Urinalysis Flashcards
5 Clinical reasons for performing urinalysis testing:
- important indicator of health
- screening test
- cost-effective
- non-invasive
- simple to perform
Urinalysis screening test is used to assess 4 things?
- renal function
- endocrine function
- systemic disease
- UTI
What are the 2 methods of urine collection?
- Non-instrumented
- Instrumented collection
4 Types of non-instrumented collection:
- first morning void
- random urine specimen
- clean catch urine specimen
- 24hr urine specimen
3 types of instrumented collection:
- urethral catheterization
- suprapubic needle aspiration
- catheterization and bladder irrigation
Urine specimens should be analyzed within how many hours?
1-2 hours
You can refrigerate the specimen for how many hours?
3-6 hours
specimens left at room temp will begin to decompose due to what?
presence of bacteria
If urine is left at room temp it will decompose and cause what?
inaccurate results
what process produces bacteria that produces ammonia that combines with hydrogen ions to increase pH?
Urea splitting
Changes in pH will dissolve what?
casts
If glucose is present in the urine, bacteria will use it as a source of energy causing what?
false negative glycosuria
blood cells and casts will deteriorate without what?
a preservative
What is the advantage of freezing?
simple and no cost
Which is the most concentrated urine specimen?
first morning void
What is the recommended specimen for chemical and microscopic exam?
first morning void
Which is the most common & convenient for pt?
random urine
Which specimen is best for bacterial cultures?
clean catch
cultures should be performed within how many hours after collection?
only if _______
12 hours
refrigerated
For clean catch what must you tell the pt
genitalia must be cleaned with antiseptic wipe
collect mid-stream
what kind of results does a 24hr urine specimen give
qualitative/quantitative?
quantitative
Urethral catheterization is not recommended for what?
bacteriologic examination
urethral catheterization is commonly used on what type of pts?
obese
suprapubic aspiration is collection of choice for what type of pts?
infants and children
How many mL of saline are inserted for bladder irrigation?
50-72 mL
Catherization and bladder irrigation is best for
cytologic study
which method yields optimum sample of bladder epithelium?
Catheterization and bladder irrigation
3 methods of urine sample analysis?
- physical (appearance)
- chemical (dipstick)
- microscopic (formed elements)
5 methods of physical analysis of a urine sample
- volume
- color
- turbidity
- odor
- specific gravity
What is the normal volume range in a 24hr period?
600-2000 mL
What is the average urine volume?
1500mL
The amount of urine is directly related to what 3 things?
- fluid intake
- temperature and climate
- amount of perspiration
What is the normal color of urine?
straw color to dark amber
blue/green urine means?
methylene
dye or stain in diagnostic testing
dark orange urine means?
pyridium used to tx UTI
milky white urines?
chyle (fat)
olive green to brown black urine means?
phenols
yellow to brown urine that turns green with foam when shaken?
bile
red to red-brown (smokey appearance)
blood
what is turbid alkaline due to?
amphorous sulfate & carbonate
what is turbid acidic urine due to?
amorphous urates
pinkish turbidity is from
urates
urine that has been sitting develops what type of odor?
ammonia
what causes the ammonia odor in urine?
breakdown of urea by bacteria
sweet or fruity smelling urine
ketones
pungent smelling urine
ammonia
maple syrup smelling urine
maple syrup disease a congenital metabolic disorder
musty or mousy smelling urine
phenylketonuria
PKU
sweaty feet smelling urine
isovaleric acidemia
presence of butyric or hexanoic acid
what is the specific gravity of random urine?
1.003 - 1.035
what is the specific gravity of 24hr urine?
1.015 - 1.025
Does normal urine have glucose?
Negative
when will the presence of glucose appear in the urine?
160-180
what may glucose in the urine indicate?
diabetes mellitus or hyperglycemia
Does normal urine have ketones?
Negative
what may ketones in the urine indicate?
diabetes mellitus
what conditions are associated with ketosis?
- starvation
- diabetes mellitus
- keto diet
- eclampsia
Does normal urine have occult blood?
Negative
Intact RBCs present in the urine may indicate?
trauma to the kidney or urinary tract
hematuria may also be due to
menstrual blood or excessive exercise
Does normal urine have bilirubin?
Negative
What conditions could cause bilirubin in the urine
jaundice
Is Urobilinogen present in normal urine?
yes, 1 or less
An increase in urobilinogen may indicate what?
liver disease or hemolytic disease
what is the normal pH range for urine?
4.6 - 8.0
Is the pH of urine slightly base/acidic?
acidic
What is the average pH of urine?
6.0
What 5 conditions may cause acidic urine?
- Respiratory/metabolic acidosis
- UTI by E. coli
- Uremia
- Severe diarrhea
- Starvation
UTIs are caused by what?
Proteus and Pseudomonas
Does normal urine have protein?
Negative
what is an important indicator of renal disease if present in the urine?
protein
Does normal urine have nitrite?
Negative
Does normal urine have leukocyte esterase (LE)?
Negative
What is used as an indirect test for bacteriuria?
leukocyte esterase
what is associated with an inflammatory process in or around the urinary tract?
leukocyturia
macroscopic analysis is based on
appearance
chemical analysis is based on a
dip stick
microscopic analysis is looking for
formed elements
Normal color results:
clear to yellow
Normal Leukocyte esterase results:
Negative
Normal Nitrite results:
Negative
Normal Urobilinogen results:
less than or equal to 1
Normal Protein results:
Negative to trace
Normal pH results:
4.6 to 8.0
Normal Blood results:
Negative
Normal Specific gravity results:
1.003-1.035
Normal Ketones results:
Negative
Normal Bilirubin results:
Negative
Normal Glucose results:
Negative
Normal results RBC:
0-3
Normal WBC results:
0-2
Normal Epithelial cells results:
0-1
Normal Casts results:
depends on the type
Normal Bacteria results:
Negative to trace
Mild proteinuria
>0.5
Moderate
0.5 - 3.5
Significant proteinuria
>3.5
What is an indirect test for bacteriuria (UTI)?
Leukocyte esterase (LE)
What may an increase in urobilinogen indicate?
anemia, cirrhosis, viral hepatitis
Bilirubin in the urine may suggest
obstruction of the bile duct
Dipsticks for blood are dependent on the presence of
hemoglobin, RBCs, and myoglobin
A dipstick can detect as few as
1-2 RBCs
The presence of how many RBCs is considered abnormal
<3 RBCs
Persistent RBCs may indicate:
glomerulonephritis
kidney stones
cancer
infection
Myoglobin is highly suggestive of what?
Rhabdomyolysis
Presence of _____ in the urine is an indirect indicator of a UTI?
Nitrite
Glycosuria is suggestive of what?
Diabetes
If microorganisms are found in the urine what is the first consideration?
contamination
<1 epithelial cells is considered abnormal and may indicate
inflammation
what gives urine its color
urochrome