFELCTANCE PHOTOMETRY
These preservatives do not interfere with routine test
-Toluene
- Phenol
*ToPhe
this is a.k.a polyethylene glycol
carbowax
what is the normality of the HCl preservative that is used for catecholamines?
6N HCL
Types of urine specimen
-random specimen
-first morning specimen or 8hr specimen
-second morning (fasting specimen)
-2hr post prandial specimen
-timed specimens (24 hr urine spx)
- afternoon urine (2pm-4pm)
-12hr urine spx
- catheterized specimen
-midstrea, clean catch
-supra-pubic aspiration
- pediatric specimen
this urine specimen is the most commonly received specimens
random specimen
this urine spx is east to collect and convenient
random spx
this urine spx is for routine screening
random spx
this urine spx can be collected at any time, usually during daytime hours, and without patient prep
random spx
This urine spx is ideal for cytology
Random urine “clean catch” with prior hydration
This urine spx is ideal for routine UA
First morning spx
first morning spx is a.k.a
8hr specimen
this urine spx is the most concentrated spx
First morning spx
this urine spx is ideal to test for substances that require concentration or incubation for detection
first morning spx
these urine spx are often preferred for cytology studies
1st morning spx
why are 1st morning spx preferred for cytology studies?
because the number of epithelial cells present can be significant
T/F: A first morning specimen does not always represent a fasting specimen because glucose
from an evening meal may remaln in the bladder overnight, and patients should be advised to
eempty the bladder and collect the second specimen
TRUE
This urine spx is for glucose and diabetic monitoring and screening
2nd morning (fasting spx)
this urine spx refers to second morning urine voided after rising
2nd morning
this urine spx is collected after 2 hours of meal
2-hr post prandial spx
this urine spx is for quantitative measurement of analytes that shows diurnal variation
timed spx (24hr urine spx)
This urine spx is used for clearance test
timed spx (24hr urine spx)
this urine spx is for evaluation of fistulas
timed spx (24hr urine spx)
to obtain this urine spx, the px must begin and end the collection period with an empty bladder
timed spx (24hr urine spx)
With this type of urine spx, all specimens should be refrigerated or kept on ice
timed spx (24hr spx)
what must be done on arrival of a 24-hour spx in the laboratory?
thoroughly mix and measure the volume and record
What are the solutes that exhibit diurnal vairations?
-catecholamines
-17 - hydroxysteroids
- electrolytes
*lowest concentration in the morning and HIGHEST concentration in the afternoon
this urine spx is preferred for urobilinogen measurements
Afternoon urine (2pm - 4pm)
this urine spx is ideal for screening microalbuminuria
12-hr urine spx
this urine spx is for the determination of urine albumin, creatinine, and the albumin-to-creatinine ratio
12-hr urine spx
this specimen is collected under sterile conditions by passing a hollow tube through the urethra into the bladder
catheterized spx
this specimen is used for bacterial culture
catheterized spx
this procedure is safer, less traumatic for obtaining urine for baterial culture and routine urinalysis
midstrean clean catch
this specimen is less contaminated by epithelial cells and bacteria
midstream clean catch
this urine spx is more representative of the actual urine than the routinely voided spx
midstream clean catch
what must be done before the collection of a midstream clean catch spx?
the glans penis of the male or the urethral meatus of the female is thoroughly CLEANSED AND RINSED
In midstream clean catch method, these should not be used as cleansing agents?
strong bacterial agents such as hexachlorophene or povidone-iodine
What cleaning agents must be used for midstream clean catch method?
Mild antiseptic towelettes
this urine spx type is for bacterial culture (especially for anaerobic microbes)
supra-pubic aspiration
supra-pubic aspiration is especially used for what?
especially used for ANaerobic microbes
this urine spx type is used for CYTOLOGICAL EXAMINATION
supra-pubic aspiration
this urine spx type uses a we-we bag
pediatric spx
this urine spx type uses a soft, clear plastic bag with hypoallergenic skin adhesive to attach to the genital area of boys and girls
pediatric spx
When a both a routine urinalysis and a culture are requested on a catheterized or midstream collection. Which should be performed first?
the CULTURE should be performed first to prevent contamination of the spx
What are the majority use for first morning spx?
-Pregnancy test (because mataas ang HCG in the morning)
- Orthostatic proteinuria / postural proteinuria
- glucose monitoring
What urine spx is considered as the fasting sample?
SECOND MORNING urine
*considered but not always. Pag wala sa choices, pwedeng fasting spx si FIRST MORNING. but the best answer for fasting sample is SECOND MORNING
How to collect the second morning urine?
- collecte the SECOND ihi pagkagising. hindi yung UNANG ihi
2 HOUR POST PRANDIAL specimen’s primary usage
for glucose monitoring
For Bence Jones Proteins, what is the spx used?
24 hour urine spx
What spx for urobilinogen?
Afternon urine (2PM-4PM) peak level
for nitrite, what spx to be used?
- first morning or 4 hours urine
For schistosoma hematobium, what spx is used?
-24 hours unpreserved urine (harr)
- 12-2pm urine (bailey’s)
this is the safest method for bacterial culture
midstream clean catch
What are the spx for cytology?
1-suprapubic
2- random w midstream
3-first morning
What are the spx for culture?
- suprapubic
-catheterized
-midstream
What are the specimens for prostatitis?
- three-glass collection
- pre and post massage test
- stamey-mears (four glass)
What is the urine spx for glucose?
-1st morning
-2nd morning
- 2hr post prandial
How was the process for the three-glass collection?
1st sterile container - contain the first urine passed
2nd sterile container - contain the midstream portion of urine
3rd sterile container - contain a urine with prostate fluid (the prostate is massaged)
T/F: In individuals with RTA, urine is acidic
F.
Alkaline/Basic
in the three-glass collection, which specimen can be used for routine UA if additional testing is required
Second specimen
What is the result if spx is positive for prostatic infection?
if the 3rd spx will have a white cell / hpf count and bacterial count 10x that of the 1st spx
in the three-glass collection, this specimen serves as a control for bladder and kidney infections and should not be positive for bacteria
2nd spx
in the three-glass collection, quantitative cultures are performed on which spx?
on all spx
for prostatitis, this is a clean-catch midstream urine spx
pre and post massage test
What are the types of four glass specimens?
VB1
VB2
EPS
VB3
This type of 4-glass spx is for initial voided urine, for bacterial cultures, urethral infection or inflammation testing
VB1
This type of 4-glass spx uses midstream urine and is used to test for urinary bladder infection
VB2
This type of 4-glass spx utilized expressed prostatic secretion
EPS
This type of 4-glass spx utilizes post prostatic massage urine
VB3
In saccomanno fixative, what is its percentage composition?
50% ethanol and 2% carbowax
In the 3-glass, if result is positive in all 3 containers,, it indicates what?
UTI
In this spx for prostatitis, this compare the post massage spx with the pre-massage count
Pre-and post massage test
In pre and post massage test, which must have greater than 10 times bacteria in order for it to indicate prostate infection?
post massage spx of greater than 10x the pre massage
This is a.k.a as VB1
Urethral spx
This is a.k.a VB2
Bladder spx
In stamey-meares, these are cultured and examined for white blood cells
Prostatic secretions
How much of WBCs is considered abnormal in four-glass spx?
More than 10 to 20 WBCs/hpf
T/F: More than 10 to 20 WBC/hpf is considered normal.
F.
abnormal
This process provides documematlon of proper sample
identification from the time of collection to the receipt of laboratory results
Chain of evidence or COC
This is a standardized form that must document and accompany every step of drug testing; from collector to courier to laboratoy to medical officer to employer
COC (Chain of custody)
This type of 4-glass specimen can be used to measure cystitis
VB2
What are parts of the 4-glass spx that is checked for wbc and bacteria?
EPS and VB3
The collector adds what to the toilet water reservoir to prevent adulterated specimen
Bluing agent (dye)
This is the person who will submit urine for drug testing
Donor or client
Who adds bluing agent to toilet water reservoir to prevent an adulterated spx?
the collector
the collector adds a bluing agent or dye to the toilet water reservoir because?
to precent an adulterated spx
what is the MOST common adulterant?
Water
What is the container capacity in DTM?
60 mL
Urine volume collected for DTM?
30 to 45 mL
Within how many minutes or how long must the urine temperature be read?
within 4 minutes
What must the urine temperature be upon reading?
32.5 - 37.7 C
What must be done if the spx temperature is not within range?
the temp should be recorded and the supervisor or employer is contacted immediately.
*DO NOT DISCARD. NOTFY!
