quizlet Urinalysis mikem Flashcards
Describe the clean catch method
For women, it’s important to wipe 2x from front to back with an antibacterial wipe in order to prevent the collection of a contaminated sample. You must also catch the urine mid stream.
Name 3 reasons for ordering a urinalysis.
Diagnose Renal or UT Disease, Monitor Disease, Detect Metabiolic or systemic
What are 3 advantages to ordering a urinalysis
Cost Effective, painless (usually), quick
What are the four types of urine specimens?
First Morning Specimen
Random
Timed
Culture and sensitivity
What is the most common reason for ordering a 24 Hour urine collection?
Because you found protein in the urine and you want to asess proteinuria
How long can you wait to culture a urine specimen?
Must be cultured within a hour
In a 24 hour collection why do you flush your first morning specimen?
Because that is from the previous day.
True or False? In a 24 hour collection you will collect the first morning void of the 2nd morning.
True
What is the most common pathogen that causes urinary tract infection?
E.Coli
True or False? Men are more likely to get a UTI.
False Women are most likely to get a UTI due to a shortened urethra
What does a gram stain tell you?
Whether the bacteria is gram positive or gram negative this can help you select a proper antibiotic
Is it ok to give antibiotics to a patient before you send the specimen for sensitivity and culture?
No, always send the specimen for culture and sensitivity before you give antibiotics.
What would cloudy urine indicate?
presence of WBCs, RBCs, bacteria
What is the normal color of urine?
Pale yellow to amber
What gives urine its color?
Urochrome (a pigment which is a product of bilirubin metabolism)
What would dark yellow colored urine indicate?
Bilirubin in the urine
What would bright red colored urine indicate?
Bleeding from the bladder
What would dark red colored urine indicate?
Bleeding from the kidney
True or False? 90% of blood in the urine is from the bladder.
True
The measure of the kidney’s ability to concentrate urine (remove wastes)
Specific Gravity
In a specific gravity test the weight of urine is compared to the weight of what?
Distilled Water (1.00)
The value of __________ is affected by the amount of solutes and volume/hydration status
Specific Gravity
A low specific gravity may indicate
Diabetes Insipidus
_______ is the bodies inability to produce ADH or the inability of ADH to work in the body.
Diabetes Insipidus
Drinking _______ inhibits the production of ADH.
Alcohol
A high specific gravity may indicate (3)
- Diabetes Mellitus
- high ADH level
- dehydration
True or False? Urine osmolarity is measured as a part of the urinalysis.
False, it is seperate
The number of particles in a unit of solution (not specific to a particular particle)
Urine Osmolality
True or false? The same diseases that are correlated with a high or low specific gravity are correlated with urine osmolality.
True
How would an increase in ADH effect your specific gravity?
It would increase it
Average PH of urine
6
_______ actually makes your PH lower and is a good preventative measure for UTI but can’t treat a UTI
Cranberry Juice
What condition may result in alkaline urine?
Bacteria, especially UTI
An increase in hydrogen ions would make the environment _______ and a decrease in hydrogen ions would make the environment ________
Acidic / Basic
The distal and proximal conv tubule include what transporter important in urine pH?
Hydrogen (secretion) - Na (reabsorption)
What can cause transient proteinuria? (2)
Exercise, fever
Why is protein typically not seen in the urine?
Because the spaces of the glomerular membrane are too small to allow passage
Why is protein in the urine a concern?
It indicates glomerular injury. If the spaces of the glomerular membrane are enlarged, protein (usually albumin, smaller than globulins) seeps into filtrate
What type of protein is most commonly found in the urine?
Albumin
Clinical causes for proteinuria (4)
Preeclampsia (HTN, edema), Eclampsia (w/seizures), diabetes complications, glomerulonephritis
What is the leading cause of end-stage renal disease?
Diabetes
MCC of hematuria
Cystitis (in women, men typically do not get cystitis or UTIs)
What are 3 common causes of blood in the urine?
Cystitis, glomerulonephritis, cancer
What is the renal threshold for glucose?
>180 mg/dl in the serum
How much glucose is filtered from the blood
100% (then 100% is reabsorbed in prox tubule)
Byproduct of fatty acid catabolism; used as energy source when glucose cannot be utilized
Ketones
What are the clinical implications of ketones in the urine? (5)
Poorly controlled diabetes (hyperglycemia), diabetic ketoacidosis, alcoholic ketoacidosis, starvation, high protein diets
What is bilirubin?
Breakdown product of hemoglobin
Bilirubin is conjugated in the ________ and excreted in the _______ which is metabolized in small intestine by bacteria to _________.
Liver / bile / urobilinogen
What type of bilirubin is fat soluble, difficult to excrete, and excreted in the feces?
Unconjugated
What type of bilirubin is water soluble and easily excreted by kidneys?
Conjugated
How is urobilinogen made?
Bilirubin is metabolized and transformed to urobilinogen in the small intestine by bacteria.
True or False? It is abnormal to have urobilinogen in the urine.
False, a small amount of urobilinogen is normal (up to 0.2 mg/dl)
A portion of ________ is absorbed and carried to liver and excreted in bile and urine .
urobilinogen
What are the clinical implications of having increased levels of urobilinogen.
An overproduction of RBCS / Hemolytic anemia
What type of data do you get from a urine dip?
Qualitative
True or False? Urinalysis is not a good monitor for liver disease
True
A urinalysis with increased bilirubin and increased urobilinogen levels is indicative of __________ .
Hemolytic Anemia
A urinalysis with increased bilirubin and normal urobilinogen level is indicative of ___________.
an obstruction of excretion (unable to get to bowels e.g. gallstones)
A screening test for WBCs in urine
Leukocyte Esterase
A positive leukocyte esterase test suggests the presence of a ______.
UTI (or STI)
The most reliable test for detecting urinary tract infections - 90% accurate in detecting WBCs in urine
Leukocyte Esterase
True or False, a positive leukocyte esterase test is diagnostic of a UTI.
False, you can’t say that there are WBCs in the urine without actually looking at a slide. Don’t diagnose based on this test alone.
What type of bacteria is e.coli, gram negative or positive?
Gram negative
Why would you test nitrites in the urine?
To screen for UTI
What bacteria will give a positive nitrite test?
gram negative with the nitrate reductase enzyme
What indicates a good probability of stone formation?
Crystals
Do crystals cause pain?
No, they do not produce symptoms until they form stones
Name a reason you might have a false positive for proteinuria.
RBCs can give you a false positive due to the hemoglobin component
What would a lot of epithelial cells indicate in a urine specimen?
Contaminated sample
Where are casts formed? (2)
distal convoluted tubule or collecting duct
The formation of cast are favored by what? (3)
decreased urine flow (stasis)
envelope-shaped crystals in acidic urine
Ca oxalate
Composed primarily of mucoprotein called Tam-Horsfall
Hyaline Cast
Where are mucoproteins secreted?
tubule cells
Can be seen in normal patients, especially after strenuous exercise, dehydration
Hyaline casts
Tamm-Horsfall is indicative of ______________
multiple myeloma
When __________ remain in nephron long time, may degenerate into coarsely granular casts, then finely granular casts and ultimately broad waxy casts
cellular casts
Result from degeneration of cellular material into granular particles within WBC or epithelial cell cast
Granular cast
In Fatty casts, fat within epithelial cell casts becomes incorporated with protein into casts or coalesce to large droplets called ____________.
oval fat bodies
What type of cast is a hallmark of nephrotic syndrome (large amount of proteinuria)?
Fatty casts
These casts are associated with chronic renal diseases, chronic renal failure, diabetic nephropathy, and malignant HTN.
Waxy Casts
Occur when flow thru tubule diminished and granular casts degenerate
Waxy Casts
May be cell casts or hyaline casts
Waxy Casts
Renal tubular cell casts indicate _____________.
glomerulonephritis
Cast that is typically found in infections, mostly pyelonephritis, inflammatory nephritis (lupus)
WBC cast
Found w/ disruption of blood/urine barrier at any level of tract, usually bladder, ureteral, urethral diseases
RBC cast
On a slide what is the difference between epithelial tissue in a sample and a epithelial cell cast?
In epithelial cell casts the cells are clustered rather than randomly found in the sample
In epithelial cell casts, ___________ casts can be normal and ___________ Casts indicate membrane damage - glomerulonephritis
Squamous epithelial cell / renal tubular cell
