UA/UC + GU Overview

Question 1

List the 3 major functions of the urinary system

Answer 1

• cleanses waste left in blood
• keeps water balanced in body
• produces erythropoietin

Question 2

List some DDx for dysuria

Answer 2

Question 3

List some DDx for hematuria

Answer 3

Question 4

List some DDx for acute urinary retention

Answer 4

Question 5

List some DDx for scrotal pain

Answer 5

Question 6

What are the 2 types of dialysis

Answer 6

• hemodialysis
• peritoneal dialysis

Question 7

What does a UA evaluate

Answer 7

Question 8

List the 3 parts of a UA

Answer 8

Question 9

List some indications for cath over clean catch

Answer 9

• 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)

Question 10

List the gross assessment criteria of urine color

Answer 10

Question 11

Gross hematuria typically involves DDx that are pre or post-renal?

Answer 11

post-renal

Question 12

What does a urine dipstick evaluate

Answer 12

Question 13

List some causes of decreased specific gravity

Answer 13

Question 14

List some causes of increased specific gravity

Answer 14

Question 15

What does urine pH screen

Answer 15

H+ concentration, reflects the degree of acidification of the urine
- ranges from 4.5-8 depending on systemic acid-base balance

Question 16

What does urine heme detect on dipstick

Answer 16

• 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

Question 17

What does leukocyte esterase detect on urine dipstick

Answer 17

• released by lysed neutrophils & macrophages
• marker of WBCs in urine think infection

Question 18

What does nitrite detect on urine dipstick

Answer 18

• enterobacteriae species taht produce nitrate reductase converting to nitrite
• think bacteria

Question 19

What does urine bilirubin detect on urine dipstick

Answer 19

extremely high levels of bili in urine - bili metabolism problem

Question 20

what does a high indirect bili suggest

Answer 20

hemorrhage/hemolysis

Question 21

what does high direct bili suggest

Answer 21

cholestatic issues

Question 22

What does urine protein detect on dipstick

Answer 22

• sensitive to albumin
• can be misleading if urine is dilute

Question 23

What does urine glucose & ketones assess on dipstick

Answer 23

• 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

Question 24

What is evaluated under microscope after urine is centrifuged in urine microscopy

Answer 24

the sediment at the bottom of the tube, the rest is discarded

Question 25

What might be seen on urine microscopy

Answer 25

- RBCs (<3/HPF normal) - WBCs (<3/HPF normal) - Casts: cylindrical structures from tubular lumen - Crystals

Question 26

What do RBC casts on urine microscopy suggest

Answer 26

glomerular disease (likely glomerulonephritis)

Question 27

What do WBC casts on urine microscopy suggest

Answer 27

inflammation or infection

Question 28

What do hyaline casts on urine microscopy suggest

Answer 28

usually seen in diuretics or **dehydration**, nearly transparent & empty appearing

Question 29

What do granular casts on urine microscopy suggest

Answer 29

injury to epithelial cells, muddy brown casts characteristic for acute tubular necrosis (primary cause of AKI in hosp patients)

Question 30

What do waxy casts on urine microscopy suggest

Answer 30

late stage granular cast degeneration, nonspecific, seen in a variety of acute/chronic renal diseases

Question 31

What are these an example of and is this normal or abnormal

Answer 31

RBC in the urine, abnormally high - biconcave discs

Question 32

What happens if RBCs are squished through a membrane (glomerular disease)

Answer 32

dysmorphic RBCs

Question 33

Is microscopic hematuria renal, supra-renal, or post-renal in origin?

Answer 33

renal

Question 34

If there is hematuria (RBC) + proteinuria, what is the likely source?

Answer 34

glomerular

Question 35

T/F: people on anticoagulants typically have some hematuria

Answer 35

false- work it up so you don't miss something serious like cancer

Question 36

Describe glomerular hematuria

Answer 36

- 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)

Question 37

List some of the MC causes of glomerular hematuria

Answer 37

Question 38

Describe the urine microscopy of extraglomerular hematuria

Answer 38

- **normal** appearing RBCs in urine - no casts (coming from renal parenchyma, ureters, bladder, prostate, urethra)

Question 39

List some DDx for extraglomerular hematuria

Answer 39

Question 40

List the color and microscopy findings for extraglomerular hematuria

Answer 40

- Color: red/pink - clots: maybe - proteinuria: <500 mg/day - RBC morphology: normal - RBC casts: absent

Question 41

List the color and microscopy findings for glomerular hematuria

Answer 41

- color: red, smoky brown, cola - clots: absent - proteinuria: >500 mg/day - RBC morphology: dysmorphic - RBC casts: likely present

Question 42

What may be on the DDx for heme+ red supernatant

Answer 42

- hemoglobinuria (Hemolysis d/t SCD, HUS, PNH) - myoglobinuria (rhabdo)

Question 43

What might be on the DDx for Heme- red supernatant

Answer 43

- meds (rifampin, nitrofurantoin, phenytoin, ibuprofen) - foods (beets, rhubarb, berries, dye) - porphyria