PRELIM-chemical examination of the urine Flashcards
1
Q
Simple, rapid means for performing medically significant chemical
analysis of urine
A
reagent strip
2
Q
The
two major types of reagent strips are manufactured under
the trade names
A
Multistix (Siemens Healthcare Diagnostics,
Deerfield, IN)
Chemstrip (Roche Diagnostics, Indianapolis,
IN).
3
Q
Chemical-impregnated absorbent pads are attached to a plastic strip
A
reagent strip
4
Q
for the reporting, we follow _____ value. From trace, 1+, 2+, 3+, or 4
A
Semiquantitative
5
Q
3 types of reagent strip
A
- 4 parameters
-10 parameters - 11 parameters
6
Q
what are the 4 parameters in a 4-parameter type of reagent strip?
A
glucose - 35s
specific gravity - 45s
pH - 60s
protein 60s
7
Q
what are the 10 parameters in a 10-parameter reagent strip?
A
glucose, SG, ph, protein ketone, blood, nitrite, bilirubin, urobilinogen, leukocytes
8
Q
why do we need to blot the urine?
A
to prevent runover
9
Q
what is the other substance we can measure in an 11-parameter reagent strip?
A
Ascorbic acid
10
Q
what are the parameters corresponding time?
A
glucose - 30s
bilirubin - 30 s
ketone - 40 s
specific gravity - 45 s
blood - 60s
pH - 60 s
protein - 60s
urobilinogen - 60 s
nitrite - 60 s
leukocytes - 120s
11
Q
Care of Reagent Strip
A
- Store with desiccant in an opaque, tightly closed container.
- Store below 30C; Do not freeze
- Do not expose to volatile fumes
- Do not use past the expiration date
- Do not use if chemical pads are discolored
- Remove strips immediately prior to
12
Q
standard temperature we can store the reagent strip
A
below 30* C
13
Q
Quality control of Reagent Strips
A
- Test open bottles of reagent strips with known positive and
negative controls every 24 hr.
o Depends on the laboratory, sometimes every shifts - Resolve control results that are out of range by further testing
- Test reagents used in backup tests with positive and negative
control - Perform positive and negative controls on new reagent and newly
opened bottles of reagent strips - Record all control results and reagent lot number
14
Q
Major regulator of acid-base content of the body
A
Lungs and kidney
15
Q
Why do we need to determine the pH of the urine? Or what is the clinical
significance of pH?
A
we can determine if the problem came from the tubules of the kidney or from the lungs.
If there’s no problem with the tubules, most probably the problem is with the lungs that is why some doctors request ABG or arterial blood gas analysis to check the reason for pH disturbance
16
Q
which part of the tubule is affected is there’s a secretion of the HYDROGEN ION in the urine?
A
proximal tubules
17
Q
which part of the tubule is affected is there’s a secretion of the AMMONIUM in the urine?
A
Distal convoluted tubule
18
Q
what is the normal ph of the first morning urine in a healthy individual
A
pH 5.0-6
19
Q
. In respiratory or metabolic acidosis not related to renal function disorders, the urine is ___
acidic or basilic?;
A
acidic
20
Q
If respiratory or metabolic alkalosis is present, the urine is ___
A
alkaline
21
Q
calcium oxalate, a frequent constituent of renal calculi, precipitates primarily in ____
A
acidic and
not alkaline urine.
22
Q
maintaining urine in alkaline pH discourages formation of the calculi.
true or false
A
true
23
Q
Maintaining an acidic urine can be valuable in treating
‘____ caused by urea-splitting organisms
because they do not multiply as readily in an acidic medium
A
urinary tract infections
24
Q
has long been used as a home remedy for minor bladder in
fections because it inhibits the colonization of certain urinary
pathogens.
A
cranbrry juice
25
Collecting specimens in containers
other than the single-use laboratory-supplied containers
can produce a pH above 8.5 if alkaline detergent remains
in the container
true or false
true, that is why we should not re use containers
26
what is the normal ph level/range for a normal urine random sample in a healthy individual?
4.5 pH - 8.00 pH
27
what are the cause of the acidic pH in the urine?
Emphysema
Diabetes Mellitus
Starvation
Dehydration
Diarrhea
Presence of acid-producing bacteria
High protein diet
Cranberry juice
Medications
(Methenamine, Mandelate
[Mandelamine],
Fosfomycin tromethamine)
28
what are the cause of the alkaline pH in the urine?
Hyperventilation
Vomiting
Renal tubular acidosis
Presence of Urease-producing bacteria
Vegetarian Diet
Old Specimens
29
Clinical Significance of pH
* Respiratory or metabolic acidosis/ketosis
* Respiratory or metabolic alkalosis
o Renal tubular acidosis → Detects in renal tubular
secretion and reabsorption of acids and bases
* Renal Calculi/stone formation
* Treatment of urinary tract infections
* Precipitation/Identification of crystals
* Determination of unsatisfactory specimens
30
In acidic conditions, which carbonates are formed, is it amorphous urates or phosphate?
amorphous urate
31
In basic conditions, which carbonates are formed, is it amorphous urates or phosphate?
amorphous phosphate
32
the pH level on the reagent strip ranges from --- to ---
pH 5 to pH 9
orange to green
33
is there substance that can interfere with the pH test using the reagent strip?
No known substance to cause interference
34
what is the principle of pH in the reagent strip reaction?
Principle → Double-indicator system of methyl red and bromothymol blue
35
For the references in pH, for the methyl red, the pH level ranges from -- to --
red to yellow (pH range 4-6)
36
For the references in pH, for the bromothymol blue, the pH level ranges from -- to --
yellow to blue (pH range 6-9)
37
pH can be correlate with other test such as the
Nitrite
Leukocytes
Microscopic
38
the protein we detect in the urine is the
albumin
39
a low molecular weight, it is easily
excreted after the filtration of the glomerulus.
Albumin
40
it is an indicative of the renal disease particularly in the filtration
albumin/proteinuria
41
Other proteins
include small amounts of serum and tubular microglobulins are called
__
They are as well produced by the renal
tubular epithelial cells; and proteins from prostatic, seminal,
and vaginal secretions.
Tamm-Horsfall protein (uromodulin)
42
Uromodulin is routinely produced in
the ___
distal convoluted tubule
43
normal value of protein in urine
<10 mg
44
higher than 10 mg in urine is called
proteinuria
45
what is the clinical proteinuria level or range
≥ 30mg/dL or 300mg/L
46
a type of proteinuria that is Caused by conditions affecting the PLASMA prior to reaching the kidney
Pre-renal Proteinuria
47
pre renal transient reasons of increased level of albumin/glucose
hemoglobin,
myoglobin, and the acute phase reactants associated with
infection and inflammation.
48
Seen in case of multiple myeloma
Bence Jones Protein
49
a confirmatory test if the protein really is a myeloma or a bence jones protein is the
Serum electrophoresis
50
what is the screening test for bence jones protein?
Solubility test
51
characteristics of soluble test
o Coagulates at 40-60°C (Turbid)
o Dissolves when tempt reaches 100°C 9 (Clear)
o Filter at 100°C and observe for turbidity as it cools to 40
60°C
52
Proteinuria associated with true renal disease may be the result
of either glomerular or tubular damage.
Renal Proteinuria
53
glomerular damage might be caused by the following
o Amyloid material
o Toxic substances
o Immune complexes found in lupus erythematosus and
streptococcal glomerulonephritis
54
transient reasons of renal proteinuria
Strenuous exercise, dehydration or associated with hypertension
pre-eclampsia (pregnant women)
55
transient reason of pre-renal proteinuria
o Hemoglobin
o Myoglobin
o APR due to inflammation
o Not usually discovered in routine urine
56
a type of proteinuria wherein there will be some Disorders affecting tubular reabsorption
- Filtered albumin can no longer be reabsorbed
Tubular (renal) proteinuria
57
a type of proteinuria wherein there will be a selective filtration that is impaired, there will be an increase in the rbcs and wbcs as well including CHON
Glomerular (renal) Proteinuria
58
some reasons why there are renal tubular proteinuria
o Exposure to toxic substances and heavy metals
o Severe viral infections
o Fanconi Syndrome
59
a type of proteinuria that is still part of the RENAL PROTEINURIA but Seen frequently in young adult whose standing for a long time
Orthostatic (Postural) Proteinuria
60
a proteinuria that Appears in vertical position; disappears in horizontal position
Orthostatic (Postural) Proteinuria
61
confirmatory test for orthostatic (postural) proteinuria
a first morning urine
62
another type of proteinuria under the renal proteinuria that is associated with the Diabetes mellitus
Microalbuminuria
63
in microalbuminuria, ___ leads to reduced glomerular filtration and
eventual renal failure
Diabetic nephropathy
64
Onset of renal complications can first be predicted
by detection of ___
microalbuminuria
65
a special reagent strip specific only with the albumin
micral test
66
is microalbuminuria included on the reagent strip for the routine urinalysis?
no
67
reference value of creatinine ration for microalbuminuria
Creatinine ration > 3.4mg/mmol
68
organs affected by the post renal proteinuria
structures of the lower urinary tracts
o Ureters
o Bladder
o Urethra
o Prostate
o Vagina
69
this type of proteinuria is can be affected by The presence of blood as the result of injury or menstrual
contamination
post-renal proteinuria
70
this type of proteinuria is can be affected by The Presence of prostatic fluid and large amounts of spermatozoa
post-renal proteinuria
71
based on the table
list the possible reason of pre-renal proteinuria
intravascular hemolysis
muscle injury
acute phase reactant
multiple myeloma
72
based on the table
list the possible reason of tubular proteinuria
Fanconi syndrome
Toxic agent/heavy metal
severe viral infection
73
based on the table
list the possible reason of renal proteinuria
Glomerular disorders
Immune complex disorders
Amyloidosis
Toxic agent
Diabetic Nephropathy
Strenuous activity
Dehydration
Hypertension
Pre-eclampsia
Orthostatic or postural
proteinuria
74
based on the table
list the possible reason of post renal proteinuria
Lower urinary tract
infections/inflammation
Injury/trauma
Menstrual contamination
Prostatic fluid/spermatozoa
Vaginal secretion
75
what is the principle of the protein (reagent strip)
Protein error of indicators
76
give the reagents for protein reagent strip
Multistix: Tetrabromphenol blue
Chemstrip: or 3',3",5',5"-tetrachlorophenol, 3,4,5,6-tetrabro-
mosulfonphthalein
77
in order to check the intensity of the reaction, if the protein resulted in reagent strip as +1, we use the conventional method ___
SSA or sulfosalicylic acid test
78
causes of the false-positive in protein reagent test
Highly buffered alkaline
urine
Pigmented specimens,
phenazopyridine
Quaternary
ammonium
compounds
Antiseptics, chlorhexidine
Loss of buffer from prolonged exposure of the
reagent strip to the specimen
high specific gravity
detergents ng container - that's why it is not recommended to reuse urine containers
79
causes of the false-negative in protein reagent test
proteins other than albumin
microalbuminuria
80
what are the test we can correlate for the false-negative result of proteinuria
Blood
Nitrite
Leukocytes
Microscopic
81
urine specimen used for micral test and immuno drip (microalbuinuria)
morning urine specimen
82
urine collection for post renal proteinuria
midstream clean catch
83
2 test of microalbuminuria
micral test and the immunodip
84
principle of micral test
Enzyme Immunoassay -
Albumin in the urine binds to the antibody. The bound and unbound conjugates move up the strip by wicking action. Unbound conjugates are removed in a captive zone by
combining with albumin embedded in the strip. The urine
albumin-bound conjugates continue up the strip and reach an area containing enzyme substrate. The conjugated enzyme re-
acts with the substrate, producing colors ranging from white to red. The amount of color produced represents the amount
of albumin present in the urine. The color is compared with a
chart on the reagent strip bottle after 1 minute. Results range
from 0 to 10 mg/dL.
85
____ reagent strips contain a gold-labeled antihu-man albumin antibody-enzyme conjugate.
Micral-Test
86
The ___ reagent strip uses an immunochromo-graphic technique.
ImmunoDip
87
Strips are individually packaged in specially designed containers. The container is placed in the urine spec-
imen for 3 minutes. A controlled amount of urine enters the
container through a vent hole. The urine encounters blue latex
particles coated with antihuman albumin antibody. Albumin
in the urine binds with the coated particles. The bound and
unbound particles continue to migrate up the strip. The mi-
gration is controlled by the size of the particles; unbound par-
ticles do not migrate as far as the bound particles. First a blue
band is formed by the unbound particles. The bound particles
continue to migrate and form a second blue band further up
the strip. The top band therefore represents the bound particles
(urine albumin) and the bottom band represents unbound
particles. The color intensity of the bands is compared against
the manufacturer’s color chart. albumin. A darker bottom band is negative, equal
band color is borderline, and a darker top band represents
positive results.
Immunodip
88
how many minutes do we need to dip the immunodip container in the urine specimen?
3 minutes
89
In the IMMUNODIP, The ___ therefore represents the bound particles
(urine albumin) and the bottom band represents unbound
particles.
top band
90
how many seconds we need to dip the test for micral test in a urine specimen?
5 seconds
91
principle for the albumin: creatinine ration
Sensitive albumin tests related to creatinine concentration to
correct for patient hydration
92
interference in the creatinine ration
Interference: Visibly bloody or abnormally colored urine
* Creatinine: Cimetidine-false positive
93
Heat and acetic acid's reagent and + result
Reagent: Acetic Acid
o (+) Result: White Cloudiness
94
Sulfosalicylic acid/exton's test reagent and positive result
reagent: → Sulfosalicylic acid or sodium sulfate(+) Result: white ring at zone of contact
95
Heller’s Ring Test ring test and + result
Reagent: Concentrated nitric acid
* (+) Result: White opaque ring
96
Purdy’s Test's reagent and + result
Reagent: 50% Acetic Acid
* (+) Result: White Cloudiness
97
Picric Acid Test reagent and + test results
Reagent: Saturated solution of picric acid
* (+) Result: Precipitation
98
robert's ring test reagent and + results
Reagent: Magnesium sulfate or concentrated nitric acid
* (+) Result: White ring at the zone of Contract
99
Potassium Ferrocyanide Test reagent and + results
Reagent: Glacial Acetic acid and K-Ferrocyanide
* (+) Result: Cloudiness (Proteases)
100
reporting SSA turbidity
negative
no increase n turbidity
protein is < 6
101
reporting SSA turbidity
trace
noticeable turbidity
protein in range 6-30 mg/dl
102
reporting SSA turbidity
+1
distinct turbidity with no granulation
30-100 mg/dl
103
reporting SSA turbidity
+2
turbidity with granulation with no flocculation
100-200 mg/dl
104
reporting SSA turbidity
+3
turbidity with granulation and flocculation
200-400
105
reporting SSA turbidity
+4
clumps of protein >400
106
Esbach’s test reagent and positive result
Picric acid & Citric acid
Precipitation Grams/24hr
107
Shevky and
Stafford test
reagent and specimen?
Tsuchiya’s
Precipitation Grams/24hr
108
Kingsbury Clark
Test reagent and specimen
3% and 24 hr urine
109
Kwilecki’s Test reagent and urine specimen
10% Ferric Chloride and 24 hr urine
110
Purdy’s test reagent and urine specimen
50% Acetic Acide
10% K ferrocyanide and 24 hr urine specimen
111
what is the glucose threshold of the renal reabsorbtion?
160 -180 mg/dl
112
what is the clinical significance of glucose in the urine
it can be an indicative for the diabetes mellitus or the renal tubular nmalfunction
113
Most informative glucose results are obtained from specimens
collected under controlled conditions
the patient should aonduct fasting or not?
needs a fasting, a morning fasting is not ideal. Discard the first urine then collect again for the best sample
114
list the hyperglycemia associated in glucose determination
Diabetes mellitus
Pancreatitis
Pancreatic cancer
Acromegaly
Cushing syndrome
Hyperthyroidism
Pheochromocytoma
CNS damage
Stress
Gestational diabetes
115
list the renal associated in glucose determination
Fanconi syndrome
Advance renal disease
Osteomalacia
Pregnancy
116
interferences in glucose oxidase causing false positive results
Contamination by oxidizing
agents and detergents
117
interferences in glucose oxidase causing false negative results
High levels of ascorbic acid
High levels of ketones
High Specific gravity
Low temperature
Improperly preserved
specimen
118
what is the component of the absorbent pad for glucose reagent strip?
it is a mixture of glucose oxidase, peroxidase, chromogen, and buffer
119
what is the principle for the glucose oxidase or the glucose reagent strip?
double sequential enzyme reaction
because of the reaction of the oxidase and the peroxidase
120
Relies on the ability of Glucose and other substances to reduce
copper sulfate to cuprous oxide in the presence of Alkali and Heat
Copper Reduction Test
121
Benedict’s Test's reagent
CuSO4 - cupric sulfide
Sodium citrate
buffer
NaCO3
122
positive results of benedict tests
(-) Blue
+/- (trace):
Green, no ppt.
1+: Green w/ ppt
2+: Yellow-green
w/ ppt
3+: Muddy
orange w/ ppt
4+: Orange to
brick red
123
Clinitest's reagent
cuso4 - cupric sulfide
Sodium citrate
buffer
NaCO3
NaOH
124
Clinitest's positive result
(Blue to
orange/red)
125
Fehling’s Test
* A
* B
reagent and positive result
Cupric Salt/dH2O
Rochelle
Salt/KOH/dH2O
Yellow ppt
126
steps for clinitest tablets
1. Place five drops of urine in a clean test tube
2. Add 10 drops of water to the urine in the test tube
3. Place a clinitest tablet in the mixture of urine and water in the test
tube
4. Observe the reaction carefully. If sugar content isexcess of 2gm%
there is a rapid production of an orange color which quickly turns
to brown
5. Wait 15 seconds after boiling
6. Shake test tube gently to mix contents
7. Compare the color produced with clinitest color chart
8. Record the result
127
Osazone Test
(Phenylhydrazine) reagent and positive result
Phenylhydrazine
HCl sodium
acetate
Bright yellow
needle crystal
128
Nylander’s Test reagent and positive result
Bismuth
subnitrite
Brown-black
solution
129
Moore Heller’s reagent and positive result
10% KOH
1% or less:
Canary Yellow
1-2%: Wine
yellow
2-3%: Cherry
Red
3-4%: Rum
>4%: Dark
Brown-Black
130
test for fructose
Seliwanoff’s
Test
Borchardt’s
Test
(Resorcinol
and HCl)
Barfoed Test
(CuSO4 and
Hac)
131
what are the test for pentose?
Bial Test
Cole Test
(FeCl3 and
Charcoal)
Tauber’s Test
(Benzidine
and Glacial
HAc)
Tollen’s Test
(Conc. HCl
and
Phoroglucin)
132
what are the test for lactose
Rubner’s Test
(Lead acetate
and conc.
NH4OH)
Ormsby Test
(methylamine
HcL and
NaOH)
133
what are the test for galactose
Mucin Acid
Test (Conc.
HNO3)
Tollen’s Test
(Conc. HCl
and
Phoroglucin)
Osazone Test
134
what are the test for maltose and the positive result?
Barfoed’s - red color
135
what is the principle for SG reagent strip
pKa change (Dissociation constant) of a polyelectrolyte in an
alkaline medium
136
ranges of level of SG in the reagent strip
Blue (1.000) to shades of green-yellow (1.03)
137
reagent for the SG in the 2 type of reagent strip - multistix and chemstrips
Multistix: Poly (Methyl vinyl ether/ Maleic anhydride)
bromthymol blue
o Chemstrips: Ethyleneglycoldiaminoethylethertetraacetic
acid, Bromthymol blue
138
SG depends and only measure the body's ______
ionic solute
139
higher concentration of the urine, higher hydrogen ion. higher hydrogen ion, more urine components will lower the pH level. urine becoming more acidic
true or false?
true
140
141
