Urinalysis Flashcards
Urinalysis
Also known as ______ and _____ ,is an array of tests performed on urine
Routine and Microscopy
Urinalysis is one of the most common methods of Medical diagnosis.
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Routine urinalysis includes assessment of ______ characteristic, ______ analyses and a ______ examination of the ______ from a urine specimen.
physical
chemical
microscopic
sediment
SPECIMEN COLLECTION
Specimen should be collected by a clean _________ or _______
midstream catch or catheterization.
SPECIMEN COLLECTION
The urine should be freshly collected into a _____,______ container with a ____________ cover.
clean ,dry
tight-fitting
SPECIMEN COLLECTION
It must be analyzed within ___ of collection if held in at room temperature
1hr
SPECIMEN COLLECTION
Can be analyzed not more than _____ if refrigerated at __-___ C.
8hr
2o-8oC
(2-8 degrees Celsius)
The urine container may or may not be sterile if the urine is to be cultured
T/F
F
must be sterile
Specimen for routine urinalysis are usually _______ or ______ collection.
random,or spot
VISUAL APPEARANCE
Urine is meant to be ______ and ———
clear and colorless.
VISUAL APPEARANCE
Color intensity of urine correlates with ________.
concentration
VISUAL APPEARANCE
Various colors observed in urine are as a result of ________
different pigmentation.
VISUAL APPEARANCE of urine
Yellow and amber- __________.
Yellow-brown to green- ___________.
Red and brown after standing – _________.
urochomes
bile pigment oxidation
porphyrins
VISUAL APPEARANCE of urine
Reddish-brown in fresh specimen- _________ or ______
Brownish-black after standing – _______ and _______
heamoglobin or RBC.
alkaptonuria and malignant melanoma.
ODOR Ordinarily has little significance
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ODOR
Characteristic ______ odor of fresh urine is due to __________ ,in contrast to the typical ______ odor of urine that has been allowed to stand.
pungent; volatile aromatic acids
ammonia
ODOR
UTI impart a _____,_______ smell to urine.
noxious,fecal
Urine of diabetics often smells ______ as a result of _______.
fruity
ketones
TURBIDITY
The cloudiness of urine specimen depends on _______ and ________
pH and dissolved solids composition.
TURBIDITY
generally may be due to gross ________.
bacteriuria
TURBIDITY
Smoky appearance is seen in _______.
heamaturia
TURBIDITY
Threadlike cloudiness is observed when the specimen is full of _____.
mucus
TURBIDITY
In alkaline urine-precipitate of ___________ and ________
In acidic urine- _____________.
amorphous phosphates and carbonates.
amorphous urates
VOLUME
It indicates the balance between ________ and _______ from lungs,sweat and intestine.
fluid ingestion
water loss
VOLUME of urine
Most adults produce from ____-____ml every 24hrs with average of ____L/person.
750-2000
1.5
VOLUME of urine
Diabetes mellitus
Polyuria, oligonuria, or anuria
Polyuria
VOLUME of urine
Diabetes insipidus
Polyuria, oligonuria, or anuria
Polyuria
VOLUME of urine
Chronic renal failure
Polyuria, oligonuria, or anuria
Polyuria
VOLUME of urine
Acromegaly
Polyuria, oligonuria, or anuria
Polyuria
VOLUME of urine
Myxedema.
Polyuria, oligonuria, or anuria
Polyuria
VOLUME of urine
______uria–Urinary tract obstruction
Anuria or Oliguria
VOLUME of urine
_____uria -Acute renal failure
Anuria or Oliguria
VOLUME of urine
Polyuria –Nephritis,ESRD
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Anuria or Oliguria
SPECIFIC GRAVITY
Normal range for urinary SG is ______ to _____
1.005-1.030.
SPECIFIC GRAVITY
SG of urine is the weight of __________ in ______ (multiplied or divided?) by the weight of _________
1ml of urine
grams
Divided
1ml of water.
SPECIFIC GRAVITY
It varies with the ________ to be excreted.
solute load
SPECIFIC GRAVITY
It is used to assess the state of _______/______ of an individual
hydration/dehydration
SPECIFIC GRAVITY
Used As an indicator of the ______ ability of the kidneys.
concentrating
LABORATORY METHODS
Most commonly encountered analytic method consists of a _______,or _________.
This operates on the principle that the ______ of a urine specimen will vary directly with the ___________ in the sample
refractometer
total solid meter
refractive index
total amount of dissolved solids
LABORATORY METHODS
Unlike the refractometer, _____ measure only _______ and do not take into account of _______ and _____
dipsticks
ionic solutes
glucose and protein.
Specific gravity of urine varies in pathologic states.
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Specific gravity of urine
Pyelonephritis
Low or high?
Low
Specific gravity of urine
Glomerulonephritis.
Low or high?
Low
Specific gravity of urine
Diabetes mellitus
Low or high?
High
Specific gravity of urine
Chronic heart failure
Low or high?
High
Specific gravity of urine
Dehydration
Low or high?
High
Specific gravity of urine
Adrenal insufficiency
Low or high?
High
Specific gravity of urine
liver Diseases and Nephrosis.
Low or high?
High
SG will increase about ______ unit for every 1% change in glucose concentration and about ______ units for every 1% change in protein
0.004
0.003
Fixed SG(_________) around 1.010 is observed in ________ in which the kidneys excrete urine that is ______ with the plasma.
isosthenuria
severe renal damage
iso-osmotic
PH
Normal urine pH falls within the range of ____ - ____
4.5-8.0.
PH
Determination of urinary pH must be performed on fresh specimens because of _____________
the significant tendency of urine to alkalinize on standing.
PH
Acidic urine <7.0 is primarily caused by _______ which are excreted as salts conjugated Na,K and Ca.
phosphates
Acidity of urine also reflects the excretion of the nonvolatile metabolic acids: _____,_____, and ______
pyruvate,lactate and citrate.
Pathologic states with increased acidity include: Systemic acidosis- _________ and _________
DM and Renal tubular acidosis.
Alkaline urine >7.0 is observed post_______.
Which is a Normal reaction to the ______ of ____ dumped into the _____ and then into the circulation.
prandially
acidity of gastric HCL
duodenum
Alkaline urine May follow the ingestion of alkaline food or medication.
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Urinary tract infections and bacterial contamination can lead to (alkaline or acidic?) urine
Alkaline
Acidic urine is also found in Fanconi’s syndrome.
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Alkaline
CHEMICAL ANALYSES
Routine urine analysis is rapid and easily performed with commercially available ________ or ______
reagent strips or dipsticks.
reagent strips or dipsticks
These strips are _______ coated with ________ directed toward different analyses.
Abnormal results are followed up by specific quantitative or confirmatory urine assays.
plastics
different reagent bands
Centrifuged, decanted urine aliquot, leaves behind a sediment of formed elements that is used for microscopic examination.
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Sediment examination: cells
Evaluation is best accomplished by _______ and then taking ______ of at least _______ for cellular elements.
counting
the average
10 microscopic fields
Sediment examination: RED BLOOD CELLS
Erythrocytes >_____/HPF are considered abnormalgy
0-2
Sediment examination: RED BLOOD CELLS
May result from simple _______ / _______ contamination.
severe exercise
menstrual blood
Sediment examination: RED BLOOD CELLS
May be indicative of Trauma especially from _____ injury,renal/urinary ______, ________itis or cystitis.
vascular
calculi obstruction
pyelonephr
Sediment examination: RED BLOOD CELLS
_______ + ________ - Infection.
Heamaturia
leukocytes
Sediment examination: WHITE BLOOD CELLS
Leukocytes >_____/HPF are considered abnormal.
0-1
Sediment examination: WHITE BLOOD CELLS
They are usually polymorphonuclear phagocytes-segmented _______.
neutrophils
Sediment examination: WHITE BLOOD CELLS
They are observed when there is _______,_______, or ________ of any type.
Acute glomerulonephritis,UTI or inflammation
Sediment examination : EPITHELIAL CELLS
Several types are frequently encountered in (normal or abnormal ?) urine.
Due to ____________________ of nephrons and urinary tract
Normal
continuously sloughed off the lining
Sediment examination : EPITHELIAL CELLS
(Small or Large?),_____ ,squamous vaginal epithelia-female specimen.
Renal epith cells are _____,uninucleated
cells , if> _____/HPF-Active tubular injury.
Large; flat
round
2
Sediment examination : EPITHELIAL CELLS
______ bladder epith may be flat,cuboidal,or columnar- occassionally.
Large numbers will be seen only in cases of urinary __________,bladder _______ or ______.
Transitional
catheterization
inflammation
neoplasm
Sediment examination: MISCELLANEOUS
Usually not reported because they are of no pathologic significance
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Spermatozoan-M and F,in Male-________ abnormalities.
T
prostate
Sediment examination: MISCELLANEOUS
Yeast
Parasites-fecal(_________) and vaginal(________)
Enterobium vermicularis
T.vaginalis
Sediment examination: MISCELLANEOUS
True urinary parasite –ova of the trematode __________
Usually occur with significant _______.
S.heamatobium.
heamaturia
Normal urine is sterile with no bacteria.
T/F
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Sediment examination: bacteria
_____ Number of organisms OR —— numbers + _____ and ____ symptoms -True infection.
Large
Small
WBCs; UTI
Sediment examination: bacteria
Clinical significant bacteriuria->___orgs/HPF or10^___ OR > registered on a microbiologic colony count.
20
5
Sediment examination: bacteria
Most seen pathogen are gram _______ve coliforms e.g ______ and _____
Negati
E.coli; proteus
Sediment examination: bacteria
Asymptomatic bacteriuria- ____ girls, ______ woman and patients with ——-.
Young
pregnant
DM
Sediment examination: CASTS
They are precipitated, ________ shaped impressions of the ______.
cylindrical
nephrons
Sediment examination: CASTS
They comprise ______ ———- from the tubular epithelia in the ____________________
Tamm- Horsfall
mucoprotein
ascending loop of Henle
Sediment examination: CASTS
Casts form whenever there is sufficient ______, increased ______ or _____ concentration and decreased ______.
renal stasis
urine salt or protein ; urine pH
Casts should be examined under ______ and are most often located around the _____ of the coverslip.
low power
edges
Sediment examination: HYALINE
The matrix of these casts is ____ and _______, without _______ or particulate matter.
clear ; gelatinuos
embedded cellular
Sediment examination: HYALINE
May be difficult to visualize unless a ___________ is used.
high-intensity lamp
Sediment examination: HYALINE
Presence indicates ___________
Leakage may be temporary( fever, ____ posture, dehydration, or emotional stress) or may be permanent.
glomerular leakage of protein
upright
The occassional presence of hyaline cast is considered pathologic.
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Their occassional presence is not considered pathologic.
Sediment examination: GRANULAR cast
Casts are descriptively classified as either _____ or _____.
coarse or finely granular
Sediment examination: GRANULAR cast
Is simply a matter of the amount of ______ that the ________ have undergone.
L
degeneration
epithelial cell inclusions
Sediment examination: GRANULAR cast
Occasional presence is not pathologic.
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Sediment examination: GRANULAR cast
Large numbers may be found in chronic _____ toxicity and ___.
lead
Sediment examination: CELLULAR casts
RBC Casts- diagnostic for ______ that results in renal ______ ,seen in SBE,kidnry infarcts,collagen dxs and acute glomerulonephritis.
glomerular inflammation
heamaturia
Sediment examination: CELLULAR casts
WBC Casts-diagnostic for inflammation of the ______.observed in pyelonephritis, nephrotic syn, and acute glomerulonephritis
nephrons
RBC Casts-not always pathologic
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RBC Casts-always pathologic
WBC Casts- is always pathologic
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Sediment examination:CELLULAR
Epithelial cell casts- sometimes formed by ____ of ________ after ______.
fusion
renal tubular epithelia
desquamation
Sediment examination:CELLULAR
Waxy casts-uniformly ———— color, refractile, and ____ appearing, with (sharply or bluntly ?) defined , often _____ edges.
yellowish; brittle
Sharply ; broken
Waxy casts-
Almost always pathologic
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Sediment examination:Cellular
Waxy cast:
Indicate _____ inflammation.
Formed by ______ in the collecting ducts –CRF.
tubular
renal stasis
Sediment examination:Cellular
Fatty casts-
(Normal or abnormal?) , coarse, granular casts with ____ inclusions that appear as ________ of different sizes.
Abnormal
lipid
refractile globules
Sediment examination : CRYSTALS
Acid environment:
Ca oxalate-normal _______,may have almost like _____ appearance.
octahedrons
starlike
Sediment examination : CRYSTALS
Acid environment:
Amorphous urates-normal ______ masses with a _____ appearance.
yellow-red
grain of sand
Sediment examination : CRYSTALS
Acid environment:
Uric acid –normal yellow to red-brown that appear in extremely ____ shapes,such as ______,_____, or______
irregular
rosettes, prisms, or rhomboid.
Sediment examination : CRYSTALS
Acid environment:
Cholesterol – ____ color , flat, _____ plates with _____ corners. may be seen in ________
clear
rectangular
notched
neprotic syndrome
Sediment examination : CRYSTALS
Acid environment:
Cystine –appear _____ , refractile, nearly flat ______ , somehow similar to _______ .
seen in _______ and _____
colorless
hexagons
uric acid
homocystinuria and cystinuria.
Sediment examination : CRYSTALS
Acid environment:
List it!
Ca oxalate
Amorphous urates-
Uric acid
Cholesterol
Cystine
Which crystal found in acidic environment is highly pathologic?
Cystine
Sediment examination : CRYSTALS
Alkaline environment:
Amorphous phosphates-fine, _____ masses, resembling ____.
colorless
sand
Sediment examination : CRYSTALS
Alkaline environment:
Calcium carbonate-small, _____ , ______ or ______ shaped
colorless
dumbbells or spheres.
Sediment examination : CRYSTALS
Alkaline environment:
Triple phosphate- ________ prisms of _____ sides, resembling a “________”.
colorless
3-6
coffin lids
Sediment examination : CRYSTALS
Alkaline environment:
Ammonium biurates- _____ ,yellow-brown spheres or “ ________”.
spiny
thorn apples
Sediment examination : CRYSTALS
Alkaline environment:
List them
Amorphous phosphates
Calcium carbonate
Triple phosphate
Ammonium biurates
SG of urine
Dilute specimen-____-_____ ,Concentrated samples- ___-____
1.000-1.010
1.025-1.030.
Polyuria = _______ml of urine
Oliguria = _______ml of urine
Anuria = _______ml of urine
Greater than 3000
Less than 500
Less than 250
______ and ———- an present as pseudohyponatremia
Hyperlipidemia
Hyperlipoproteinemia
In hyperthyroidism , you can find ____ myxedema
In hypothyroidism , you can find ____ myxedema
Pretibial
Normal
Growth hormone can predispose to diabetes mellitus
T/F
With reason
T
It opposes insulin and stimulates glycogenolysis
________ cast is found AKI
_____ cast is found in ATN, pyelonephritis, and chronic lead toxicity
Hyaline
Granular
_______ cast is found in chronic renal failure
Waxy
_______ cast is found in eclampsia
Epithelial cells
_______ cast is found in amyloidosis
Epithelial cell
Eclampsia: ______,_____, and ———- in pregnancy
Pre-Eclampsia: ______ and ———- in pregnancy
Hypertension ; Proetinuria; Seizures
Hypertension ; Proetinuria
_______ cast is found in nephrotic syndrome
Fatty casts and epithelial cells casts
