UA (lec 1) Flashcards
Abnormal urine colors?
red/brown = blood or Hgb
dark brown/black = bile/bilirubin
Causes of turbid urine? (7)
crystal precipitate bacteria/yeast WBC/RBC mucus squamous epithelial cells sperm/prostatic fluids lipids
Causes of abnormal urine odors? (4)
UTI
ketone bodies
smoke
AA disorders
Dipsticks test for what? (10)
pH Specific Gravity Glucose Ketones Protein Blood Nitrite Leukocyte Esterase Bilirubin Urobilinogen
pH normal range?
- 5 - 8.0
- 5 - 5.5 = acidic
- 5 -8.0 = alkaline
Specific Gravity (SG) is what?
Normal range?
measure comparing urine to pure H2O (solutes),
water = 1.0
1.003 - 1.035
SG tells us?
kidney ability to concentrate/dilute urine
Isosthenuria is?
inability of kidney to concentrate urine,
SG fixed at 1.010
Normal Urine volume/24 hrs?
Oliguria =
Anuria =
Polyuria =
500 - 2000 cc
Oliguria = < 500 cc
Anuria = < 100 cc
Polyuria = excessive w/ SG = 1.0 - 1.002
Glucose in urine?
abnormal in urine
plasma glucose threshold = 150 - 180 mg/dL ,
excess spills into urine
Glucose dipstick ranges?
Trace - 4+
(P) causes of false negatives for urine glucose?
ascorbic acid (vit C) aspirin
Ketones result from?
3 kinds?
incomplete fat metabolism when carb stores ↓
acetoacetic acid
acetone
β-hydroxybutyrate
(P) causes Ketones in urine?
acidosis (DM, starvation, pregnancy)
Normal urine protein level?
< 150 mg/24hrs
Protein dipstick ranges?
trace - 4+
small, mod, large
Urine protein levels affects by SG how?
High SG = (P) false high protein level
Low SG = (P) false low protein level
(P) causes of false positive urine protein?
high pH
hematuria
high SG
pyridium (UTI painkiller)
Microalbuminuria is?
Normal level is?
level of albumin in urine below detection of dipstick (< 300mg/24h) BUT above upper limit for normal (30mg)
<30mg albumin/gram urinary creatinine
Microalbuminuria may indicate? (5)
early diabetic nephropathy, exercise, fever, cystitis, CHF
Best test for Microalbuminuria?
10 - 24 hr collection
or 1st void
Proteinuria may indicate?
kidney dx (glomerular capillary leakage of protein)
Proteinuria tx?
BP management (SBP <120)
ACE inhibitors
low protein diet
Dipstick detection of blood:
will show + for what 3 things?
Sensitivity?
RBC, Hgb (RBC lysis), myoglobin (mm breakdown)
sensitivity:
5 - 10 RBCs
0.05 - 0.3 mg/dL Hgb
Abnormal range for RBCs?
> 3 RBC/hpf
Blood dipstick ranges?
trace - 4+
small, mod, large
Urine Nitrate test for?
Normal results should be?
bacteria capable of reducing nitrates
negative
(P) causes for false negatives of urine nitrites?
urine in bladder < 4hrs (no time to reduce)
nitrate-deficient diet
bacteria w/o necess enz
Urine Leukocyte Esterase (LE) tests for?
Can detect as low as?
Sensitivity?
leukocytes
5 WBCs/hpf
80% in dx UTI,
higher if + LE and + nitrites
(P) causes of false positive urine LE?
vaginal contamination
trichomonads
LE dipstick ranges?
trace - 4+
small, mod, large
Bilirubin/Urobilinogen (U) excreted how?
What causes presence in urine?
in stool
liver dx
Dipstick results for Bilirubin/Urobilinogen?
(U) negative
RBC sediment abnormal level?
RBCs appear as?
> 3 RBCs/hpf
refractile disks,
(P) crenated (shrunken) appearance if hypertonic urine
(P) causes of ↑ RBCs?
UTI renal or lower UT trauma kidney stones glomerular damage nephrotoxins vaginal contamination
(C) causes of ↑ RBCs in old people?
kidney dx
CA
BPH
Approach to red/brown urine:
red sediment?
red supernatant + positive heme dip?
- >
- clear plasma?
- >
- red plasma?
red supernatant + negative heme dip?
see slide 41
red sediment = blood
red supernatant + positive heme dip = Mgb or Hgb
- >
- clear plasma = Mgb
- >
- red plasma = Hgb
red supernatant + negative heme dip = diet, meds, etc
WBCs in urine abnormal level?
Next step?
> 5 WBC/hpf
10-20 suspicious UTI
= 20 indicates UTI
C&S
Appearance of WBCs in urine?
lobed nuclei,
refractile cytoplasmic granules
U/A w/ reflex C&S is?
tells lab to run C&S if U/A suggests infection
Renal Tubular/Transitional Epithelial Cells present in large #s if?
tubular degeneration
If Lipiduria, Renal Tubular/Transitional Epithelial Cells contain?
oval fat bodies
Oval Fat Bodies are?
degenerated tubular cells w/ refractile-appearing lipid
configured in “maltese cross”
seen w/ hyperlipidemia
↑ # of Squamous Epithelial Cells (U) indicates?
contaminated specimen
Urine Casts are?
clumps of cells formed in distal convoluted tubule or collecting duct
** NOT formed in proximal convo tube or loop of Henle
Hyaline Casts made of?
Appearance?
mucoprotein from tubule cells (benign, common)
very pale, slighly refractile
RBC Casts cause by? (2)
glomerular injury
glomerulonephritis (assume this until proven otherwise)
WBC Casts (U) caused by?
acute pyelonephritis (upper kidney) "pie alone a fright us"
Renal Tubular Cell Casts suggest?
tubular epithelium injury
Granular Casts from?
broken-down renal tubular cell casts
Waxy Casts from?
Appearance?
broken-down renal tubular cell casts
sharp edges w/ cracks
Most reliable test for infection?
Urine Cx
Colony level consistent w/ infection?
> 100k colonies/ml
