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STRASINGER (7TH ED. | CHAPTER 5: PHYSICAL EXAMINATION OF URINE) Flashcards

1
Q

What are the (4) components included in the physical examination of urine?

A
  1. Color
  2. Clarity
  3. Specific gravity (SG)
  4. Odor
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2
Q

What are the (2) components of urine where early physicians based their medical decisions?

A
  1. Color
  2. Clarity
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3
Q

Observation of the color and clarity of urine provides preliminary information concerning what (4) disorders / conditions?

A
  1. Glomerular bleeding
  2. Liver dse
  3. Inborn errors of metabolism
  4. Urinary tract infection (UTI)
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4
Q

Measurement of what component aids in the evaluation of renal tubular function?

A

SG

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5
Q

True or False

The results of the physical examination of urinalysis (UA) also can be used to confirm or explain findings in the chemical and microscopic areas of UA

A

True

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6
Q

True or False

The color of urine varies from almost colorless to black. These variations may be due to normal metabolic functions, physical activity, ingested materials, or pathological conditions

A

True

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7
Q

What component of physical examination of urine is often the reason that a patient seeks medical advice?

A

Noticeable change in color

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8
Q

What are the (13) more common normal and pathological colors of urine?

A
  1. Colorless
  2. Pale yellow
  3. Dark yellow
  4. Orange-yellow
  5. Yellow-green
  6. Green
  7. Blue-green
  8. Pink
    8.1. Red
  9. Port wine
  10. Red-brown
  11. Brown
    11.1. Black
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9
Q

What is the cause of colorless urine?

A

Recent fluid consumption

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10
Q

What is the clinical / laboratory correlation associated with colorless urine?

A

Commonly observed with random specimens

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11
Q

What are the (3) causes of pale yellow urine?

A
  1. Polyuria or Diabetes insipidus (DI)
  2. Diabetes mellitus (DM)
  3. Dilute random specimen
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12
Q

(1) of the cause of pale yellow urine is polyuria or DI, what are the (2) clinical / laboratory correlations to these pale yellow urine?

A
  1. Increased 24-hour volume
  2. Low SG
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13
Q

(1) of the cause of pale yellow urine is DM, what are the (2) clinical / laboratory correlations to these pale yellow urine?

A
  1. Elevated SG
  2. (+) GLU test result
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14
Q

(1) of the causes of pale yellow urine is dilute random specimen, what is the clinical / laboratory correlations to these pale yellow urine?

A

Recent fluid consumption

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15
Q

What are the (6) causes of dark yellow urine?

A
  1. Concentrated specimen
  2. B complex vitamins
  3. Dehydration
  4. Bilirubin
  5. Acriflavine
  6. Nitrofurantoin

Bilirubin = yellow

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16
Q

(1) of the causes of dark yellow urine is concentrated specimen, what is the clinical / laboratory correlation to these dark yellow urine?

A

May be normal after strenuous exercise or in first morning specimen

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17
Q

(1) of the causes of dark yellow urine is dehydration, what are the (2) clinical / laboratory correlations to these dark yellow urine?

A
  1. Fever
  2. Burns
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18
Q

(1) of the cause of dark yellow urine is bilirubin, what are the (2) clinical / laboratory correlations to these dark yellow urine?

A
  1. Yellow foam when shaken
  2. (+) chemical test results for bilirubin
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19
Q

(1) of the cause of dark yellow urine is acriflavine, what are the (2) clinical / laboratory correlations to these dark yellow urine?

A
  1. (-) bile test results
  2. Possible green fluorescence
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20
Q

(1) of the cause of dark yellow urine is nitrofurantoin, what is the clinical / laboratory correlations to these dark yellow urine?

A

Antibiotic administered for UTIs

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21
Q

What are the (6) causes of orange-yellow urine?

A
  1. Phenazopyridine
  2. Phenindione
  3. Sulfasalazine
  4. Azo-gantrisin compounds
  5. Some laxatives
  6. Certain chemotherapy drugs

PhePhe = Phenazopyridine | Phenindione

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22
Q

What is the brand name of phenazopyridine?

A

Pyridium

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23
Q

What is the other name of sulfasalazine?

A

Azulfidine

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24
Q

(1) of the cause of orange-yellow urine is phenazopyridine, what is the clinical / laboratory correlations to these orange-yellow urine?

A

Drug commonly administered for UTIs

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25
Q

(1) of the cause of orange-yellow urine is phenindione, what are the (3) clinical / laboratory correlations to these orange-yellow urine?

A
  1. Anticoagulant
  2. Orange in alkaline urine
  3. Colorless in acid urine
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26
Q

(1) of the cause of orange-yellow urine is sulfasalazine, what is the clinical / laboratory correlations to these orange-yellow urine?

A

Anti-inflammatory drug

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27
Q

What is the cause of yellow-green urine?

A

Bilirubin oxidized to biliverdin

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28
Q

(1) of the cause of green urine is bilirubin oxidized to biliverdin, what are the (2) clinical / laboratory correlations to these yellow-green urine?

A
  1. Colored foam in acidic urine
  2. False-negative chemical test results for bilirubin
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29
Q

What are the (2) causes of green urine?

A
  1. Pseudomonas infection
  2. Asparagus
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30
Q

(1) of the causes of green urine is Pseudomonas infection, what is the clinical / laboratory correlations to these green urine?

A

(+) urine culture

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31
Q

What are the (12) causes of blue-green urine?

A
  1. Indican
  2. Phenol
  3. Familial hypercalcemia

Causes of green urine:
1. Breath deodorizers (Clorets)
2. Brightly colored food dyes
3. B vitamins
4. Asparagus

Causes of blue urine:
1. Medications
i. Methocarbamol (Robaxin)
2. Methylene blue
3. Indomethacin (Indocin, Tivorbex)
4. Amitriptyline (Elavil)
5. Propofol (Diprivan)

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32
Q

What is the other name of methocarbamol?

A

Robaxin

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33
Q

What are the (2) other names of indomethacin?

A
  1. Indocin
  2. Tivorbex
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34
Q

(1) of the causes of blue-green urine is amitriptyline, what is the clinical / laboratory correlations to these blue-green urine?

A

Antidepressant

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35
Q

(1) of the causes of blue-green urine is methocarbamol, what are the (2) clinical / laboratory correlations to these blue-green urine?

A
  1. Muscle relaxant
  2. May be green-brown
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36
Q

(1) of the causes of blue-green urine is indican, what are the (2) clinical / laboratory correlations to these blue-green urine?

A
  1. Bacterial infections
  2. Intestinal disorders
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37
Q

(1) of the causes of blue-green urine is methylene blue, what is the clinical / laboratory correlations to these blue-green urine?

A

Fistulas

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38
Q

(1) of the causes of blue-green urine is phenol, what is the clinical / laboratory correlations to these blue-green urine?

A

When oxidized

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39
Q

(1) of the causes of blue-green urine is propofol, what is the clinical / laboratory correlations to these blue-green urine?

A

Anesthetic

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40
Q

(1) of the causes of blue-green urine is familial hypercalcemia, what is the clinical / laboratory correlations to these blue-green urine?

A

“Blue diaper syndrome”

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41
Q

(1) of the causes of blue-green urine is indomethacin, what is the clinical / laboratory correlations to these blue-green urine?

A

Nonsteroidal anti-inflammatory drug (NSAID)

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42
Q

What are the (9) causes of pink and/or red urine?

A
  1. RBCs
  2. Hemoglobin
  3. Myoglobin
  4. Beets
  5. Rifampin
  6. Menstrual contamination

Nonpathogenic causes of red urine:
1. Menstrual contamination
2. Ingestion of highly pigmented foods
3. Medications
i. Rifampin
ii. Phenolphthalein
iii. Phenindione
iv. Phenothiazines

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43
Q

(1) of the causes of pink and/or red urine is RBCs, what are the (2) clinical / laboratory correlations to these pink and/or red urine?

A
  1. Cloudy urine w/ (+) chemical test results for blood
  2. RBCs visible microscopicaly
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44
Q

(1) of the causes of pink and/or red urine is hemoglobin, what are the (2) clinical / laboratory correlations to these pink and/or red urine?

A
  1. Clear urine w/ (+) chemical test results for blood
  2. Intravascular hemolysis
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45
Q

(1) of the causes of pink and/or red urine is myoglobin, what are the (2) clinical / laboratory correlations to these pink and/or red urine?

A
  1. Clear urine w/ (+) chemical test results for blood
  2. Muscle damage
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46
Q

(1) of the causes of pink and/or red urine is beets, what is the clinical / laboratory correlations to these pink and/or red urine?

A

Alkaline urine of people who are genetically susceptible

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47
Q

(1) of the causes of pink and/or red urine is rifampin, what is the clinical / laboratory correlations to these pink and/or red urine?

A

Tuberculosis medication

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48
Q

(1) of the causes of pink and/or red urine is menstrual contamination, what is the clinical / laboratory correlations to these pink and/or red urine?

A

Cloudy specimen w/ RBCs, mucus, and clots

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49
Q

What is the cause of port wine urine?

A

Pophyrins

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50
Q

(1) of the causes of port wine urine is porphyrins, what are the (2) clinical / laboratory correlations to these port wine urine?

A
  1. (-) test for blood
  2. May require additional testing
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51
Q

What are the (2) causes of red-brown urine?

A
  1. RBCs oxidized to methemoglobin
  2. Myoglobin
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52
Q

(1) of the causes of red-brown urine is RBCs oxidized to methemoglobin, what are the (2) clinical / laboratory correlations to these red-brown urine?

A
  1. Seen in acidic urine after standing
  2. (+) chemical test result for blood
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53
Q

What are the (9) causes of brown and/or black urine?

A
  1. Homogentisic acid (alkaptonuria)
  2. Malignant melanoma
    2.1 Melanin or melanogen
  3. Phenol derivatives
  4. Argyrol
  5. Methocarbamol
  6. Fava beans, rhubarb, or aloe
  7. Medications
    i. Anti-malarial drugs
    a. Chloroquine
    b. Primaquine
    c. Levodopa
    d. Methyldopa
    e. Phenol derivatives
    ii. Antibiotics
    a. Metronidazole (Flagyl)
    b. Nitrofurantoin (Furadantin)
  8. Laxatives (containing cascara or senna)

Nonpathogenic causes of a dark-brown (cola-colored) urine:
Ingesting large amounts of:
1. Fava beans
2. Rhubarb
3. Aloe

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54
Q

What is aygyrol?

A

Antiseptic

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55
Q

What is the other name of metronidazole?

A

Flagyl

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56
Q

(1) of the causes of brown and/or black urine is homogentisic acid (alkaptonuria), what are the (2) clinical / laboratory correlations to these brown and/or black urine?

A
  1. Seen in alkaline urine after standing
  2. Specific tests are available
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57
Q

(1) of the causes of brown and/or black urine is malignant melanoma, melanin or melanogen, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Urine darkens on standing and reacts w/ nitroprusside and ferric chloride

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58
Q

(1) of the causes of brown and/or black urine is phenol derivatives, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Interfere w/ copper reduction tests

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59
Q

(1) of the causes of brown and/or black urine is argyrol, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Color disappears w/ ferric chloride

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60
Q

(1) of the causes of brown and/or black urine is methyldopa or levodopa, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Antihypertensive

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61
Q

(1) of the causes of brown and/or black urine is metronidazole, what are the (3) clinical / laboratory correlations to these brown and/or black urine?

A
  1. Darkens on standing
  2. Intestinal infections
  3. Vaginal infections
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62
Q

(1) of the causes of brown and/or black urine is chloroquine and primaquine, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Antimalarial drugs

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63
Q

(1) of the causes of brown and/or black urine is methocarbamol, what is the clinical / laboratory correlations to these brown and/or black urine?

A

Muscle relaxant

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64
Q

What are the (3) common descriptions for normal urine color?

A
  1. Pale yellow
  2. Yellow
  3. Dark yellow
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65
Q

How to properly examine the color of urine?

A

Examine the specimen under a good light source, looking down through the container against a white background

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66
Q

What is the cause of the yellow color of urine?

A

Urochrome

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67
Q

What is urochrome?

A

Pigment

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68
Q

Who named urochrome, and when is it named?

A

Thudichum named urochrome in 1864

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69
Q

What is the product of endogenous metabolism, and under normal conditions, the body produces it at a constant rate?

A

Urochrome

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70
Q

True or False

The actual amount of urochrome produced is dependent on the body’s metabolic state, with decreased amounts produced in patients with thyroid conditions and/or those in fasting states

A

False, the actual amount of urochrome produced is dependent on the body’s metabolic state, with increased amounts produced in patients with thyroid conditions and/or those in fasting states

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71
Q

What are the (3) conditions or contexts where urochrome is increased?

A
  1. Patients w/ thyroid conditions
  2. Those in fasting states
  3. Urine standing in room temperature
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72
Q

Can the urine color be used as a rough estimate of the urine concentration? Why or why not? Explain

A

Yes, because urochrome is excreted at a constant rate, the intensity of yellow color in a fresh urine specimen can give a rough estimate of urine concentration

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73
Q

What is the color of a dilute urine?

A

Pale yellow

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74
Q

What is the color of a concentrated urine?

A

Dark yellow

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75
Q

True or False

The color of urine varies depending on the body’s state of hydration

A

True

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76
Q

What are the (3) pigments of urine?

A
  1. Urochrome
  2. Uroerythrin
  3. Urobilin
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77
Q

What are the (2) pigments of urine that are also present in the urine in much smaller quantities, and they contribute little to the color of normal, fresh urine?

A
  1. Uroerythrin
  2. Urobilin
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78
Q

What is uroerythrin?

A

Pink pigment

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79
Q

Where is uroerythrin evident? Explain

A

Uroerythrin is most evident in specimens that have been refrigerated, resulting in the precipitation of amorphous urates in an acid urine. Uroerythrin attaches to the urates, giving a pink color to the sediment

Refrigerated urine -> precipitation of amorphous urates in an acid urine -> uroerythrin attaches to urates -> pink color at sediment

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80
Q

What is the oxidation product of the normal urinary constituent urobilinogen?

A

Urobilin

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81
Q

What imparts an orange-brown color to urine that is not fresh?

A

Urobilin

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82
Q

What are the (4) abnormal colors of urine?

A
  1. Dark yellow / Amber / Orange
  2. Red / Pink / Brown
  3. Brown / Black
  4. Blue / Green
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83
Q

True or False

Dark yellow or amber urine may always signify a normal concentrated urine

A

False, dark yellow or amber urine may not always signify a normal concentrated urine

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84
Q

Dark yellow or amber urine can be caused by what?

A

Bilirubin

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85
Q

What are the (2) ways of detecting bilirubin in the urine?

A
  1. It can be detected via chemical examination
  2. The presence of bilirubin is suspected if yellow foam appears when the specimen is shaken
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86
Q

What is the way to detect protein in urine? Explain

A

Normal urine contains a small amount of rapidly disappearing foam when shaken, however, if a large amount of white foam occurs, it indicates an increased concentration of protein

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87
Q

What is the indication if the urine contains bilirubin?

A

The urine specimen may also contain hepatitis virus

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88
Q

What is the resulting color of urine if photo-oxidation of large amounts of excreted urobilinogen to urobilin is present?

A

Yellow-orange

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89
Q

True or False

A yellow-orange urine is indicative of photo-oxidation of urobilinogen to urobilin. However, when the urine is shaken, a yellow foam does not appear

A

True

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90
Q

What is the resulting color of urine if photo-oxidation of bilirubin is present? Explain

A

Yellow-green

Bilirubin turns into biliverdin (via photo-oxidation) -> biliverdin is the cause of yellow-green urine

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91
Q

Azo-gantrisin compounds is used to what patient population?

A

Patients who have UTIs

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92
Q

What are the (2) effects of the thick, orange pigment caused by phenazopyridine and/or azo-gantrisin compounds?

A
  1. Obscures the natural color of the specimen
  2. Interferes w/ chemical tests that are based on color reactions
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93
Q

What are the (2) causes of yellow foam when urine is shaken? Explain

A
  1. Bilirubin
  2. Phenazopyridine

Presence of yellow foam caused by phenazopyridine can be mistaken as due to bilirubin

94
Q

What is (1) of the most common causes of abnormal urine color?

95
Q

What is the usual color that blood produces in urine?

96
Q

True or False

Red is the usual color that blood produces in urine, but the color may range from pink to brown

97
Q

Red is the usual color that blood produces in urine, but the color may range from pink to brown, depending on what (3) components?

A
  1. Amount of blood
  2. pH of urine
  3. Length of contact
98
Q

What is the cause of brown urine? Explain

A

RBCs remaining in an acidic urine for several hours cause the urine to turn brown due to the oxidation of hemoglobin to methemoglobin

99
Q

A fresh urine containing blood that is brown also may indicate what condition / dse?

A

Glomerular bleeding

100
Q

What are the (4) causes of red urine?

A
  1. RBCs
  2. Hemoglobin
  3. Myoglobin
  4. Porphyrins (specifically, port wine)
101
Q

True or False

Only RBCs produce a (+) chemical test result for blood

A

False, because RBCs, myoglobin, and hemoglobin produce a (+) chemical test result for blood

102
Q

Explain the differentiation of red urine testing chemically (+) for blood

A

Red urine -> clear -> hemoglobinuria -> red plasma

Red urine -> clear -> myoglobinuria -> clear plasma

Red urine -> cloudy -> RBCs present (hematuria)

103
Q

What is the color and clarity of urine if there is hematuria?

A

Red and cloudy

104
Q

What is the color and clarity of urine if hemoglobin or myoglobin is present?

A

Red and clear

105
Q

How to distinguish if there is hemoglobinuria or myoglobinuria in the urine?

A

Hemoglobinuria (red plasma) vs Myoglobinuria (clear plasma)

106
Q

What is the cause of hemoglobinuria?

A

It results from the in vivo breakdown of RBCs

107
Q

What is the cause of myoglobinuria?

A

Breakdown of skeletal muscle

108
Q

Explain why patients with hemoglobinuria has red plasma and why patients with myoglobinuria has clear plasma

A

Hemoglobinuria (in vivo breakdown of RBCs -> hemoglobinuria -> red plasma) vs Myoglobinuria (breakdown of skeletal muscle -> myoglobinuria -> myoglobin is cleared more rapidly from the plasma -> hence, it does not affect the color of the plasma)

109
Q

Between myoglobin and hemoglobin, what is more rapidly cleared from the plasma?

110
Q

True or False

Fresh urine containing hemoglobin frequently exhibits a more reddish-brown color than does urine containing myoglobin

A

False, fresh urine containing myoglobin frequently exhibits a more reddish-brown color than does urine containing hemoglobin

111
Q

True or False

The possibility of hemoglobinuria being produced from in vitro lysis of RBCs also must be considered

112
Q

What is the cause of presence of porphyrins in the urine?

A

Oxidation of porphobilinogen to porphyrins

113
Q

What are the (3) nonpathogenic causes of red urine?

A
  1. Menstrual contamination
  2. Ingestion of highly pigmented foods
  3. Medications
    i. Rifampin
    ii. Phenolphthalein
    iii. Phenindione
    iv. Phenothiazines
114
Q

What are the effects of eating fresh beets for patients who are genetically susceptible?

A

Red color in alkaline urine

115
Q

What are the effects of eating blackberries?

A

Red color in acidic urine

116
Q

What is the difference between the effects of eating fresh beets vs blackberries?

A

Fresh beets (red color in alkaline urine) vs Blackberries (red color in acidic urine)

117
Q

What should be done for urine specimens that turn brown or black on standing and have (-) chemical test results for blood?

A

Additional testing

118
Q

Why should urine specimens (w/ [-] chemical tests for blood) that turn brown or black on standing applied w/ additional tests?

A

Because they may contain melanin or homogentisic acid

119
Q

What is melanogen?

A

Colorless pigment

120
Q

What is the oxidation product of melanogen?

121
Q

What is produced in excess in cases of melanoma?

122
Q

What is the metabolite of phenylalanine?

A

Homogentisic acid

123
Q

What is the component that imparts a black color to alkaline urine from patients w/ inborn error of metabolism (alkaptonuria)?

A

Homogentisic acid

124
Q

What are the (3) conditions / dses that can cause brown or black urine?

A
  1. Liver disorders
  2. Kidney disorders
  3. Muscle injury (from extreme exercise)
125
Q

What are the (3) nonpathogenic causes of dark-brown (cola-colored) urine?

A

Ingestion of large amounts of:
1. Fava beans
2. Rhubarb
3. Aloe

126
Q

What are the (2) pathogenic causes of blue/green urine?

A
  1. Bacterial infections
    i. UTI by Pseudomonas spp.
  2. Intestinal tract infections (resulting to increased urinary indican)
127
Q

What are the (2) characteristics of familial benign hypercalcemia?

A
  1. Rare
  2. Inherited
128
Q

Familial benign hypercalcemia is sometimes called as what?

A

Blue diaper syndrome

129
Q

Why is blue diaper syndrome called as such?

A

Because children w/ this disorder will have blue urine

130
Q

What are the (4) causes of green urine?

A
  1. Breath deodorizers (Clorets)
  2. Brightly colored food dyes
  3. B vitamins
  4. Asparagus
131
Q

What are the (5) causes of blue urine?

A
  1. Medications
    i. Methocarbamol (Robaxin)
  2. Methylene blue
  3. Indomethacin (Indocin, Tivorbex)
  4. Amitriptyline (Elavil)
  5. Propofol (Diprivan)
132
Q

What should be done if abnormally colored urine in specimen collection bags from hospitalized patients are frequently observed? Explain

A

This may signify a pathologic condition, hence, the urine of the patient is required to stand for a period of time before color development or the presence of medications

133
Q

Phenol derivatives found in certain IV medications produce what color of urine?

A

Green (due to oxidation)

134
Q

What are the (2) causes of purple staining in catheter bags?

A
  1. Indican
  2. Bacterial infection
    i. Klebsiella spp.
    ii. Providencia spp.
135
Q

What is the general tern that refers to the transparency or turbidity of a urine specimen?

136
Q

How to examine the clarity of urine in routine UA?

A

Visually examine the mixed specimen (present in a clear container) while holding in front of a light source

137
Q

True or False

Color is determined first, followed by clarity

A

False, color and clarity are routinely determined at the same time

138
Q

What are the (5) common terminologies used to report clarity?

A
  1. Clear
  2. Hazy
  3. Cloudy
  4. Turbid
  5. Milky
139
Q

What is the corresponding term of the given clarity

Given clarity: Clear

A

No visible particulates, transparent

140
Q

What is the corresponding term of the given clarity

Given clarity: Hazy

A

Few particulates, print easily seen through urine

141
Q

What is the corresponding term of the given clarity

Given clarity: Cloudy

A

Many particulates, print blurred through urine

142
Q

What is the corresponding term of the given clarity

Given clarity: Turbid

A

Print cannot be seen through urine

143
Q

What is the corresponding term of the given clarity

Given clarity: Milky

A

May precipitate or be clotted

144
Q

What are the corresponding terms of the following clarities?

  1. Clear
  2. Hazy
  3. Cloudy
  4. Turbid
  5. Milky
A
  1. No visible particulates, transparent
  2. Few particulates, print easily seen through urine
  3. Many particulates, print blurred through urine
  4. Print cannot be seen through urine
  5. May precipitate or be clotted
145
Q

True or False

Freshly voided, normal urine is usually clear, particularly if it is a clean-catch midstream specimen

146
Q

What are the (2) causes of white cloudiness in an alkaline urine?

A

Precipitation of:
1. Amorphous phosphates
2. Amorphous carbonates

147
Q

What are the (2) causes of hazy (but normal) urine in women?

A
  1. Squamous epithelial cells
  2. Mucus
148
Q

True or False

Specimens that are allowed to stand or that are refrigerated also may develop turbidity that is pathological

A

False, specimens that are allowed to stand or that are refrigerated also may develop turbidity that is nonpathological

149
Q

What is the cause of turbidity for improperly preserved urine specimens? Explain

A

Because improper preservation results in bacterial growth -> increasing specimen turbidity

150
Q

What are the (3) causes of thick turbidity on refrigerated urine specimens?

A

Precipitation of:
1. Amorphous phosphates
2. Amorphous carbonates
3. Amorphous urates

151
Q

Amorphous phosphates and amorphous carbonates produce what in alkaline urine?

A

White precipitate

152
Q

Amorphous urates produce what in acidic urine?

A

Precipitate that resembles pink brick dust

153
Q

Why is precipitate that resembles pink brick dust present in acidic urine w/ amorphous urates?

A

Due to the presence of uroerythrin

154
Q

What is the difference between amorphous phosphates and amorphous carbonates vs amorphous urates in terms of precipitates that they produce?

A

Amorphous phosphates and amorphous carbonates (white precipitate in alkaline urine) vs Amorphous urates (precipitate resembling pink brick dust in acidic urine)

155
Q

Where are amorphous phosphates and amorphous carbonates present?

A

Alkaline urine

156
Q

Where are amorphous urates present?

A

Acidic urine

157
Q

What is the difference between amorphous phosphate and amorphous carbonates vs amorphous urates in terms of the pH of urine where they are present?

A

Amorphous phosphates and amorphous carbonates (alkaline urine) vs Amorphous urates (acidic urine)

158
Q

What are the (8) nonpathological causes of urine turbidity?

A
  1. Squamous epithelial cells
  2. Mucus
  3. Amorphous phosphates, carbonates, urates
  4. Semen, spermatozoa
  5. Fecal contamination
  6. Radiographic contrast media
  7. Talcum powder
  8. Vaginal creams
  9. Normal urine crystals
159
Q

How are urine color and clarity examined (/ what are the steps)?

A
  1. Evaluate an adequate volume of specimen
  2. Use a well-mixed specimen
  3. View the urine through a clear container
  4. View the urine against a white background using adequate room lighting
  5. Maintain adequate room lighting
  6. Evaluate a consistent volume of urine
    i. Determine the urine color
    ii. Determine the urine clarity
160
Q

What are the (3) most common pathological causes of turbidity in a fresh urine specimen?

A
  1. RBCs
  2. WBCs
  3. Bacteria
    i. Caused by infection
    ii. Caused by systemic organ disorder
161
Q

What are the (6) less frequent pathological causes of turbidity in urine?

A

Abnormal amounts of:
1. Nonsquamous epithelial cells
2. Yeast
3. Trichomonads
4. Abnormal crystals
5. Lymph fluid
6. Lipids

162
Q

What are the (9) pathological causes of urine turbidity?

A

Most common:
1. RBCs
2. WBCs
3. Bacteria
i. Caused by infection
ii. Caused by systemic organ disorder

Less frequent:
Abnormal amounts of:
1. Nonsquamous epithelial cells
2. Yeast
3. Trichomonads
4. Abnormal crystals
5. Lymph fluid
6. Lipids

163
Q

True or False

The clarity of a urine specimen certainly provides a key to the microscopic examination results because the amount of turbidity should correspond w/ the amount of material observed under the microscope

164
Q

True or False

Clear urine is always normal

A

False, clear urine is not always normal

165
Q

What is (1) of the most important functions of kidney? Explain

A

The kidney’s ability to concentrate the glomerular filtrate by selectively reabsorbing essential chemicals and water from the **glomerular filtrate **

166
Q

How is the urine concentration measured in routine UA?

A

By measuring the specific gravity (SG)

167
Q

What is the importance of measuring the SG of urine?

A

To determine whether the concentration of the specimen is adequate to ensure the accuracy of chemical tests

168
Q

What is the SG of the plasma filtrate entering the glomerulus?

169
Q

What is the term used to describe a urine w/ a SG of 1.010?

A

Isosthenuric

170
Q

What is the term used to describe a urine w/ a SG of < 1.010?

A

Hyposthenuric

171
Q

What is the term used to describe a urine w/ a SG of > 1.010?

A

Hypersthenuric

172
Q

What is the range of SG of normal random specimens (depending on the patient’s hydration)?

A

~ 1.002 - 1.035

173
Q

What are specimens w/ a SG of < 1.002?

A

These are not probably urine

174
Q

What is the range of SG of most random specimens?

A

1.015 - 1.030

175
Q

What is the density of a solution compared w/ the density of a similar volume of distilled water at a similar temperature?

176
Q

What is the SG of distilled water?

177
Q

True or False

Since urine is actually water that contains dissolved chemicals, the SG of urine is a measure of the density of the dissolved chemicals in the specimen

178
Q

What is influenced by number and size of particles present in the urine?

179
Q

True or False

Since SG is influenced by number and size of particles in the urine, large molecules contribute more to the reading than do small molecules

180
Q

Currently, what is the only method used in routine UA that requires correcting?

A

Refractometer

181
Q

What are the (3) current methods of urine SG measurements?

A
  1. Refractometry
  2. Osmolality
  3. Reagent strip
182
Q

What is the principle of refractometry (in terms of measuring SG)?

A

Refractive index

183
Q

What is the principle of osmolality (in terms of measuring SG)?

A

Changes in colligative properties by particle number

184
Q

What is the principle of reagent strip (in terms of measuring SG)?

A

pKa changes of a polyelectrolyte by ions present

185
Q

What determines the concentration of dissolved particles in a specimen by measuring refractive index?

A

Refractometry

186
Q

What is the comparison of the velocity of light in the air w/ the velocity of light in a solution?

A

Refractive index

187
Q

What is the mechanism of refractometers?

A

Clinical refractometers make use of these principles of light by using a prism to direct a specific (monochromatic) wavelength of daylight against a manufacturer-calibrated scale of SG. The concentration of the specimen determines the angle at which the light beam enters the prism. Therefore, the SG scale is calibrated in terms of the angles at which light passes through the specimen

188
Q

What is the advantage of using refractometry in determining the SG?

A

It uses a small volume of specimen (1 or 2 drops)

189
Q

Are temperature corrections necessary in refractometry? Why or why not?

A

No, because the light beam passes through a temperature-compensating liquid before being directed at the SG scale

190
Q

In refractometry, temperature is compensated between what range?

A

Between 15 °C - 38 °C

191
Q

How are corrections for GLU and protein done when refractometry is used?

A

Subtract 0.003 for each gram of protein present and 0.004 for each gram of GLU present

The amount of protein or GLU present can be determined from the chemical reagent strip tests

192
Q

How is refractometer used (/ what are the steps)?

A
  1. Put 1 or 2 drops of sample on the prism
  2. Close the daylight plate gently
  3. The sample must be spread all over the prism surface
  4. Look at the scale through the eyepiece
  5. Read the scale where the boundary line intercepts it
  6. Wipe the sample from the prism clean w/ a tissue paper and water
193
Q

How to calibrate a refractometer?

A

Use distilled water -> reading should be 1.000

If necessary, the instrument contains a zero setscrew to adjust the reading for distilled water

The calibration is further checked using either 5% NaCl which should read 1.022 ± 0.001, or 9% sucrose, which should read 1.034 ± 0.001

194
Q

When should urine control specimens representing low, medium, and high concentrations be run?

A

At the beginning of each shift

195
Q

What should be done after running the urine controls?

A

Calibration and control results are always recorded in the appropriate QC records

196
Q

What is the SG of patients who have recently undergone an IV pyelogram?

A

Abnormally high (> 1.040)

197
Q

What is the cause of abnormally high SG of patients who have recently undergone IV pyelogram?

A

It is due to the excretion of the injected radiographic contrast media

198
Q

What is the SG of patients who are receiving dextran or other high MW IV fluds (plasma expanders)?

A

Abnormally high SG

199
Q

When will the SG of patients who are receiving dextran or other high MW fluids (plasma expanders) return to normal?

A

Once the foreign substance has been cleared from the body

200
Q

What are the (2) ways to measure the urine concentration of patients who are receiving dextran or other high MW fluids (plasma expanders)? Why can these be used to measure the urine concentration?

A
  1. Reagent strip chemical test
  2. Osmometry

Because these are not affected by the high MW substances

201
Q

What are the (2) conditions / dses of patients that manifests abnormally high urine SG?

A

Patients who:
1. Have recently undergone IV pyelogram
2. Are receiving dextran or other high MW fluids (plasma expanders)

202
Q

What is the difference between SG vs osmolality?

A

SG (depends on the number of particles present in a solution and the density of these particles) vs Osmolality (affected only by the number of particles present)

SG (number and density) vs Osmolality (number)

203
Q

What is defined as 1 g MW of a substance divided by the number of particles into which it dissociates?

204
Q

How to determine the osmolarity of a solution?

A

By measuring a property that is mathematically related to the number of particles in the solution (colligative property) and comparing this value w/ the value obtained from the pure solvent

205
Q

What are the (4) colligative properties?

A

“(2) points + (2) pressure” | “FP, BP, VP, OP”

  1. Freezing point
  2. Boiling point
  3. Vapor pressure
  4. Osmotic pressure
206
Q

Solute dissolved in solvent causes the following what (4) changes in colligative properties?

A
  1. Lower freezing point
  2. Higher boiling point
  3. Increased osmotic pressure
  4. Lower vapor pressure
207
Q

What is the normal pure water point of the given colligative property?

Given colligative property: Freezing point

208
Q

What is the normal pure water point of the given colligative property?

Given colligative property: Boiling point

209
Q

What is the normal pure water point of the given colligative property?

Given colligative property: Vapor pressure

A

2.38 mmHg at 25 °C

210
Q

What is the normal pure water point of the given colligative property?

Given colligative property: Osmotic pressure

211
Q

What is the effect of 1 mole of solute to the given colligative property?

Given colligative property: Freezing point

A

Lowered 1.86 °C

212
Q

What is the effect of 1 mole of solute to the given colligative property?

Given colligative property: Boiling point

A

Raised 0.52 °C

213
Q

What is the effect of 1 mole of solute to the given colligative property?

Given colligative property: Vapor pressure

A

Lowered 0.3 mmHg at 25 °C

214
Q

What is the effect of 1 mole of solute to the given colligative property?

Given colligative property: Osmotic pressure

A

Increased 1.7 X 10^9 mmHg

215
Q

What is the solvent in urine?

216
Q

Since water is the solvent in urine, how to determine the number of particles present in a sample?

A

It can be determined by comparing a colligative property value of the sample w/ that of pure water

217
Q

What is the instrument used to measure osmolality?

218
Q

How does the A2O Advanced Automated Osmometer measure osmolality?

A

Freezing-point depression, providing a more automated method for measuring both urine and serum osmolality

219
Q

What term is used most commonly because both the solute and the solvent are expressed in the same units of measure?

220
Q

What is the principle of reagent strip for SG?

A

Change in pKa (dissociation constant) of a polyelectrolyte in an alkaline medium. The polyelectrolyte ionizes, releasing hydrogen ions in proportion to the number of ions in the solution. The higher the concentration of urine, the more hydrogen ions are released, thereby lowering the pH. Incorporation of the indicator bromthymol blue on the reagent pad measures the change in pH. As the SG increases, the indicator changes from blue (1.000 [alkaline]), through shades of green, to yellow (1.030 [acid])

221
Q

Readings of SG is made in what intervals by careful comparison w/ the color chart?

222
Q

True or False

Urine odor is a noticeable physical property

223
Q

What is the odor of a freshly voided urine?

A

Faint aromatic odor

224
Q

What happens to the odor of the urine as the specimen stands? Explain why this happens in the odor of the specimen

A

The odor of ammonia becomes more prominent

The breakdown of urea is the cause of the ammonia odor

Breakdown of urea -> ammonia odor

225
Q

What is the odor of urine if caused by bacterial infections?

A

Strong, unpleasant odor similar to ammonia

226
Q

What is the odor of urine if caused by diabetic ketones?

A

Sweet or fruity

227
Q

What is the odor of urine if caused by maple syrup urine disease (MSUD)?

A

Strong odor of maple syrup

228
Q

What is the odor of urine if caused by ingestion of certain foods such as onions, garlic, and asparagus?

A

Unusual or pungent

229
Q

Who are the people that can smell the odor of urine if caused by ingestion of asparagus?

A

Those who are genetically predisposed

230
Q

What are the (9) odors of urine and their corresponding possible common causes?

A
  1. Aromatic = Normal
  2. Foul, ammonia-like = bacterial decomposition, UTI
  3. Fruity, sweet = ketones (DM, starvation, vomiting)
  4. Maple syrup = MSUD
  5. Mousy = phenylketonuria (PKU)
  6. Rancid = tyrosinemia
  7. Sweaty feet = isovaleric acidemia
  8. Cabbage = methionine malabsorption
  9. Bleach = contamination

MT (7 decks)

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