Physical Examination of Urine Flashcards
The ____ gives you an idea what are the results that you can obtain from the chemical and microscopic examination of urine.
Physical Examination
The ____ is a rough indicator of the degree of hydration.
Urine color
The urine color is a rough indicator of the ____.
degree of hydration
The ____ should correlate with the urine specific gravity.
Urine color
The urine color should correlate with the ____.
urine specific gravity
Low fluid intake = ____ = ____ = ____.
- darker urine color
- higher amount of solute
- increased specific gravity
High fluid intake = ____ = ____ = ____.
- lighter urine color
- lower amount of solute
- decreased specific gravity
The yellow color of urine is caused by the presence of ____.
Urochrome
Urochrome is a product of ____.
endogenous metabolism
____ is a product of endogeneous metabolism.
Urochrome
____ is produced by the body at a constant rate under normal conditions.
Urochrome
The urochrome produced is dependent on the ____.
body’s metabolism
TRUE OR FALSE.
Urochrome is decreased when left at room temperature.
False
Answer: Increased
Because urochrome is excreted at a constant rate, a dilute urine will be ____.
pale yellow
Because urochrome is excreted at a constant rate, a concentrated urine will be ____.
dark yellow
____ is a water-soluble pigment.
Urochrome
TRUE OR FALSE.
Urochrome is water-insoluble
False
Answer: Water-soluble
The rate of production of urochrome depends on the ____.
metabolism
The higher the metabolism, the production of urochrome is ____.
increased
Is urochrome normally present in the body?
Yes, it is excreted in urine.
Why is urochrome water-soluble?
Because the urine is made up of water
Examples of instances when metabolism is increased, which will result in increased urochrome
- Hyperthyroidism
- Fever
- Starvation
Why are patients with renal disease, failure, or CKD have a yellowish-skin?
Since the filtering capacity of their kidneys is damaged, the urochrome is deposited under the subcutaneous fats which causes the pigmentation.
____ is most evident in specimens that have been refrigerated.
Uroerythrin
Uroerythrin is most commonly seen in specimens that have been ____.
refrigerated
____ deposit in amorphous urates and uric acid crystals.
Uroerythrin
____ gives a pink pigment to the sediments.
Uroerythrin
What pigment does uroerythrin produce?
Pink
Also gives reddish or brick-red crystals
How does uroerythrin give the pink color to the sediment?
By attaching to urates
____ forms reddish or brick-red crystals.
Uroerythrin
Uroerythrin produces ____ crystals.
reddish or brick-red
____ imparts an orange-brown color of urine that is not fresh.
Urobilin
What pigment does urobilin produce?
Orange-brown
____ is the oxidized form of urobilinogen.
Urobilin
____ gives color in feces as stercobilin.
Urobilin
Is urobilin a normal constituent of urine?
No
Factors affecting urine color
- Amount of substance
- Urine pH
- Structural form
Urine Pigments
- Urochrome
- Uroerythrin
- Urobilin
Normal Urine Color
- Colorless/Straw
- Pale Yellow
- Dark Yellow
Determine the color of Urine
Recent fluid consumption
Colorless or Straw
Determine the color of Urine
Lead poisoning
Colorless or Straw
TRUE OR FALSE.
A colorless first morning urine specimen is normal.
False
Reason: Not normal as it should be concentrated; kidney failure.
Pathological instances when urine is colorless
- Kidney failure (first morning urine specimen is colorless)
- Lead poisoning
Determine the color of Urine
Diluted random specimen
Pale yellow
Determine the color of Urine
Polyuria
Pale yellow
Determine the color of Urine
Diabetes mellitus
Pale yellow
Determine the color of Urine
Diabetes insipidus
Pale-yellow to Colorless/Straw
In ____, glucose and water excretion is increased.
Diabetes mellitus
How will you describe the specific gravity of a patient with Diabetes Mellitus?
Increased
Why is the specific gravity of patients with Diabetes Mellitus increased?
Due to the excretion of glucose
In ____, there is a deficiency in ADH, but increased water excretion.
Diabetes insipidus
How will you describe the specific gravity of a patient with Diabetes Insipidus?
Decreased
How is diabetes mellitus similar to diabetes insipidus?
Both have increased water excretion
How is diabetes mellitus different than diabetes insipidus?
- DM: ↑ Glucose = ↑ SG
- DI: ↓ ADH = ↓ SG
Determine the color of Urine
Concentrated specimen
Dark yellow
Determine the color of Urine
Increased urochrome
Dark yellow
Determine the color of Urine
Dehydration
Dark yellow
Determine the color of Urine
Strenuous exercise
Dark yellow
Determine the color of Urine
First morning urine specimen
Dark yellow
Determine the color of Urine
Complex B vitamins
Dark yellow
Determine the color of Urine
Bilirubin
Dark yellow
Determine the color of Urine
Acriflavine
Dark yellow
Determine the color of Urine
Nitrofurantoin
Dark yellow
Determine the color of Urine
Good hydration, overhydration, or mild hydration
Clear
Determine the color of Urine
Good hydration of mild hydration
Pale yellow
Determine the color of Urine
Mild or moderate dehydration; taking vitamin supplements
Bright yellow
Determine the color of Urine
Moderate or severe dehydration
Orange, Amber
Determine the color of Urine
Severe dehydration or burned patients
Tea-colored
Determine the color of Urine
Presence of abnormal pigment bilirubin
Dark yellow/Amber/Orange
____ produces a yellow foam when the specimen is shaken.
Bilirubin
Bilirubin produces a ____ when the specimen is shaken.
yellow foam
The yellow foam produced by bilirubin may contain ____.
hepatitis virus
____ also causes yellow foam.
Phenazopyridine (Pyridium)
Bilirubin increases when there is a ____.
liver problem
____ increases when there is a liver problem.
Bilirubin
↑ Bilirubin = ____ color.
orange
Normal color of foam in urine
White
A large amount of white foam in the urine indicates an ____.
increased concentration of protein
Determine the color of Urine
Photo-oxidation of large amount of excreted urobilinogen to urobilin
Yellow-orange
TRUE OR FALSE.
A yellow foam appears when photo-oxidation of large amounts of excreted urobilinogen to urobilin occurs.
False
Determine the color of Urine
Phenazopyridine
Orange-yellow
Determine the color of Urine
Phenindione
Orange-yellow
Determine the color of Urine
Sulfasalazine (Azulfidine)
Orange-yellow
Determine the color of Urine
Photo-oxidation of bilirubin
Yellow-green
The ____ is one of the most common causes of abnormal urine color.
presence of blood
____ is the most commonly encountered abnormal urine color.
Red
When is the red pigment pathological in urine?
If there is glomerular bleeding
Determine the color of Urine
Intact RBC
Cloudy red or pink
Determine the color of Urine
Hemolyzed RBCs
Clear red
Besides RBCs, ____ also produce a red urine.
Hemoglobin and Myoglobin
How can we differentiate hemoglobin from myoglobin?
Through Plasma Examination Test
Hemoglobin: Red
Myoglobin: Yellow
Color of hemoglobin in Plasma Examination Test
Red
Color of myoglobin in Plasma Examination Test
Yellow
Hemoglobin or Myoglobin?
Stays in the blood
Hemoglobin
Hemoglobin or Myoglobin?
Immediately filtered
Myoglobin
Determine the color of Urine
Oxidation of phorphobilinogen (Porphyrins)
Port wine or Burgundy red
____ occurs when there is a problem in globin.
Thalassemia
A ____ causes Thalassemia.
problem in globin
____ lack the enzyme necessary to convert the pre-cursor substance to become heme.
Porphyria
____ is a familial disease.
Porphyria
Porphyria
If there is no enzyme, ____.
no heme = ↑ pre-cursor susbtance
Determine the color of Urine
Beets
Pink or Red
Determine the color of Urine
Rifampin, phenolphthalein, pheninedione, and phenothiazines
Pink or Red
Determine the color of Urine
Ingestion of blackberries
Red
Determine the color of Urine
Oxidation of hemoglobin to methemoglobin
Red-brown
____ is a pre-cursor of heme.
Porphobilinogen
If you will check for hematuria, and the urine specimen submitted is contaminated with menstrual blood, should you accept or reject it?
Reject
Determine the color of Urine
Pseudomonas infection
Green
Determine the color of Urine
Asparagus
Green
Determine the color of Urine
Amitriptyline
Blue-green
Determine the color of Urine
Methocarbamol (Robaxin)
Blue-green
Determine the color of Urine
Breath deodorizers such as clorets
Blue-green
Determine the color of Urine
Indican
Blue-green
Indican came from ____.
indole
Indole is converted by bacteria to become ____.
Indican
____ is responsible for giving an indigo-blue color.
Indican
↑ organisms = ____ indole.
↑
Determine the color of Urine
Methylene blue
Blue-green
Determine the color of Urine
Phenol
Blue-green
Determine the color of Urine
Propofol
Blue-green
Determine the color of Urine
Familial hypercalcemia
Blue-green
Determine the color of Urine
Indomethacin (indocin, tivorbex)
Blue-green
Determine the color of Urine
Observed among catheterized patients
Purple
Purple bag syndrome is associated with patients with ____.
catheter bags
Aside from blue-green color of urine, indican/indole also gives a ____ pigment.
Purple
Determine the color of Urine
Bacterial infection caused by Klebsiella or Providencia species
Purple
____ is an oxidation product of melanogen.
Melanin
____ is a colorless substance that precedes melanin.
Melanogen
____ is produced in excess when a malignant melanoma is present.
Melanogen
Determine the color of Urine
Homogentisic acid
Black
____ imparts a black color to alkaline urine from patients with alkaptonuria.
Homogentisic acid
In patients with skin cancer, ____ proliferate.
melanocytes
____ is a substance of the phenyl-alanine-tyrosine pathway of amino acid.
Homogentisic acid
Determine the color of Urine
Malignant melanoma
Black/Brown
Determine the color of Urine
Melanin
Brown
Determine the color of Urine
Phenol derivatives
Brown/Black
Determine the color of Urine
Argyrol
Brown/Black
Determine the color of Urine
Methyldopa or levodopa
Brown/Black
Levodopa: cola-colored
Determine the color of Urine
Metronidazole
Brown/Black
Determine the color of Urine
Chloroquine and primaquine
Brown/Black
Determine the color of Urine
Methocarbamol
Brown/Black
Determine the color of Urine
Fava beans, rhubarb, or aloe
Brown/Black
Urine color changes with commonly used drugs
Levodopa
- Cola-colored
- Due to myoglobin
Urine color changes with commonly used drugs
Mepacrine (Atabrine)
Yellow
Urine color changes with commonly used drugs
Methyldopa (Aldomet)
Green-brown
Urine color changes with commonly used drugs
Metronidazole (Flagyl)
- Darkening
- Reddish-brown
Urine color changes with commonly used drugs
Phenazopyridine (Pyridium)
- Orange-red
- Acidic pH
Urine color changes with commonly used drugs
Rifampin
Bright red
Urine color changes with commonly used drugs
Riboflavin
Bright yellow
Normal range of urine volume
600 mL - 2000 mL
Average range of urine volume
1200 mL - 1500 mL
Night:Day Ratio
1:2 or 1:3
Factors that influence urine volume
- Fluid intake
- Fluid loss from non-renal sources (sweating, vomitting, diarrhea)
____ is the decrease in urine output.
Oliguria
Oliguria amount
<400 mL/day
Causes of Oliguria
- Nephrotic syndrome
- Edema
- Dehydration
In order for us to maintain the filtration of blood within the glomerulus, we need ____.
constant pressure
↓ glomerular pressure = ____ = ____.
↓ filtration = ↓ UV
Nephrotic syndrome can lead to ____.
albuminuria
____ is a disease caused by the disruption of the shield of negativity.
Nephrotic syndrome
Edema occurs due to the ____.
accumulation of fluid in the interstitial tissues as a result of no pressure
____ is the cessation of urine flow.
Anuria
Anuria amount
<100 mL/day
According to Graff’s textbook
Causes of Anuria
Urinary tract obstruction (tumor, kidney stones, etc.)
Kidney stones are usually formed in the ____.
renal pelvis or urinary bladder
Composition of Kidney Stones
- Uric acid
- Cysteine
- Calcium oxalate
____ is the most common, and hardest kidney stone.
Calcium oxalate
____ is an increase in daily urine volume.
Polyuria
Amount of polyuria
- Henry’s: 2000 mL/24 hours
- Strasinger: 2.5 L/day
Polyuria is artificially induced by ____.
Diuretics, caffeine, or alcohol
Diuretics, caffeine, and alcohol all suppress the secretion of ____.
ADH
Other causes of Polyuria
- Diabetes mellitus
- Diabetes insipidus
____ is the increased noctural excretion of urine.
Nocturia
Amount of nocturia
> 500 mL/night
Causes of Nocturia
- Pregnancy
- Chronic progressive kidney failure
The ____ describes the overall visual apperance of a urine specimen.
Urine clarity
In ____, we will check the presence of particulates.
Urine clarity
↑ turbid = ____ SG.
↑
Urine Clarity
No visible particles, 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
Non-pathological causes of Turbidity
- Squamous epithelial cells
- Mucus
- Amorphous phosphates, carbonates, urates
- Semen, spermatozoa
- Fecal contamination
- Radiographic contrast media
- Talcum powder
- Vaginal creams
The presence of squamous cells with bacteria can indicate that the patient has ____.
UTI
TRUE OR FALSE.
Turbid urine is normal in females before and after menstruation.
True
The presence of squamous cells and bacilli (G. vaginalis) can indicate that the patient has ____.
Bacterial vaginosis
Determine if pathologic or non-pathologic cause of turbidity
Squamous epithelial cells
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Mucus
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Amorphous phosphates, urates, and carbonates
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Semen, spermatozoa
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Fecal contamination
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Radiographic contrast media
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Talcum powder
Non-pathologic
Determine if pathologic or non-pathologic cause of turbidity
Vaginal creams
Non-pathologic
Pathological causes of Turbidity
- RBCs
- WBCs
- Bacteria
- Yeast
- Non-squamous epithelial cells
- Abnormal crystals
- Lymph fluid
- Lipids
Determine if pathologic or non-pathologic cause of turbidity
RBCs
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
WBCs
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Bacteria
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Yeast
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Non-squamous epithelial cells
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Abnormal crystals
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Lymph fluid
Pathologic
Determine if pathologic or non-pathologic cause of turbidity
Lipids
Pathologic
RBCs are soluble in ____ acetic acid.
2%
Lipids are soluble in ____.
ether
RBCs are soluble in ____.
Dilute acetic acid
The ____ is an expression of urine concentration in terms of density.
Specific gravity
Specific gravity is correlated with ____.
Clarity and Color
The specific gravity of the plasma filtrate entering the glomerulus is ____.
1.010
The term ____ is used to describe urine with a specific gravity of 1.010.
Isosthenuric
The term ____ is used to describe urine with a specific gravity below 1.010.
Hypostenuric
The term ____ is used to describe urine with a specific gravity above 1.010.
Hyperstenuric
Specific gravity of Urine
1.003 - 1.035
Average specific gravity of Urine
1.015 - 1.030
↑ solute = ____ BP.
↑ BP
↑ solute = ____ FP.
↓FP
