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Marion Chem Mlab124 > Lecture 3 > Flashcards

Lecture 3 Flashcards

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1
Q

Glucose

A

Glucose present in the urine when blood glucose exceeds 10mmol/L
Blood glucose exceeds the renal threshold and cannot be absorbed by the tubules
Read at 30 seconds
RR: Negative

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2
Q

Glucose Normal

A

Normal urine is negative for glucose. Glucose results semi-quantitative
If present – Glycosuria or glucosuria
Indicate diabetes that’s not under control
Color reaction must be read in the prescribed time, as it will continue react, giving a false result

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3
Q

Significance of Glucose

A

Diabetes mellitus.

Renal glycosuria.

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4
Q

Limitation of Glucose

A

Interference: Javex, Ascorbic acid, temperature
Only measures glucose and not other sugars.
Renal threshold must be passed in order for glucose to spill into the urine.

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5
Q

Other Tests for glucose

A

CuSO4 test for reducing sugars. (Clinitest)Drop of urine to CuSO4 tablet, colour reaction occurs

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6
Q

Maltose

A

Reducing Sugars

Malt sugar, starch fermented yeast e.g. corn syrup, beer, breads

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7
Q

Fructose

A

Reducing Sugars

fruit sugar found in pops, candy bars, fruit juices, junk food, sweetened yogurt

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8
Q

Galactose:

A

Reducing Sugars

Dairy products – milk, cheese, butter. The breakdown of milk is lactose and finally glucose

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9
Q

Sucrose

A

Non-reducing Sugar

Added to processed foods to increase the flavour e.g. table sugar, jams, chewing gum

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10
Q

Protein normal
What does presence mean
interfered by

A
  • Normal urine is negative or sometimes a trace in concentrated urine (mostly albumin)
  • Presence of protein – Proteinuria and the nephrotic syndrome.
  • Renal diseases, urinary tract infection, Multiple Myeloma

Interference: highly alkaline urine.
- Much more sensitive to albumin than other proteins (e.g., immunoglobulins, light chains, Bence Jones).

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11
Q

Protein Other Tests

A

Sulfosalicylic acid (SSA) turbidity test.

- Urine protein electrophoresis (UPEP)
- Bence Jones protein
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12
Q

Bilirubin; Urobilinogen

A

The liver destroys old red blood cells and bilirubin is the by-product.
In the liver, the bilirubin is conjugated with glucuronic acid (direct bilirubin) excreted by the liver through the bile duct into the duodenum
In intestine, bacteria convert bilirubin into several compounds referred to as urobilinogen
An oxidized form of urobilinogen is excreted in the feces and small amount is excreted by the kidneys

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13
Q

Bilirubin normal
what does increased bilirubin means
and what can interfere with it / its limitations

A

Normal urine is negative for bilirubin
If present - Liver disease, bile duct obstruction, hepatitis
Bilirubin reacts with a diazonium salt and colour develops

Increased direct bilirubin (correlates with urobilinogen and serum bilirubin)

Interference: prolonged exposure of sample to light, bilirubin will disappear
- Only measures direct bilirubin–will not pick up indirect bilirubin

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14
Q

Bilirubin Other Tests

A

Ictotest (more sensitive tablet version of same assay)

- Serum test for total and direct bilirubin is more informative

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15
Q

Urobilinogen Normal
what happens if too high or too low
results can be interfered by?

A

Bilirubin degradation product by intestinal bacteria
Normal: 0.2 – 1 mg/dl

Increased in liver and hemolytic diseases
High: increased hepatic processing of bilirubin
- Low: bile obstruction

  • Interference: prolonged exposure of specimen to oxygen (urobilinogen —> urobilin)
    • Cannot detect low levels of urobilinogen
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16
Q

Other Tests Urobilinogen

A

Serum total and direct bilirubin

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17
Q

Ketones normal
what happens if present
caused by?
results can be interfered by how can false positives happen?

A

Normal urine is negative for ketone
If present – Ketonuria – Incomplete fat metabolism
Ketone bodies are acetoacetic acid B-hydroxybutyric acid, acetone

Diabetes, starvation, fasting state, alcoholism, Diabetic ketoacidosis

  • Interference: expired reagents (degradation with exposure to moisture in air)
    • Only measures acetoacetate not other ketone bodies
    • False positive when urine is highly pigmented
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18
Q

Other Tests Ketones

A

Ketostix (more sensitive tablet version of same assay)

- Acetest

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19
Q

Blood

A

Occult blood means “hidden”
Dipstick can detect small amounts of blood
Detects intact RBCs, free hemoglobin from lysed RBCs and myoglobin
Myoglobin is the heme protein from muscle and facilitates movement of oxygen within the muscles. Injury to cardiac or skeletal muscle releases myoglobin
Hemoglobin oxidizes a chromogen in the pad to cause a colour change
False positives – menstrual blood

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20
Q

Normal Blood
what if present
results can be interfered by?

A
  • Normal urine is negative for blood
  • Presence of 0-4 RBC per high power field is considered normal
  • If blood is present – Hematuria – Infection, trauma, bleeding,Myoglobinuria , Hemoglobinuria (hemolysis, etc
  • Interference: Javex, sodium hypochlorite
    • Cannot distinguish between the above disease processes
21
Q

Other Tests Blood

A

Urine microscopic examination

- Urine cytology

22
Q

Nitrite Normal
why is nitrite important
what are the results interferred by ?

A

Normal urine is negative for nitrite

Gram negative bacteriuria (E. Coli) produce enzymes that convert nitrates to nitrites

  • Interference: bacterial overgrowth
    • Only able to detect bacteria that reduce nitrate to nitrite
23
Q

Nitrite Other Tests

A

Correlate with leukocyte esterase and

- Urine microscopic examination (bacteria)
- Urine culture
24
Q

Leukocyte Esterase Normal
what if its present
what can the tests be interfered by

A
  • Normal urine is negative for -
  • Presence of 0-5 WBC per high power field is considered normal
  • Presence of WBC in urine may indicate – infection or inflammation of the urinary tract
  • Esterase reacts with granules in WBC
  • Pyuria
    • Acute inflammation
    • Renal calculus
  • Interference: oxidizing agents, menstrual contamination
25
Q

Leukocyte Esterase Other Tests

A
  • Urine microscopic examination (WBCs and bacteria)

- Urine culture

26
Q

Specific Gravity Normal
what if too high or too low
what if its present
what can the tests be interfered by

A
  • Provide information on the ability of the kidneys to dilute or concentrate urine
  • Dilute urine – lower specific gravity
  • Concentrated urine – higher specific gravity\

Diabetes insipidus

  • Interference: alkaline urine
    • Does not measure non-ionized solutes (e.g. glucose)
27
Q

Specific Gravity Other Tests

A
  • Refractometry

- Hydrometer

28
Q

pH

A

Range 5.0 – 8.0
Measure the acidity / alkalinity of urine
Can be affected by diet, disease, drugs

29
Q

Urinalysis - Confirmatory test

A

confirmation may be required for the following tests:

Glucose, protein, ketones, and bilirubin

30
Q

Reasons for Confirmatory Testing

A

To confirm a result obtained on the reagent strip
To obtain a result from a highly pigmented urine that masks the result on the reagent strip
Example – Large amounts of blood, drugs that discolour the urine
To test for analytes that are not included in the specificity of the reagent strip test –
The glucose reagent strip test is specific for glucose, but other reducing substances might be needed

31
Q

Clinitest

A

Confirmatory Test
All Sugars (Reducing Substances)
Glucose, fructose, galactose, lactose, maltose

32
Q

Sulfosalicylic acid (SSA)

A

Confirmatory Test
Turbidity test – Protein
Unlike the protein test on the dipstick, the SSA reaction will detect albumin and globulins
The SSA detect Bence-Jones proteins

33
Q

Acetest or Ketostix

A

Confirmatory Test

Ketone

34
Q

Ictotest

A

Confirmatory Test

Bilirubin

35
Q

Red Blood Cells

A

Sediments Found in Urine
Presence of 0 to 4 per high-power field is considered normal
Greater than 4, indicates bleeding - hematuria

36
Q

White Blood Cells

A

Sediments Found in Urine
Presence of 0 to 5 per high-power field is considered normal
More than 5 indicate inflammation / UTI

37
Q

Epithelial Cells

A

Squamous epithelial cells from the urethra, bladder and meatus – normally present in small amounts in urine
Renal epithelial cells from the deeper layers of the urinary tract – presence in the urine is abnormal

38
Q

Bacteria

A

should not normally exist (mid-stream) – Clean Catch

Their presence may indicate contamination or a UTI

39
Q

Yeast cells

A

smooth, refractile bodies with an oval shape
Urine of female patients – vaginal contaminant caused by the yeast Candida albicans
Produce the vaginal infection candidiasis

40
Q

Amorphous Urates or Phosphates

A 
Amorphous urates appear very similar
Differentiate:
Alkaline pH – phosphates
Acidic pH - Urates
Phosphates are soluble in acetic acid
41
Q

Calcium Oxalate

A

Calcium oxalate found in acid or alkaline relates to ingestion oxalate rich foods e.g. tomatoes, spinach, garlic, oranges, asparagus

42
Q

Triple Phosphate Crystals

A

Triple phosphate composed of magnesium, ammonium, phosphate associated with UTI caused by bacteria splitting urea

43
Q

Oliguria

A

decreased urine production, due to dehydration (vomiting, diarrhea, fever, lack of fluid intake)
Acute renal failure, metabolic toxicity, patient survives 2 -3 weeks

44
Q

Polyuria

A

excessive urine production Due to bladder infection, kidney failure, enlarged prostate

45
Q

Anuria

A

complete suppression / absence of urine formation by the kidneysIs the kidneys functioning – tests done are kidney biopsy, CT scan, MRI

46
Q

Dysuria

A

difficult or painful urination Urinary tract infection, men with enlarge prostrate, persistent kidney stones

47
Q

Nocturia

A

excessive urination during the night due to anti-diuretic medication

48
Q

Dialysis

A

removal of waste when the kidneys no longer function

Marion Chem Mlab124 (8 decks)

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