Physical Examination Of Urine Flashcards
Why do Urinalysis (4)
- Diagnose infections
- Diagnose metabolic disorders (diabetes)
- Aid in diagnosis of renal function
- If treatments for above are effective
Route in Microscopic includes looking for..?
- Physical - colour, clarity and odour
2. Chemical - specific gravity
Microscopic examination of ..?
Cells, sediment, crystals and casts (cylindrical structures formed in tubules)
Chemical examination of urine..?
PH, glucose, ketones, proteins, specific gravity, red blood cells or by products, white cells, bilirubin, urobilonigen and nitrites using strip and table reagents
Pink Urine causes
Blood, menstrual contamination, renal calculi, trauma, acute glomerlunophritis, pyelonephritis, severe cystitis
Pink urine confirmation
Microscopic, blood reagent +
Red urine causes
Blood, hemoglobin, menstrual contamination, beets, rhubarb, rifampin (TB med)
Same as pink
Red Urine confirmation
Microscopic, blood reagent +
Tan- Brown Urine causes
Myoglobin, muscle damage/ breakdown due to MI (heart attack), muscular dystrophy, ALS, extreme exertion
Tan- Brown urine confirmation
Blood +
Orang urine causes
Pyridium (phenazo)- analgesic for UTI pain, excess carrot ingestion (beta carotene)
Orange urine confirmation
Persistent yellow foam on shaking
Amber urine causes
Bilirubin, liver disease, excess intravascular hemolysis - transfusion reaction or sickle cell
Dark brown / Black urine causes
Melanin, metronidazole (Flagyl), Melanoma, anaerobic/ parasitic infection treatment, levodopa
Amber Urine confirmation
Persistent yellow foam on shaking, bilirubin reagent +
Dark brown / Black urine confirmation
N/A
Green Urine causes
Closets/ chlorophyll gum in excess. Pseudomonas aeruginosa infection
Green urine confirmation
In Ps. aeruginosa will have rotting fruit smell, bacteria, WBC’s in microscopic and leukocyte eateries reagent +
Blue urine causes
Amitriptyline (sleep aid, anti-depressant), robaxin (muscle relaxant), oral gentian violet for thrush
Blue urine confirmation
N/A
Yellow, Amber, Orange Urine
Can indications concentration due to dehydration, first morning specimen or post exercise
Bright Yellow Urine Causes
Vitamin C or Vitamin B12
Unochrome
Norma pigment colour of urine
What should you always do with a sample if you think it contains bilirubin?
Wrap it in an opaque substance such as aluminum foil to prevent the bilirubin from being destroyed
Hemoglobinuria
Hemoglobin in urine due to hemolytic anemia or trauma (lysed red cells), intravascular hemolysis, transfusion reactions, burns, infections or hemolysis of red. Cells in dilute, alkaline urine
Hematuria
Blood present in urine
Myoglobin
Due to the breakdown of muscle tissues (ALS, heart attack, muscular dystrophy)
Transport oxygen in bloodstream
What does Flagyl treat?
Trichomonas vaginellas
What does levodopa treat?
Parkinson’s disease
Clarity of Urine
How well can you see through the urine
Normal turbidity of urine
Clean if it’s a proper clean catch mid stream
- should be able to read print on paper
Benign turbidity of urine
Cloudy due to presence of epithelial cells, mucus, semen, fecal presence, talcum powder, vaginal creams and lubricants, radiographic contrast dyes and if specimen is chilled (precipitation of crystals that should redissolve at 20*)
A Brno all turbidity of urine
Due to presence of white blood. Cells and bacteria but may indicate abnormal excretion of lipids and lymph fluid
Odour of urine
Not always part of normal exam
Ammonia smell is due to
Due to old, non-refrigerated samples or bacterial infections
Where should you process urine
In a bio safety cabinet or behind a splash shield, allows you to smell urine
Waft gasses towards face, holding container 12 inches from face
Ketones smell like..?
Fruity smell, or like someone who has been drinking
Ketones in urine are caused by
Ketoacidosis, or insufficient caloric intake (anorexia)
Maple syrup urine disease
Smells like maple syrup
Other things that can cause smells in urine
Ingestion of pungent foods - garlic, onions, asparagus, or coffee
Specific Gravity
Measures the density of a solution compared to a similar volume of distilled water at a similar temperature
Measures the density or amount of dissolved particles in the urine
Two ways to measure specific gravity
- Urinometer
2. Refractometer
Urinometer
Consists of a weighted float that has been designed to sink to a level marked 1.0 in distilled water at 20*C
- when allowed to float in a similar volume of urine, will indicate specific gravity by the level at which it floats
Done when colour does not correlate with reading
Urinometer must be corrected for
Temperature (if not 20*C) , glucose and protein if present
Volume needed for urinometer?
Large volume
Urineometer is..
Less easy to disinfect Less accurate Cheap Less safe due to mercury it in Tests buoyancy
Normal specifics gravity range
1.010 (pale yellow)-1.025 (dark yellow)
>1.025 = dehydrate <1.010 = over hydrated
Refractometer
Measures refractive index of urine to determine density and therefore specific gravity
- concentration of dissolved particles
- determines the angle that light will travel through urine specimens
Refractometer uses how much of a sample?
One drop
Refractometer is..?
Easy to disinfect (alcohol wipe) More accurate more expensive Easily calibrated using a jewellers screwdriver to adjust internal prism Testing the change of light
Refractometer needs to be corrected for
Glucose and protein if present using standard solutions
Chemical examination of urine is done using..?
Done with reagent test strips, tablets and precipitation tests
Reagent Strips
Chemical impregnated pads attached to a plastic strip
- reactions produce colour changes that are compared to a chart - strip is dipped into urine completely but briefly and excess is removed
Can be done automatically or manually
Errors in using Reagent Strips
- Improper/insufficient mixing of specimen
- may leave large molecules at bottom (WBC,RBC) false - - Allowing strip to remain in sample too long
- leaching of reagent, false - - Not draining/ blotting - causes run over
- Not testing at room temp (20*C)
- false - - Not timing properly (short time -, long +)
- Do not use expired strips
Handling and storage of strips
- Do not expose to light, moisture, volatile chemicals
- remove strips from container just prior to testing, container should be tightly sealed
- Strips should not be open near volatile compounds such as alcohol, acetone or formalin)
- Only used if not expired
Do not expose strips to
- Light
- Moisture
- Extreme heat, cold - keep at 20*C
- Volatile chemicals
Quality control is done when
- At the start of each shift & or
- Each new shift & or
- Each new lot # (not each bottle)
- Minimum once each day
PH test is done
To determine systemic acid base balance disorders -> metabolic acidosis or respiratory alkalosis
What can cause pH shifts?
High protein diets (meats) - make urine acidic
Vegetarians - alkaline urine (bicarbonate production)
Cranberry juice - acidifies urine
Normal and abnormal urine pH
Normal: 4.5-8
Average: 6-6.5
No one will ever reach pH of 9-14 (old sample if it reads 9+)
PH reagents
Methylene red (4-6) Bromothymol Blue (6-9)
Protein in urine can indicate
Early renal disease
Benign cause for proteinuria
Orthostatic proteinuria: due to long periods spent in vertical position
How do they test for proteinuria?
Compare urine samples after being in vertical position to lying horizontal
Ie. daytime vs first morning test
Bense Jones Protein
- produced in multiple myeloma
Coagulate at 40-60C and dissolve again at 100C
+ if they coagulate and dissolve at these temps or electrophoresis
Microalbuminuria is produced in what condition?
Produced and filtered as a complication of diabetes melatus
Indicates eventual renal failure
Microalbuminura is found in
Semen, mucus, prostatic fluid, vaginal fluid,
- all are contaminants
- indicates not a clean catch midstream
Protein reagent
Tetra x 2
Indicators with really long names
Protein false +
Highly alkaline pH
Phenazo (overrides buffers)
Protein false -
Non-albumin proteins
Protein confirmation
SSA -sulfosalicylic acid
Bense Jones
microalbumin protein
Renal threshold
The threshold or blood level at which tubular reabsorption stops
- stops the absorption of glucose if its met
- thus glucose will be excreted in urine
Reagent for glucose
- Glucose peroxidase
2. Peroxidase and a dye
Glucose reagent equations
- Glucose + O2 -> glucose oxidase –> gluconic acid +peroxide (H2O2)
- Peroxide + peroxidase with a dye –> H2o + O with dye makes colour
Glucose false +
Peroxide contamination
Glucose false -
Vitamin C
Improper preservation
Glucose Confirmation test
Clinitest
Ketones +
Clinitest (monosaccharide / reducing sugar test)
- used to check for all three simple sugars
- glucose, galactose, fructose
Reagent in a clinitest
Copper sulfate
- results in a colour change (blue) if positive
How clinitest works
Urine added to clinitest tablet in a test tube
- heat is created
- colour changes from blue to orange to red
- reaction may go through a pass through if high amounts of reducing sugars are present
2 cautions when doing a clinitest
- Dont hold in hands - produces heat
2. Watch for full 2 mins as it may go through a pass through and you can miss the positive reaction colour change
Ketones are produces through?
Produced as a results of breaking down adipose and muscle for energy
What condition are ketones present it?
Diabetics melatus and calorie reduced diets (anorexia and Dr.Bernstein)
Carb and insulin insufficiency
What smell to ketones cause?
Sweet smelling , fruity, or like someone has been drinking
Ketone Reagent
Sodium Nitroprusside - produces a purple colour
Ketone False +
Medications
Ketones false -
Leaving container open - ketones evaporate quickly
Blood
Looking for presence of hemoglobin (doesn’t have to be intact) and peroxidase (enzyme attached to myoglobin and hemoglobin)
Blood reagent
Peroxide and a dye
Peroxide + dye –> peroxidase H2O + O = dye changes colour
Blood false +
Menstruated contamination
Peroxidase producing bacteria
Blood false -
high SG
Vitamin C
Poor mixing
Blood confirmation test
Microscopic (RBC’S)
Colour
Hematuria indicates ?
Renal calculus, renal diseases, trauma, pyelonephritis, chemical exposure, and anticoagulant therapy
Benign condition of hematuria is?
Menstruation or strenuous exercise
Myoglobinuria
Presence or myoglobin in urine
- red-brown in colour
- present in crush injuries, trauma, alcoholism, heroin abuse, muscle wasting disease (MI) and extensive exertion
bilirubin
Produced in liver disease a or hemolytic anemias
- when rbc’s are broken down the bilirubin is released into circulation and bound to albumin and send to the liver
- will appear in urine when there is damage or a blockage in bile duct, liver is allowing leakage or water solvable bilirubin (hepatitis or cirrhosis)
Bilirubin reagent
Diazo (diazonium salt)
colour change reaction from pink to purple
Bilirubin false +
Phenazo or medications
Bilirubin false -
Vitamin C
High nitrites
Exposure to light
Not a fresh sample
bilirubin confirmation
- Ictotest
- colour
- yellow foam on shaking
Ictotest
Ravioli test
- preformed on filter paper that removes affecting substances (ex. Phenazo)
- tablet on paper
- colour reaction is blue to purple with all other colour considered negative
Urobilinogen
Bile pigment resulting from hemoglobin breakdown
- product of bacteria action on bile in intestines
- produces brown colour in feces
- Less than 1mg/do are considered normal
Too much urobilinogen is indicative of
Liver disorders and disease and hemolytic disorders
Reagents for urobilinogen
Multistix - Erlich’s - light to dark pink colour
Chemstrip - diazo -white - pink colour
Urobilinogen False +
Multistix - Medications
Chemstrip- Phenazo
Urobilinogen False -
Chemstrip - High nitrites and vitamin C
Multistix - nothing
Urobilinogen Confirmation test
+ bilirubin
Nitrites
- Broken down from nitrates by bacteria in bladder
- Some break down further into N2 gas
- byproduct of digestion of green leafy vegetables
Nitrites can indicate..?
Bacterial UTI infection and can help determine if treatment is effective
- untreated UTI can lead to pyelonephritis - permanent damage
Nitrite reagent
- diazo
- Any indication of pink is positive
- Test only reported as + or -
Colour reaction are set to only occur if 100,000 bacteria /ml are present - infection is present
Nitrite false +
Phenazo
Improper preservation
Nitrites false -
Vitamin C
Non-nitrite reducing bacteria
Nitrite to N2 reducing bacteria
No veg in diet (all meat)
Nitrite confirmation test
Microscopic : WBC’s, bacteria, leukocyte esterase +
Leukocyte esterase
- Indicates presence of enzyme in WBC’s (whole/ lysed blood)
- cells must lyse on pad to have enzyme detected
- cant determine how many are present, just that they are
- can be used with nitrite to determine UTI before culture done
Leukocyte esterase reagent
Diazo - produce a purple colour
Leukocyte esterase false +
Phenazo, formalin, pigments, antibiotics
Leukocyte esterase false -
High nitrites High SG Vitamin C Poor mixing High protein and glucose
Leukocyte esterase confirmation test
Microscopic: WBC’s, bacteria, yeast, parasites
Specific Gravity
-Measuring the concentration of your urine
Specific gravity reagent
Polyelectrolyte- releases H+ ions in the same proportion as ions present in urine
- change in H+ ions results in change in pH which causes colour change in indicator Bromothymol blue which changes from blue (alkaline) to green (neutral) to yellow (acid)
Bromothymol blue
Specific gravity false +
None
Specific gravity false -
Low urine
PH 6
Less interferes with indicator
How to maintain consistancy in microscopic analysis
- Always use same volume of sample
- Centrifuge all samples at same speed for same time
- Decant all specimens to same volume
- Give same drop of urine on each slide (micropipette, calibrated unalysis pupette or slide with calibration built in)
- Always use 2x22mm coverslip
- Look for 10 fields of material (5 from centre, 5 from peripheral)
Supernatent
Fluid part of urine after centrifugation (plasma)
Sediment
Solid portion of urine after centrifugation (formed elements)
Microscopic urinalysis
Used to see physical structures in urine under microscope
- RBC’s WBC’s, bacteria, parasites, contaminants
What type of cells are pelvis, ureters, bladder, urethra
Transitional epithelium (anywhere you find urine)
What type of cells are tubes made from?
Simple cuboidal
What type of cells are the vaginal canals made of?
Stratified squamous
