Physical Examination of Urine Flashcards
what must be determined during the physical examination of urine
- color
- clarity
- specific gravity
what causes the yellow pigment of the urine
urochrome
who termed the word “urochrome”
thudichum in 1864
urochrome can be increased in px w/?
- increased in thyroid conditions
- increased for those in fasting states
urochrome can also be increased when
left standing at room temp
a pink pigment caused by precipitation of amorphous urates in acidic urine due to refrigeration
uroerythrin
an oxidation product of urobilinogen which imparts an orange-brown color in a urine that is not fresh
urobilin
pale yellow urine; increased urine volume; low SG
diabetes insipidus
pale yellow urine; increased urine volume; high SG; (+) glucose
cause:
DM
px taking b complex vitamins
color of urine:
dark yellow
strenuous exercise or first morning urine color of urine:
dark yellow
Fever and burns
cause and color of urine:
dehydration; dark yellow
yellow foam when shaken; (+) result for bilirubin
cause; color of urine:
Increased bilirubin; dark yellow
(-) bile test and possible green fluorescence
cause and color of urine:
acriflavine
antibiotic administered for urinary tract infections
cause and color of urine:
nitrofurantoin; dark yellow
drug commonly administered for UTI; orange-yellow urine color
cause:
phenazopyridine (pyridium)
anticoagulant, orange in alkaline urine, colorless in acid urine
cause and color of urine:
phenindione; orange yellow
when using phenindione, what is the color of the px when urine pH is alkaline? how about when the pH is acidic?
alkaline: orange or orange yellow
acid: colorless
anti-inflammatory drug that causes orange yellow urine?
sulfasalazine (azulfidine)
sulfasalazine (azulfidine) is an anti-inflammatory drug that cause _ urine color?
orange-yellow urine
colored foam in acidic urine but false negative chemical test in bilirubin
cause and color of urine:
biliverdin (due to oxidation of bilirubin); yellow-green
positive urine culture
cause and color of urine:
p. aeruginosa; green
px eats asparagus and turns it into what color of urine (not everybody has this, some px are just genetically disposed of producing this kind of urine color)
green
an anti-depressant that turns urine into blue green color
amitriptyline (elavil)
amitriptyline is an antidepressant, it turns urine into what color?
blue green
a muscle relaxant that produces blue green color
methocarbamol (robaxin)
methocarbamol (robaxin) is a muscle relaxant that cause __ color in the urine
blue green/green brown
when ingesting clorets, what would the color of your urine be? clorets are chewing gums
blue green
when u have bacterial infections or intestinal disorders, your urine may have a distince blue green color. what causes this?
production of indican, an indole byproduct (trytophan is broken down into indican by bacterial overgrowth)
when the px has a fistula, they might have what color of urine?
blue green
oxidation of phenol leads to what urine color
blue green
what anesthetic produces blue green color?
propofol (diprivan)
blue diaper syndrome
cause and color of urine?
familial hypercalcemia; blue green
non-steroidal anti-inflammatory drugs such as indomethacin (indocin//tivorbex) causes _ color in the urine
blue green
Cloudy urine with positive chemical test results for blood
and RBCs visible microscopically
cause and urine color?
pink red
what is the cause of cloudy urine with positive chemical test results for blood
and RBCs visible microscopically
rbcs
Clear urine with positive chemical test results for blood; intravascular hemolysis
- color?
pink red
what is the cause of clear urine with positive chemical test results for blood; intravascular hemolysis
hemoglobin
Clear urine with positive chemical test results for blood; muscle damage
color?
pink red
what is the cause of clear urine with positive chemical test results for blood; muscle damage
myoglobin
people who are genetically susceptible to beets have ___ color of urine
pink red
px diagnosed with TB medication such as rifampin have _ color of urine
pink red
TB medication that cause pink red urine color
rifampin
Cloudy specimen with RBCs, mucus, and clots
menstruation
negative result for blood but have portwine color in urine
porphyrins
cause of red-brown urine seen in acidic urine after standing; (+) for blood
Methemoglobin (RBC oxidation)
when methemoglobin is present, what is the color of the urine
red-brown
methemoglobin is formed when there is oxidation of RBCs, give examples on how it is formed?
- acidic urine after standing
aside from methemoglobin giving red-brown urine color, give another example
myoglobin
a brown black urine is seen in an alkaline urine when standing, what is the cause of this?
homogentisic acid (alkaptonuria)
homogentisic acid (alkaptonuria) causes __ urine color
brown black
px with malignant melanoma or with excess melanin/melanogen have darkened urine when standing due to the addition of what oxidizers?
- ferric chloride
- sodium nitroprusside
when ferric chloride/sodium nitroprusside is added to a urine from px with malignant melanoma, what is the color of their urine?
brown black
phenol derivatives might interfere with copper reduction tests and might produce
__ urine color
brown black
when using copper reduction test, it is important to not have any ___ or ____ that might cause the urine to have a brown black color
phenol or phenol derivatives
color disappears with ferric chloride
antiseptic (argyrol) - brown black urine
antihypertensive (methyldopa/levodopa) causes __ urine color
brown black
brown black urine color may be observed when using anti-hypertensive medicine such as?
methyldopa and levodopa
what medication is used for intestinal and vaginal infections
metronidazole
metronidazole is a medication used for intestinal and vaginal infxns, it often causes _ urine color
brown black
antimalarial drugs that cause brown black urine
chloroquine and primaquine
chloroquine and primaquine are antimalarial drugs that causes ___ urine color
brown black
muscle relaxant that can either cause blue green or brown black urine
methocarbamol (robaxin)
fava beans, rhubarb or aloe can cause what kind of urine color
brown black
large amount of white foam when shaken indicates?
increased protein concentration
does the oxidation of urobilinogen to urobilin have yellow foam appearance when shaken?
no (only urine with bilirubin has an appearance of yellow foam when shaken)
what is mistaken for bilirubin when it shaken, since it also produces yellow foam?
phenazopyridine (pyridium) or azo-gantrisin
intact rbcs (physical appearance)
- red and cloudy
hemoglobin and myoglobin (physical appearance)
- red and clear (to distinguish them, look at their plasma)
which is cleared rapidly? hgb or mgb
mgb (thats why when distinguishing them through plasma, the plasma appears clear when myoglobin is suspected since it is cleared rapidly)
nonpathogenic causes of red urine
- menstruation
- ingestion of highly pigmented food/ medication (beets - red color in alkaline urine; blackberries - red color in acidic urine)
- ingestion of highly pigmented medication (rifampin, phenolphthalein, phenindione, phenothiazines)
melanin is an oxidation product of
melanogen (colorless product) produced in excess when a px has malignant melanoma
homogentisic acid is a metabolite of
phenylalanine
homogentisic acid imparts a black color to alkaline urine from px with inborn error of metabolism called?
alkaptonuria
A purple staining may occur in catheter bags and is caused by indican in the urine or a bacterial infection, frequently caused
Klebsiella or providencia species
precipitation of amorphous phosphates and carbonates may cause
white cloudiness in an alkaline urine
amorphous urates in an acid urine produces ___ due to uroerythrin
pink brick dust/pink pigment
urine clarity:
No visible particulates, transparent
clear
urine clarity:
Few particulates, print easily seen through urine
hazy
urine clarity:
Many particulates, print blurred through urine
cloudy
urine clarity:
print cannot be seen through urine
turbid
urine clarity:
may precipitate or be clotted
milky
clear
no visible particulates, transparent
hazy
few particulates, print easily seen through urine
cloudy
many particulates, print blurred through urine
turbid
print cannot be seen through urine
milky
may precipitate or be clotted
common pathological turbidity
- rbcs
- wbcs
- bacteria
is used to describe urine with an SG of 1.010
isosthenuric
is used to describe urine with an SG of above 1.010
hypersthenuric
is used to describe urine with an SG of below 1.010
hyposthenuric
SG is influenced by
- number of particles
- size of particles
determines the concentration of dissolved particles in a specimen by measuring refractive index
refractometry
is a comparison of the velocity of light in the air with the velocity of light in a solution
refractive index
are temperature corrections necessary when using refractometers
no because the light beam passes through a temperature-compensating liquid before being directed at the specific gravity scale
in refractometers, temperature is compensated between
15°C and 38°C
how is refractometer calibrated?
- using distilled water; it should give a reading of 1.000 SG
in refractometers, corrections for glucose
and protein
glucose : subtract 0.004 for each gram
protein : subtract 0.003 for each gram
in refractometer, the calibration is further checked using ___ or _____
- 5% NaCl; 1.022 ± 0.001
- 9% sucrose; 1.034 ± 0.001
Results that are abnormally high—above 1.040—are seen in patients who have recently undergone an
IV pyelogram (excretion of the injected radiographic contrast media)
High SG above 1.040 is caused by?
- iv pyelogram (radiographic contrast media)
- dextran
- plasma expanders
high sg above 1.040 can be measured through ___ or ____
rgt strip (chemical) or osmometry
is affected only by the number of particles present
osmolality
in osmolality, small molecules primarily ___ and ____ is important in evaluating renal concentration ability
sodium and chloride
in osmolality, ___ which is not an important substance will contribute more to the sg than sodium and chloride
urea
An _____ is defined as 1 g molecular weight of a substance divided by the number of particles into which it dissociates
osmole
glucose contains how many osmole per gram
180 g per osmole
nacl contains how many osmole per gram
58.5 g per osmole (29.25g per osmole if dissociated)
consists of a weighted float attached to a
scale that has been calibrated in terms of urine specific gravity
urinometer
Solute dissolved in solvent causes the following changes in colligative properties:
Lower FV; Higher OB
- freezing point
- vapor pressure
- osmotic pressure
- boiling point
The —- is based on the change in pKa
(dissociation constant) of a polyelectrolyte in an alkaline medium
reagent strip reaction
increased sg leads to what changes in the pH?
- lowering of the pH (acid urine)
— is based on the principle that the frequency of a sound wave entering a solution changes in proportion to the density of the solution
Harmonic oscillation densitometry
normal urine odor
aromatic
bacterial decomposition, urinary tract infection urine odor
foul, ammonia-like
Ketones (diabetes mellitus,
starvation, vomiting)
Fruity, sweet
Maple syrup urine disease
Maple syrup
Phenylketonuria
Mousy
Tyrosinemia
Rancid
Isovaleric acidemia
Sweaty feet
Methionine malabsorption
Cabbage
Contamination
Bleach
