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Clinical Chem > Unit 6 > Flashcards

Unit 6 Flashcards

Urinalysis

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1
Q

What is the typical urine daily volume

A

600-2000 mL

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2
Q

What is the typical Urine Osmolality

A

300-900

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3
Q

pH for Urine

A

4.6-8.0

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4
Q

When is a post prandial specimen needed

A

To test for estimation of glucose or of urobilinogen

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5
Q

What temperature should a 24 hour urine specimen be kept at

A

4-6

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6
Q

What is 24 hour testing used for

A

quantitative estimation of proteins and hormones

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7
Q

When urine is left at RT what occurs to it

A

-Increase of pH
-Formation of crystals
-Loss of ketone bodies (volatile)
-Decrease of glucose
-Oxidation of bilirubin to biliverdin (false = for bilirubin)
-Oxidation of urobilinogen to urobilin (false = for urobilinogen)
-Bacterial proliferation
-Disintegration of cellular elements (especially alkaline and hypotonic urine)

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8
Q

What is polyuria

A

urine volume over 2000mL in 24 hours

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9
Q

When is polyuria seen

A

diabetes mellitus
diabetes insipidus
chronic renal failure
diuretic therapy

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10
Q

What is oliguria

A

<400mL of urine in 24 hours

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11
Q

What are causes of oliguria

A

Febrile state
acute glomerulonephritis
CHF
Dehydration

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12
Q

What anuria

A

<100mL of urine in 24 hours

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13
Q

What are the causes of anuria

A

acute tubular necrosis
acute glomerulonephritis
complete urinary tract obstruction

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14
Q

What can cause red urine

A

Hematuria
hemoglobinuria
porphyria
myoglobinuria

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15
Q

What causes dark brown to black urine

A

Alkaptonuria
Melanoma

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16
Q

What causes brown urine

A

hemoglobinuria

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17
Q

What causes yellow-green or green urine

A

Biliverdin

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18
Q

What causes orange or orange-brown urine

A

Urobilinogen
porphobilinogen

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19
Q

What causes milky white urine

A

Chyluria

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20
Q

What cause red or orange and fluorescence with UV light urine

A

Porphyria

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21
Q

What is the reason for foamy urine

A

presence of excess proteins or bilirubin

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22
Q

What is the appearance of amorphous phosphates

A

White and cloudy
*alkaline urine

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23
Q

What is the appearance of amorphous urates

A

Pink and cloudy
*Acidic urine

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24
Q

What is the appearance of pus cells

A

varying grades of turbidity

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25
Q

What does fruity urine signify

A

ketoacidosis
starvation

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26
Q

what does mousy or musty urine signify

A

phenylketonuria

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27
Q

what does a fishy urine signify

A

urinary tract infection with E coli
old standing urine

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28
Q

What does a foul smelling urine signify

A

UTI

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29
Q

What does a sulfurous urine signify

A

Cystinuria

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30
Q

What is Specific Gravity mainly related to

A

Urea and Sodium

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31
Q

What will make SG decrease

A

When temperatures rise

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32
Q

What does SG measure

A

Concentrating ability of kidneys and determines tubular function

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33
Q

What can SG be affected by

A

Proteinuria
Glycosuria

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34
Q

What are the SG Methods

A

Refractometer
Reagent Test Strip
Urinometer

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35
Q

What does a refractometer do

A

Measures the reflective index of the total soluble solids

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36
Q

How does the SG reagent strip work

A

Measures the concentration of ions. Depending on ionic strength, a polyelectrolyte will ionize in proportion.

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37
Q

What is the color change indicator for SG on reagent strip

A

Bromothymol blue

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38
Q

How does urine become alkaline

A

loss of Carbon dioxide and production of ammonia from urea

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39
Q

What are the pH methods

A

Litmus paper test
pH indicator paper
pH meter
reagent test strip

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40
Q

What color will litmus paper test turn in acidic urine

A

red

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41
Q

What are the color change indicators on pH indicator paper

A

Bromthymol blue
methyl red

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42
Q

When is pH meter used

A

When exact pH is required

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43
Q

How does the pH reagent strip work

A

Area contains polyionic polymer bound to H+. If reacts with cations in urine, H+ is released causing a change in color

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44
Q

What is the average pH for urine

A

6.0

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45
Q

What does urine pH depend on

A

diet
acid base balance
water balance
renal tubular function

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46
Q

When is acidic urine seen

A

Ketosis
UTI by E. coli
High protein diet

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47
Q

When is alkaline urine seen

A

UTI by bacteria that split urea into Ammonia (Proteus, Psuedamonas)
Severe vomitting
Vegetarian diet
Chronic renal failure

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48
Q

tamm-Horsfall protein is secreted by

A

Ascending limb of the loop of henle

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49
Q

What does proteinuria mean

A

> 150mg per 24 hour

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50
Q

What is Glomerular proteinuria

A

Due to increased permeability of glomerular capillary wall

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51
Q

What are the 2 types of glomerular proteinuria

A

Selective
non selective

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52
Q

What is selective glomerular proteinuria

A

When glomeruli can retain large molecular weight proteins but allow passage of comparatively lower molecular weight proteins

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53
Q

What is non selective glomerular proteinuria

A

With further glomerular damage, the selectivity is lost and larger molecular weight proteins (gamma globulins) are also excreted along with albumin

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54
Q

What is the most severe degree of proteinuria

A

Nephrotic syndrome

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55
Q

Lab values for nephrotic syndrome

A

> 3.5 protein in 24 hour
<3.0 alumbin
generalized edema
hyperlipidemia >350 serum cholesterol
lipiduria

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56
Q

What low weight proteins are reabsorbed by the proximal renal tubules

A

Beta2-microglobulin
retinal-binding protein
alpha1-microglobulin
free immunoglobulin light chains (Bence Jones Protein)

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57
Q

When is tubular type proteinuria seen

A

acute and chronic pyelonephritis
Heavy metal poisoning
tuberculosis of kidney
interstitial nephritis
cystinosis
Fanconi syndrome
rejection of kidney transplant

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58
Q

How do we test for purely tubular proteinuria

A

NOT reagent strip
Heat and acetic acid test and SSA

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59
Q

What proteins can overflow from plasma into urine

A

immunoglobulin light chains
hemoglobin
myoglobin
lysozyme

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60
Q

What is hemodynamic proteinuria

A

alteration of blood flow through the glomeruli causes increased filtration of proteins

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61
Q

What is postural proteinuria

A

occurs when the subject is standing or ambulatory, but is absent in recumbent position

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62
Q

why is postural proteinuria happen more in adolescents

A

due to lordotic posture that causes inferior venocaval compression between the liver and the vertebral column

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63
Q

What is post renal proteinuria

A

caused by inflammation or neoplastic conditions in renal pelvis, ureter, bladder, prostate, or urethra

64
Q

How does the protein reagent strip work

A

Strip is coated with an indicator and buffered to an acid pH which changes color in the presence of proteins
protein error of indicators

65
Q

What is the protein indicator color

A

bromophenol blue

66
Q

what is the indicator buffer pH for protein reagent strip

A

3.0 with citrate

67
Q

What proteins can give the protein reagent strip a false negative

A

Bence jones proteins
myoglobin
hemoglobin

68
Q

What can give the protein reagent strip a false positive

A

highly alkaline
gross hematuria
contamination with vaginal secretions

69
Q

what is the sensitivity for protein on the reagent strip

A

5-10mg/dL

70
Q

what color is positive for protein on reagent strip

A

blue-green

71
Q

What methods do we use for quantitative estimation of proteins

A

Biuret reaction
Esbach’s albuminometer
Turbidimetric
Immunologic

72
Q

What are the protein/creatinine qualitative ranges

A

<0.2 Normal protein/creatinine ration
0.2-1.0 Low-grade proteinuria
1.0-3.5 moderate
>3.5 nephrotic-range proteinuria

73
Q

What is microalbuminuria

A

Urinary excretion of 30-300 mg/24 hrs
or
2-20mg/dL of albumin in urine

74
Q

What do we use microalbuminuria for

A

It is the earliest sign of renal damage in diabetes mellitus

75
Q

What is the independent risk factor for cardiovascular disease in diabetes mellulitis

A

microalbuminuria

76
Q

How do we detect microalbuminuria

A

albumin-creatinine ratio in random urine
albumin in an early morning or random urine sample
albumin in 24 hour urine

77
Q

What are Bence Jones proteins

A

monoclonal immunoglobulin light chains

78
Q

What makes Bence Jones Proteins

A

neoplastic plasma cells

79
Q

What is the characteristic Bence Jones Protein thermal behavior

A

When heated they precipitate (40-60)
Precipitate disappear at 85-100
Rapper when cooled to 60-85

80
Q

Where is glucose reabsorbed in the kidneys

A

proximal renal tubules

81
Q

What is detectable glucose in the urine called

A

glycosuria

82
Q

What is the renal threshold for glucose

A

180 mg/dL

83
Q

When is glycosuria with hyperglycemia seen

A
  1. endocrine diseases
  2. non-endocrine diseases
  3. Drugs
  4. Lag-storage glycosuria
84
Q

What are the endocrine diseases that are associated with glycosuria and hyperglycemia

A

Diabetes mellitus
acromegaly
cushing’s syndrome
hyperthyroidism
pancreatic disease

85
Q

What are the non-endocrine diseases that are associated with glycosuria and hyperglycemia

A

central nervous system diseases
liver disorders

86
Q

What is Lag-storage glycosuria

A

Alimentary glycosuria
*after a meal the glucose load goes over the renal threshold

87
Q

What is the Benedict ‘s Copper Reduction Test

A

Qualitative test
Blue alkaline copper sulphate is reduced to red-brown cuprous oxide if a reducing agent is present.
**Not specific for glucose

88
Q

What is the Clinitest sensitivity for glucose

A

200 mg/dL

89
Q

What is the glucose reagent test based on

A

Glucose oxidase-peroxidase reaction

90
Q

Glucose + oxygen —–glucose oxidase =

A

Gluconic acid + Hydrogen peroxide

91
Q

Hydrogen peroxide + Chromagen —–peroxidase =

A

Oxidized chromogen (Blue) + Water

92
Q

What will cause a false positive glucose result

A

Oxidizing agents
-bleach or hypochlorite

93
Q

What will cause a false negative glucose result

A

Large amounts of ketones
salicylates
ascorbic acid
severe E. coli infection

94
Q

What do ketones in urine indicate

A

Excessive fatty acid metabolism

95
Q

Wha is the most common ketone

A

beta-hydroxybutyric acid

96
Q

What is the step to achieve a ketone

A

Free fatty acid
Acetoacetyl CoA
Acetoacetate
B-hydroxybutyric acid or acetone

97
Q

What are causes of ketonemia

A
  1. uncontrolled Type 1 or 2 diabetes mellitus with ketoacidosis
  2. gylcogen storage disease (von Gierke disease)
  3. Decreased availability of carbs in diet
  4. increased metabolic needs
98
Q

If glycosuria is present what must we test for

A

ketone bodies

99
Q

Glycosuria + ketone bodies =

A

diabetes mellitus with ketoacidosis

100
Q

ketone bodies in urine can mean

A

impending ketoacidotic coma

101
Q

What are the proportions of ketone bodies in urine

A

78% b-hydroxybutyric acid
20% acetoacetic acid
2% acetone

102
Q

Ferric chloride tests only detect

A

acetoacetic acid

103
Q

What is the method for the detection of ketone bodies in urine

A

Rothera’s test
Acetest tablet
ferric chloride
reagent test strip

104
Q

What is the classic test for ketones

A

Rothera’s Nitroprusside test

105
Q

How does rothera’s test work

A

Acetoacetic acid or acetone react with nitroprusside in alkaline solution to form a purple color

106
Q

How sensitive is Rothera’s nitroprusside test

A

1-5mg/dL of acetoacetate
10-25 acetone

107
Q

what can cause a false positive rothera’s nitroprusside test

A

L-dopa in urine
Phenylketonuria

108
Q

Steps in Rothera’s test

A
  1. 5mL urine in tube and saturate with ammonium sulphate
  2. add a small crystal of Na nitroprusside
  3. slowly run along the side ammonia to form a layer
  4. immediate purple color is a positive
109
Q

Reagent test strip for ketones

A

Acetoacetate + Na nitroprusside + glycine
Alkaline pH
= purple color

110
Q

what do the acetest tablets mimic

A

rothera’s

111
Q

what do the acetest tablets contain

A

sodium nitroprusside
glycine
alkaline buffer

112
Q

What is more sensitive for ketones than reagent test strip

A

acetest tablet

113
Q

Ferric chloride test is how sensitive for ketones

A

25-50 but is not specific for ketones

114
Q

When bilirubin is bound to albumin circulating in the blood it is called

A

unconjugated

115
Q

What bilirubin is not water soluble

A

unconjuctated

116
Q

What does bilirubin combine with to form conjugated bilirubin

A

Glucuronic acid

117
Q

What bilirubin is water soluble and can appear in urine

A

conjugated

118
Q

When is bilirubin seen in urine

A

Hepatocellular jaundice
obstructive jaundice

119
Q

If the person is febrile and has bili in the urine what does that suggest

A

hepatitis

120
Q

What is the reagent for the bilirubin reaction on reagent test strip

A

diazo

121
Q

what does urinary excretion of urobilinogen show

A

diurnal variation with highest levels in the afternoon

122
Q

Reasons for increased urobilinogen in urine

A
  1. hemolysis
  2. hemorrhage
123
Q

Reasons for reduced urobilinogen in urine

A
  1. obstructive jaundice
  2. reduction of intestinal bacterial flora
124
Q
A
125
Q

A pink color is produced if urobilinogen reacts with?

A

ehrlich’s reagent
(p-dimethylaminobenzaldehyde)

126
Q

What interferes with ehrlich’s aldehyde test

A

bilirubin

127
Q

Diseases that cause hematuria

A

glomerulonephritis
Berger’s disease
Lupus nephritis
Henoch-Schonlein purpura
Calculus
tumor
infection
tuberculosis
pyelonephritis
hydronephrosis
polycystic kidney disease
trauma

128
Q

How many RBC must be seen in microscopic examination to be hematuria

A

3+ per high power field

129
Q

Chromogens used for hematuria chemical test

A

benzidine
orthotoluidine
guaiac

130
Q

H2O2 + chromogen in alkaline pH and RBC =

A

Oxidized Chromagen + Water

131
Q

Reagents in Ketone Tests that are positive with hematuria, hemoglobinuria, myoglobinuria

A

Benzidine test
orthotoluidine test
reagenst strip

132
Q

False positives for RBC in urine

A

Menstrual blood
oxidizing agents (hypochlorite or bleach)
microbial peroxidase in UTI

133
Q

False negatives for RBC in urine

A

reducing agent like ascorbic acid in high concentration

134
Q

what is hemoglobinuria

A

free hemoglobin in urine

135
Q

causes of hemoglobinuria

A

hematuria with subsequent lysis of RBC in low SG
intravascular hemolysis

136
Q

When will hemoglobin appear in urine

A

when haptoglobin is completely saturated with hemoglobin

137
Q

causes of intravascular hemolysis

A

Infections
Trauma to RBC
G6PD deficiency after exposure to oxidant drugs
Immune hemolysis (transfuse reaction)
Paroxysmal cold hemoglobinuria
Paroxysmal nocturnal hemoglobinuria
HUS
DIC

138
Q

What is hemosiderinuria

A

hemosiderin in urine

139
Q

what does hemosiderinuria indicate

A

presence of free hemoglobin in plasma

140
Q

When is hemosiderinuria seen

A

Intravascular hemolysis

141
Q

Where is myoglobin found

A

protein present in striated muscle (skeletal and muscular)

142
Q

What is the role of myoglobin

A

binds oxygen

143
Q

What test is used for screening of myoglobinuria

A

ammonium sulfate solubility test

144
Q

How do gram negative bacteria produce nitrites

A

reduce the nitrates to nitrites through the action of bacterial enzyme nitrate reductase

145
Q

How long must urine be in bladder for conversion of nitrate to nitrite

A

4 hours

146
Q

What of UTI are detected with nitrite testing

A

70%

147
Q

What is the Nitrite reagent pad impregnated with

A

p-arsanilic acid
tetrahydrobenzo(h)quinolin-3-ol

148
Q

How do we get the color change in Nitrite testing

A

Arsanilic acid converts to diazonium salt which changes to pink if quinolol is present

149
Q

What does leukocyte esterase detect

A

esterase enzyme from granules of leukocytes

150
Q

what does leukocyte esterase test entail

A

Pyrrole amino acid ester which liberates 3-hydroxy-5-phenylpyrrole
Reacts with diazo salt to create purple

151
Q

Sensitivity of leukocyte esterase

A

5-15 granulocytes

152
Q

Negative interference in leukocyte esterase

A

Elevated glucose
High SG
Presence of cephalexin, cephalothin, tetracycline
High concentrations of oxalic acid

153
Q

What are the organized substances in urine micro

A

RBC
WBC
Epi
Casts
Bacteria
Parasites

154
Q

What are the unorganized substance in urine micro

A

Crystalline
Amorphous material

155
Q

What are cellular elements best preserved in

A

Acid, hypertonic urine

156
Q

What do cellular elements deteriorate in

A

alkaline, hypotonic

157
Q

What can be added to urine to preserve it

A

1 crystal of thymol
1 drop of formalin (40%)

Clinical Chem (5 decks)

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