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Urinalysis > Lab Practical > Flashcards

Lab Practical Flashcards

1
Q

Epithelial Cells in Urine

A

Squamous

Transitional

Renal Tubular

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2
Q

Renal Tubular cells (RTEs)

A

olives

Small Cell, Big nucleus

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3
Q

Sq Epi Cells (SECs)

A

Apple Fritters

Big rigid shape

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4
Q

Transitional Epi Cells (TECs)

A

Donuts

Central Nucleus

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5
Q

Microscopic RBCs in Urine?

A

From any part of renal system

Large #s may indicate: Trauma, Tumors, Renal Calculi

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6
Q

Microscopic WBCs in Urine?

A

Pyuria

Suggest Infection, Cystitis, Pyelonephritis

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7
Q

Casts are formed where?

A

DCT and Collecting duct

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8
Q

Major component of casts?

A

Uromodulin

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9
Q

Hyaline Casts in urine?

A

Formed from protein gel in Renal tubule.

May contain cellular inclusions

Dissolve rapid in alkaline urine

Normal urine may have 1-2 per lpf.

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10
Q

Granular Casts in urine?

A

Casts W/ granules t/o matrix.

Quite refractile

Coarsely Granular Cast (Large Granules)

Small granules( fine granular cast).

Appear in normal and abnormal

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11
Q

RBC casts are?

A

Pathological

Indicates severe injury

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12
Q

RBC casts found in?

A

Acute glomerulonephritis

Lupus

Bacterial Endocarditis

Septicemias

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13
Q

RBC casts are granular containing?

A

Hgb from denatured RBCs

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14
Q

WBC Casts occur when?

A

WBCs are present in cast matrix

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15
Q

WBC Casts indicate?

A

Infection, most commonly Pyelonephritis.

Glomerular diseases

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16
Q

Epithelial Casts?

A

tubular damage, heavy metals, viral infections, drug toxicity, graft rejection, pyelonephritis

Formed in DCT

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17
Q

Fatty Casts?

A

Nephrotic Syndrome, Diabetes, Crush Injuries, Tubular necrosis

W/ OFBs and fat droplets

Highly refractile

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18
Q

Waxy Casts?

A

Brittle

Highly Refractile

Jagged edges, Notches

Dark pink

Renal Failure

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19
Q

Broad Casts?

A

Renal Failure casts

Destruction & widening of DCTs

Form in upper collecting duct

All types of casts can be broad.

Most common granular and waxy

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20
Q

Pathological Crystals found in Acidic Urine?

A

Uric acid crystals

Leucine/Tyrosine Crystals

Cystine Crystals

Cholesterol Crystals

Bilirubin Crystals

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21
Q

Uric Acid Crystals?

A

Chemo for Leukemia

Lesch-Nyhan Syndrome

Gout

Always polarize

“Whetstones”

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22
Q

Cystine Crystals?

A

Hexagonal plates

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23
Q

Cystine Crystals are seen in?

A

Genetic Defect

Cystinuria (Inability to reabsorb)
(Inborn error)

Homocystinuria

Confirm W/ Cyanide Nitroprusside

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24
Q

Cholesterol Crystals?

A

Notched corners of rectangular plates.

Highly birefringent- polarized

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25
Q

When do we see cholesterol crystals?

A

Refrigerated specimens

PTs W/ damage to their glomerular basement membrane.

Nephrotic Syndrome

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26
Q

Tyrosine Crystals?

A

Fine

Colorless-yellow needles

Clumps or Rosettes

Inherited Amino Acid disorder

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27
Q

Leucine Crystals?

A

Yellow-Brown spheres

Concentric Circles

Radial striations

Accompany Tyrosine crystals.

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28
Q

When do we see leucine/tyrosine crystals?

A

Together, usually in severe liver disease.

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29
Q

Bilirubin Crystals?

A

Clumped needles/granules

Yellow color

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30
Q

Bilirubin crystals are seen in?

A

Viral Hepatitis and tubular damage

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31
Q

Other pathological crystals?

A

Sulfonamide Crystals

Ampicillin Crystals

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32
Q

Sulfonamide Crystals?

A

Dehydration

Could cause tubular damage

Needles, sheaves of wheat

Colorless to yellow-brown

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33
Q

Ampicillin Crystals?

A

Colorless needles that form bundles following refrigeration.

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34
Q

Non-pathological Crystals in urine?

A

Amorphous Urates

Uric Acid (Can be pathological)
(Lesch-Nyhan Syndrome)

Acid Urates

Sodium Urates

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35
Q

Amorphous Urates?

A

Yellow-Brown granules

Sediment of urine pink due to pigment uroerythrin, attached to granules.

pH greater than 5.5

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36
Q

Calcium Oxalate Crystals?

A

Acidic or Neutral (N usually)

2 pyramid shape

Dumbbell shape

Major component of renal calculi

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37
Q

Sodium Urate Crystals?

A

Needle shape

Synovial fluid, during gout.

Appears in Urine

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38
Q

Non-pathological crystals in alkaline urine?

A

Amorphous Phosphates

Triple Phosphate

Calcium Phosphate

Calcium Carbonate

Ammonium Biurate

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39
Q

Amorphous Phosphates

A

Removed W/ acetic acid

Granular appearance

White precipitate after refrigeration

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40
Q

Triple Phosphate?

A

Colorless prisms, coffin lids.

Highly alkaline urine or UTIs

Urea splitting bacteria

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41
Q

Calcium Crystals?

A

Calcium Phosphate

Calcium Cabonate

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42
Q

Calcium phosphate?

A

Colorless, flat rectangles and thin prisms in rosettes.

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43
Q

Calcium Carbonate?

A

Small colorless dumbbell and spherical shaped.

Gas produced W/ addition of acetic acid.

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44
Q

Ammonium Biurate?

A

Yellow Brown Spicule covered Spheres.

Only urate in alkaline urine

Thorny Apples

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45
Q

Hippuric Acid crystals?

A

Colorless or pale yellow

Acidic

Needles, Six-sided prisms, star-shaped clusters.

After ingestion of certain veggies and fruits W/ benzoic acid.

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46
Q

Bacteria in urine?

A

Bacteriuria

Contamination

UTI

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47
Q

Yeast

A

Vary in size

Colorless ovoid

Seen in: Diabetes, Pregnancy, Obesity, Debilitating conditions.

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48
Q

Trichomonas Vaginalis

A

Flagellate protozoan

Males and females

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49
Q

Reagent Strip Tests?

A

pH

Protein

Glucose

Ketones

Blood

Bilirubin

Urobilinogen

Nitrate

Leukocytes

SG

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50
Q

QC is done on reagent strips when?

A

+/- @ beginning of shift.

New bottle of strips

Questionable results

Strip integrity concern

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51
Q

Clinical Significance of urine pH

A

Respiratory or metabolic acidosis/ketosis

Respiratory or metabolic alkalosis urine is alkaline

Renal calculi formation

Treatment of urinary tract infections

Precipitation/identification of crystals

High-protein diets=acidic urine

Low-protein diets=alkaline urine

A pH above 8.5 is associated with a specimen that has been preserved improperly and indicates that a fresh specimen should be obtained to ensure the validity of testing

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52
Q

pH reactions are what kind?

A

Double-indicator system reaction

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53
Q

Methyl Red =

A

4-6 red/orange to yellow

acidic

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54
Q

Bromothymol Blue =

A

6-9 green-blue

Alkaline

55
Q

What protein is checked in a urine reagent stick reading?

A

Albumin

56
Q

3 products of fat metabolism?

A

Acetone

Acetoacetic acid

B-hydroxybutyrate

57
Q

% of fat metabolism of acetone?

A

2%

58
Q

% of fat metabolism of Acetoacetic acid?

A

20%

59
Q

% of fat metabolism of
B-hydroxybutyrate?

A

78%

60
Q

Primary reagent of Ketones?

A

Sodium Nitroprusside

61
Q

Primarily measured?

A

Acetoacetic acid

62
Q

What test is used to confirm a questionable ketone test?

A

Acetest Tablet test

63
Q

Hematuria?

A

Damage to renal system.

64
Q

Hemoglobinuria

A

lysis of RBCs

Hemosiderin, yellow-brown granules in sediment.

65
Q

Myoglobinuria

A

Heme containing protein in muscle tissue due Rhabdomyolysis (muscle destruction), clear, red/brown urine.

Muscular trauma

66
Q

Bilirubin in urine is an early indicator of?

A

Liver Disease

67
Q

Conjugated urine appears in the urine with?

A

Bile duct Obstruction- backs up, excreted in urine, No urobilinogen.

Liver disease or damage- Hepatitis, cirrhosis.

68
Q

Principle of bilirubin reaction?

A

Diazo reaction

69
Q

False-positive Bilirubin tests?

A

Urine pigment

Pyridium (Phenazopyridine)

Drugs

70
Q

False-negative Bilirubin tests?

A

Old specimens

Ascorbic acid

Nitrite- bind W/ diazo salt, block bilirubin reaction

71
Q

Ictotest Tablets

A

Confirm bilirubin

72
Q

Ictotest table positive?

A

blue to purple color

73
Q

Early detection of liver disease and hemolytic disorders?

A

Urine urobilinogen greater than 1 mg/dL.

Also, seen liver disorders, hepatitis, cirrhosis, carcinoma

74
Q

Why do hemolytic disorders have increased urobilinogen?

A

Excess bilirubin converted to urobilinogen & increases urobilinogen to liver.

75
Q

Common results in urine W/ hemolytic disorders?

A

Negative Bilirubin

Strong Positive Urobilinogen

76
Q

Multistix Urobilinogen reaction?

A

Ehrlich’s Aldehyde reaction

77
Q

Erlich Reagent gives us what color for positive?

A

Light to dark pink

78
Q

Chemstrip urobilinogen reaction?

A

diazo (azo-coupling) reaction.

79
Q

Color range for Chemstrip?

A

White to pink

80
Q

Nitrite has a rapid screening test for the presence of what?

A

UTI

81
Q

Reasons for Nitrite testing?

A

Cystitis (Initial bladder infection)

Pyelonephritis (Tubules)

Evaluation of ABX therapy

Monitor PTs @ high risk for UTI.

82
Q

Confirmation of nitrite testing with?

A

Urine culture W/ leukocyte esterase.

83
Q

Infections are commonly caused by?

A

GN organisms

84
Q

Most common GN organisms causing UTIs?

A

E. coli

Proteus species

Enterobacter species

Klebsiella species

85
Q

UTIs are more common in?

A

Women by 8x

86
Q

Nitrite reaction is?

A

Greiss reaction

W/ diazonium salt forms pink azodye.

87
Q

False negatives in nitrite?

A

High SG

High ascorbic acid level

Presence of ABX

Large #s of nitrite converting bacteria

88
Q

Leukocyte Esterase?

A

detection of leukocytes.

Detects lysed WBCs

Microscopic if possitive

89
Q

Increased WBCs indicate?

A

UTI

Also seen W/: Trichomonas, Chlamydia, Yeast, interstitial nephritis.

90
Q

Positive leukocytes is what color?

A

Purple

91
Q

Leukocyte esterase catalyzes?

A

Hydrolysis of acid esterase

92
Q

False-positive Leukocyte esterase?

A

Strong oxidizers

Formalin

Highly pigmented urine

93
Q

False-negative Leukocyte?

A

High concentrations of: Protein, Glucose, oxalic acid, ascorbic acid.

Presence of ABX

Crenation from high SG

94
Q

SG

A

Bromothymol Blue measures pH change.

95
Q

What color in SG is alkaline?

A

green.

96
Q

What color in SG is acidic?

A

Yellow

97
Q

Physical Exam consists of?

A

Color

Clarity

SG

98
Q

Uroerythrin

A

pink pigment, attaches to amorphous urates in refrigerated specimens.

99
Q

Urobilin

A

oxidation of urobilinogen, causing orange-brown color in older specimens.

100
Q

Abnormal Urine colors?

A

Dark yellow/Amber/Orange

Red/pink/brown

Brown/Black

Blue/Green

101
Q

Dark yellow and amber?

A

Normal=concentrated urine

Abnormal=bilirubin

Foamy when shaken due to bilirubin.

102
Q

Increased bilirubin in urine indicates possible?

A

Viral hepatitis

103
Q

Yellow-Orange color?

A

Photooxidation of large amounts of Urobilinogen.

No yellow foam when shaken.

104
Q

Photooxidation of bilirubin to biliverdin causes what color?

A

yellow-green

105
Q

Phenazopyridine causes?

A

Thick orange pigment

106
Q

Brown color urine?

A

Oxidation of Hgb to methemoglobin.

107
Q

A fresh brown urine specimen can indicate?

A

Glomerular bleeding

108
Q

Myoglobin breakdown color?

A

Reddish-brown

109
Q

Oxidation of porphobilinogen to porphyrias is?

A

Port Wine

110
Q

Cloudy red urine?

A

RBCs

111
Q

Clear red urine?

A

Hemoglobin

112
Q

Melanin turns what color after sitting at room temp?

A

Black

113
Q

Homogentisic Acid (Alkaptonuria) turns black in what pH of urine?

A

Alkaline

114
Q

Blue, green, and purple in catheter bags is indicators of?

A

Bacterial infection

115
Q

Clear clarity?

A

No visible particulates, transparent.

116
Q

Hazy clarity?

A

Few particulates, print easily seen through urine.

117
Q

Cloudy clarity?

A

Many particulates, print blurred

118
Q

Turbid

A

Print not seen

119
Q

Milky

A

Precipitate or clotted

120
Q

Amorphous phosphates and carbonates cause what in alkaline urine?

A

White cloudiness

121
Q

Refrigerated Specimens turn urates and carbonates what colors? (2 types of urates)

A

Amorphous phosphates-White
Carbonates- White

Amorphous Urates- Pink

122
Q

Most common pathological turbidity cause?

A

RBCs, WBCs, Bacteria

123
Q

Isosthenuric has SG of?

A

1.010 (Plasma ultrafiltrate)

124
Q

Hyposthenuric SG is?

A

Lower than 1.010

125
Q

Hypersthenuric

A

SG higher than 1.010

126
Q

Normal SG range?

A

1.002-1.035

127
Q

Most common normal range of SG?

A

1.015-1.025

128
Q

Osmolality

A

the # of particles present.

129
Q

SG

A

The # of particles present in a solution and the density of the particles.

130
Q

The SG reagent strip reaction is based on?

A

Dissociation constant

131
Q

Microscopic Exam procedure

A

Examination
1. Position the slide on the mechanical stage of the microscope.
2. Use the low power objective to get the field into focus.
3. Scan the slide under low power to get an “overall impression.” Then observe 10-15 low power fields, checking for casts and mucous threads.
4. Using high power, check another 10-15 fields for epithelial cells, red blood cells, white blood cells, crystals, sperm, bacteria, yeast, and parasites. Check with available pictures and diagrams to aid in identification.
5. Use the “Urinalysis Reporting Standardization Guide” to aid in quantitation and reporting of urine microscopic sediment.

132
Q

Reporting of microscopic exam?

A

Color

Clarity

Quantifying microscopic elements

133
Q

Quantifying Microscopic Elements?

A
  1. Find the name of the element in the far-left column.
  2. Note whether the element is counted using low power (10X/lpf) or high power (40X/hpf).
  3. Use the block of information under the “Enumerated As” to report the urine sediment.

Casts require special consideration; they are counted using 10X, but you may have to go to 40X to identify them.

134
Q

What is a quick way to determine more than 200 RBCs/field?

A

Split the field into quarters.

Count 1 quarter.

Over 50 in that quarter, indicates over 200

Urinalysis (2 decks)

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