physical Examination Of The Urine Flashcards by Loui Mojica

Give Normal Urine Colors:

Pale yellow, yellow, dark yellow, and amber

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URINE Color based on:

◦ normal metabolic functions
◦ physical activity
◦ingested materials
◦ pathologic conditions

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Responsibility of the laboratory to determine whether this color change is normal or pathologic.

Determining urine color

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Who discover the urochrome in the urine

Johann Ludwig Wilhelm Thudichum 1864

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It produce yellow color

Urochrome

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Urochrome increased amounts produced in thyroid conditions and fasting states

thyroid conditions and fasting states

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product of endogenous metabolism, and under normal conditions the body produces it at a constant rate

Urochrome

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It produce pink pigment

Uroerythrin

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most evident in specimens that have been refrigerated

Uroerythrin

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attaches to the urates, producing a pink color to the sediment.

Uroerythrin

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an oxidation product of the normal urinary constituent urobilinogen

Urobilin

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imparts an orange-brown color to urine that is not fresh

Urobilin

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Commonly observed with random specimens

Colorless

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Pale yellow caused by

◦ Polyuria or diabetes insipidus
◦ Diabetes mellitus
◦ Dilute random specimen

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Increased secretion of urine in 24-hour volume

Polyuria or diabetes insipidus

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Elevated specific gravity and positive glucose test result

Diabetes mellitus

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Recent fluid consumption

Dilute random specimen

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It is Concentrated specimen

Dark yellow

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Dehydration from fever or burns

Amber

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Bilirubin oxidized to biliverdin

Yellow-green to Yellow-brown

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Colored foam in acidic urine and false-negative chemical test results for bilirubin

Yellow-green to Yellow-brown

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Yellow foam when shaken and positive chemical test results for __________

Bilirubin

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Negative bile test results and possible green fluorescence

Acriflavine

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Drug commonly administered for urinary
tract infections

Phenazopyridine (Pyridium)

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Anticoagulant, orange in alkaline urine, colorless in acid urine

Phenindione

Antibiotic administered for urinary tract infections

Nitrofurantoin

Cloudy urine with positive chemical test results for blood and __________ visible microscopically

RBCs

Clear urine with positive chemical test results for blood; intravascular hemolysis

Hemoglobin

Clear urine with positive chemical test results for blood; muscle damage

Myoglobin

Port wine colored urine

Porphyrins

Porphyrins Detected with ________________or ____________ under ultraviolet light

Watson-Schwartz screening test or fluorescence

Pink to red that gives color:

• RBC • hemoglobin • myoglobin • porphyrins • beets • rifampin • menstrual contamination

Cloudy specimen with RBCs, mucus, etc

Menstrual contamination

Brown to Black that gives color

• Homogentisic acid • Melanin • Argyrol • Phenol derivatives • RBCs oxidized to methemoglobin • Methyldopa or levodopa • Metronidazole (Flagyl)

Brown to Black that gives color

• Homogentisic acid • Melanin • Argyrol • Phenol derivatives • RBCs oxidized to methemoglobin • Methyldopa or levodopa • Metronidazole (Flagyl)

Seen in acidic urine after standing; positive chemical test result for blood

RBC oxidized to methemoglobin

Seen in alkaline urine after standing; specific tests are available

Homogentisic acid (alkaptonuria)

Urine darkens on standing and reacts with nitroprusside and ferric chloride

Melanin

Interfere with copper reduction tests

Phenol derivatives

Color disappears with ferric chloride

Argyrol (antiseptic)

Antihypertensive

Methyldopa or levodopa

Darkens on standing

Metronidazole (Flagyl)

GreeN / BLUE-green that gives color

• Pseudomonas infection • phenol • Methocarbamol (Robaxin) • Amitriptyline • Clorets • Indican • methylene blue

cause a stable white foam to be produced when urine is poured or agitated

URINE WITH LARGE AMOUNT OF PROTEIN (ALBUMIN)

Common terms used to report the appearance of urine are:

Clear, hazy, cloudy, turbid, and milky

No visible particulates, transparent.

Clear

Few particulates, print easily seen through urine.

Hazy

Many particulates, print blurred through urine.

Cloudy

Print cannot be seen through urine.

Turbid

May precipitate or be clotted.

Milky

Pathologic Causes of Urine Turbidity

• RBCs • WBCs • Bacteria • Yeast • Nonsquamous epithelial cells • Abnormal crystals • Lymph laid • Lipids

Nonpathologic Causes of Urine Turbidity

• Squamous epithelial cells • Mucus • Amorphous phosphates, carbonates, unates • Semen, spermatozoa • Fecal contamination • Radiographic contrast media • Talcum powder • Vaginal creams

Laboratory Correlations in Urine Turbidity:

• Acidic Urine • Alkaline Urine • Soluble With Heat • Soluble in Dilute Acetic Acid • Insoluble in Dilute Acetic Acid • Soluble in Ether

detects possible dehydration or abnormalities in antidiuretic hormone

Specific gravity

___________ of a solution compared with the density of a similar volume of distilled water at a similar temperature

Density

Direct method used in specific gravity

• Urinometer or hydrometer • Harmonic oscillation densitometry

Indirect method used in specific gravity

• Refractometer • reagent strip

Urinometer (hydrometer) principle

Density

Major disadvantage of Urinometer (hydrometer)

◦ Requires large volume (10-15ml) ◦ Spinning motion ◦ Read at lower meniscus

Urinometer (hydrometer) Temperature Sensitive

20 degree Celsius

Glucose & Protein sensitive:

- 1 g/dl protein subtract 0.003 - 1g/dl glucose subtract 0.004

Refractometer Principle:

refractive index

Refractometer advantage:

• Small volume (1 or 2 drops) • Temperature compensated bet. 15-38°C

is a comparison of the velocity of light in air with the velocity of light in a solution.

Refractive index

REFRACTOMETER calibration:

◦1.000 (dH2O) ◦1.022 ± 0.001 (5% NaCl) ◦1.034 ± 0.001 (9% sucrose)

Harmonic oscillation densitometry Principle

Density

The frequency of a sound wave entering a solution changes in proportion to the density of the

Harmonic oscillation densitometry

Harmonic oscillation densitometry Results are linear up to a specific gravity of

1.080

Uses mass gravity meter

Harmonic oscillation densitometry

Reagent strip Method Principle:

changes of a polyelectrolyte

SPECIFIC GRAVITY of Isosthenuric

1.010 SG OF URINE

SPECIFIC GRAVITY of Hyposthenuric

< 1.010 SG OF URINE

SPECIFIC GRAVITY of Hypersthenuric

> 1.010 SG OF URINE

Specimen with SG of __________ probably are not urine!

1.003

SG of random specimen falls between _______ & __________

1.015 and 1.030

Abnormally high SO results are seen:

> 1.035

Freshly voided urine

Aromatic odor

Prolonged standing of specimen and Breakdown of urea

Ammoniacal odor

Odor: Aromatic cause:

Normal

Odor: Foul, ammonia-like Cause:

Bacterial decomposition, urinary tract infection

Odor: Fruity, sweet Cause:

Ketones (Diabetes Mellitus, Starvation, Vomiting)

Odor: Maple syrup Cause:

Maple syrup urine disease

Odor: Mousy Cause:

Phenylketonuria

Odor: Rancid Cause:

Tyrosinemia

Odor: Sweaty feet Cause:

Isovaleric acidemia

Odor: Cabbage Cause:

Methionine malabsorption

Odor: Bleach Cause:

Contamination (Semen)

Odor: Rotting fish Cause:

Trimethylaminuria

Odor: Menthol Cause:

Phenol

Odor: Sulfur odor Cause:

Cystinuria