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AUBF Lecture > Lesson 2: Introduction to Urinalysis (History and Urine Formation and Composition) > Flashcards

Lesson 2: Introduction to Urinalysis (History and Urine Formation and Composition) Flashcards

1
Q

References to the study of urine can be found in the drawings of cavemen and in Egyptian hieroglyphics, such as the?

A

Edwin Smith Surgical Papyrus

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2
Q

Who wrote a book on “uroscopy”?

A

Hippocrates

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3
Q

Who discovered “albuminuria” by boiling urine?

A

Frederik Dekkers

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4
Q

“Pisse prophets” as a subject of his book.

A

Thomas Bryant (1627)

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5
Q

Who spearheaded the methods for quantitating the microscopic sediments?

A

Thomas Addis

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6
Q

Introduced the concept of “urinalysis” as part of a doctor’s routine patient examination (1827)

A

Richard Bright

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7
Q

Defined urinalysis as “the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner”

A

CLSI (Clinical and Laboratory Standards Institute)

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8
Q

It is an ultrafiltrate of plasma

A

Urine

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8
Q

Average daily urine output

A

1,200 mL

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9
Q

It is a cessation of urine flow, may result from any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys

A

Anuria

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9
Q

Approximately how much filtered plasma is converted to urine?

A

170,000 mL of filtered plasma

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10
Q

Urine composition:

Water:
Solutes:

A

Water: 95%
Solute: 5%

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10
Q

A metabolic waste product produced in the liver from the breakdown of protein and amino acids

A

Urea

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11
Q

It accounts for nearly half of the total dissolved solids in the urine

A

Urea

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12
Q

These components are significantly higher in urine that in other body fluids, that is why they are important to determine whether a fluid is urine or not

A

Creatinine
Urea
Sodium
Chloride

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12
Q

The major inorganic solid dissolved in urine is _______, followed by _______ and _______

A

Chloride –> Sodium –> Potassium

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12
Q

True or False

Glucose and Protein are normal constituents of urine

A

False, these are not normal constituents of urine because of their molecular size

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13
Q

Normal daily urine output is usually _______ to ________

A

1200 to 1500 mL

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14
Q

Oliguria (a decrease in urine output) levels in:

Infants:
Children:
Adults:

A

Infants: < 1mL/kg/hr
Children: <0.5 mL/kg/hr
Adults: <400mL/day

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14
Q

True or False

A range of 600 to 2000 mL of urine output is also considered normal

A

True

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15
Q

True or False

The kidneys excrete 2x or 3x more urine in the day compared to nighttime

A

True

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15
Q

This urine output disorder is commonly seen in patients that enter a state of dehydration caused by vomiting, diarrhea, perspiration, or severe burns

A

Oliguria

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16
Q

An increase in the nocturnal excretion of urine is termed as?

A

Nocturia

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17
Q

It is an increase in daily urine volume that is often associated with Diabetes mellitus and Diabetes insipidus

A

Polyuria

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18
Q

Artificial cause of Polyuria can be caused by these substances that suppress the secretion of ADH

A

Diuretics
ADH
Alcohol

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18
Q

Polyuria levels in:

Adults:
Children:

A

Adults: > 2.5 L/day
Children: 2.5 to 3.0 mL/day

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19
Q

Primary organic component of urine

A

Urea

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20
Q

Product of breakdown of nucleic acid in food and cells

A

Uric acid

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21
Q

Primary inorganic component

A

Chloride

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22
Q

Chloride + Sodium = __________

A

Table Salt

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22
Q

It combines with sodium to BUFFER the blood

A

Phosphate

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23
Q

Regulates blood and tissue fluid activity

A

Ammonium

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23
Q

It combines with chloride, sulfate, and phosphate

A

Calcium

23
Q

A type of diabetes where there is a defect either in the pancreatic production of insulin or in the function of insulin, which results in increased concentration of body glucose

A

Diabetes mellitus

24
Q

How can Diabetes mellitus cause Polyuria?

A

Since there is increased glucose concentration, it will increase water excretion to remove the dissolved glucose from the body

24
Q

Recommended capacity of the container for urine specimen

A

50 mL

Allows 12 mL of specimen needed for microscopic analysis and the rest is for mixing

25
Q

Tubes with conical bottoms are used for?

A

Sediment analysis

25
Q

Sterile containers are suggested if more than __ hours elapse between specimen collection and analysis

A

more than 2 hours

25
Q

Tubes with round bottoms are used for?

A

Automated reagent strip testing

26
Q

True or False

Labels must be attached to the lid

A

False, it should be attached to the container(body) and not the lid

27
Q

This should accompany specimens delivered to the laboratory

A

Requisition form

27
Q

Technical Tip: NEVER DISCARD A SPECIMEN before checking with a supervisor

A

Okay!

28
Q

Identify the preservative:

Advantages: Excellent sediment preservative
Disadvantages: Acts as a “reducing agent”, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction

Additional Information: Rinse specimen with this to preserve cells and casts

A

Formalin (Formaldehyde)

28
Q

Specimen collected should be delivered to the laboratory and tested within?

A

2 hours

28
Q

Most routinely used method of preservation of urine specimens

A

Refrigeration at 2-8C

Note: This temperature decreases bacterial growth and metabolism

29
Q

When refrigeration is impossible as a preservation method, there are commercially prepared transport tubes with ____________ available that allow for the transport, testing, and storage of the urine specimens

A

Lyophilized preservative

29
Q

What test is commonly requested on a catheterized specimen?

A

Bacterial culture

30
Q

Technical Tip: Specimens must be returned to room temperature before chemical testing by reagent strips because the enzyme reactions on the strips perform best at Room Temperature

A

Okay! Thanks!

31
Q

Identify the preservative:

Advantages: Good preservative for drug analyses (prevents glycolysis)
Disadvantages: Inhibits reagent strip tests for glucose, blood, and leukocytes

Additional Information: May use sodium benzoate

A

Sodium Fluoride

31
Q

This is the specimen received most commonly because of its ease of collection and convenience for the patient

A

Random specimen

31
Q

Identify the preservative:

Advantages: Prevents bacterial growth and metabolism
Disadvantages: Interferes with analysis of drugs and hormones

Additional Information: Keeps pH at 6.0 , used for transport of urine cultures

A

Acids (boric acid, HCL, acetic acid, tartaric acid)

32
Q

This urine specimen is essential for preventing “false-negative pregnancy tests” and for evaluating “orthostatic proteinuria”

A concentrated specimen.

A

First morning specimen

33
Q

Identify the preservative:

Advantages: Specimen stable at RT for 48 hours; prevents bacterial growth and metabolism
Disadvantages: Do not use if urine is below minimum fill line

Additional Information: preservative is boric acid, sodium borate, and sodium formate ; keeps pH at 6.0

A

Light gray and gray C&S Tube

33
Q

Urine specimen used for: Quantitative chemical tests

A

24-hour (or time)

34
Q

What type of specimen is used for solutes with diurnal variation like:

Catecholamines
17-hydroxysteroids
Electrolytes

A

24-hour (or Timed) Specimen

34
Q

Prostatitis Specimen: Three Glass Collection

1st: Before collection, area is cleansed using male midstream clean-catch procedure
2nd: Instead of discarding the first urine passed, it is collected in a “sterile container”
3rd: The midstream portion is collected in another sterile container
4: Prostate is massaged and prostate fluid is passed with the remaining fluid in a third sterile container

Note: 1st and 3rd specimens are examined microscopically
Note: 2nd specimen is used as a control for bladder and kidney infection (If positive = results from the 3rd specimen is invalid)

Note: In prostatic infection, the 3rd specimen will have a WBC/Hpf count and bacterial count 10x than of the 1st specimen

A

Okay thank you gid! Go! Go! Go! Topnotcher!

34
Q

Urine specimen used for: Bladder urine for bacterial culture and cytology

A

Suprapubic aspiration

35
Q

Identify the preservative:

Advantages: Specimen stable for 72 hours at RT ; instrument-compatible
Disadvantages: Must be filled to minimum fill line

Additional Information: preservative is sodium propionate, ethyl paraben, and chlorhexidine

A

Cherry red/yellow preservative plus tube

36
Q

It is used to produce accurate Quantitative Results

A

24-Hour (or Timed) Specimen

36
Q

This is the ideal screening specimen

A

First morning specimen

36
Q

Technical Tip: Adding urine formed before the start of the collection period will falsely elevate the results; and failure to include the urine produced at the end of the collection period will falsely decrease the results

For 24-Hour (Time) Specimen

A

Okay! Thank you so much!

36
Q

Urine specimen used for: Bacterial culture

A

Catheterized
Midstream clean-catch

36
Q

Urine specimens used for: Routine Screening

A

Random
First morning
Midstream clean-catch

37
Q

Urine specimen used for: Pregnancy tests and orthostatic protein

A

First morning

37
Q

It provides a specimen that is less contaminated by epithelial cells and bacteria therefore is more representative of the actual urine that is routinely voided specimen.

A

Midstream clean-catch specimen

38
Q

True or False

Strong bacterial agents such as hexachlorophene or povidone-iodine can be used as cleansing agents for Midstream clean-catch specimens

A

False, the recommended cleansing agent for Midstream clean-catch specimens is “Mild antiseptic towelettes”

38
Q

Urine specimen used for: Prostatic infection

A

Three-glass collection
Four-glass collection

39
Q

It is an alternative to the catheterized specimen which provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis

A

Midstream clean-catch specimen

40
Q

Technical Tip: When both a routine urinalysis and a culture are requested on a catheterized or midstream collection, the culture should be performed first to prevent contamination of the specimen. A collection transfer kit also can be used.

A

Okay! Yehey!

41
Q

Four-glass urine collection technique is also known as?

A

Stamey-Meares Test for Prostatitis

41
Q

Prostatitis Specimen: Four-Glass Collection

1st specimen(urine specimen): Voided bladder (VB1), first 10 mL, represents urethral specimen

Then, the patient voids another 100 to 150 mL of urine

2nd specimen(urine specimen) : Voided bladder (VB2), another 10 mL, represent the bladder specimen

3rd specimen: Expressed prostatic specimen (EPS), the fluid collected during prostatic massage

4th specimen(urine specimen): Voided bladder (VB3), first 10 mL collected after EPS, contains EPS trapped in prostatic urethra

Note: All specimens are sent for culture
Note: The 3 urine specimens are centrifuged and examined

Urethral infection or inflammation: VB1 (Voided bladder 1)
Urinary bladder infection: VB2 (Voided bladder 2)

A

Okiiiiiiiiiiiii

42
Q

Technical Tip: For Pediatric Specimens, check the applied bags approximately every 15 minutes until the needed amount of sample has been collected

A

YAY!

42
Q

It is the most vulnerable part of a drug-testing program

A

Urine specimen collection

42
Q

If a witnessed specimen collection is ordered, a same-gender collector will observe the collection of __ to __ mL of urine

A

30 to 45 mL of urine

43
Q

A specific gravity of less than _____ could indicate dilution of the urine specimen and requires recollection

A

< 1.005

43
Q

It is the process that provides this documentation of proper specimen identification from the time of collection to the receipt of laboratory results

A

Chain of Custody (COC)

43
Q

It is a standardized form that must document and accompany every step of drug testing, from collector to courier to laboratory to medical review officer to employer

A

Chain of Custody

44
Q

The urine temperature must be taken within __ minutes from the time of collection to confirm the specimen has not be adulterated

A

4 minutes

44
Q

The temperature should read within the range of ___ to ___

A

32.5 to 37.7C

45
Q

A urine pH of greater than _ suggests adulteration of the urine specimen and requires that the specimen be recollected if clinically necessary

A

greater than 9

AUBF Lecture (7 decks)

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