UA/UC + GU Overview Flashcards
List the 3 major functions of the urinary system
- cleanses waste left in blood
- keeps water balanced in body
- produces erythropoietin
List some DDx for dysuria
List some DDx for hematuria
List some DDx for acute urinary retention
List some DDx for scrotal pain
What are the 2 types of dialysis
- hemodialysis
- peritoneal dialysis
What does a UA evaluate
List the 3 parts of a UA
List some indications for cath over clean catch
- kids with fever or suspected UTI
- menstruating women with suspected UTI
- women with vaginal discharge
- pts who are physically unable to provide clean catch
- severely ill pts (sepsis)
List the gross assessment criteria of urine color
Gross hematuria typically involves DDx that are pre or post-renal?
post-renal
What does a urine dipstick evaluate
List some causes of decreased specific gravity
List some causes of increased specific gravity
What does urine pH screen
H+ concentration, reflects the degree of acidification of the urine
- ranges from 4.5-8 depending on systemic acid-base balance
What does urine heme detect on dipstick
- detection of heme by dipstick is highly sensitive for presence of 1-2 RBCs
- can’t distinguish between hemoglobin & myoglobin
- if positive, need to differentiate between RBCs or myoglobin
What does leukocyte esterase detect on urine dipstick
- released by lysed neutrophils & macrophages
- marker of WBCs in urine think infection
What does nitrite detect on urine dipstick
- enterobacteriae species taht produce nitrate reductase converting to nitrite
- think bacteria
What does urine bilirubin detect on urine dipstick
extremely high levels of bili in urine - bili metabolism problem
what does a high indirect bili suggest
hemorrhage/hemolysis
what does high direct bili suggest
cholestatic issues
What does urine protein detect on dipstick
- sensitive to albumin
- can be misleading if urine is dilute
What does urine glucose & ketones assess on dipstick
- glucosuria can be d/t inability of kidney to reabsorb filtered glucose or overflow scenario
- ketonuria: small amount normal, if cells can’t get enough glucose, body breaks down fat which produces ketones
What is evaluated under microscope after urine is centrifuged in urine microscopy
the sediment at the bottom of the tube, the rest is discarded
What might be seen on urine microscopy
- RBCs (<3/HPF normal)
- WBCs (<3/HPF normal)
- Casts: cylindrical structures from tubular lumen
- Crystals
What do RBC casts on urine microscopy suggest
glomerular disease (likely glomerulonephritis)
What do WBC casts on urine microscopy suggest
inflammation or infection
What do hyaline casts on urine microscopy suggest
usually seen in diuretics or dehydration, nearly transparent & empty appearing
What do granular casts on urine microscopy suggest
injury to epithelial cells, muddy brown casts characteristic for acute tubular necrosis (primary cause of AKI in hosp patients)
What do waxy casts on urine microscopy suggest
late stage granular cast degeneration, nonspecific, seen in a variety of acute/chronic renal diseases
What are these an example of and is this normal or abnormal
RBC in the urine, abnormally high
- biconcave discs
What happens if RBCs are squished through a membrane (glomerular disease)
dysmorphic RBCs
Is microscopic hematuria renal, supra-renal, or post-renal in origin?
renal
If there is hematuria (RBC) + proteinuria, what is the likely source?
glomerular
T/F: people on anticoagulants typically have some hematuria
false- work it up so you don’t miss something serious like cancer
Describe glomerular hematuria
- blood originating from the nephron
- disruption of the filtration barrier in the glomerulus may result from inherited/acquired abnormalities in structure of glomerular basement membrane
(RBC casts on microscopy)
List some of the MC causes of glomerular hematuria
Describe the urine microscopy of extraglomerular hematuria
- normal appearing RBCs in urine
- no casts
(coming from renal parenchyma, ureters, bladder, prostate, urethra)
List some DDx for extraglomerular hematuria
List the color and microscopy findings for extraglomerular hematuria
- Color: red/pink
- clots: maybe
- proteinuria: <500 mg/day
- RBC morphology: normal
- RBC casts: absent
List the color and microscopy findings for glomerular hematuria
- color: red, smoky brown, cola
- clots: absent
- proteinuria: >500 mg/day
- RBC morphology: dysmorphic
- RBC casts: likely present
What may be on the DDx for heme+ red supernatant
- hemoglobinuria (Hemolysis d/t SCD, HUS, PNH)
- myoglobinuria (rhabdo)
What might be on the DDx for Heme- red supernatant
- meds (rifampin, nitrofurantoin, phenytoin, ibuprofen)
- foods (beets, rhubarb, berries, dye)
- porphyria
