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Urinalysis and Body Fluids 4214 > Physical Examination Of Urine Test 2 > Flashcards

Physical Examination Of Urine Test 2 Flashcards

1
Q

Best practic analyze fresh or suitalbey preserved urine, usually refrigerated

A

1.Examine urine within 30 minutes of the collection, as the changes (decomposition) start
during this time.
2.Examine the urine in the first 1 to 2 hours of collection.
3.Urine is the best culture media for the growth of bacteria.
4.If it is delayed, then refrigerate the urine at 4 °C.
5.Urine left at room temperature >2 hours is not acceptable.

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2
Q

Urine samples to be rejected

A

1.When urine has incorrect preservatives.
2.When the urine quantity is insufficient.
3.When urine is not transported correctly.
4.When there is a missing or incomplete request form.
5.When urine has no proper identification.
6.When urine shows contamination like stool, etc.

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3
Q

Specimen integrity

A

 Changes in urine composition take place not only in vivo but also in vitro
 Test within 2 hours of collection
 Refrigerate or chemically preserve if testing is delayed
 Most problems are caused by bacterial multiplication
 Increased: color, turbidity, pH, nitrite, bacteria, odor
 Decreased: glucose, ketones, bilirubin, urobilinogen, RBCs, WBCs, casts

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4
Q

Physical changes in unpreserved urine
Color

A

color- oxidation or reduction of metabolites

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5
Q

Physical changes in unpreserved urine

Clarity

A

Decreased- Bacterial growth and precipitation of
amorphous material

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6
Q

Physical changes in unpreserved urine

Odor

A

Increased- Bacterial multiplication causing breakdown
of urea to ammonia

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7
Q

Physical changes in unpreserved urine
pH

A

Increased-Breakdown of urea to ammonia by urease-
producing bacteria/loss of CO2

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8
Q

Physical changes in unpreserved urine
Glucose

A

Decreased- Glycolysis and bacterial use

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9
Q

Macroscopic changes to unpreserved urine

A

 Turbidity
 Amorphous crystals may form
causing a pink color. Amorphous
crystals have no clinical significance
 Smell - If urine is kept for a long time
at room temperature, it will give an
ammonia smell produced by the
bacteria, which will decompose the
urea in the urine
-erythrin gets deposited on amorphous crystals in a stored
urine specimen causing a pink or “brick dust appearanc

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10
Q

Microscopic changes in Unpreserved urine

A

 Formed elements tend to disintegrate, especially in alkaline urine.
 Formed elements are WBCs, RBCs, casts

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11
Q

Is this fluid urine

A

 May be needed in drug screen collections or specimens collected
by needle aspiration
 Urine creatinine concentrations 50 times higher than plasma
 Urea, sodium (Na), and chloride (Cl) higher in urine than in other
body fluids
 Physiologic range is 1.002 to 1.035 for urine specific gravity and
4.0 to 8.0 for pH
 Urine from healthy persons contains no protein or glucose,
whereas many other body fluids do

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12
Q

Physical examination of urine includes

A

 Color
 Clarity
 Specific gravity

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13
Q

Results provide

A

 Preliminary information
 Correlation with other chemical and microscopic
results

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14
Q

Physical characteristics
Preliminary information concerning
disorders such as

A

 Glomerular bleeding
 Renal tubular function
 Liver disease
 Inborn errors of metabolism
 Urinary tract infection

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15
Q

Color of urine

Normal variations and Abnormal variation causes

A
  • Ranges from colorless to black
  • Normal variations caused by
    – Normal metabolic functions
    – Physical activity
    – Ingested materials
    – Pathologic conditions
  • Abnormal variations caused by
    – Bleeding
    – Liver disease
    – Infection
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16
Q

normal urine

A
  • Pale yellow, yellow, dark yellow
  • Should be consistent within institution
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17
Q

Urochrome

A

Urochrome is pigment causing yellow color.

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18
Q

Urochrome is excreted at

darkens upon

A
  • Excreted at a constant rate. More concentrated when
    hydration is low resulting in darker urine.
  • Darkens upon exposure to light
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19
Q

Uroerythin and urobilin

A
  • Uroerythrin and Urobilin are also normal pigments
    found in urine. Uroerythrin is most evident when
    deposited on amorphous crystals in a stored urine
    specimen, causing a pink color or “brick dust” sediment.
    Urochrome is pigment causing yellow color.
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20
Q

Dark yellow urine

A
  • may be dehydrated
  • may have high conversion of urobilinogen →urobilin
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21
Q

Amber or organe urine

A
  • RBC breakdown in alkaline urine
  • may have bilirubin (shake and look at foam)
  • Formation of urobilinogen (normal component of urine but
    photo oxidizes and turns yellow orange). No yellow foam.
  • Patient is taking phenazopyridine to relieve symptoms of
    urinary tract infection
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22
Q

Pink urine

A

– oxidized porphobilinogen in patient with
porphyria if specimen has set out too long.
 Amorphous crystal formation causes a light pink
color to form

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23
Q

Red urine

A

RBCs, hemoglobin, beets

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24
Q

Brown or black urine

A

could be blood or Hgb)
 Myoglobin – muscle breakdown. Too much is
damaging to kidney.
 oxidized melanogen in patient with malignant
melanoma if specimen has set out too long

25
Blue/green urine
 Biliverdin, Pseudomonas, or propofol Numerous drugs can change urine color.Numerous drugs can change urine color
26
Foam
 Not normally included on report forms  Normal urine when shaken will produce white foam that rapidly dissipates  Stable white foam indicates large amounts of albumin in urine  Yellow foam caused by increased bilirubi
27
Clarity of urine
* Refers to the transparency or turbidity of a specimen * Normal reporting – Clear, hazy, cloudy, turbid * Visual examination – Gently swirl specimen in a clear container in front of a good light source * Automated turbidity readings are available * Fresh clean-catch urine is normally clear
28
Clarity descriptions
Clear- all solutes are soluble Visible particles or transparent abnormal solutes such as glucose, proteins(albumin) or bilirubin are not ruled out
29
Hazy or slightly cloudy urine
Visible particles are present, and newsprint can read through Blood cells- RBCs or WBCs present
30
Cloudy urine
Significant particulate matter, newsprint is blurred or difficult to read Crystals, epithelial cells, Fats(lipids and Chyle), Microbes bacteria, yeast, trichomonads
31
Turbid
newspaper cant be seen Mucus, Mucin, pus, Radiographic contrast media, semen, Spermatozoa, prostatic fluid, Contaminants- feces, powders, talc, creams, and lotions
32
pathologic turbidity
* Most common: RBCs, WBCs, bacteria * Turbidity is a good guide to assess possible pathogenic conditions, but a clear urine doesn’t necessarily mean normal. Clear can contain glucose, protein, lysed RBCs and WBCs * A turbid urine may become cloudy if allowed to sit for too long, especially without refrigeration, due to formation of nonpathological amorphous crystals.
33
Color and clarity procedure
 Use a well-mixed specimen  View through a clear container  View against a white background  Maintain adequate room lighting  Evaluate a consistent volume of specimen  Determine color and clarity
34
Odor
* Not routinely reported * Fresh urine: faintly aromatic * Older urine: ammonia * Metabolic disorders: maple syrup urine disease, ketosis (fruity), infection (ammonia/unpleasant) * Food: garlic, onions, asparagus (genetic: only certain people can smell asparagus, but all produce odor) * See Table in text
35
Aromatic odor
Normal
36
Foul ammonia-like odor
Bacterial decomposition, urinary tract infectio
37
Fruity sweet odor
Ketones (diabetes mellitus, starvation, vomitin
38
Maple syrup odor
Maple syrup urine disease
39
Mousy odor
Phenylketonuria
40
Rancid
Tyrosinemia
41
sweaty feet
Isovaleric acidemia
42
Cabbage odor
Methionine malabsorption
43
Bleach odor
Contamination
44
Specific gravity Definition
 Evaluation of urine concentration  Determines if specimen is concentrated enough to provide reliable screening results  Definition: the density of a solution compared with the density of an equal volume of distilled water at the same temperature  The greater the urine density, the larger the SG.  Measures all solutes (unlike osmolaity).
45
Isosthenuric
SG of 1.010 (the SG of the plasma ultrafiltrate)
46
Hypothenuric and hypersthenuric
 Hyposthenuric: SG lower than 1.010  Hypersthenuric: SG higher than 1.010
47
Normal random specimen range
 1.003 to 1.035; most common 1.015 to 1.025  Below 1.003 may not be urine  Consistent low readings: further testing
48
Refractometer Definition and how it works
 Measures velocity of light in air versus velocity of light in a solution  Concentration changes the velocity and angle at which the light passes through the solution  The prism in the refractometer determines the angle that light passes through the urine and converts angle to calibrated viewing scale
49
Methodology of refractometer
 Drop of urine placed on prism  Focus on light source, and read scale  Wipe off prism between specimens  Calibration  Distilled water should read 1.000; adjust set screw if necessary  5% NaCl should read 1.022 ± 0.001  9% sucrose should read 1.034 ± 0.001
50
Refractometer advantages
 Temperature compensation not needed * Light passes through temperature-compensating liquid * Compensated between 15°C and 38°C  Small specimen size: one or two drops
51
Disadvantages of Refractometer
 Disadvantage: technically requires a correction when high levels of glucose or protein or radiologic contrast dyes are present, but this correction rarely performed by labs.
52
Reagent strip method
 Specific gravity (SG) measured with the reagent strip method correlates well with gravimetric measurement, and, unlike the gravimetric or refractometer methods, does not need to be corrected for glucose or protein. Cloudy/turbid urines do not need to be clarified before measuring SG with the reagent strip method.  Alkaline urine can affect the indicator system and lower the SG result on the reagent pad. If the result is being read visually, it is recommended that .005 be added to the SG result when the pH is alkaline. Most dipstick readers, however, will automatically adjust the SG reading for pH.  A SG reading higher than the reagent strip range would need to be measured by another method and may require dilution.
53
Reagent strip method impregnated with when strip is immersed in urine released
 Reagent strip pad impregnated with polyelectrolyte and pH indicator at an alkaline pH  When strip immersed in urine, protons released from polyelectrolyte in proportion to ionic concentration  Released protons change pH of test pad, resulting in a color change of pa
54
Osmolality
* A more representative measure of renal concentrating ability can be obtained * Specific gravity depends on the number of particles present in a solution and the density (size) of these particles * Osmolality is affected only by the number of particles present
55
Osmolality normal urine and serum values
 Normal urine values 275 to 900 mOsm/kg  Normal serum values 275 to 300 mOsm/kg  Serum remains relatively constant, but urine value depends on diet, fluid intake, and physical activity
56
Osmolality tests
* Osmolality of a solution can be determined by measuring a property that is mathematically related to the number of particles in the solution – Colligative property * Changes in colligative properties – Lower freezing point – Higher boiling point – Increased osmotic pressure – Lower vapor pressure
57
What device is used for Osmolality measurements
 Measuring osmolality in the urinalysis laboratory requires an osmometer  Additional step in the routine urinalysis procedure  Automated osmometer utilizes freezing point depression to measure osmolalit
58
urine volume
 Normal volume 600 to 1800 mL/day  Amount of solutes excreted increases as water required to excrete them increases  Terminology:  Isothenuria * Inability of kidneys to change specific gravity of plasma ultrafiltrate (which is 1.010)  Polyuria * Excretion of >3 L/day  Oliguria * Excretion of <400 mL/day  Anuria * Complete lack of urine excretion

Urinalysis and Body Fluids 4214 (14 decks)

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