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Body Fluids > Macroscopic Properties of Urine > Flashcards

Macroscopic Properties of Urine Flashcards

1
Q

What is Urinalysis?

A

The testing of urine with procedures commonly performed in an expeditious, realible, safe and cost- effective manner.

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2
Q

What characteristics do we consider when performing the physical examination of urine?

A

Color, clarity, odor, viscosity

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3
Q

what can cause color changes?

A

medication, foods, hydration.

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4
Q

what can cause odors?

A

disease, ketoacidosis, bacteria’s.

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5
Q

What are some values of performing an urinalysis test?

A
  1. easy to obtain specimen.
  2. inexpensive test.
  3. “liquid biopsy” of the kidney because it helps in diagnosis of some diseases like diabetes, ketoacidosis, maple syrup disease.
  4. Screening for pregnancy, drug screen, forensics, measure for kidney function. Determine how well the kidney are concentrating urine.
  5. monitor disease progress
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6
Q

the basics of urine

A
  1. ultrafiltrate of plasma
  2. kidneys convertr approximately 170,000ml of unfiltered plasma
  3. average urine output 1200ml
  4. normal range 600-2000ml
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7
Q

Urinalysis sequence

A
  1. physical analysis
  2. chemical analysis
  3. microscopic examination
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8
Q

main composition of urine

A 
95% water, 5% solutes 
solutes vary depending on 
diet
activity
metabolism 
endocrine 
body position
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9
Q

what are some major organic solutes of urine?

A

urea (protein/amino acid breakdown)

creatinine and uric acid

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10
Q

What two components may identify a fluid as urine?

A

Urea and creatinine

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11
Q

what are some inorganic solutes found in urine?

A

Chloride, sodium, potassium

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12
Q

what are some other compounds that can be found in urine?

A

hormones, vitamins, medications

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13
Q

what are some compounds found in urine that can suggest disease?

A

cell, cast, crystals, mucus and bacteria

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14
Q

Anuria

A

cessation of urine flow

may be a cause of severe kidney damage, decreased renal blood flow, heart failure, shock, and toxic drugs

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15
Q

Oliguria

A

decreased urine output
Adults <400ml/day
children <0.5ml/day
may be caused by vomiting, diarrhea, perspiration, severe burns, obstruction, end stage, renal disease, dehydration or not enough volume to eliminate daily waste products.

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16
Q

Polyuria

A

increased in urine output
adults >2.5L/day
children >2.5-3ml/day
may be caused by decreased production or function of ADH, diuretic use, disease

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17
Q

Nocturia

A

increased urine excretion at night.

normally 2-3 times more excretion in the day.

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18
Q

What are some causes of polyuria?

A

Diabetes insipidus, heavy drinking, diuretics (medications), diabetes mellitus, and psychogenic polydipsia (associated with mental illness with compulsive water intake)

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19
Q

Patient with diabetes insipidus with polydipsia and polyuria

A

decreased production of function of ADH.
This results in decreased reabsorption of water.
Dilute urine with a decreased SG.

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20
Q

Patient with diabetes mellitus with polydipsia and polyuria

A

Decreased production or function of insulin.
Results in increased volume of urine to excrete excess glucose.
Urine looks dilute but increased SG

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21
Q

Specimen Collection

A

Disposable, wide mouth, and flat bottom containers with screw caps are recommended.
Clear container 50ml
Adhesive bags for pediatrics and large 24h containers.
Always wear gloves when working with urine.

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22
Q

Specimen Labelling

A

Label should contain: patients ID, name, date and time of collection, location, age and physician.
A requisition form must accompany specimen. Information must match label and contain other information like interfering meds and type of specimen,

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23
Q

Specimen integrity

A

Test with 2h of collection.

Refrigerate if necessary but remember to allow specimen to reach Room temperature before testing.

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24
Q

What are some problems that can affect the integrity of a urine sample?

A

Mostly caused by bacteria overgrowth.
Increased: color, turbidity, pH, nitrite, odor.
Decreased: glucose, ketones, bilirubin, urobilinogen, RBC, WBC, casts

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25
Q

Specimen preservation

A

Ideal preservative is bactericidal to inhibit urase that is an enzyme that breaks down urea to ammonia and carbon dioxide.
Refrigeration.
Commercial transport tubes are available but they must be compatible with test.

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26
Q

what are some types of samples that might be collected?

A 
First morning
Random
Time collection
Clean catch, midstream
Catheterized
Suprapubic aspiration 
Pediatric
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27
Q

First morning (void)

A

Collected first thing in the morning because it is the most concentrated.
Best for chemical and microscopic exams
Allows for better detection of analytes
Cells and cast are more stable in concentrated urine ( lower pH, high osmolality)
Requires patient to pick up container before hand.

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28
Q

Fasting urine sample

A

second morning void
glucose monitoring
cytology studies

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29
Q

Random urine

A

Collected at anytime
Hydration dependent
Easy and convenient
Volume and concentrations of analytes vary on diet and exercise.

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30
Q

Timed collection

A

24h most common ( req. collection for a period of time)

Quantitative chemical test (creatinine clearance, proteinuria, glucosuria, etc.

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31
Q

How to collect a 24h urine?

A

First voided urine is discarded
All urine after that is saved for 24h.
refrigerated or preservative added.
Used to analyze proteinuria and get accurate baseline creatinine excretion values.

32
Q

Oral Glucose tolerance test (OGTT)

A

Patient fast 10-16h before
Collect urine and draw fasting serum in morning, if not >200mg/dl then give glucose load (75-100g adult)
Measure serum glucose after load every 30min for 2h

<140mg/dl normal
140-199mg/dl is impaired
>200 mg/dl DM

33
Q

Clean catch, midstream

A

Cystitis (bladder infection)
Used when microorganism contamination cannot be tolerated.
Requires patient to clean area around urethra.
A sample of urine is then obtained in midstream
Inside of container cannot come in contact with skin.

34
Q

Catharized

A

Used if voiding is difficult (obstruction, severe UTI, obesity)
Obtained through urethral catheter
Catheter might be already in patient. Sample can be taken from bag.
Catheters can also be inserted into left or right ureter to sample a specific kidney.

35
Q

Suprapubic Aspiration

A

Collection directly from bladder using syringe.
Used to assure contamination- free collection in infants
Procure anaerobic cultures for microbiology.

36
Q

Prostatitis Specimen

A

Collection similar to midstream clean-catch

Not a routine specimen

37
Q

Drug specimen collection

A

Chain of custody- documentation from time of specimen collection until the time specimen is in lab for testing.

38
Q

Physical examination: Color

A

Normal is yellow.
Color is made up of:
Urochrome: primary pigment in normal urine; yellow
Uroerythrin: pink-red. Attaches to amorphous urates.
Urobilin: orange-brown are normally present in lesser concentrations.

39
Q

Urochrome in urine

A

cause yellow color.
Normally excreted at a constant rate.
Increased in thyroid disorders and fasting.
Increases when specimen is sits at room temperature.
Provides estimate of body hydration
Pale yellow to dark yellow is normal.

40
Q

Terms used to describe color of urine

A 
Straw or pale yellow
Yellow
Dark Yellow 
Amber 
Red 
Brown
41
Q

what does dark yellow/ amber/ orange color mean?

A

Oxidation of large amounts of urobiligen produces yellow-orange color.
No foam when shake.
Oxidation of biliruben to biliverdin causes yellow-green color.

42
Q

How does Phenazopyridine or Azogastrisin affect urine color?

A

Used for UTIs and produces a thick orange pigment and yellow foam (no biliruben)
Thick pigment is noticeable, interferes with reagent strip.

43
Q

What does red/pink/brown color mean?

A

Blood commonly causes red urine.
range pink-brown
Pink= small amount of blood
Brown= oxidation of hemoglobin to methemoglobin.
Fresh brown specimen can indicate glomerular bleeding.

44
Q

what does red color mean?

A

Cloudy red= RBC

Clear red= hemoglobin/myoglobin

45
Q

what is hemoglobin?

A

Lysis of RBC

Patients plasma will also be red.

46
Q

what is myoglobin?

A

Breakdown of skeletal muscle.
Fresh urine is often more red/brown
Patient plasma will be clear.

47
Q

What does a port wine color mean?

A 
Oxidation of porphobilinogen to porphyrias.
Nonpathogenic red urine: 
Mestrual 
Pigmented foods
Medications( rifampin) 
Fresh beets 
Black raspberries in acid urine
48
Q

What does a brown/black color mean?

A

Melanin: excess in malignant melanoma. Oxidation of melanogen to melanin.
Homogentisic acid: Black color in alkaline urine(high pH) and in alkaptonuria.
Medications: levodopa and phenol derivates.

49
Q

When should addition testing be done if urine is brown/black?

A

Turn black after standing at rook temperature.

test negative for blood.

50
Q

What does a blue/green color mean?

A

Urinary and intestinal bacterial infections are pathogenic cause.
Urinary- pseudomonas
Intestinal- infection causing increased urinary indican oxidizing to indigo blue.
Catheter bags- purple from Klebsiella
Medications: IV phenol (green), clorents (green), Elavil( blue)

51
Q

Procedure to measure color and clarity

A 
Mix well specimen. 
use a clear container 
View against a white background 
Use adequate lighting
Evaluate a consistent volume of specimen
52
Q

Clarity of specimen

A

Refers to transparency or turbidity of specimen.

Normal are: Clear, hazy, cloudy, turbid, milky.

53
Q

How to do a visual examination of clarity in a urine specimen

A

Gently swirl specimen in a clear container using good lighting.
Fresh clean-catch are usually clear.

54
Q

Clear

A

No visible particulates, transparent

55
Q

Hazy

A

Few particulates, print easily seen through urine

56
Q

Cloudy

A

Many particulates, print blurred through urine

57
Q

Turbid

A

Print cannot be seen through urine

58
Q

Milky

A

May precipitate or be clotted.

59
Q

Some causes of nonpathogenic Turbidity

A

Hazy female specimen with squamous epithelial cell and mucus.
Bacterial growth in non preserved specimens
Refrigerated specimen with precipitated amorphous phosphate(white) and urates (pink)
Contamination: fecal, semen, creams, IV

60
Q

Some causes of pathogenic turbidity

A

Most common: RBC,WBC, bacteria.

yeast, abnormal crystals, lymph fluid, lipids and nonsquamous epithelial cells.

61
Q

When should a microscopic examination be performed?

A

using the clarity criteria

62
Q

Foam

A

Normal- white, small amount
Protein- white, large amount
Bilirubin- yellow, large amount

63
Q

Specific Gravity

A

Says about the concentrating ability of the kidneys. Concentrated enough for reliable results.
Density of solution with density of an equal volume of distilled water at same temperature.

64
Q

What is Specific Gravity influenced by?

A

The number and size of dissolved substance.
Normal 1.003-1.035
Measurements methods: Urinometer, HOD, refractometry, reagent strip.

65
Q

Isosthenuric

A

Urine with SG equal to 1.010

66
Q

Hypersthenuric

A

Urine with SG above 1.010

67
Q

Hyposthenuric

A

Urine with SG below 1.010

68
Q

Refractometer

A

Measures velocity of light in air vs. velocity of light in solution.
Concentration changes the velocity and angle at which the light passes through the solution.

69
Q

Refractometer methodology

A

Calibration:
Distilled water reads 1.000
5% NaCl reads 1.022 +/- 0.001
9% sucrose reads 1.034 +/- 0.001

70
Q

Urinometer

A

Weight of float in distilled water= 1.000
Density of urine raises float to higher level relative to the density of the urine.
Least accurate method.

71
Q

Refractometer and Urinometer corrections for temperature

A

Subtract 0.001 for every 3 degrees urine is below standard calibration temperature 20C.

72
Q

Refractometer and Urinometer corrections for high density substances

A

Protein: minus 0.003 for every g/dl of protein present in specimen
Glucose: minus 0.004 for every g/dl of glucose present in specimen.

73
Q

Harmonic oscillation densitometry (HOD)

A

The frequency of a sound wave entering a solution will change in proportion to the density of the solution.
Used in the IRIS automated urinalysis workstations.
Changes are measured by a microprocessor and converted to SG.

74
Q

Specific Gravity by reagent strip

A

Reagent strip uses change in the pka of a ploy-electrolytes.
It interferers with high protein and pH >6.5
Decreased can mean increased fluid.
Increased can mean vomiting and dehydration.

75
Q

What does a Decreased Specific Gravity mean?

A

Ingestion of large amount of fluids.
Lack of renal concentration
Diabetes insipidus

76
Q

what does an Increase in Specific Gravity mean?

A

Diabetes mellitus
Metabolites of certain drugs
Abnormal high result >1.040 can mean radiopaque dye, glucose, protein.

77
Q

Reagent strip and Osmometer corrections

A

These are not affected by high molecule weight substances.

No need for glucose or protein correction.

Body Fluids (1 decks)

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