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Unit 2 Clin Med Lab > L5: Urinalysis > Flashcards

L5: Urinalysis Flashcards

1
Q

how to get a clean “catch”

A

clean nonfoaming disenfectant, allow to dry

discard first voided portion as it may contain urethral contaminants, collect midstream speciman

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2
Q

Dark brown→ black urine

A

bile/bilirubin due to liver/bile disease

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3
Q

turbidity causes

A

Crystal precipitation of amorphous material, bacteria, yeast, WBCs, RBCs, mucus, squamous epithelial cells, sperm prostatic fluid, lipids

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4
Q

bile/bilirubin due to liver/bile diseases that can cause brown/black urine

A

alkaptonuria: lack of homogentisic acid oxidase

malignant melanoma: melanogen

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5
Q

ash tray smell to urine

A

cigarrete smokers

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6
Q

fruity smell to urine

A

ketone bodies

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7
Q

putrid, foul smelling urine

A

bacteria of UTI

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8
Q

Amino acid disorders that change urine smell

A

Phenylketonuria

Maple syrup urine disease

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9
Q

Normal pH

A

4.5-8

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10
Q

Urine pH reflects

A

serum pH

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11
Q

acidic urine pH

A

4.5-5.5

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12
Q

alkaline urine pH

A

6.-8.0

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13
Q

Specific gravity

A

Concentration/weight of dissolved solutes

Ability of kidney to concentrate and dilute urine

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14
Q

normal Specific gravity

A

1.003-1.035

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15
Q

Isosthenuria

A

Fixed at 1.010→ kidney disease

→ same SG as initial plasma

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16
Q

normal urine volume

A

500CC-2000CC/24 hours

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17
Q

oliguria

A

<500 CC/24 hours

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18
Q

anuria

A

<100 CC/24 hours

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19
Q

polyuria

A

Excessive amounts, dilute, SG=1.0-1.002

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20
Q

When does glucose appear in the urine

A

plasma glucose >150-180 mg/dL exceed renal threshold

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21
Q

false negatives for glucose

A

ascorbic acid, aspirin

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22
Q

Ketones are

A

Products of incomplete fat metabolism when carbohydrate stores are diminished

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23
Q

When are ketones present

A

acidosis: DKA, rapid weight loss, fasting, starvation, pregnancy

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24
Q

Proteins are mostly

A

albumin

reflect renal endothelial function

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25
Q

Elevated proteins indicate

A

Early sign of kidney disease

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26
Q

proteins are overestimated in

A

concentrated urine

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27
Q

proteins are underestimated in

A

dilute urine

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28
Q

proteins false positive due to

A

pyridium

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29
Q

can moderately increased albumin be detected by a urine dipstick?

A

No

Must perform a special test

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30
Q

If a patient has persistently positive proteins on dipstick, the next step is to

A

quantify albumin:
abumin: creatinine ration
24 hour urine sample

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31
Q

high risk patients to screen for moderately increased albumin

A

DM
HTN
CVD

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32
Q

causes of blood in urine

A

hemoglobin or myoglobin

have to centrifuge to determine which

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33
Q

false negatives when hematuria is present

A

ascorbic acids

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34
Q

hematuria testing sensitivity

A

5-10 RBC/ .05-.3 mg/DL of hemoglobin

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35
Q

nitrite is produced by

A

enterobacteriaceae that reduce nitrates→ nitrite

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36
Q

nitrite indicates

A

UTI

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37
Q

false negatives for nitrite

A

urine in bladder < 4 hours

different bacteria don’t have enzymes

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38
Q

leukocyte esterase

A

Released by lysed neutrophils and macrophages

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39
Q

leukocyte esterase + nitrate both positive

A

increased sensitivity for UTI

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40
Q

false positives for leukocyte esterase

A

vaginal contamination, trichomonas

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41
Q

bilirubine and urobilinogen

A

Used in conjunction to determine pathology

Both normally negative

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42
Q

bilirubin turns urine

A

brown

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43
Q

Hemolytic disease findings

A

(-) bilirubin

Increased urobilinogen

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44
Q

Hepatic disease findings

A

(+/-) bilirubin

Increased urobilinogen

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45
Q

Biliary obstruction findings

A

(+) bilirubin

normal urobilinogen

46
Q

RBCs in urine appear

A

refractile discs, shriveled

47
Q

normal RBCs

A

0-3 RBC/HPF

48
Q

cause red urine that isn’t hematuria

A

beeturia, phenazopyridine, porphyria, other

49
Q

causes of >3 RBC/HPF:

A 
Renal/lower urinary tract trauma
Kidney stones
Glomerular damage
Tumors
UTI
Acute tubular necrosis
Nephrotoxins
Vaginal bleeding
Cancer: kidney, bladder, prostate
Benign prostatic hypertrophy
50
Q

If urine is red:

A

centrifuge it

51
Q

Red sediment after centrifuging urine means

52
Q

Red supernatant after centrifuging urine

A

do a dipstick heme

53
Q

a negative dipstick heme means

A

the red urine was a false positive

54
Q

a positive dipstick heme means

A

myoglobin or hemoglobin: centrifuge blood sample and evaluate plasma color

55
Q

clear centrifuged plasma color

A

myoglobinuria

56
Q

red centrifuged plasma color

A

hemoglobinuria

57
Q

WBCs appear

A

Lobed nuclei and refractile cytoplasmic granules

58
Q

Normal WBCs

A

0-5 WBC/HPF

59
Q

5-10 WBC/HPF

A

suspicious for UTI

60
Q

> 20 WBC/HPF

61
Q

bacteria

A

0-4+/HPF

May or may not be significant, depends on method of collection and how long it stands for

62
Q

Renal tubular and transitional epithelial cells

A

Slough from tubule lining in small numbers normally

63
Q

large numbers of renal tubular and transitional epithelial cells

A

tubular degeneration

64
Q

Oval fat bodies definition and appearance

A

Degenerated tubular cells containing abundant lipoproteins
Appear refractile
Exhibit “maltese cross” under polarized light microscopy

65
Q

Presence of oval bodies

A

nephrotic syndromes

66
Q

Squamous epithelial cells

A

Large polygonal squamous epithelial cells with small nuclei normally present in small numbers

67
Q

large numbers of squamous epithelial cells

A

contaminated by skin or external urethra

68
Q

casts are formed

A

only in the distal convoluted tubule or collecting duct

69
Q

RBC/WBC are measured

A

Number per high power field (hpf)

70
Q

casts are measured

A

Number per low power field (lpf)

71
Q

Hyaline casts

A

Very pale, slightly refractile. Composed of mucoprotein tamm-horsfall protein secreted by tubule. normal.

72
Q

Red cell casts indicate

A

Glomerular or renal tubular injury

GLOMERULONEPHRITIS

73
Q

White cell casts indicate

A

Acute pyelonephritis, glomerulonephritis

74
Q

Renal tubular cast cells

A

Injury to tubular epithelium: acute tubular necrosis

75
Q

granular casts

A

Cellular casts which remain in tubules break down so that cells forming them degenerate into granular disease
coarse→ finely granular→ waxy cast

76
Q

granular casts indicate

A

abnormality, but not specific

77
Q

uric acid crystals indicate

A

Acidic urine, form secondary to hyperuricema

78
Q

Crystine crystals indicate

A

Cystinuria: rare genetic cause of kidney stones

79
Q

struvite crystals indicate

A

Crystalluria: secondary to infection by urease producing bacteria in alkaline urine

80
Q

Calcium oxalate crystals

A

Form independent of pH, cause kidney stones, 2 forms: monohydrate/dihydrate

81
Q

Urine culture indicates UTI when

A

> 100,000 colonies/ml

UTI still possible with fewer colonies esp if sx dysuria, frequencia, pyuria

82
Q

major intracellular cation

A

serum potassium

83
Q

potassium is excreted by

A

kidneys, controlled by distal nephron

84
Q

who not to administer K+ to

A

impaired kidney function

85
Q

Effects of aldosterone

A
  1. Increases renal sodium reabsorption

2. Increases renal potassium excretion

86
Q

Hyperkalemia

A

> 5.0MEQ, >6.0–6.5 dangerous

87
Q

Hyperkalemia presentation

A

Serum potassium >7
Ascending muscle weakness→ flaccid paralysis
Conduction abnormalities and arrhythmias

88
Q

Mild hyerkalemia ECG

A

5.5-6.5 mEq/L peaked T waves

89
Q

Moderate hyperkalemia ECG

A

6.5-8.0 mEq/L prolonged QRS complex

90
Q

Severe hyperkalemia ECG

A

Vfib, asystole

91
Q

Pseudohyperkalemia

A

due to hemolysis at venipuncture site→ repeat k+

92
Q

Causes of hyperkalemia due to inadequate excretion of K+

A
  1. Renal failure → check BUN/Creatinine
  2. Medications:
    aldosterone antagonist
    K+ sparing diuretics
    ACEI/ARBS
3. Hypoaldosteronism:
Addison’s disease (adrenal insufficiency)
Congenital Adrenal hyperplasia
NSAIDS
Renal tubular dysfunction
93
Q

Causes of hyperkalemia due to Redistribution of K+: ICF→ ECF

A
  1. Tissue damage (rhabdomyolysis)
  2. Acidosis
  3. Decreased insulin
94
Q

.1 decrease in pH causes

such as acidosis

A

.5-1.0 increased K+

95
Q

causes of hyperkalemia due to excessive administration of K+

A

Rx K+ supplements

K+ containing salt substitutes, exp. In patient with some renal impairment

96
Q

To rapidly correct hyperkalemia

A

Calcium chloride, IV (antagonizes K+)
Shift K+ from ECF to ICF

Sodium bicarb IV→ increases pH

Insulin + D50W → insulin shifts K+ into cells, D50W prevents hypoglycemia

97
Q

to slowly correct hyperkalemia

A

Loop or thiazide diuretics
→ beware in decreased renal function

Hemodialysis if: kidney failure, very severe, refractory

98
Q

when to send a hyperkalemic patient to the ER/ICU for monitoring

99
Q

treat the underlying cause of hyperkalemia:

A

Stop meds: K+ sparing diuretic, ACEIs, ARBs, K+ supplements

Addison’s→ mineralocorticoid replacement

100
Q

Hypokalemia is defined as

A

<3.5 mEq/L, <3→ dangerous

101
Q

Hypokalemia presentation

A

Ascending muscle weakness/paralysis
Respiratory failure
Muscle cramping
Rhabdomyolysis
GI: N/V/A→ vomiting causes further hypokalemia
EKG: arrhythmias, U waves, flattened T waves, ST depression

102
Q

To rapidly correct hypokalemia

A
  1. Cardiac monitor
  2. IV potassium chloride (KCl)
  3. Check K+ every 2-4 hours
103
Q

To slowly correct hypokalemia

104
Q

When correcting hypokalemia, be sure to

A

Check for hypomagnesemia: low K+ difficult to correct if not also corrected

105
Q

Inadequate intake of K+ hypokalemia

A

usually in a patient who takes thiazide/loop diuretic→ use supplements/K+ rich foods to prevent

106
Q

GI tract loss of K+ hypokalemia

A

Upper GI: vomiting, NG suction
→ metabolic alkalosis→ promotes K+ loss

Lower GI: diarrhea
→ metabolic acidosis

107
Q

____ promotes K+ loss

A

metabolic alkalosis

108
Q

Renal losses of K+ hypokalemia

A

Diuretics

Bicarb excretion

Mineralocorticoid excess:
Hyperaldosteronism
Cushing’s syndrome

109
Q

Redistribution of K+ from ECF to ICF hypokalemia

A

Metabolic alkalosis

Insulin administration

B adrenergic agonists
→ induce uptake of K+
→ promote insulin secretion
Hypokalemic periodic paralysis

110
Q

.1 increase in pH causes

such as alkalosis

A

K+ decrease by .5-1.0 mEq/L

111
Q

pH and K+ have a _____ relationship

Unit 2 Clin Med Lab (8 decks)

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