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Urinalysis Flashcards

1
Q

What are the clinical reasons for performing urinalysis testing?

A

An important indicator of health, a screening test to detect and assess: Renal funciton, endocrine or metabolic function disorder, urinary tract infection and systemic diseases.

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2
Q

What are the methods of urine collection?

A

First morning void
Random urine
Clean catch
24-hour specimen

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3
Q

What are the methods of instrumented collection?

A

Urethral catheterization
Suprapubic needle aspiration
catheterization and bladder irrigation

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4
Q

How soon should urine specimens be analyzed while fresh?

A

1-2 hours

refrigerate the specimen 3-6 hrs after

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5
Q

What do urea splitting bacteria produce?

A

Ammonia, which then combines with hydrogen ions to increase ph of teh urine. Changes in pH will dissolve any casts present. If glucose is present, the bacteria may use it as a source of energy resulting in false negative glycosuria.

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6
Q

What urinary elements will deteriorate if left standing without any kind of preservative?

A

Blood Cells and casts

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7
Q

What is the advantage and disadvantage of freezing?

A

A: no cost, simple to perform
D: May destroy formed elements

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8
Q

What is the advantage and disadvantage of toluene?

A

A: Preserves acetone, diacetic acid and proteins by floating on top of urine
D: Flammable, difficult to separate from specimen.

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9
Q

What is the advantage and disadvantage of thymol?

A

A: Inhibits bacteria/fungus
D: False positive for protein

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10
Q

What is the advantage and disadvantage of chloroform?

A

A: Preserves urine aldosterone levels
D: Settles to bottom of containers

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11
Q

What is the advantage and disadvantage of formaldehyde?

A

A: Preserves urinary sediment/ cells
D: Interferes with glucose evaluation.

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12
Q

What is the advantage of hydrogen chloride?

A

A: Stabilizes steroids
D: Hazardous liquid and fumes, formed elements are destroyed.

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13
Q

What are the advantages and disadvantages of boric acid?

A

A: Preserves chemical and formed elements
D: Uric Acid may precipitate.

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14
Q

What are the advantages and disadvantages of preservation tablet?

A

A; Preserves urine for dipstick chemical analysis and sediment evaluation.
D: Unsuitable for sodium, potassium, and hormone analysis.

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15
Q

What is the diagnostic use of first morning void?

A

most concentrated, increased number of abnormal elements, decreased deterioration of formed elements, recommended specimen for chemical and microscopic examination.

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16
Q

What is the diagnostic use of random urine specimen?

A

Collected anytime, most convenient and most common, can detect abnormalitites but not as sensistive as first morning void

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17
Q

What is the diagnostic use clean catch?

A

specimen of choice for bacterial cultures. may perform cultures within 12 hours after collection if specimen was refrigerated. genitalia must be cleaned with mild antiseptic solution.

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18
Q

What is the diagnostic use of 24 hour specimen?

A

gives quantitative results and preservatives may be needed

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19
Q

What is the diagnostic use of urethral catheterization?

A

not recommended for bacteriologic examination, use only if no other way to collect urine, commonly used on marked obese patient with difficulty in urine collection

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20
Q

What is the diagnostic use of suprapubic needle aspiration?

A

in place of catheterization for obtaining a single urine sample, inserting the needle directly into the distended bladder, avoids vaginal and urethral contamination, performed for bladder outlet obstruction, urine colleciton of choice on infants and young children, performed to confirm positive cultures from disposable bag and prior to institution of specific therapy.

21
Q

What is the diagnostic use of catherterization and bladder irrigation?

A

utilizes vigorous transcatheter agitation of the bladder, 50-72 ml saline inserted into bladder, bladder content is then removed for cytologic study, this method yields optimum celllular sample of bladder epithelium.

22
Q

What is the diagnostic use of urine sample analysis?

A

Physical, chemical, microscopic.

23
Q

What is the volume portion of physical analysis?

A

normal volume in a 24 hour period reanges from 600-2000ml
average is 1500 ml
directly related to fluid intake, temperature and climate, amount of perspiration that occurs

24
Q

What is the color portion of phyical analysis?

A

depends on urochrome concentration,
normal color straw to dark amber
color may also vary because of ingested foods or medications

25
What is the diagnostic significance of the following colors?
Blue green- used as dye ro stain in diagnostics procedure dark orange-pyridium used for uti milky white-caused by chyle olive green to brown black-phenols (poisonous compound used for antimicrobial agent red or red bron-presence of blood
26
What is turbidity in the physical portion
normal urine is clear, turbid alkaline urine due to amorphous phosphate or amorphous carbonate turbic acid urine due to amorphous urates or a pinkish turbidity frequently indicates the presence of urates
27
What is the odor portion of physical?
Normal urine has a characteristic odor due to volatile acids, urine that has been standing for a long time develops an ammonia odor due to breakdown of urea by bacteria, odor of the urine is not considered to be of special diagnositc importance. sweet or fruits smell-ketones pungent smell-ammonia maple syrup-maple syrup disease musty or mousy-infant with phenylketonuria sweaty feet-isovaleric acidemia, presence of butyric or hexanoic acid in urine
28
What is the specific gravity of each test?
Random: 1.003-1.035 | 24-hour urine: 1.015-1.025
29
What is the glucose portion of chemical analysis?
normal urine is negative for glucose, the quantity of glucose in the urine is dependent on the blood glucose level, rate of glomerular filtration, and the degree of tubular reabsorption. Glucosuria- will appear in the urine on ce the threshold level of 160-180 in the blood is exceeded. may indicate diabetes mellitus, or any condition that causes hyperglycemia.
30
what is the ketones portion for chemical?
``` normal urine is negative for ketones, ketonuria is the presence of ketones in urine as a result of icomplete fatty acid, may indicate diabetes mellitus, ketosis increase ktone in blood and urine found in condtions associated with decreased intake of carbohydrates decreases utilization of carbohydrates digestive disturbance or dietary imbalance eclampsia prolonged vomiting diarrhea ```
31
What is the occult blood portion of chemical?
normal urine is negative for occult blood may cause the sample to appear red and smoky presence of blood is termed hematuria intact rbcs present in the urine may indicate: damage/trauma to the kidney or urinary tract Renal diseases such as glomerulonephritis malignant hypertesntion polycystic kidney disease may also be due to mestrual contamination
32
What is the bilibrubin poriton of chemical?
normal urine is negative for bilirubin any condition that causes jaundice will resullt in appearance of bilirubin in urine yellow to brown bilirubinuria indicates hepatocellular disease intra or extra hepatic biliary obstruction
33
What is the urobilinogen portion of chemical?
Normally present in the urine in concentration of 1 eu or les same as bilirubin urobilinogen- small urobilinogen amounts up to 1 mg/dL is normal any incrase idnicates liver disease and hemolytic disease
34
What is the pH portion of chemical?
The range for pH is 4.6 to 8.0 but since it averages around 6.0, it us usually slightly acidic pathologic conditions that may cause acidic urina are respiratory and metabolic acidosis uti by e.coli uremia severe diarrhea starvation pathologic conditions that cause alkaline urine are UTIs caused by Proteus and Pseudomonas species respiratory and metabolic alkalosis
35
What is the protein portion of chemical?
Normal urine is negative for protein it is an important indicator of renal disease proteinuria mainly occurs by two mechanisms glomerular damage defect in the reabsorption process of the tubules associated disease due to proteinuria minimal proteinura less than .5 gram a day polycystic kidneys chronic pyelonephritis inactive chronic glomerulonephritis benighn orhtostatic proteinura
36
What is teh mild proteinuria, moderate, and sever proteinuria levels>
minmal less than .5 a day moderate .5-3.5g a day severe greater than 3.5 a day
37
What is the ntirite portion of chemical?
normal urine is negative for nitrites it is formed by breakdown of nitrates by organisms that cause UTIs Bacteriuria presence of bacteria in urine, indicative of UTI
38
What is the Leukocyte esterase portion of chemical?
esterase is an enzyme normal urine is negative for LE, which detects esterase released by the neutrophils in the urine an indirect test for bacteriuria leukocyturia associated with an inflammatory process in or around the urinary tract
39
What are critical values?
Strong positive test for glucose and ketones glucose on urine dipstick greater than 1000mg urine colony cound of greater than 50,000 colonies
40
What is clinical proteinuria defined as?
Loss of greater than 500 mg a day
41
What is persistent pH greater than 7 associated with?
calcium carbonate, calcium phosphate, and magnesium ammonium phosphate.
42
What are pH's below 5.5 associated with?
cystine and uric acid stones
43
What does an increase in urobilinogen indicate?
hemolytic anemia, cirrhosis, or viral hepatitis
44
What does bilirubin indicate
obstructions of the bile duct
45
What is myoglobin highly indicative of?
Rhabdomyolysis
46
What is potentially significant pyuria defined as?
Greater than 3 WBC HPF
47
What does the presence of nitrite in the urine indicate?
UTI or bacterial infection
48
What does the presence of glucose and ketones indicate?
Diabetes

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