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Laboratory 2 > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What are some clinical reasons for urinalysis testing?

A
  • Important indicator of health
  • Screening test to detect and assess
  • Cost-effective in-vitro diagnostic
  • Non-invasive procedure
  • Simple to perform
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2
Q

What can a urinalysis screening test detect and asses?

A
  • Renal function/disorder
  • Endocrine or Metabolic function/disorder
  • Urinary Tract Infection
  • Systemic diseases
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3
Q

What are the two methods of urinalysis collection?

A
  • Instrumented Collection

- Non-instrumented Collection

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4
Q

What are the methods of non-instrumented urinalysis collection?

A
  • First morning void
  • Random urine specimen
  • Clean catch urine specimen
  • 24-hour urine specimen
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5
Q

What are the methods of instrumented urinalysis collection?

A
  • Urethral catheterization
  • Suprapubic needle aspiration
  • Catheterization and Bladder irrigation
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6
Q

How should urinalysis specimens be analyzed?

A

While fresh, preferably within 1-2 hours

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7
Q

If unable to analyze urinalysis specimen at point of collection, what can you do?

A

Refrigerate the sample for 3-6 hours

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8
Q

Why do you not want to leave urinalysis specimens unrefrigerated?

A

It will begin to decompose and deliver inaccurate results

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9
Q

Why will urinalysis begin to decompose if left at room temperature?

A
  • Due to bacteria in urine

- Bacteria produces ammonia, which combines with hydrogen ions to increase pH

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10
Q

When/why would you collect a first-morning void?

A
  • Most concentrated
  • Increase number of abnormal elements
  • Decrease deterioration of formed elements
  • Recommended specimen for chemical and microscopic examination
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11
Q

When/why would you collect random urine specimen?

A
  • Collected anytime
  • Most convenient and most common
  • Can detect abnormalities but not as sensitive as first morning void
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12
Q

When/why would you collect clean catch urine specimen?

A
  • Specimen choice for bacterial cultures
  • May perform cultures within 12 hours (if refrigerated)
  • Genitalia must be cleaned with mild antiseptic solution
  • Collect midstream in a sterile container
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13
Q

When/why would you collect 24 hour specimen?

A
  • Gives quantitative results

- Preservatives may be needed

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14
Q

When/why would you collect urethral catheteration?

A
  • Not recommended for bacteriologic examination
  • Use only if no other way to collect urine
  • Commonly used marked obese Pt with difficulty in urine collection
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15
Q

When/why would you collect Suprapubic needle aspiration?

A
  • In place of catheterization for obtaining a single urine sample
  • Inserting needle directly into distended bladder
  • Avoids vaginal/urethral contamination
  • Performed for bladder outlet obstruction (urinary retention)
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16
Q

When/why would you collect Catheterization and Bladder irrigation?

A
  • Utilizes vigorous transcatheter agitation of the bladder

- Method yields optimum cellular sample of bladder epithelium

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17
Q

How much saline is inserted into bladder for vigorous transcatheter agitation?

A

50-72 mL

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18
Q

What are the 3 different types of urine sample analysis?

A
  • Physical
  • Chemical
  • Microscopic
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19
Q

When performing physical analysis, what parts of urine sample do you look at?

A
  • Volume
  • Color
  • Turbidity
  • Odor
  • Specific Gravity
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20
Q

What are you looking for with volume in the physical analysis of urine?

A
  • Normal volume in 24 hrs is 600-2000 mL
  • Average about 1500 mL
  • Amount directly related to:
  • Fluid intake
  • Temperature and climate
  • Amount of perspiration that occurs
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21
Q

What are you looking for with color in the physical analysis of urine?

A
  • Depends on pigment (urochrome) concentration
  • Normal color straw (light yellow) to dark amber
  • Color may vary because of ingested foods or medications
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22
Q

What does a blue green urine sample indicate?

A

Methylene Blue (used as dye or stain in diagnostic procedures)

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23
Q

What does a dark orange urine sample indicate?

A

Pyridium (used for UTI)

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24
Q

What does a milky white urine sample indicate?

A

Caused by chyle

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25
Q

What does an olive green to brown black urine sample indicate?

A

Phenols (poisonous compound used for antimicrobial agent)

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26
Q

What does a yellow to brown (turning greenish with foam when shaken) urine indicate?

A

Presence of bile

  • Bilirubin
  • Urobilinogen
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27
Q

What does red or red-brown (smokey appearance) urine indicate?

A

Presence of blood

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28
Q

What are you looking for with turbidity in the physical analysis of urine?

A
  • Normal urine is clear
  • Turbid alkaline
  • Turbid acidic urine
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29
Q

What is turbid alkaline urine due to?

A
  • Amorphous phosphate

- Amorphous carbonate

30
Q

What is turbid acidic urine due to?

A
  • Amorphous urates

- Pinkish turbidity frequently indicates presence of urates

31
Q

What are you looking for with odor in the physical analysis of urine?

A
  • Normal urine has characteristic odor due to volatile acids
  • Ammonia odor due to breakdown of bacteria after standing for a long period of time
  • Odor is not considered to be of special diagnostic importance
32
Q

What does a fruity/sweet odor of urine indicate?

A

Ketones

33
Q

What does a pungent odor or urine indicate?

A

Due to ammonia produced bacteria

34
Q

What does a maple syrup odor of urine indicate?

A

“Maple syrup urine disease” a congenital metabolic disorder

35
Q

What does a musty or mousy odor of urine indicate?

A

Infant with phenylketnouria

36
Q

What does a sweaty feet odor of urine indicate?

A
  • Isovaleric acidemia

- Presence of butyric or hexanoic acid

37
Q

What are the normal ranges for specific gravity in urine?

A
  • Random sample: 1.003-1.035

- 24 hour sample: 1.015-1.025

38
Q

When performing chemical analysis, what parts of urine sample do you look at?

A
  • Glucose
  • Ketones
  • Occult blood
  • Bilirubin
  • Urobilinogen
  • pH
  • Protein
  • Nitrite
  • Leukocyte Esterase (LE)
39
Q

What does the presence of glucose indicate in a urine sample?

A
  • Normal urine = negative
  • Glucosuria
  • May indicate diabetes mellitus, or any condition that causes hyperglycemia
40
Q

What does the quantity of glucose dependent on?

A
  • Blood glucose level
  • Rate of glomerular filtration
  • Degree of tubular reabsorption
41
Q

What does the presence of ketones indicate in a urine sample?

A
  • Normal urine = negative
  • Ketonuria
  • May indicate diabetes mellitus
  • Ketosis
42
Q

What is Ketonuria?

A

Presence of ketones in urine as a result of incomplete fatty acid utilization

43
Q

What is Ketosis?

A

Increase of ketone in blood and urine

44
Q

Ketosis is also found in conditions associated with?

A
  • Decreased intake of carbohydrates (starvation)
  • Decreases utilization of carbohydrates (diabetes mellitus)
  • Digestive disturbance/ dietary imbalance
  • Eclampsia
  • Prolonged vomiting
  • Diarrhea
45
Q

What does the presence of occult blood indicate in a urine sample?

A
  • Normal urine = negative
  • May cause sample to appear red and “smokey”
  • Hematuria
46
Q

What is Hematuria?

A

Presence of blood in urine

47
Q

Hematuria is indicative of what?

A
  • Damage/trauma to kidney or urinary tract
  • Renal disease
  • May be also due to menstrual contamination or exercise
48
Q

What renal diseases are associated with hematuria?

A
  • Glomerulonephritis
  • Malignant HTN
  • Polycystic kidney disease
49
Q

What does the presence of bilirubin indicate in a urine sample (bilirubinuria)?

A
  • Normal urine = negative
  • Jaundice will result in bilirubin in urine
  • Hepatocellular disease
  • Intra or extra-hepatic biliary obstruction
50
Q

What does the presence of urobilinogen indicate in a urine sample?

A
  • Normally present in urine in concentrations of 1 EU or less
  • Small amounts up to 1mg/dl is normal
  • Any increase indicates liver disease and hemolytic disease
51
Q

What does the presence of pH indicate in a urine sample?

A
  • Normal range is 4.6-8.0 with average of 6.0
  • Respiratory/metabolic acidosis
  • UTI by E. coli
  • Uremia
  • Severe diarrhea
  • Starvation
52
Q

What are some pathological conditions that can cause alkaline urine?

A
  • UTI’s caused by Proteus and Pseudomonas species

- Respiratory and metabolic alkalosis

53
Q

What are the two mechanisms for proteinuria

A
  • Glomerular damage

- Defect in the reabsorption process of the tubules

54
Q

What is an important indicator of renal disease?

A

Proteinuria

55
Q

What are the associated diseases with minimal (<0.5 g/day) proteinuria?

A
  • Polycystic kidneys
  • Chronic pyelonephritis
  • Inactive chronic glomerulonephritis
  • Benign orthostatic proteinuria
56
Q

What are the associated diseases with moderate (0.5-3.5 g/day) proteinuria?

A
  • Nephrosclerosis
  • Tubular interstitial disease
  • Preeclampsia
  • Multiple myeloma
  • D diabetes nephropathy
  • Malignant HTN
  • Toxic nephropathies
  • Pyelonephritis with HTN
57
Q

What are the associated diseases with severe (>3.5 g/day) proteinuria?

A
  • Glomerulonephritis
  • Lupus nephritis
  • Amyloid disease
  • Lipoid nephrosis
  • Intercapillary glomerulonephritis
  • Severe venous congestion of the kidney
58
Q

What is bacteriuria?

A

Presence of bacteria in the urine, indicative of UTI

59
Q

What is the presence of Nitrites in the urine indicate?

A

Bacteriuria, caused by E coli

60
Q

What does Leukocyte Esterase (LE) detect?

A

Esterase released by neutrophils in the urine

- Indirect test for bacteriuria

61
Q

What is Leukocyturia?

A

Associated with an inflammatory process in or around the urinary tract

62
Q

What are the critical values associated urinalyis?

A
  • Strong positive test for glucose and ketones
  • Glucose on dipstick >1000 mg/dL with small/medium/large ketones
  • Urine colony count >50,000 colonies/mL if a single organism
63
Q

What is clinical proteinuria define as?

A

Loss of >500mg/day

64
Q

What can mild proteinuria (<0.5 g/day) be caused by?

A
  • HTN
  • Lower UTI
  • Fever
  • Exercise
65
Q

What can moderate proteinuria (0.5-3 g/day) be caused by?

A
  • CHF
  • Chronic/Acute glomerulonephritis
  • Diabetic nephropathy
  • Pyelonephritis
66
Q

What can significant proteinuria (>3 g/day) be caused by?

A
  • Amyloid
  • Chronic glomerulonephritis (severe)
  • Diabetic nephropathy
  • Lupus nephritis
67
Q

What is persistent pH >7 associated with?

A
  • Calcium carbonate stones
  • Calcium phosphate stones
  • Magnesium-ammonium phosphate stones
68
Q

What is an increase of urobilinogen indicative of?

A
  • Hemolytic anemia
  • Cirrhosis
  • Viral hepatitis
69
Q

What does dark yellow or greenish brown urine color suggest?

A

Bilirubin in the urine seen in Pt’s with obstructions within the bile duct

70
Q

At what blood glucose level will glucose be present in the urine?

A

160-180 mg/dL

Laboratory 2 (4 decks)

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