Urinalysis Flashcards
Red color in biosafety indicates
Stop / danger / fire protection equipment
Accepted “biohazard” label color
Fluorescent orange
_____ chemicals should be labeled as poisonous, corrosive or carcinogenic
Hazardous
All biological wastes EXCEPT URINE must be placed in a container with the _____ symbol
Biohazard
Empty urine containers can be discarded as _____ hazardous waste
Nonbiologically
Disinfectant for equipment and countertop surfaces
1:10 Bleach
Best way to break the chain of infection
Handwashing
When hands are not visibly soiled,
Apply sanitizer
When hands are visibly soiled,
Wash hands with soap and water
Most important part of handwashing procedure
Friction
Handwashing song
Happy birthday (2x)
Benedict’s reagent splashes on eyes, what to do? (MSDS)
Flash eyes with plenty of water
What reference material will you consult after accidentally spilling a hazardous chemical?
MSDS
MSDS stands for
Material Safety Data Sheet
Work related hazard that includes strain due to repeated positions
Ergonomic hazard
A hazard due to extremely low temperature
Cryogenic hazard
_____ hazards include fire/explosion, asphyxiation, pressure buildup, tissue damage similar to burns
Liquid nitrogen
Centrifuges, refrigerators, autoclaves, homogenizers, and glasswares are examples of _____ hazards
Mechanical
Centrifuge accidents or improper removal of rubber stoppers from test tubes may produce _____
Aerosols
Grinding, mixing, vortexing, centrifuging, and preparation of direct smears are known to produce _____
Aerosols
It is required that all electrical equipment is grounded in a _____ plug to avoid electrical shock
Three-pronged
Flammable chemicals should be stored in a (an) _____ in a remote area
Explosion-proof refrigerator
Functional unit of the kidney
Nephron
Part of the nephron that resembles a “sieve”
Glomerulus
MW of plasma substances that can be filtered by the glomeruli
> 70,000 Daltons
Reference method for measuring glomerular filtration rate
Inulin
Analyte (s) used to identify unknown body fluid as urine
Urea and creatinine
If the voided sample PRIOR to collection period is included in the 24-hour sample, clearance will be falsely _____
High / elevated
If the voided sample PRIOR to collection period is included in the 24-hour sample,
Repeat the collection
The greatest source of error in any clearance procedure is the use of _____
Improperly timed urine specimens
Blood vessel that supplies blood to the kidneys
Renal artery
Normal renal blood flow
1,200 mL/min
Normal renal plasma flow
600 mL/min
Normal glomerular filtration rate
120 mL/min
The fluid leaving the glomerulus normally has a specific gravity of
1.010
65% of reabsorption occurs at what part of the nephron?
PCT
Substances reabsorbed in the proximal convulated tubule include
Salts, water, amino acids, glucose, urea
Passive reabsorption of water takes place in all parts of the nephron except the _____
Ascending loop of Henle
A SELECTIVE urine concentration process in the ascending and descending loops of Henle
Countercurrent mechanism
A high level of ADH increases permeability of _____ & _____, resulting in increased water reabsorption, and a low-volume concentration
DCT and CD
Region of the kidney with the highest solute comcentration
Loop of Henle (bottom part)
Effect of high ADH on the walls of DCT and CD
Increased permeability to water
Renal threshold for glucose
160-180 mg/dL
Renal threshold for ketones
70 mg/dL
Renal threshold for sodium
120 mmol/L
Renal threshold for water
None
Renal threshold for potassium
None
Renal threshold for magnesium
0.60 - 0.85 mmol/L
(1.46 - 2.07 mg/dL)
Major composition of urine
Water, urea, sodium chloride
Major organic substance in the urine
Urea
Major inorganic substance in the urine
Chloride
Patient is deprived of fluid for 24 hours, then urine SG is measured
Fishberg test
Comparison of day and night urine in terms of volume and SG
Mosenthal test
Urine pH in renal tubular acidosis
Alkaline
Ideal specimen for routine urinalysis, PREGNANCY TESTING, and crystal identification
First morning urine
Why is 1st morning urine the most ideal specimen in urinalysis?
Most comcentrated
Urine specimen for urobilinogen determination
Afternoon urine specimen (2-4 pm)
Preferred specimen for measuring urine creatinine
24-hour urine
Urine specimen should be tested within
2 hours
Urine specimen should be examined within 2 hours because bacterial contamination will cause _____ of urine
Alkalinization
This will integrate in an ALKALINE HYPOTONIC urine
Casts
LEAST AFFECTED urine parameter in a unpreserved urine specimen
Protein
Most routinely used method of urine preservation
Refrigeration
Chemical preservative for urine albumin
Boric acid
Unlabeled urine received in the laboratory. What will you do?
Reject the specimen
UA is done first. Then 3 hours later, urine is sent for culture. The specimen should be
Rejected
Method of preservation if urine is not processed immediately for culture
Refrigeration (up to 24 hours)
Specimen for urine culture (out-patient)
Midstream clean-catch
Purpose of the 2nd container used in the three-glass collection
Control for UTI
Urine volume produced in polyuria
> 2,000 mL/day
Disorder associated with polyuria
Diabetes Mellitus, Diabetes Insipidus
Single parameter used to differentiate DM and DI
SG (specific gravity)
Urine volume produced in oliguria
<500 (or 400) mL/day
Complete cessation of urine flow
Anuria (<100 mL/day)
Definition of nocturia
> 500 mL of urine at night
For urine CLARITY determination, thoroughly mix the specimen then view through a _____
Newspaper print
For urine COLOR determination, look down through the container against a _____
White background
Major pigment in urine
Urochrome
Excess urobilin in urine causes what color?
Yellow-orange / orange-brown
White foamy bubbles in urine indicates the presence of
Albumin (protein)
Urine that produces yellow foam when shaken contains
Bilirubin
Recent consumption of B-complex vitamins or CAROTENE can make the urine appear
Dark yellow
Phenol in urine produce what color
Green (when oxidized)
Cloudy or smoky red urine
Hematuria
Clear red urine
Hemoglobin / myogblobin
Causes of tea-colored urine
Bilirubin and myoglobin
Portwine or red urine
Porphyria (porphyrin)
Homogentisic acid, melanin, and methemoglobin all causes what urine color?
Brown or black
Normal urine odor
Aromatic / fragrant / distinct / faint
Large numbers of COLIFORMS in urine will produce
Foul / ammoniacal odor / Nitrite (+)
Rancid butter urine odor
Tyrosinemia
Sulfur urine odor
Cystinuria / Cystinosis
Significance of rotting fish (galunggong) urine odor
Trimethylaminuria
Significance of cabbage-urine odor
Methionine malabsorption
Significant of fruity odor urine
Diabetes mellitus (ketones)
Asparagus urine odor is caused by ingestion of
Asparagus (methylmercaptan)
Ingestion of onions, garlic, and asparagus, UTI urine odor
Pungent
Cause of menthol-like urine odor
Phenol-containing medications
Peculiar amount of ODORLESS urine can be seen in
Acute tubular necrosis
_____ the edge of the strip on a disposable absorbent pad
Blot
Store __________ with desiccant in an opaque, tightly closed container
Reagent strips
Store reagent strips in a __________ area
Cool, dry
When reading the color reaction, urine reagent strips should be held at what position?
Horizontal
Normal pH range (random urine)
4.5 - 8.0
pH range in the first morning
5.0 - 6.0
A fruit that can cause acidic urine and is used as a home remedy for bladder infections
Cranberry
A vegetarian individual will produce urine that is
Alkaline
Normal daily protein excretion
Less than 150 mg/day
A protein that originate from the urinary tract itself
Uromodulin (THP)
Increased filtration of APRs leads to what category of proteinuria?
Pre-renal
It has an indicator that changes color with the pH being constant
Protein reagent strip
Reason behind protein error of indicators
Protein accepts H+ from indicator
The protein section of urine reagent strip is most sensitive to
Albumin
Negative reagent strip for protein and positive SSA test indicates
Proteins other than albumin
Bence-Jones protein coagulates at _____, then dissolves at _____
40-60C; 100C
(50-60C); 100C
Bence-Jones protein is seen in
Multiple myeloma
Purpose of determining the albumin:creatinine ratio
To detect microalbuminuria
Principle of Micral test strip
Enzyme immunoassay
PRE-ECLAMPSIA produces positive reaction with what reagent parameter?
Protein
Patient preparation for detecting orthostatic proteinuria
Empty bladder before going to bed
Increased pressure on the renal vein when in the vertical position is believed to account for _____ proteinuria
Orthostatic
A non-specific test for reducing sugars
Clinitest (copper reduction test)
Copper sulfate is used to determine what ability of glucose?
Reducing / reduction
Cause of FALSE-POSITIVE copper reduction test for urine sugars
Ascorbic acid, uric acid
Cause of FALSE-NEGATIVE copper reduction test for urine sugars
Detergents / pass-thru phenomenon
To prevent pass-through phenomenon, use how many drops of urine?
2 drops
Rubner’s test detects what sugar (s)?
Lactose and glucose
If glucose reagent strip is 4+ what other parameter (s) should be checked?
Ketones and protein
Patient is on a starvation diet. What can be found in urine?
Ketones
Ketone body not detected by reagent strip?
Beta-hydroxybutyrate (78%)
Percentage of acetoacetic acid in the ketone bodies
20%
Ketone body detected when glycine is included in the reagent strip
Acetone (2%)
Toxic to the renal tubular epithelium
Hemoglobin, myoglobin
A person suffering from crush injuries will manifest _____ in urine
Myoglobinuria
Drug that causes rhabdomyolysis leading to myoglobinuri
Statin (cholesterol-lowering drug)
Test to differentiate hemoglobin and myoglobin
Blondheim’s test
A red PRECIPITATE in urine is formed after adding ammonium sulfate. What is present?
Hemoglobin
A red SUPERNATANT in urine is formed after adding ammonium sulfate. What is present?
Myoglobin
Urine specimen handling for bilirubin testing
Wrap the specimen in foil
Bilirubin reagent strip detects what bilirubin fraction?
Conjugated (direct, B2)
Positive Ictotest result
Blue to purple after 60 seconds
Parameter reported in Ehrlich units
Urobilinogen
Convert 0.4 mg/dL urobilinogen to Ehrlich units?
0.4 EU (CF : 1)
Differentiates urobilinogen, porphobilinogen, and other Ehrlich-reactive compounds
Watson-Schwartz test
Soluble in (extracted by) both chloroform and butanol
Urobilinogen
Insoluble in (not extracted) both chloroform and butanol
Porphobilinogen
Soluble in (extracted by) butanol, insoluble in (not extracted by) chlorofom
Other Ehrlich reactive compounds
Patient preparation prior to testing urinary nitrite
Eat vegetables the night before
Bacteria that produces positive nitrite reagent strip
E.coli (gram-negative bacilli)
What is responsible for pink color reaction in the nitrite reagent pad?
Azo dye reacting with aromatic compounds
All leukocytes contain esterase enzyme except?
Lymphocytes
Nitrite should NOT INTERFERE with the reagent strip test for
Leukocytes
Relationship of urine SG to urine volume
Inversely proportional
Urine SG is equal to 1.010
Isosthenuria
Urine SG >1.010
Hypersthenuria
Urine SG <1.010
Hyposthenuria
Actual SG formula
Actual SG = Decimal portion of given SG x Dilution factor
If urine specimen yielded an SG reading of 1.014 after using 1:4 dilution, the actual SG is?
1.056
Urine volume requirement for urinometry
10-15 mL
Used to calibrate a urinometer to base (1.000)
Distilled water
Instrument based of refractive index
Total solids meter (refractometer)
Refractive index is a comparison of
Light velocity in air to light velocity in solution
Urine volume needed by the refractometer?
1 or 2 drops
Specific gravity of (triple) distilled water
1.000
Specific gravity of 3% sodium chloride
1.015 +/- 0.001
Specific gravity of 5% sodium chloride
1.022 +/- 0.001
Specific gravity of 7% sodium chloride
1.035 +/- 0.001
Specific gravity of 9% sucrose
1.034 +/- 0.001
Specific gravity of potassium sulfate solution
1.015 +/- 0.001
_____ for every 3C that the specimen temperature is ABOVE calibration temperature
+0.001
_____ for every 3C that the specimen temperature is BELOW calibration temperature
-0.001
Correction factor in urinometer or refractometer for every 1 g/dL of glucose present in urine
-0.004
Correction factor in urinometer or refractometer for every 1 g/dL of protein present in urine
-0.003
Temperature correction factor when using REFRACTOMETER
None
Reading of distilled water using refractometer is 1.002. What should you do?
Adjust set screw to 1.000
11th pad in the reagent strip
Ascorbic acid
Specimen used for Addis count
12-hour urine
Preservative for Addis count urine specimens, excellent sediment preservative
Formalin
Normal values for Addis count
0-500,000 RBCs
0-1,800,000 WBCs and EC
0-5,000 Hyaline casts
Primary components of the microscope LENS system
Oculars
Objectives
Adjustment knobs
Components of the microscope ILLUMINATION system
Light source
Condenser
Diaphragms
Components of the microscope BODY
Base
Body tube
Nosepiece
They perform the INITIAL magnification of object on the mechanical stage
Ojectives
Objective used for preliminary assessment (screening) of the urine sediment
10x (LPO)
Magnification power of ocular lens
10x
_____ illumination precisely focuses and centers the light path and spreading the light uniformly over the field of view
Kohler
A type of microscope that forms a HALO around the specimen
Phase-contrast
Microscope for identifying hyaline/mixed cellular casts and mucus threads
Phase-contrast
To convert a brightfield into a darkfield microscope, what should be replaced?
Condenser
To convert a brightfield into a polarizing microscope, what should be installed?
2 polarizing filters
Microscope that produces 3D image and layer-by-layer imaging of the specimen
Interference-contrast
Nomarski and Hoffman are examples of _____ microspcope
Interference-contrast
_____ microscopes can be adapted for Hoffman and Nomarski microscopes
Bright-field
Optical surfaces of the microscope should be cleaned with
Lens paper
Used to remove DUST on the optical surface of the microscope
Camel-hair brush
Clean any contaminated lens immediately with
Commercial lens water
If lens cleaning solution is not available, what can be used as an alternative?
Alcohol-based solution
Supravital stain that differentiates WBCs from RTE cells
Toluidine blue
Lipid stains can stain triglycerides and neutral fats, but not
Cholesterol
Color produced by neutral fats using Sudan III stain
Orange-red
Preferred stain for urinary eosinophils
Hansel stain
Stain for hemosiderin in urine
Prussian blue
Stain used in automated UA to visualize WBC, mitochondria, nuclear and cell membrane
Carbocyanine (green)
Stain used in automated UA to visualize DNA elements
Phenathridine (orange)
RBCs in hypotonic urine will
Swell / hemolyze (ghost cell)
RBCs in hypertonic urine will
Shrink / crenate
RBCs in glomerular membrane damage or bleeding appear as
Dysmorphic
When blood is negative but RBCs were reported on microscopy, recheck sediment and look for __________
Budding yeasts
Uniform blue color on blood reagent pad, 8 ghost cells seen/HPF. This indicates?
Hematuria (RBCs are lysed)
Positive for blood reagent strip, 0-1 RBC/HPF. What indication?
Hemoglobinuria / myoglobinuria
Term that indicates presence of WBCs in urine
Pyuria / leukocyturia
Glitter cells are seen in urine with
Low specific gravity
Normal value for urinary eosinophils
1% or less
TRUE OR FALSE: The percentage of eosinophils in 100-500 cells is NOT determined
False; determined
If eosinophils in urine are >1%, this is associated with what condition?
Acute interstitial nephritis
Largest cell in the urine sediment
Squamous epithelial cell
Epithelial cell variant associated with bacterial vaginosis / Gardenella vaginalis
Clue cell
Epithelial cell known as “bladder cell”
Transitional epithelial cell
These cells originate from the lining of renal pelvis, calyces, ureters, & bladder and from upper portion of male urethra
Urothelial cells
Most clinically significant epithelial cell
RTE (renal tubular epithelial) cell
Clinically significant squamous epithelial cell
Clue cell
Epithelial cell in urine with eccentric nucleus
RTE cell
Shape of proximal convulated tubule RTE cells
Oblong / cigar / rectangular / columnar
Shape of distal convulated RTE cells
Round / oval
Shape of collecting duct RTE cells
Polygonal, cuboidal, columnar
Number of RTE cells per HPF indicative of tubular injury
> 2 per HPF
Oval fat bodies are derived from what cell?
RTE cell
Highly refractile RTE cell
Oval fat body
Oval fat bodies are seen in what condition?
Nephrotic syndrome
RTE cell variant seen in acute tubular necrosis
Bubble cell
RTE cell inclusion that are formed after prolonged hemoglobinuria
Hemosiderin granules
Glucose (+); Round cells insoluble in dilute acetic acid. What is present?
Moniliasis (yeast)
To consider as significant for yeast infection, yeast cells should be accompanied by?
WBC
Most frequently encountered parasite in urine; Leukocyte esterase (+)
Trichomonas vaginalis
When not moving, Trichomonas is more difficult to identify. Observe for the presence of
Undulating membrane
Mistaken for non-motile Trichomonas vaginalis in urine
RTE cell / WBC / Transitional epithelial cell
Most common fecal contaminant in urine
Enterobius vermicularis
Most common urine contaminant in female patients
Squamous epithelial cells
Might be missed if the coverslip is overflowed
Casts
Objective used for DETECTING cast
LPO
Objective used for IDENTIFYING cast
HPO
Total magnification for reporting casts
100x (LPO x ocular lens)
Major component of urinary casts
Uromodulin (THP)
Other protein component of urinary casts
Albumin, immunoglobulins
Order of casts degeneration
Hyalin > cellular > coarsely granular > finely granular > waxy
The most commonly seen broad cast are
Granular and waxy
This can occur following strenuous exercise
Cylinduria
RBC casts can be easily identified due to its
Orange-red color
Final degenerative form of all cast types; Seen in chronic renal failure
Waxy cast
Also known as renal failure cast
Broad cast
As a mold of the distal convoluted tubules, the presence of broad casts indicates _____ of the tubular walls
Destruction (widening)
Pink sediment in urine
Amorphous urates
What to do in a precipitated specimen containing pink precipitates before testing?
Heat urine at 60C
White precipitate in urine
Amorphous phosphates and carbonates
Envelope or pyramid-shaped, octahedral, square with an “X” crystal
Calcium oxalate dihydrate
Common form of calcium oxalate crystals
Dihydrate or Weddellite
Calcium oxalate crystals are also associated with foods high in oxalic acid, such as _____ and asparagus, and ascorbic acid
Tomatoes
Amorphous urates + acetic acid
Uric acid
Gold lemon-shaped crystals
Uric acid
Crystal associated with chemotherapy, leukemia, lymphoma or polycythemia vera
Uric acid
Shape of ammonium biurate crystals
Thorny apples
Feathery, fern-leaf, coffin-lid, prism
Triple phosphate
Other name for struvite
Triple phosphate, magnesium ammonium phosphate
Colorless, flat rectangular plates or thin prisms often in rosette forms
Calcium phosphate
Other name for apatite
Calcium phosphate
Most abnormal crystals are found in what urinary pH?
Acidic or neutral
Colorless hexagonal crystals
Cystine
Staircase pattern with notch in one or more corners
Cholesterol
Notched crystals are seen in what condition?
Nephrotic syndrome (lipiduria)
Bilirubin, tyrosine, and leucine crystals are seen together in
Liver disease
Yellow needle-shaped crystals in amber urine; what significance?
Bilirubin, liver disease
Crystal precipitated with tyrosine crystals if alcohol is added to urine
Leucine
Yellow-brown SHEAVES OF WHEAT, rosettes, arrowheads, PETALS, needles
Sulfonamide
Colorless needles that tend to form BUNDLES following refrigeration
Ampicillin
Cigarette butt urinary crystal
Calcium sulfate
Urinary artifact with DIMPLED appearance
Starch granules
Urinary elements exhibiting maltese cross formation
Oval fat bodies
Fatty casts
Fat droplets
Starch granules
UA result: pH 5.0, WBCs and struvite crystals present. What to do?
Repeat testing
Screening for specific substances associated with IEMs in infant’s blood sample
MS/MS (tandem mass spectrophotometry)
Metabolic disorder that lacks phenylalanine hydroxylase
Phenylketonuria
The most well known of the aminoacidurias
Phenylketonuria
The most common in IEM detected in the Philippines
MSUD (maple syrup urine disease)
Metabolic disorder where urine turns black after opening the container
Melanuria
Cetyltrimethylammonium bromide (CTAD) is screening test for
Mucopolysaccharides
Positive result in the CTAB test
White turbidity
Positive color in the MPS (mucopolysaccharide) paper test
Blue
Increased aminolevulinic acid (ALA) in urine is seen in
Lead poisoning
When testing urinary ALA, the specimen must be pre-treated with
Acetyl acetone
Infant urine yielded negative glucose but positive Clinitest results, suspects for
Galactosemia
Deficient melanin production results in
Albinism
Metabolite of serotonin
5-HIAA (5-hydroxyindoleacetic acid)
Preservative for urine 5-HIAA testing
HCl or boric acid
Serotonin-rich foods include
Bananas
Pineapples
Tomatoes
Avocadoes
Chocolates
Plums
Walnuts
Findings in Henoch-Schonlein purpura include heavy _____ & _____ with RBC casts
Proteinura & hematuria
Crystal seen in Fanconi’s syndrome
Cystine
Protein in urine seen microscopically in renal diseases
Tamm-Horsfall protein (cast)
Precursor of acute glomerulonephritis
Respiratory infection (S. pyogenes)
Progressive, irreversible renal disease
Chronic kidney disease (CRF / CGN)
Renal disease with the greatest proteinuria (>3.5 g/day)
Nephrotic syndrome
Main characteristics of nephrotic syndrome
Proteinuria and lipiduria
Urine SG in acute tubular necrosis
1.010 (isosthenuric)
Presence of WBCs, bacteria and casts is seen in
Acute pyelonephritis
Presence of WBCs and bacteria, and absence of CASTS is seen in
Cystitis
Presence of WBCs and WBC casts; absence of BACTERIA
Acute interstitial nephritis
Tumor markers for urinary bladder cancer
NMP, BTA (nuclear matrix protein, bladder tumor antigen)
Primary urinalysis finding in renal lithiasis
Microscopic hematuria
Urinary calculi are most commonly formed from
Calcium
Renal calculi may form in the
Renal calyces
Renal pelvis
Ureters
Urinary bladder
