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Rotation: Chemistry > UDS & 24 HR Urines > Flashcards

UDS & 24 HR Urines Flashcards

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1
Q

What is KIMS?

A

kinetic interaction of microparticles in solution measured by changes in light transmission

no drug = free antibody binds to microparticle conjugates

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2
Q

What is the methodology of KIMS?

A

When a urine sample contains the drug in question, the drug competes with the particle-bound drug derivative for free antibody. The antibody bound to sample drug is no longer available to promote particle aggregation, and subsequent particle lattice formation is inhibited. The presence of sample drugs diminishes the increasing absorbance in proportion to the concentration of drug in the sample. The sample drug content is determined relative to the value obtained from a known cutoff concentration of drug.

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3
Q

amphetamines

A

commonly known as “uppers”, CNS stimulant like epinephrine and nonrepinephrine

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4
Q

barbituates

A

hypnotic, CNS depressant; used as a sedative

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5
Q

benzodiazepines

A

minor tranquilizers such as Valium; CNS depressant, muscle relaxant, antianxiety agents

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6
Q

cannabinoids

A

psychoactive component of the hemp plant; CNS impairment, hallucinogens, marijuana

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7
Q

cocaine

A

CNS stimulant, local anesthetic; freebase crack

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8
Q

methadone

A

used for detoxification and temporary maintenance of narcotic addictions

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9
Q

opiates

A

codeine, heroin, poppy seed; reduction of sensitivity to pain, CNS depressant

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10
Q

phencyclidine

A

hallucinogenic, CNS stimulant; street name is “Angel Dust”

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11
Q

propoxyphene

A

painkillers such as Darvon; analgesic

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12
Q

What are the acceptable limits for the pH and specific gravity for a urine drug screen?

A
  • pH: 4.5-8.0
  • specific gravity: 1.003-1.034
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13
Q

What do you do if both the pH and specific gravity are unacceptable?

A

If both are unacceptable, perform urine creatinine tests.
- If creatinine <10, DO NOT TEST
- If creatinine >10, perform UDA reporting the pH and specific gravity

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14
Q

What is the pathophysiology of an elevated calcium in urine?

A

high amounts can lead to kidney stones
- hyperparathyroidism
- kidney stone disease
- renal hypercalciuria

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15
Q

What is the pathophysiology of an elevated phosphorus in urine?

A

hyperparathyroidism

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16
Q

What is the pathophysiology of an elevated creatinine in urine?

A

waste product from the metabolism of food for energy, excreted by the kidneys

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17
Q

What is the pathophysiology of an elevated protein in urine?

A

warning sign
- could indicate kidney damage or disease
- could be transient elevation due to infection, medication, vigorous exercise, emotion or physical stress
- could be when patient is lying down (orthostatic proteinuria)
- in pregnant women, elevated urine protein levels can be associated with preeclampsia

diseases & conditions
- amyloidosis
- bladder cancer
- congestive heart failure
- diabetes
- drug therapies that are potentially toxic to kidneys
- glomerulonephritis
- kidney infection
- urinary tract infection

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18
Q

What is the pathophysiology of an elevated uric acid in urine?

A
  • low amounts mean that the body cannot metabolize the byproducts of the breakdown of the body’s own cells
  • increase of uric acid in blood can lead to accumulation of uric acid in the joints, causing gout, and accumulation in the kidneys forming kidney stones
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19
Q

What is the pathophysiology of an elevated sodium in urine?

A

measures water balance and monitors kidney or adrenal gland diseases

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20
Q

What disease states are associated with an elevated microalbumin/creatinine level?

A
  • diabetic nephropathy
  • non-diabetic renal disease
  • hypertension
  • pregnancy
  • nephrotoxic medication use
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21
Q

What factors can influence creatinine clearance results?

A
  • collection timing
  • complete collection
  • body size
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22
Q

Why must 24-hour urine specimens for magnesium, phosphorus, and calcium determinations be acidified to a pH of <3.0 before running the samples?

A
  • when pH >3.0, complexes are formed that are not in solution and will not be tested properly causing lower results
  • Ca: prevent calcium salt precipitation
  • Mg: prevent precipitation of magnesium ammonium phosphate
  • Phos: necessary for formation of [phosphomolybdate] complexes which are measured photometrically to determine phosphorus concentration
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23
Q

Why must pH of 24-hour urine specimens for uric acid determination be adjusted between 8.5-10 before testing?

A

to prevent urate precipitation in urine samples

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24
Q

What factors contribute to the formation of renal calculi?

A
  • high supplementation of Vitamin C
  • dehydration/urinary stasis
  • low levels of citrate, magnesium, pyrophosphate in urine
  • high salt diet
  • high animal protein diet
  • pH changes
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25
Q

How does high supplementation of Vitamin C contribute to formation of renal calculi?

A

can cause increased excretion of oxalate in urine which increases risk of kidney stones

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26
Q

How does dehydration/urinary stasis contribute to formation of renal calculi?

A

if a person does not pass enough liquid in the urine due to dehydration/urinary stasis, the solutes in the urine may form crystals which can build up and become kidney stones

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27
Q

How does low levels of citrate, magnesium, and pyrophosphate in the urine contribute to formation of renal calculi?

A

these chemicals act as inhibitors to the formation of kidney stones

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28
Q

How does a high salt diet contribute to formation of renal calculi?

A

too much salt means that your kidneys must filter excess sodium which can cause crystallization and lead to kidney stones

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29
Q

How does a high animal protein diet contribute to formation of renal calculi?

A

high protein diet leads to higher levels of uric acid which can cause crystallization and lead to kidney stones

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30
Q

How do pH changes contribute to formation of renal calculi?

A
  • when pH becomes more alkaline, crystallization of calcium and phosphate may occur and lead to stone formation
  • when pH becomes more acidic, crystallization of uric acid or cystine becomes more likely
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31
Q

What are the four main types of renal calculi?

A
  • calcium stones
  • uric acid stones
  • cystine stones
  • struvite stones
32
Q

What is the composition of the most common type of renal calculi?

A

calcium oxalate

33
Q

uric acid stones

A

more likely in people with gout, people who eat high protein diet, or people with other conditions leading to high uric acid levels

34
Q

calcium stones

A

can either be a combination of calcium and oxalate or calcium and phosphate

35
Q

cystine stones

A

only common in people with hereditary conditions in which amino acids are not broken down and are instead passed into the urine

36
Q

struvite stones

A

caused by certain bacteria species during urinary tract infections

37
Q

What lifestyle choices contribute to the prevention and treatment of kidney stones?

A
  • drinking sufficient water
  • getting sufficient calcium in the diet
  • reducing sodium intake
  • limit the consumption of animal protein
38
Q

How does drinking sufficient water help with the prevention of kidney stones?

A

water is needed to flush out excreted solutes so minerals do not crystallize and lead to calculi formation

39
Q

How does getting sufficient calcium in the diet help with the prevention of kidney stones?

A

low calcium levels cause oxalate levels to rise which increases the risk for stone formation

40
Q

How does reducing sodium intake help with the prevention of kidney stones?

A

increased sodium causes the kidneys to filter excess calcium which increases the risk for stone formation

41
Q

How does limiting the consumption of animal protein help with the prevention of kidney stones?

A

high animal protein diets lead to increased levels of uric acid which can form stones and also decrease the body’s amount of citrate which prevents stone formation

42
Q

What treatments are used for kidney stones?

A
  • Tamsulosin (Flomax)
  • Lithotripsy (SWL)
  • Percutaneous Lithotripsy (PCNL)
43
Q

Tamsulosin (Flomax)

A

medication that allows stone to pass easier by relaxing ureter

44
Q

Lithotripsy (SWL)

A

procedure that uses x-rays or ultrasounds to produce shock waves targeted at stones in the kidney or ureters to break up the stones to be passed in smaller pieces

45
Q

Percutaneous Lithotripsy (PCNL)

A

half-inch incision is made in the back or side so that a rigid scope can be passed into the hollow center area of the kidney so that an instrument can break up the stone to be passed through the nephroscope and the broken pieces are removed by suction

46
Q

What could cause high levels of urine calcium?

A
  • chronic kidney disease
  • leaking of urine from the kidneys which causes calcium kidney stones
  • sarcoidosis
  • taking too much calcium
  • too much production of parathyroid hormone by the parathyroid glands in the neck
  • use of water pills called loop diuretics
  • very high vitamin D levels
47
Q

What could cause low levels of urine calcium?

A
  • disorders in which the body does not absorb nutrients from food well
  • parathyroid glands in the neck do not produce enough parathyroid hormone
  • use of a water pill called a thiazide diuretic
  • very low levels of vitamin D
48
Q

What could an increased amylase levels be a sign of?

A
  • acute pancreatitis
  • alcohol consumption
  • cancer of the pancreas, ovaries, lungs
  • cholecystitis
  • ectopic or ruptured tubal pregnancy
  • gallbladder disease
  • infection of the salivary glands
  • intestinal obstruction
  • pancreatic duct obstruction
  • pelvic inflammatory disease
  • perforated ulcer
49
Q

What could a decreased amylase be caused by?

A
  • damage to the pancreas
  • kidney disease
  • pancreatic cancer
  • toxemia of pregnancy
50
Q

What do low urine BUN levels indicate?

A
  • malnutrition (inadequate protein in diet)
  • kidney problems
51
Q

What do high urine BUN levels indicate?

A
  • too much protein intake
  • increased protein breakdown in the body
52
Q

What conditions potentially have abnormal urine creatinine results?

A
  • glomerulonephritis
  • high meat diet
  • kidney infection (pyelonephritis)
  • kidney failure
  • muscular dystrophy (late stage)
  • myasthenia gravis
  • prerenal azotemia
  • reduced kidney blood flow
  • rhabdomyolysis
  • urinary tract obstruction
53
Q

What could cause a greater than normal urine sodium level?

A
  • too much salt in the diet
  • certain medications, like diuretics
  • adrenal gland insufficiency
  • salt-wasting nephropathy
54
Q

What could cause a lower than normal urine sodium level?

A
  • aldosteronism
  • chronic kidney disease/kidney failure
  • cirrhosis
  • congestive heart failure
  • diarrhea and fluid loss
  • glomerulonephritis
  • hepatorenal syndrome
  • nephrotic syndrome
55
Q

What could high urine potassium levels indicate?

A
  • acute tubular necrosis
  • Cushing’s
  • diabetic acidosis and other forms of metabolic acidosis
  • eating disorders
56
Q

What could low blood magnesium levels indicate?

A
  • hyperaldosteronism
  • renal tubular acidosis
  • use of non-potassium-sparing diuretics
57
Q

What could low urine potassium levels indicate?

A
  • adrenal gland insufficiency
  • hypoaldosteronism
  • certain medications
58
Q

What could cause increased urine chloride levels?

A
  • adrenocortical insufficiency
  • increased salt intake
  • inflammation of the kidney that results in salt loss
  • production of an unusually large amount of urine
59
Q

What could cause decreased urine chloride levels?

A
  • Cushing’s
  • decreased intake/salt retention
  • fluid loss that occurs with diarrhea, vomiting, sweating, and gastric suction
60
Q

When does greater than normal levels of glucose occur?

A
  • diabetes **blood glucose tests are needed to diagnose diabetes
  • renal glycosuria, rare condition is released from the kidneys into the urine, even when blood glucose levels are normal
  • pregnancy
61
Q

What could a reduced output of urine magnesium be caused by?

A
  • decreased renal function (dehydration, diabetic acidosis, Addison’s)
  • poor diet
  • malabsorption
  • hyperparathyroidism
62
Q

What could a high output of urine magnesium be caused by?

A
  • chronic glomerulonephritis
  • aldosteronism
  • drug therapy
63
Q

What are larger amounts of protein in the urine due to?

A
  • amyloidosis
  • bladder tumor
  • congestive heart failure
  • dehydration
  • diabetic nephropathy
  • glomerulonephritis
  • goodpasture syndrome
  • heavy metal poisoning
  • kidney-damaging kidneys
  • polycystic kidney disease
  • preeclampsia
  • systemic lupus erythematosus
  • UTI
64
Q

What are high urine phosphate levels caused by?

A
  • kidney diseases
  • an overactive parathyroid gland
  • too much vitamin D
65
Q

What are low urine phosphate levels caused by?

A
  • an underactive parathyroid gland
  • kidney or liver disease
  • severe malnutrition
  • UTI
66
Q

What are high uric acid levels in the urine due to?

A
  • cancers that have spread (metastasized)
  • disorders that affect the bone marrow (myeloproliferative disorder)
  • high-purine diet
  • Fanconi
  • gout
  • rhabdomylosis
  • Lesch-Nyhand syndrome
67
Q

What are low uric acid levels in the urine due to?

A
  • long-term alcohol use
  • chronic glomerulonephritis
  • lead poisoning
68
Q

What is the normal range of urine output?

A

800-2000 mL/24 hr

69
Q

What does an abnormally low urine volume indicate?

A
  • inadequate fluid intake
  • dehydration
  • renal insufficiency/failure
70
Q

What does an abnormally high urine volume indicate?

A
  • diabetes
  • some forms of kidney failure
  • unusually large fluid intake
  • use of diuretic medications
71
Q

What is the normal urine pH range for healthy kidneys?

A

4.5-8.0

72
Q

What could a high urine pH be due to?

A
  • gastric suction
  • kidney failure
  • kidney tubular acidosis
73
Q

What could a low urine pH be due to?

A
  • diabetic ketoacidosis
  • diarrhea
  • starvation
  • vomiting
74
Q

How much creatinine should a normal urine have?

A

20-350 mg/dL

75
Q

What values use mg/24 hr as the unit?

A

calcium and glucose

76
Q

What values use mmol/24 hr?

A

sodium, potassium, chloride

77
Q

What is the creatinine clearance formula?

A

(urine creatinine/serum creatinine) x (urine flow/1440) x (1.73/body surface area)

Rotation: Chemistry (5 decks)

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