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AUBF > UA 1: PHYSICAL EXAMINATION OF URINE PT. 2 > Flashcards

UA 1: PHYSICAL EXAMINATION OF URINE PT. 2 Flashcards

1
Q

urine character/clarity

A

observing the turbidity/clarity of urine

- if particulate matter is present in unspun urine, it should be examined microscopically

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2
Q

urine turbidity may be due to the following…

A

a. precipitation of crystals/non-pathologic salts
b. WBCs
c. bacterial growth
d. high number of epithelial cells (usu. females)
d. RBCs (i.e. hematuria)
e. spermatozoa/prostatic fluid
f. mucus from urinary passages
g. fecal material (esp. in LBM)
h. contamination with powders/antiseptics
i. chyluria
j. lipiduria

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3
Q

Precipitation of Crystals:

amorphous phosphates vs. uric acid/urates

A

a. amorphous phosphates
- seen in alkaline urine
- occasionally carbonates
- redissolves when acetic acid (HAc) is added

b. uric acid/urates
- seen in acid urine
- redissolves on warming at 60 degrees Celsius (do not boil)

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4
Q

causes uniform opalescence, not removed by acidification or boiling

A 
Bacterial growth
- E. coli
- Proteus
- Enterococcus
- Yeast
 Staphylococcus
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5
Q

T/F:

turbidity due to hematuria is not cleared on warming

A

TRUE

- it should be examined microscopically

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6
Q

increases in inflammation of the lower UT

A

mucus from urinary passages

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7
Q

substance that becomes opaque with water

A

(diluted) phenol

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8
Q

chyluria

A

Urine contains lymphocytes associated with obstruction to lymph flow

  • rupture of lymphatic vessels into the renal pelvis, ureter, bladder & urethra
  • urine may be normal, opalescent, or milky
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9
Q

fat globules in urine

A

Lipiduria

  • caused by nephrotic syndrome & crush injury
      • crush injury = due to major skeletal trauma; 1 or more fractures to major long bones/pelvis
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10
Q

test to check for lipiduria/chyluria

A

Mix urine with ether

- chyluria & lipiduria are soluble in ether –> clear solution is exhibited

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11
Q

describing urine clarity

A

Place print at the back of the sample:

  1. no visible particulates present; transparent = “CLEAR”
  2. few particulates present; print can easily be seen through urine = “HAZY”
  3. many particulates present; print is blurred through urine = “CLOUDY”
  4. print cannot be seen through urine = “TURBID”
  5. urine may be precipitated or be clotted = “MILKY”
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12
Q

physical test not usually included in physical exams

A

Urine Odor

  • normal odor: slightly aromatic
  • contaminated/long-standing urine: ammoniacal
  • odor can be caused by certain diseases
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13
Q

urine odors associated with amino acid disorders

A
  1. SWEATY FEET odor
    - isovaleric acidemia, glutaric acidemia
  2. MAPLE SYRUP odor
    - maple syrup urine disease
  3. CABBAGE odor
    - methionine malabsorption
  4. MOUSY odor
    - phenylketonuria (PKU)
  5. ROTTING FISH odor
    - trimethylaminuria
  6. RANCID odor
    - tyrosinemia
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14
Q

not measured during routine UA, but is measured for timed specimens

A

Urine Volume

- the average daily volume of a normal adult: 1200-1500mL OR 600-2000mL

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15
Q

urinary occurrence & characteristics in normal pregnancy

A
  • nocturia (urine at night)
      • excretion of more than 500mL urine with an SG of less than 1.018 at night
  • urine excreted is dilute
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16
Q

a term referring to increased urine volume

A

Polyuria

- urine excreted is more than 2000mL in 24h

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17
Q

this refers to decreased urine output

A

Oliguria

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18
Q

anuria

A

The patient cannot void

  • “an” = lack or absent
  • “uria” = urine
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19
Q

reflects the ability of the kidneys to maintain normal H+ concentration in the plasma & ECF

A

Hydrogen ion concentration

  • “Urine pH”
  • urine pH of healthy individuals:
      • first morning urine = pH 5-6
      • after meals = alkaline “tide”
      • random specimens = pH4.5-8.0
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20
Q

clinical significance/s of measuring urine pH

A
  • respiratory or metabolic acidosis/ketosis
  • respiratory or metabolic alkalosis
  • defects in renal tubular secretion & reabsorption of acids/bases
      • i.e. in renal tubular acidosis
  • renal calculi formation
  • treatment of UTI
  • precipitation & identification of crystals
  • determination of unsatisfactory specimens
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21
Q

possible causes of acidic urine

A
  • emphysema
  • DM
  • starvation
  • dehydration
  • diarrhea
  • high protein diet
  • intake of cranberry juice
  • taking medications for UTI (eg. Mandelamine)
  • presence of acid-producing bacteria (ex. E. coli)
22
Q

possible causes of alkaline urine

A
  • hyperventilation
  • vomiting
  • renal tubular acidosis
  • old specimens
  • presence of urease-producing bacteria
  • vegetarian diet
23
Q

basic methods of H+ determination

A
  1. potentiometric determination

2. indicator paper strips

24
Q

unsuitable for routine measurement

A

Potentiometric determination

  • “pH meter”
  • should be used for QC
25
Q

test for pH that uses indicator systems to determine urine pH

A

Indicator paper strips

  • rapid & inexpensive
  • some brands use double-indicator systems:
      • Multistix
      • Chemstrip
  • pH range: 5.0-8.5 (in half units)
26
Q

T/F:

indicator paper strips should be dipped in urine for a long time to obtain accurate results

A

FALSE

  • strips should NOT BE DIPPED FOR A LONG TIME because reagents will be washed out in the urine
  • results should be read 60 SECONDS AFTER DIPPING
27
Q

indicator/s used in pH strips

A
  1. METHYL RED = ACID indicator
    - range: pH 4-6 (high H+ concentration)
    - strip color: from RED TO YELLOW
  2. BROMTHYMOL BLUE = ALKALINE indicator
    - range: pH 6-9 (low H+ concentration)
    - strip color: from YELLOW TO BLUE
28
Q

this measures the concentrating & diluting power of the kidneys

A

Specific Gravity & Osmolality

  • both tests should give an indication of urinary total solute concentration
      • the inability of the kidneys to concentrate & dilute urine indicates renal disease or hormonal deficiency
29
Q

dependent on the number of particles present & their density

A 
Specific Gravity (SG)
- influenced by the size of molecules that are not significant in renal concentration (eg. urea, glucose, proteins)
30
Q

the specific gravity of a protein-free glomerular filtrate

A

1.010

31
Q

dependent on the number of solutes in a unit of solution

A

Osmolality

  • a more exact measurement of urine concentration than SG
  • commonly employed method: freezing point determination
32
Q

hyposthenuric urine

A

urine constantly has low SG (less than 1.007)

33
Q

isosthenuric urine

A

urine constantly has fixed SG

34
Q

methods of specific gravity measurement

A
  1. refractometer
  2. urinometer
  3. reagent strip
  4. harmonic oscillation densitometry
  5. falling drop
35
Q

measures the refractive index of a solution

A

Refractometer

  • “TS meter”
  • PROS:
      • the temperature is compensated between 60-100F
      • small sample required (1 drop)
36
Q

calibrators that can be used in a refractometer

A
  1. distilled water
    - SG: 1.000
  2. 5% NaCl
    - SG: 1.022 +/- 0.001
  3. 9% Sucrose
    - SG: 1.034 +/- 0.001
37
Q

a hydrometer adapted to measure SG at room temperature

A

Urinometer

38
Q

parts of the urinometer

A
  1. urinometer cylinder
  2. urinometer float
    - a weighted float with a calibrated stem where calibrations are read
39
Q

T/F:

the urinometer float displaces a volume of liquid equal to its weight

A

TRUE

  • “weight” = the amount of dissolved solutes in the sample
      • the additional mass provided by the solutes causes the float to displace a volume of urine smaller than the volume of distilled H2O
      • the float is designed to sink to a level of 1.000 (SG of dist. H2O)
40
Q

source/s of error in using the urinometer

A
  1. urine volume
    - urinometer cylinder needs to be filled approx. 3/4 full
  2. temperature differences
    - a difference of 3C between the urine & calibration temps. requires correction of 0.001
    - urinometer is mostly calibrated at 20C
  3. proteinuria
    - correction: subtract 0.003 for every 1g/100mL CHON
  4. glycosuria
    - correction: subtract 0.004 for every 1g/100mL glucose
  5. presence of x-ray contrast media
    - used in the examination of patients to follow the course of a dye
    - - dye is injected into the patient & its course is followed using x-ray; dye is excreted later through the urine
  6. presence of urinary preservative
    - SG is increased
41
Q

urine passed out after injecting the dye will have (high, low) SG

A

High SG

  • sometimes it cannot be read; may be > 1.050
  • correction: dilute urine with dist. H2O & multiply the SG by the dilution
42
Q

this method is based on the pKa of a polyelectrolyte in an alkaline medium

A

Reagent strip method

  • “pKa” = dissociation constant
  • polyelectrolyte ionizes releasing H+ in proportion to the number of ions in the solution
      • higher urine concentration = more H+ released = lower pH
  • indicator: Bromthymol blue
43
Q

Principle:

the frequency of a soundwave entering a solution will change in proportion to the density of the solution

A

Harmonic oscillation densitometry
- used by the Yellow IRIS (International Remote Imaging System)

  1. a portion of urine enters a U-shaped tube
  2. a soundwave of a specific frequency is generated at 1 end of the tube
  3. the soundwave passes through the urine
  4. the frequency is altered by the density of the solution
44
Q

a direct method of measuring the specific gravity

A

Falling drop method
- by M. Winstead; more historical method

  1. a specially designed column is filled with water-immiscible oil
  2. a measured drop of urine is introduced into the column
  3. as the drop falls, it encounters 2 light beams
    - - 1st light beam = timer starts
    - - 2nd light beam = timer ends
  4. the time that the drop of urine passes through the 2 beams is measured
45
Q

Sample scenario:

urine temperature = 30C
calibration temperature (urinometer) = 20C

how to correct SG?

A
  1. determine the difference between urine & calibration temps.
    - 30-20 = 10C difference
  2. divide the difference by 3C
    - 10 / 3 = 3.33
  3. multiply quotient by 0.001
    - 3.33 x 0.001 = 0.003
  4. ADD the product to the SG reading
    - 0.003 + SG reading
46
Q

Sample scenario:

urine temperature = 17C
calibration temperature (urinometer) = 20C

how to correct SG?

A
  1. determine the difference between urine & calibration temps.
    - 20-17 = 3C difference
  2. divide the difference by 3C
    - 3 / 3 = 1
  3. multiply quotient by 0.001
    - 1 x 0.001 = 0.001
  4. SUBTRACT the product to the SG reading
    - 0.001 - SG reading
47
Q

Sample scenario:

patient name - Maria Cruz
urine temperature = 36C
calibration temperature (urinometer) = 21C
SG reading = 1.015

Determine urine true SG

A
  1. 36-21 = 15C difference
  2. 15 / 3 = 5
  3. 5 x 0.001 = 0.005
  4. 0.005 + 1.015 = 1.020

True SG = 1.020

48
Q

Sample scenario:

patient Maria Cruz has proteinuria. Her urine contains 2g CHON/100mL. What is the final SG?

A

CORRECTION: SUBTRACT 0.003 FOR EVERY 1g/100mL CHON

Final SG = True SG - (0.003 x 2g)
Final SG = 1.020 - (0.006)

Final SG = 1.014

49
Q

Sample scenario:

patient Maria Cruz had a very high SG. So, 5mL of the urine was diluted with 15mL distilled H2O. What is the final SG?

A

True SG x DILUTION

  • dilution = 5mL urine / 15mL dist. H2O
    = 1 part urine to 3 parts H2O

Final SG = 1.020 x 3
= 1.060

50
Q

why is the final SG 1.060 and not 3.060 (1.020 x 3)?

A

There is no SG that begins with any number except 1.
ALL SG STARTS WITH 1.

Therefore,
1.020 x 3 = .020 x 3 = 1.060

AUBF (9 decks)

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