Physical Examination of Urine Flashcards
Enumerate the Physical Characteristics of Urine:
Color
Clarity
Odor
Taste
Foam
Volume
Concentration
In the evaluation of urine physical characteristics it is recommended to view through a clear container
TRUE OR FALSE
TRUE
Clear containers either plastic or glass.
What may this describe?
Can be inverted; a vortex can be used to mix the specimen (for the urine to be well-distributed all throughout).
A well-mixed specimen
Main determinant of body’s state of hydration.
Urine Volume
Characterized by decreased urine output.
Dehydration
Reabsorbs water retention in the body; prevents water to be excreted in the urine.
ADH also called Arginine Vasopressin
Waste products and solutes are released from the blood to the urine.
TRUE OR FALSE
TRUE
Of the approximate renal blood flow of 100 mL/min, only an average of 1 mL/min is excreted as urine.
TRUE OR FALSE
FALSE
the approximate renal blood flow is not 100 mL/min, its 120mL/min
____% of our blood passes through the renal artery, which will later on be filtered by the kidney.
25%
if an average of 1 mL/min is excreted as urine.
what may a value of 0.3mL/min imply?
Dehydration
if an average of 1 mL/min is excreted as urine.
what may a value of 15mL/min imply?
Excessive hydration
The kidneys excrete 2 – 3x more urine at night than it will during the day.
TRUE OR FALSE
FALSE
The kidneys excrete 2 – 3x more urine during the day than it will at night.
Night-and-Day Volume Ratio of Urine
1:2 to 1:3
Day-and-Night Volume Ratio of Urine
2:1 to 3:1
Normal Daily Urine Output
600 – 2000 mL
Average Daily Urine Output
1200 – 1500 mL
This derangement is characterized by an increase in daily urine output.
Polyuria
This derangement is characterized by an decrease in daily urine output.
Oliguria
Name this derangement
Possible Causes:
o (1) Increased fluid intake;
o (2) Nervousness;
o (3) Diabetes Mellitus;
o (4) Diabetes Insipidus;
o (5) Diuretics (e.g., alcohol, coffee, etc.).
Polyuria
Name this derangement
Possible Causes:
o (1) Decreased fluid intake;
o (2) Excessive water loss;
o (3) Calculi or tumors of the kidney.
Oliguria
increased urine excretion (>1800 mL/day).
Diuresis
Increased urine output at night.
Nocturia
Name this derangement
Possible Causes:
o (1) Increased fluid intake at night;
o (2) Reduction in bladder capacity;
o (3) Chronic progressive renal failure.
Nocturia
Can be caused by pregnancy (placenta occupies the space in the bladder), old age, or enlarged prostate.
Reduction in bladder capacity
Loss of circadian rhythm in the kidney.
Chronic progressive renal failure.
Absence of urine output; complete cessation of urine output
Anuria
<100 mL/day in 2 – 3 consecutive days in spite of high fluid intake is a product of?
Anuria
Name this derangement
Possible Causes:
o (1) Decreased renal blood flow;
o (2) Serious kidney damage;
o (3) Urinary tract obstruction.
Anuria
Both are characterized by High urine output (polyuria)
DIABETES MELLITUS AND DIABETES INSIPIDUS
Diabetes characterized by Decreased/defective insulin
DIABETES MELLITUS
Diabetes characterized by High concentration of glucose in the urine
DIABETES MELLITUS
Diabetes characterized by Decreased/defective ADH
DIABETES INSIPIDUS
Diabetes characterized by Diluted urine
DIABETES INSIPIDUS
Diabetes characterized by an increased Specific Gravity
DIABETES MELLITUS
Diabetes characterized by decreased Specific Gravity
DIABETES INSIPIDUS
Roughly indicates the degree of hydration; should be correlated with specific gravity. Affected by concentration
Urine Color
Describe the observation
Pale yellow: Diluted urine
Properly hydrated
Describe the observation
Dark yellow: Concentrated urine
Dehydrated
Describe the observation
Almost colorless or straw → pale or light yellow
NORMAL
The yellow urine pigment
Urochrome
Lipid soluble (does not dissolve in water); named by Thudichum in 1864.
Urochrome
Produced at a constant rate via endogenous metabolism; present in plasma.
Urochrome
Imparts the normal yellow color in urine.
Urochrome
Increased in thyroid conditions, fasting state, and prolonged urine standing at room temperature.
Urochrome
The urine pigment that resembles Pink brick dust
UROERYTHRIN
Attaches to urates as a result of amorphous urates precipitation in an acid urine.
UROERYTHRIN
Urine pigment most evident in refrigerated specimens.
UROERYTHRIN
the dark yellow/orange urine pigment
UROBILIN
Oxidation product of normal urinary urobilinogen.
UROBILIN
Imparts an orange-brown color to urine that is not fresh.
UROBILIN
Hemoglobin degrades → bilirubin → urobilinogen.
UROBILIN
Interpret the pathologic cause of this urine color
Colorless to pale yellow
Diabetes mellitus and diabetes insipidus.
Interpret the pathologic cause of this urine color
Dark yellow, amber, orange
- Bilirubinuria
- Biliverdin
- Excess urobilin
Interpret the pathologic cause of this urine color
Blue, green
- Indican (product of tryptophan metabolism)
- Pseudomonas infection
Interpret the pathologic cause of this urine color
Pink, red
- Hematuria
- Hemoglobinuria
- Myoglobinuria
Interpret the pathologic cause of this urine color
Brown, black
- Methemoglobinuria (oxidized hemoglobin; brown)
- Alkaptonuria
- Melanuria
metabolic disorder wherein homogentisic acid accumulates in the urine; upon alkalinization, this imparts the color black in the urine
Alkaptonuria
Increased indican in the urine = indicanuria; seen in what condition?
Hartnap Syndrome (Blue Diaper Syndrome)
Produces pyocyanin and pyoverdine.
Pseudomonas infection
Interpret the non-pathologic cause of this urine color
Colorless to pale yellow
Recent fluid consumption or diuresis
Interpret the non-pathologic cause of this urine color
Dark yellow, amber, orange
- Acriflavine
- Phenazopyridine (Pyridium)
- Carotene
- Warfarin (Coumadin)
- Riboflavin (vitamin) /Nitrofurantoin
- Phenindione
Interpret the non-pathologic cause of this urine color
Blue, green
- Amitriptyline
- Methocarbamol
- Methylene blue
- Phenol
- Clorets
- Azure A
Interpret the non-pathologic cause of this urine color
Pink, red
- Beets (alkaline/acid urine)
- Rifampin (anti-TB drug)
- Menstrual contamination
- Blackberries
- Phenolphthalein
- Phenolsulfonphthalein
- Phenothiazines
- Senna (laxative; Carcasa)
Interpret the non-pathologic cause of this urine color
Brown, black
- Levodopa
- Methyldopa
- Metronidazole
- Argyrols
- Phenol derivatives
used in Diagnex Blue Test, which tests for gastric fluid and the presence of HCl
Azure A
Urine has a lot of intact RBCs, which gives the smoky or cloudy red urine
Hematuria
High amounts of hemoglobin in the urine; degraded RBCs and their cell membranes.
Hemoglobinuria:
Myoglobin is present in the skeletal muscles; keeps oxygen in the muscles.
Myoglobinuria
Wherein: Hemoglobin and myoglobin are both present as clear, red urine.
A by-product of heme synthesis; imparts a portwine red-purple color
Porphyrin
Came from the oxidation of porphobilinogen/porphyrinogen, a by-product of heme synthesis.
Porphyrin
When one has melanoma, the excess melanin will be excreted in the urine.
Melanuria
Upon air exposure/standing of urine (environment turns alkaline), this will present a black color.
Melanuria
color of urine that may occur in catheter bags
Violet
This color of urine may indicate the ff
o (1) Indican;
o (2) Klebsiella infection;
o (3) Providencia infection.
Violet
faint cloud in urine after standing due to WBCs, epithelial cells and mucus.
Nubecula
- Provides a key or correlation to the microscopic
examination results. - Amount of turbidity correlates with materials observed
under the microscope
CLARITY/TRANSPARENCY/TURBIDITY
This is the normal CLARITY/TRANSPARENCY/TURBIDITY of urine
Usually clear or transparent
CLARITY/TRANSPARENCY/TURBIDITY OF URINE
No visible particulates (transparent); all solutes are soluble (all are dissolved in water).
CLEAR
CLARITY/TRANSPARENCY/TURBIDITY OF URINE
Few particulates (print is easily seen); amount of haziness varies with substances and its’ amount present in urine.
HAZY/SLIGHTLY CLOUDY
CLARITY/TRANSPARENCY/TURBIDITY OF URINE
Many particulates (print is blurred); difficult to read.
CLOUDY
CLARITY/TRANSPARENCY/TURBIDITY OF URINE
Print cannot be seen
TURBID
CLARITY/TRANSPARENCY/TURBIDITY OF URINE
May precipitate or be clotted (crystals).
MILKY
These are the non-pathlogical cause of urine turbidity
RBCs
WBCs
Bacteria
Yeast
Nonsquamous epithelial cells
Abnormal crystals
Lymph fluids (chyle – chyluria)
Lipids (lipiduria)
TRUE OR FALSE
FALSE
These are all pathological causes of turbidity
These are the non-pathlogical cause of urine turbidity
Squamous epithelial cells
Mucus
Amorphous crystals
Semen (spermatozoa)
Fecal contamination
Radiographic contrast media
Talcum powder
Vaginal creams
TRUE OR FALSE
TRUE
Correlate the urine turbidity when viewed in the laboratory
Amorphous urates, radiographic contrast media (dye).
ACIDIC URINE
Correlate the urine turbidity when viewed in the laboratory
Amorphous phosphates, carbonates.
ALKALINE URINE
Correlate the urine turbidity when viewed in the laboratory
Amorphous urates, uric acid crystals.
SOLUBLE WITH HEAT
Correlate the urine turbidity when viewed in the laboratory
RBCs, amorphous phosphates, carbonates.
SOLUBLE WITH DILUTE ACETIC ACID
Correlate the urine turbidity when viewed in the laboratory
WBCs, bacteria, yeast, spermatozoa
INSOLUBLE WITH DILUTE ACETIC ACID
Correlate the urine turbidity when viewed in the laboratory
Lipids, lymphatic fluid, chyle.
SOLUBLE WITH ETHER
Not reported in routine urinalysis. Serves as preliminary and supportive evidence for the presence of protein and bilirubin.
FOAM
Are these conditions normal when describing foam in urine?
When urine specimen is shaken or agitated sufficiently, a white foam can be forced to develop at its’ surface that readily dissipates on standing
YES OR NO
YES
These conditions are NORMAL
Present in White, stable Foam
Protein (albumin)
Present in Yellow, yellow-green Foam
Bilirubin
produces orange foam; can resemble the foam caused by bilirubin
Phenazopyridine (Pyridium)
When discussing foam in urine these happen upon?
o Amorphous phosphates: Imparts white turbidity.
o Amorphous urates: Imparts pink turbidity.
Refrigeration
Historically done (circa 1674) to detect presence of urinary sugars (for diabetes mellitus).
Urine Taste test
disorder producing copious amount of urine
Diabetes
The following is the taste of urine for each form of diabetes
MELLITUS: Tasteless.
INSIPIDUS: Sweet.
TRUE OR FALSE
FALSE
MELLITUS: Sweet.
INSIPIDUS: Tasteless.
This urine characteristic is seldom of clinical significance unless distinct ones are present.
Odor (distinct odor)
These are normal conditions for the odor of urine
FAINT AROMATIC (freshly voided) which becomes ammoniacal (from bacterial accumulation) when the urine is allowed to stand.
TRUE OR FALSE
TRUE
What makes urine ammoniacal?
Solutes undergo further oxidation in the urine, making it ammoniacal.
What derangement corresponds to the odor?
Odorless
Acute Tubular Necrosis
What derangement corresponds to the odor?
Ammonia-like
Bacterial decomposition: UTI
(pungent/fluid), old/improperly
preserved urine.
What derangement corresponds to the odor?
Fruity, sweet
Ketones: Diabetes Mellitus,
starvation, vomiting, diarrhea.
What derangement corresponds to the odor?
Maple syrup, caramelized sugar, curry
Maple Syrup Urine Disease
What derangement corresponds to the odor?
Mousy, barny, musty
Phenylketonuria
What derangement corresponds to the odor?
Rancid
Tyrosinemia
What derangement corresponds to the odor?
Sweaty feet
Isovaleric and glutaric acidemia
What derangement corresponds to the odor?
Cabbage, hops
Methionine malabsorption
What derangement corresponds to the odor?
Rancid butter
Tyrosiluria, hypermethioninemia
What derangement corresponds to the odor?
Rotting fish, old fish, fishy
Trimethylaminuria, hypermethioninemia
What derangement corresponds to the odor?
Bleach
Contamination or adulteration of
specimen.
What derangement corresponds to the odor?
Menthol-like
Phenol-containing medications
What derangement corresponds to the odor?
Rotten eggs, sulfur
Cystinuria
What derangement corresponds to the odor?
Swimming pool
Hawkinsinuria
What derangement corresponds to the odor?
Mercaptan, pungent, unusual, distinctive
Ingestion of asparagus, onions, garlic, and eggs.
Expressed as specific gravity or osmolality. Used to measure the concentrating ability of the kidney in maintaining homeostasis.
Urine Concentration
density (principle) of a solution compared with the density of a similar volume of distilled water (SG 1.000) at a similar temperature.
Specific Gravity
the concentration of a solution expressed in terms of osmoles of solute particles per kilogram of water (osm/kg)(principle = colligative properties).
Osmolality
These ALL measure specific gravity
- Freezing Point Depression
- Vapor pressure depression
TRUE OR FALSE
FALSE
These depressions measure Osmolality instead
These all measure specific gravity
- Reagent strip test
- Refractometry
- Falling drop
- Harmonic Oscillation Densitometry
- Urinometry
TRUE OR FALSE
TRUE
Measure of osmolality where all solutes
contribute equally to result obtained
Freezing Point Depression
Measure of osmolality that does not detect volatile solutes
(e.g., ethanol, methanol, ethylene glycol).
Vapor Pressure Depression
A specific gravity test that is characterized by pKa change of polyelectrolyte.
Reagent Strip Test
A specific gravity test that is characterized by refractive index.
Refractometry
The indirect methods to measure Specific gravity
Reagent Strip Test and Refractometry
The direct methods to measure Specific gravity
- Falling Drop
- Harmonic Oscillation Densitometry
- Urinometry
This is the PRINCIPLE of specific gravity in urine
Density
Specific gravity is affected by both the number and size of particles in the solution.
TRUE OR FALSE
TRUE
These are the observed values for random specific gravity tests
1.002 – 1.035
1.040 if there is notable (radiocontrast media).
These are the observed values for a 24hr specific gravity test
1.015 – 1.025
Variations in specific gravity
Urine with S.G. fixed at 1.010 (filtrate from the glomerulus).
ISOSTHENURIA
Variations in specific gravity
Urine with S.G. less than 1.010 (1.007).
HYPOSTHENURIA
Variations in specific gravity
Urine with S.G. greater than 1.010
HYPERSTHENURIA
Direct method for specific gravity that is calibrated daily with distilled water (S.G. 1.000).
URINOMETRY
Direct method for specific gravity that is Calibrated at 20°C.
URINOMETRY
Direct method for specific gravity that requires 10 – 15 mL of urine.
URINOMETRY
Less accurate than other methods for specific gravity.
URINOMETRY
Direct method for specific gravity that requires temperature, protein, and glucose correction.
URINOMETRY
tool used in URINOMETRY
Urinometer or Hydrometer
Direct method for specific gravity that is a change in the frequency of sound waves oscillation is in proportion to the density in the solution.
HARMONIC OSCILLATION DENSITOMETRY
Direct method for specific gravity that has a microprocessor that corrects sample temperature; valid results up to an S.G. of 1.080.
HARMONIC OSCILLATION DENSITOMETRY
Direct method for specific gravity that utilizes a specially-designed column filled with water-immiscible oil.
FALLING DROP
Direct method for specific gravity where a measured drop of urine is introduced into the column, and as this drop falls, it encounters two beams of light (breaking the first beam starts a timer, and breaking the second turns it off).
FALLING DROP
Direct method for specific gravity where the falling time is measured electronically and is expressed as a specific gravity
FALLING DROP
Indirect method for specific gravity based on the refractive index, which is differentiating the velocity of light in air vs. the velocity of light in a solution.
REFRACTOMETRY
Indirect method for specific gravity where degree or deviation or refraction of light is in proportion with the density in the solution.
REFRACTOMETRY
Indirect method for specific gravity that requires 1 – 2 gtts/drops of urine.
REFRACTOMETRY
Indirect method for specific gravity that is calibrated between 15 – 38°C.
REFRACTOMETRY
Indirect method for specific gravity that is interfered by radiographic contrast media.
REFRACTOMETRY
Indirect method for specific gravity that is calibrated daily using distilled water, 3% NaCl, 5% NaCl, and 9% sucrose to adjust the set screw.
REFRACTOMETRY
Indirect method for specific gravity where temperature correction is not required. Instead requires protein and glucose correction.
REFRACTOMETRY
Identify their calibration values for Refractometry
D. H2O
1.000
Identify their calibration values for Refractometry
3% NaCl
1.015 +/- 0.001
Identify their calibration values for Refractometry
5% NaCl
1.022 +/- 0.001
Identify their calibration values for Refractometry
9% Sucrose
1.034 +/- 0.001
The reading on the refractometer is generally lower
than a urinometer reading on the same urine specimen
by about 0.002.
TRUE OR FALSE
TRUE
Indirect method for specific gravity that detects ionized solutes only (indicator changes color in relation to ionic concentration).
REAGENT STRIP TEST
Indirect method for specific gravity where the S.G. pad contains polyelectrolytes and bromthymol blue as indicator with color reaction of blue (1.000) to green to yellow (1.030).
REAGENT STRIP TEST
Indirect method for specific gravity wherein manufacturers recommend adding 0.005 when the pH is 6.5 or higher.
REAGENT STRIP TEST
Indirect method for specific gravity where there are no glucose, protein, and radiographic contrast media
interferences.
REAGENT STRIP TEST
Identify how these values for specific gravity are corrected for Reagent Strip Test
TEMPERATURE
- (Urinometer); Adjust by 0.001
for every 3°C difference from
calibration temperature. - Subtract if below (colder
temp). - Add if above (warmer temp); if
hindi umabot by 3 increments,
retain
Identify how these values for specific gravity are corrected for Reagent Strip Test
PROTEIN
Subtract 0.003 for every 1 g/dL of
protein.
Identify how these values for specific gravity are corrected for Reagent Strip Test
GLUCOSE
Subtract 0.004 for every 1 g/dL of
glucose
Indirect method for specific gravity affected only by the number of particles present
OSMOLALITY
Normal values for Osmolality
Serum
275 – 295 mOsm/kg;
Normal values for Osmolality
Urine
275 – 900 mOsm/kg.
the amount of a substance that dissociates to produce 1 mole of particles in a solution.
Osmole
Because the osmolality of biological fluids such as
urine and serum is very low, the milliosmole (mOsm) is
the unit of choice.
TRUE OR FALSE
TRUE
Where; 1 osm = 1000 mOsm
Osmolality is considered more precise than its’ counterpart, osmolarity because osmolality does NOT vary with temperature.
TRUE OR FALSE
TRUE
In every 1 mole of substance that is dissolved in a
solution, the freezing point and vapor pressure
INCREASES while the boiling point DECREASES.
TRUE OR FALSE
FALSE
In every 1 mole of substance that is dissolved in a
solution, the freezing point and vapor pressure
DECREASES while the boiling point INCREASES.
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Freezing Point
What is the normal pure water point?
0°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Freezing Point
WHAT IS THE EFFECT OF 1 MOLE OF SOLUTE?
Lowered 1.86°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Boiling Point
What is the normal pure water point?
100°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Boiling Point
What is the EFFECT OF 1 MOLE OF SOLUTE?
Raised 0.52°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Vapor Pressure
What is the normal pure water point?
2.38 mm Hg at 25°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Vapor Pressure
What is the EFFECT OF 1 MOLE OF SOLUTE?
Lowered 0.3mm Hg at 25°C
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Osmotic Pressure
What is the normal pure water point?
0 mmHg
PARTICLE CHANGES TO COLLIGATIVE PROPERTIES
Osmotic Pressure
What is the EFFECT OF 1 MOLE OF SOLUTE?
Increased 1.7 x 109 mm Hg
Which of the following conditions will cause a smoky red urine?
HEMATURIA
POLYURIA
NOCTURIA
MARIA
HEMATURIA
All of the following methods are considered as direct methods for specific gravity, EXCEPT:
REFRACTOMETRY
URINOMETRY
FALLING DROP
REFRACTOMETRY
The ammoniacal color of urine can suggest which of the following diseases?
URINARY TRACT INFECTION
CANCER
MAPLE SYRUP DISEASE
URINARY TRACT INFECTION
In the foam test, which of the following substances will produce persistent yellow bubbles when urine is shaken?
BILIRUBIN
Which of the following derangements in urine volume will have a urine output of less than 100 mL per day for 2 – 3 consecutive days?
ANURIA
is a weighted glass float with a long, narrow, calibrated stem.
URINOMETER
