UA Flashcards
What are the 3 components of a UA?
gross examination
urine dipstic
microscopic analysis
Collection of a urine sample requires what two things?
aseptic technique (disinfection, spread labia)
clean midstream catch
In gross examination, what two things should you be observing for?
color, turbidity
In gross examination, should you smell the urine?
yes
dark amber urine is (normal/abnormal) and indicates what?
normal, concentrated urine
Red or red-brown urine indicates… (2)
hematuria
hemoglobinuria
dark brown/black urine indicates…
bile/bilirubin due to biliary or liver disease
Red urine in a female, you must rule out…
menstrual contamination
Red urine in a patient of any sex, consider… (3)
myoglobin, food dye, beets/rhubarb
The following disorders would cause urine to be what color?
alkaptonuria
homogentisic acid oxidase
malignant melanoma
dark brown/black
The following could have what effect on urine clarity?
- crystal precipitate
- bacteria/yeast
- WBCs/RBCs
- mucous
- squamous epithelium
- sperm, prostatic fluid
- lipids
cloudy/turbid
putrid/foul odor of urine indicates…
bacteria
fruity odor of urine indicates…
ketones
ash-tray urine smell indicates
cigarette smoker
phenylketonuira/maple syrup odors indicate…
amino acid disorder
10 measures on a urine dipstick…
ph specific gravity glucose ketones protein blood nitrite leukocyte esterase bilirubin urobilinogen
urine pH parallels…
serum pH
Increased concentration of urine has what effect on its specific gravity?
increased SG
This measure:
reflects ability of kidney to concentrate and dilute urine
specific gravity
In kidney disease, specific gravity can become fixed at 1.010. This is called…
fixed at
called isothenuria
urine < 500cc / 24 hours
oliguria
urine < 100cc/24 hrs
anuria
excessive urine, dilute, SG 1.000-1.002
polyuria
Glucose can “spill” into urine when plasma glucose exceeds…
150-180 mg/DL
What 2 substances can cause false negatives for glucosuria?
ascorbic acid
aspirin
Acidosis, DKA, rapid weight loss, fasting, starvation and pregnancy can all cause what to be present in urine?
ketones
Urine dipstick is sensitive to what protein?
albumin
albuminuria is an indicator of…
renal endothelial dysfunction/early kidney disease
albuminuria is an indicator of…
renal endothelial dysfunction/early kidney disease
What may cause a false positive for protein in a urine dipstick?
pyridium
What is a limitation to detecting protein in urine via dipstick?
dilute urine underestimates degree of albuminura
Moderately increased albuminuria in the range of ____ to _____ cannot be detected with dipstick
30-300
Moderately increased albuminuria is a marker for staging and prognosis of…
kidney disease
Persistently positive dipstick for protein should have what quantified?
albuminuria
What two diagnostics outside of urine dipstick can be helpful in staging/prognosis of kindey disease?
24 hr collection
Albumin/Cr ratio on randome urine
Albuminuria is a good screen for kidney damage in what high risk patients? (3)
diabetes, HTN, CVD
what can cause a false negative for hematuria?
ascorbic acid
what must be done in order to determine the presence of RBCs, Hb, or Mb in urine?
centrifuge and microscopy
Urine diptick sensitivity is ______ for RBCs or _____ for Hb
5-10 RBCs, .05-.3 Hb
Nitrite test on UA is 50% sensitive for UTI. This means…
can’t r/o UTI
Nitrite in urine can indicate…
bacteria
False negatives for nitrite in UA can be caused by…
urine in bladder < 4 hrs
bacteria w/out nitrite enzymes
What releases leukocyte esterase?
neutrophils and macrophages
This measure on a urine dipstick is a marker for the presence of WBCs indicating infx…
leukocyte esterase
Vaginal contamination and trichomonas can give a false positive for…
leukocyte esterase
LE and Nitrite increases sensitivity for diagnosing…
UTI
detects metabolic acidosis/alkalosis…
pH
can detect acute kidney failure…
specific cravity
indicates DM
glucose
indicates DKA/acidosis…
ketones
Can indicate kidney pathology…
proteinuria
sign of early kidney disease…
moderately increased albumin
___ + _____ indicates infection
nitrate/LE
indicates liver disease, hemolysis, biliary obstruction
bili/urobili
in hypertonic urine, RBCs appear…
crenated
What age for hematuria via these causes?
Glomerulonephritis
UTI
congenital anomaly
0-20yr
What age for hematuria via these causes?
UTI
Caliculi
Bladder CA
20-60
What age for hematuria via these causes?
BPH Bladder CA Prostate CA UTI Kidney CA
> 60 Male
What age for hematuria via these causes?
UTI
Bladder CA
Kidney CA
> 60 female
After centrifuging urine, you see sediment red. This indicates…
hematuria
After centrifuging urine, you see supernatant red. What do you do next?
dipstick heme
After centrifuge of supernatant red, you see a positive heme dipstick. If plasma was clear, what was the cause?
myoglobinuria
After centrifuge of supernatant red, you see a positive heme dipstick. If plasma was red , what was the cause?
hemoglobinuria
on UA microscopy, you see cells with lobed nuclei and cytoplasmic granules…
What does this indicate?
WBCs
What types of renal cells can be seen on UA microscopy?
transitional epithelial
renal tubular epithelial
On UA microscopy, you see the following:
maltese cross by polarized light
refractile, lipoprotein abundant tubular cells
these cells are called ______ and indicate…
oval fat bodies, nephrotic syndrome
presence of squamous epithelial cells in UA indicates…
contamination
large polygonal cells on UA…
squamous epithelial
where are urine casts formed?
DCT
Very pale, slightly refractile cells
composed of mucoprotein (tamm-horsfall) secreted by tubule cells
common finding in normal urine…
hyaline casts
red cell casts indicate…
glomerulonephritis, tubular injury
WBC casts suggests…
acute pylonephritis
renal tubular casts suggests…
acute tubular necrosis
these are casts of debris from the tubules that are nonspecific
granular/waxy casts
this cause of crytalluria is secondary to hyperuricemia in acidic urine…
uric acid crystals
this cause of crytalluria is a rare genetic cause of kidney stones
cystine crystals
this cause of crytalluria is found in alkaline urine, secondary to urease-producing bacteria
struvite
this cause of crytalluria is independent of pH, common cause of kidney stones, can be monohydrate or dihydrate
calcium oxylate
