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Lab Diagnosis > UA- Dipstick > Flashcards

UA- Dipstick Flashcards

1
Q

What are the ten (and sometimes 11) tests on a dipstick?

A

glucose, bilirubin, ketones, SG, blood, pH, protein, urobilinogen, nitrites, leukocytes & sometimes ascorbic acid

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2
Q

What is normal SG? What does it measure?

A

1.005-1.030
1.010-1.025 for adults
1.001-1.018 for <2 yo
measures kidneys ability to concentrate urine

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3
Q

What is high SG indicative of? What can cause it?

A

high SG= concentrated urine, SG >1.025= hypersthenuria

DM, proteinuria/nephrotic syndrome, drug effects, dehydration, CHF, toxemia of pregnancy

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4
Q

What is low SG indicative of? What can cause it?

A

low SG= dilute urine, SG <1.001-1.010= hyposthenuria

increased fluids, chronic renal disease, DI, diuretics, glomerulonephritis

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5
Q

How does chronic renal disease present in relation to SG?

A

SG may consistently be at 1.010= isosthenuria

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6
Q

What can create a high false positive? What can create a low false positive?

A

high false + = proteinuria

low false + = highly buggered alkaline urine

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7
Q

Where is glucose normally filtered? Reabsorbed? When do you get glucosuria?

A

Normally filtered out in glomerulus, reabsorbed in PCT

glucosuria= blood glucose 160-180 mg/dl and thus spilling over into urine

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8
Q

What diseases can cause glucosuria?

A

DM, cushing’s syndrome, pheochromocytoma, acromegaly, chronic pancreatitis, drugs

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9
Q

What can produce false positives for glucose? false negatives for glucose?

A

false positives: oxidizing agents

false negatives: ascorbic acid, aspirin, ketones

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10
Q

What does increased ketones in the blood lead to?

A
  • electrolyte imbalance
  • dehydration
  • acidosis & coma
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11
Q

What is the only ketone the dipstick can detect? What is this ketone not indicative of (what disease)?

A

only detects acetoacetic acid, not indicative of diabetic ketoacidosis (beta-hydroxybutyric acid is what you would see if someone has DKA)

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12
Q

What are the 3 types of ketones we care about?

A

acetoacetic acid
beta-hydroxybutyric acid
acetone

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13
Q

What 2 diseases have ketonuria?

A
  1. DM

2. increased metabolic states: hyperthyroidism, fever, pregnancy

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14
Q

What can give you a false positive for ketones?

A

drugs, highly pigmented urine

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15
Q

What can give you false negatives for ketones?

A

prolonged air exposure (it is volatile)

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16
Q

What are the three types of blood a dipstick can detect?

A

free hemoglobin: lysed RBCs (hemoglobinuria)

hemogloblin: intact RBCs (hematuria)
myoglobin: muscle protein

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17
Q

What do we need to determine if there is blood in the urine? What can it be indicative of?

A

Need to determine the SOURCE.
glomerular dz, kidney stones, pyelonephritis, trauma, cystitis, bladder cancer, prostate cancer, exercise hematuria, MI, contamination (vaginal secretions)

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18
Q

What are false positives for blood?

A
  • microbial peroxidases
  • myoglobinuria
  • menstrual blood
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19
Q

What are false negatives for blood?

A
  • nitrites
  • increased SG decreases reactivity of test
  • ascorbic acid
20
Q

What is the range of pH for urine? What maintains pH balance?

A

4.5-8 (average of 6.0)

kidneys maintain by excretion of H+ and reabsorption of Na2+

21
Q

What can an alkaline pH reading indicate? (4 things)

A
  1. alkalosis, respiratory or metabolic
  2. UTI
  3. gastric suction, vomiting, renal tubular acidosis
  4. vegetarians, high citrus intake
22
Q

What can an acidic pH reading indicate? (6 things)

A
  1. acidosis, respiratory or metabolic
  2. DM
  3. starvation
  4. COPD
  5. UTI
  6. high meat, high cranberries
23
Q

What is protein in urine a sensitive indicator of?

A

KIDNEY FXN
slit pores normally too small to allow high molecular weight proteins through, also have negative charge to repel proteins

24
Q

What are fxnal renal causes of proteinuria?

A
  • severe muscular exertion
  • glomerulonephritis
  • pregnancy
  • nephrotic syndrome
  • orthostatic proteinuria
  • renal tumor or infection
25
Q

What are pre-renal causes of proteinuria?

A
  • fever
  • renal hypoxia
  • hypertension secretions
26
Q

What are post-renal causes of proteinuria?

A
  • cystitis
  • urethritis or prostatitis
  • contamination with vaginal secretions
27
Q

When can transient proteinuria occur?

A

with fever, stress, exercise of CHF

28
Q

What can cause a false positive for protein?

A
  • vaginal secretions
  • hematuria
  • pyridium
  • highly alkaline urine
29
Q

What can cause a false negative for protein?

A

-dilute sample

30
Q

What protein is the dipstick most sensitive to? What will it not detect?

A

most sensitive to albumin

won’t detect: globulins, glycoproteins, Bence-Jones proteins

31
Q

What is the path of RBCs to urobilinogen excreted in the feces?

A

RBCs get lysed and release hemoglobin–> (globin &) heme catabolized to–> biliverdin reduced to–> unconjugated bilirubin–> to liver via albumin–> liver conjugates with glucuronic acid–> conjugated bilirubin–> into bile–> into intestines where it gets converted to urobilinogen by intestinal flora

32
Q

What is excess bilirubin called? What can cause it?

A 
increased bilirubin= bilirubinuria
caused by: 
-gallstones
-cholestasis
-bile duct obstruction
-acute hepatitis
-congenital defects in bilirubin metabolism
33
Q

False positives for bilirubin?

A
  • fecal contamination

- pyridium indicans

34
Q

False negatives for bilirubin?

A
  • nitrites
  • light
  • ascorbic acid
35
Q

What are normal levels of urobilinogen in urine?

A

0.2-1.0 mg/dL

36
Q

When will you see increased urobilinogen? Decreased?

A

Increased: intravascular hemolysis, intestinal obstruction, early stages of hepatitis
Decreased: dipstick lacks sensitivity to test for decrease

37
Q

False positives for urobilinogen?

A
  • fecal contamination
  • pigmented drug metabolites
  • beets
38
Q

False negatives for urobilinogen?

A
  • formaldehyde
  • prolonged air exposure
  • antibiotics
39
Q

What does increased nitrites indicate? What do you have to be careful about assuming though?

A

UTI

BUT not all bacteria convert nitrates–> nitrites so can get a false negative in this way

40
Q

False positives for nitrites?

A
  • pyridium
  • beets
  • bacterial growth in old samples
41
Q

False negatives for nitrites?

A

-high SG
-low nitrate diet
-ascorbic diet
(urine doesn’t sit in bladder long enough/not in contact with bacteria long enough)

42
Q

What does a positive leukocyte test indicate?

A

UTI most likely

pts can be asx even w/significant infection

43
Q

What are 2 non-urinary causes of pyuria?

A
  • appendicitis

- pancreatitis

44
Q

False positives for leukocytes?

A

vaginal secretions

45
Q

False negatives for leukocytes?

A
  • glucose
  • protein
  • increased SG
  • some antibiotics
  • oxalates

Lab Diagnosis (5 decks)

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