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
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
3
Q
What are the two methods of urinalysis collection?
A
- Instrumented Collection
- Non-instrumented Collection
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
5
Q
What are the methods of instrumented urinalysis collection?
A
- Urethral catheterization
- Suprapubic needle aspiration
- Catheterization and Bladder irrigation
6
Q
How should urinalysis specimens be analyzed?
A
While fresh, preferably within 1-2 hours
7
Q
If unable to analyze urinalysis specimen at point of collection, what can you do?
A
Refrigerate the sample for 3-6 hours
8
Q
Why do you not want to leave urinalysis specimens unrefrigerated?
A
It will begin to decompose and deliver inaccurate results
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
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
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
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
13
Q
When/why would you collect 24 hour specimen?
A
- Gives quantitative results
- Preservatives may be needed
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
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)
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
17
Q
How much saline is inserted into bladder for vigorous transcatheter agitation?
A
50-72 mL
18
Q
What are the 3 different types of urine sample analysis?
A
- Physical
- Chemical
- Microscopic
19
Q
When performing physical analysis, what parts of urine sample do you look at?
A
- Volume
- Color
- Turbidity
- Odor
- Specific Gravity
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
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
22
Q
What does a blue green urine sample indicate?
A
Methylene Blue (used as dye or stain in diagnostic procedures)
23
Q
What does a dark orange urine sample indicate?
A
Pyridium (used for UTI)
24
Q
What does a milky white urine sample indicate?
A
Caused by chyle
25
What does an olive green to brown black urine sample indicate?
Phenols (poisonous compound used for antimicrobial agent)
26
What does a yellow to brown (turning greenish with foam when shaken) urine indicate?
Presence of bile
- Bilirubin
- Urobilinogen
27
What does red or red-brown (smokey appearance) urine indicate?
Presence of blood
28
What are you looking for with turbidity in the physical analysis of urine?
- Normal urine is clear
- Turbid alkaline
- Turbid acidic urine
29
What is turbid alkaline urine due to?
- Amorphous phosphate
| - Amorphous carbonate
30
What is turbid acidic urine due to?
- Amorphous urates
| - Pinkish turbidity frequently indicates presence of urates
31
What are you looking for with odor in the physical analysis of urine?
- 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
What does a fruity/sweet odor of urine indicate?
Ketones
33
What does a pungent odor or urine indicate?
Due to ammonia produced bacteria
34
What does a maple syrup odor of urine indicate?
"Maple syrup urine disease" a congenital metabolic disorder
35
What does a musty or mousy odor of urine indicate?
Infant with phenylketnouria
36
What does a sweaty feet odor of urine indicate?
- Isovaleric acidemia
| - Presence of butyric or hexanoic acid
37
What are the normal ranges for specific gravity in urine?
- Random sample: 1.003-1.035
| - 24 hour sample: 1.015-1.025
38
When performing chemical analysis, what parts of urine sample do you look at?
- Glucose
- Ketones
- Occult blood
- Bilirubin
- Urobilinogen
- pH
- Protein
- Nitrite
- Leukocyte Esterase (LE)
39
What does the presence of glucose indicate in a urine sample?
- Normal urine = negative
- Glucosuria
- May indicate diabetes mellitus, or any condition that causes hyperglycemia
40
What does the quantity of glucose dependent on?
- Blood glucose level
- Rate of glomerular filtration
- Degree of tubular reabsorption
41
What does the presence of ketones indicate in a urine sample?
- Normal urine = negative
- Ketonuria
- May indicate diabetes mellitus
- Ketosis
42
What is Ketonuria?
Presence of ketones in urine as a result of incomplete fatty acid utilization
43
What is Ketosis?
Increase of ketone in blood and urine
44
Ketosis is also found in conditions associated with?
- Decreased intake of carbohydrates (starvation)
- Decreases utilization of carbohydrates (diabetes mellitus)
- Digestive disturbance/ dietary imbalance
- Eclampsia
- Prolonged vomiting
- Diarrhea
45
What does the presence of occult blood indicate in a urine sample?
- Normal urine = negative
- May cause sample to appear red and "smokey"
- Hematuria
46
What is Hematuria?
Presence of blood in urine
47
Hematuria is indicative of what?
- Damage/trauma to kidney or urinary tract
- Renal disease
- May be also due to menstrual contamination or exercise
48
What renal diseases are associated with hematuria?
- Glomerulonephritis
- Malignant HTN
- Polycystic kidney disease
49
What does the presence of bilirubin indicate in a urine sample (bilirubinuria)?
- Normal urine = negative
- Jaundice will result in bilirubin in urine
- Hepatocellular disease
- Intra or extra-hepatic biliary obstruction
50
What does the presence of urobilinogen indicate in a urine sample?
- 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
What does the presence of pH indicate in a urine sample?
- Normal range is 4.6-8.0 with average of 6.0
- Respiratory/metabolic acidosis
- UTI by E. coli
- Uremia
- Severe diarrhea
- Starvation
52
What are some pathological conditions that can cause alkaline urine?
- UTI's caused by Proteus and Pseudomonas species
| - Respiratory and metabolic alkalosis
53
What are the two mechanisms for proteinuria
- Glomerular damage
| - Defect in the reabsorption process of the tubules
54
What is an important indicator of renal disease?
Proteinuria
55
What are the associated diseases with minimal (<0.5 g/day) proteinuria?
- Polycystic kidneys
- Chronic pyelonephritis
- Inactive chronic glomerulonephritis
- Benign orthostatic proteinuria
56
What are the associated diseases with moderate (0.5-3.5 g/day) proteinuria?
- Nephrosclerosis
- Tubular interstitial disease
- Preeclampsia
- Multiple myeloma
- D diabetes nephropathy
- Malignant HTN
- Toxic nephropathies
- Pyelonephritis with HTN
57
What are the associated diseases with severe (>3.5 g/day) proteinuria?
- Glomerulonephritis
- Lupus nephritis
- Amyloid disease
- Lipoid nephrosis
- Intercapillary glomerulonephritis
- Severe venous congestion of the kidney
58
What is bacteriuria?
Presence of bacteria in the urine, indicative of UTI
59
What is the presence of Nitrites in the urine indicate?
Bacteriuria, caused by E coli
60
What does Leukocyte Esterase (LE) detect?
Esterase released by neutrophils in the urine
| - Indirect test for bacteriuria
61
What is Leukocyturia?
Associated with an inflammatory process in or around the urinary tract
62
What are the critical values associated urinalyis?
- 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
What is clinical proteinuria define as?
Loss of >500mg/day
64
What can mild proteinuria (<0.5 g/day) be caused by?
- HTN
- Lower UTI
- Fever
- Exercise
65
What can moderate proteinuria (0.5-3 g/day) be caused by?
- CHF
- Chronic/Acute glomerulonephritis
- Diabetic nephropathy
- Pyelonephritis
66
What can significant proteinuria (>3 g/day) be caused by?
- Amyloid
- Chronic glomerulonephritis (severe)
- Diabetic nephropathy
- Lupus nephritis
67
What is persistent pH >7 associated with?
- Calcium carbonate stones
- Calcium phosphate stones
- Magnesium-ammonium phosphate stones
68
What is an increase of urobilinogen indicative of?
- Hemolytic anemia
- Cirrhosis
- Viral hepatitis
69
What does dark yellow or greenish brown urine color suggest?
Bilirubin in the urine seen in Pt's with obstructions within the bile duct
70
At what blood glucose level will glucose be present in the urine?
160-180 mg/dL
