Urinalysis Flashcards
liquid by-product of the body secreted by the kidneys through a process called urination
urine
where the urine is excreted
urethra
consist of sterile waste products composed of water-soluble soluble nitrogen products
urine
processed form of ammonia that is non-toxic to maammals
urea
average urine volume per day
1.4 litres
composition of urine
uric acid - 0.6
bicarbonate ions - 1.2
creatinine 2.7
potassium ions 3.2
sodium ions 4.1
chloride ions 6.6
urea 25.5
average urinary input in adults is
600 to 2000mL
volume varies due to fluit intake, diet, and climate
urinary input
normal urine volume
1.2-2.L/day
> 2000mL/day urine output
polyuria
<500ml/day urine output
oliguria
increased water ingestion
diabetes mellitus and insipidus
polyuria
dehydration
shock
acute glomerulonephritis
renal failure
oliguria
total suppression of urine <100ml/day
anuria
indication of renal shutdown
anuria
often a diagnostic feature for many disease conditions
urine
known as UA or routine and microscopy (R&M)
urinalysis
target parameters and properties of urine
physical properties
chemical properties
microscopic parameters
how is urine collected for UA
midstream (first morning, random, clean catch)
catheterized
plastic bag
postprandial
during or relating to the period after dinner or lunch.
postprandial
must be collected in volumetric containers
urine
to get accurate results, urine samples must be tested in the laboratory within __ hours of collection
2
preserve urine if not tested for 2 hours
refrigeration
identified by vision and olfaction
gross inspection
gross inspection can have:
color
clarity
odor
volume
influenced by medical conditions, medications, and ingested food
color
norma urine color is
pale yellow or amber
pigment in urine
urochrome
urine apperance determines the presence of substances
clarity
normal urine is usually
transparent
may be foamy due to speed of urination, but frequent frothy appearance may be due to abundance of
protein/bilirubin
study gross inspection of clarity
+1
smell of urine may provide health information
odor
has typical aromatic odor due to volatile organic acids
odor
urea develops an ammoniacal odor due to the decomposition of ____ (resulting in ammonia) after standing
urea
check the possible odors
+1
exposes urine to strips that react if the urine contains certain cells or molecules
test strip urinalysis
physical routine analysis includes
specific gravity
pH level
chemical routine analysis
protein
glucose
ketone
bilirubin
urobilinogen
nitrite
leukocyte esterase
study the testing nad reading time
+1
comparison of the density of urine gainst the density of distilled water at a particular temperature
specific gravity
normal SG ranges from what
1.001 to 1.035
dependent on solute such as urea and sodium
specific gravity
increases as the solute concentration increases
specific gravity
increased SG
hypersthenuria
decreased specific gravity
hyposthenuria
low and fixed SG at 1.010
isosthenuria
depends on diet, acid-base balance, water balance, and renal tubular function
pH
normal pH values range from
4.6 to 8
acidic urine indicats
ketosis
high protein diet
alkaline urine indicates
chronic renal failure
vegetarian diet
severe vimiting
kidneys excrete a small amount of ___ in urine
protein
the amount of protein is normally up to ___mg/24hours
150 mg
tamm-horsfall protein indicate what
tubular injury
proteinuria can be an indication of what damage
glomerular
tubular
overflow
freely filtered through the glomerulus, but almost all is reabsorbed in the proximal tubule
glucose
normal glucose in urine ranges from __mg/dL
25
defines the presence of reducing sugars in the urine, such as glucose, galactose, lactose, fructose, etc.
glycosuria
glycosuria indicates
hyperglycemia
proximal renal tubule dysfunction
highly sensitive for hemoglobin and myoglobin
heme
clinical implications of heme
hematuria
rhabdomyolysis
contamination with semen
enzyme released by white blood cells, used for qualitative measurement of WBCs
esterase
usually graded as low to high (1 to 4)
esterase
clinical implications of esterase traces include
UTIs
pyuria
detect the presence of enteriobacteriaceae
nitrites
which converts nitrates to nitrites
enteriobacteriaceae
usually tested as + or - implicating UTIs or nitrituria
nitrites
breakdown products of fatty acids and their presence in urine is indicative of excessive fatty acid metabolism
ketones
normally not detected in urine of healthy individuals
ketones
include acetoacetic acid, B-hydroxybutyric acid, acetone
ketones
happens when you have high levels of ketones in your urine.
ketonuria
pigment that is a breakdown product of hemoglobin
bilirubin
not water soluble, bound to albumin
which kind of bilirubin
unconjugated
water soluble, filtered by glomeruli
conjugatedu
undetectable in normal individuals, clinical implications include
bilirubinuria
conjugated bilirubin is converted by bacteria to urobilinogen
urobilinogen
about how much urobilinogen is excreted in urine in 25 hours
0.5 to 4mg
diurnal with highest levels in the afternoon
urobilinogen
+ urobilinogen indicates
hepatitis or cirrhosis
can yield a great detail of information and may suggest a specific diagnosis
microscopy
RBCs
WBCs
epithelial cells
bacteria
yeast
parasites
Tamm-horsfall mucoprotein
what kind of substances
organized
crystals, ion concentration, pH levels
what kind of substrances
unorganized
highly unorganized microscopic substances composed of small number of different ions and molecules
crystals
formation is most dependent upon the conecntration of ions and urine pH
crystals
smal amounts of most types of crystals are not ___ pathologic
necessarily
these are long, cylindrical structures formed in the renal tubules due to precipitation of tamm-horsfall mucoprotein
casts
formation is promoted by conecntration and/or acidic urine
casts
described based on the elements embedded withi the protein matrix
casts
the chemical, physical, and microscopic evaluation of urine.
urinalysis
used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes.
urinalysis
To collect a urine sample you should:
label a sterile, screw-top container with your name, date of birth and the date
wash your hands (and genitals if possible)
start to pee and collect either a “first-catch” or a “mid-stream” sample of urine in the container – you will be told which type to collect
screw the lid of the container shut
wash your hands thoroughly
means you don’t collect the first or last part of urine that comes out.
this reduces the risk of the sample being contaminated with bacteria from: (1) your hands and (2) the skin around the urethra.
mid stream urine sample
means you catch the first part of the urine that comes out.
first catch urine sample
The test strips consist of narrow plastic ribbons with absorbent pads attached to one side.
The pads contain chemicals that react and change color after being immersed in urine.
urine test strip
The test pad measures leukocyte esterase in the urine released by white blood cells (WBCs). Elevated levels of urine WBCs (pyuria) indicate a urinary tract infection (UTI).
leukocytes
The test pad measures nitrites in the urine that form when an enzyme is released from bacteria. A positive result (nitrituria) indicates a urinary tract infection (UTI).
nitrites
The test pad measures urobilinogen in the urine that has entered the urinary tract from the bloodstream. Bacteria in the intestines make urobilinogen from bilirubin, which is in the bile produced by the liver. Elevated levels of urine urobilinogen indicate liver disease and dysfunction.
urobilinogen
measures urine albumins that have entered the urinary tract from the bloodstream. Elevated urine proteins (proteinuria) indicate kidney disease or immune disorders
protein
indicates kidney damage, urinary tract infection (UTI), kidney or bladder stones, kidney or bladder cancer, or blood disorders
blood in urine
hmeaturia
measures urine particle concentration. The test value indicates the blood hydration level.
specific gravity
Urine with a specific gravity of 1.000 -1.010
overyhydration
indicates dehydration
1.025-1.030
measures urine ketones that have entered the urinary tract from the bloodstream
ketones
are produced in the liver from the breakdown of fats when glucose is not available to the cells for energy.
ketones
usually indicate type 1 or 2 diabetes mellitus. An accumulation of ketones in the blood can lead to ketoacidosis
ketonuria
pad measures bilirubin in the urine that has entered the urinary tract from the bloodstream
bilirubin
is produced by the liver during the breakdown of heme from RBCs and then released in the bile.
bilirubin
indicate liver disease or blockage of the bile duct
bilirubinuria
measures urine glucose that has entered the urinary tract from the bloodstream.
glucose
enters the urine when the blood glucose exceeds ~ 180mg/dL.
glucose
elevated urine glucose levels (glucosuria) usually indicate
type 1 or 2 diabetes
determines the physical properties of urine, such as volume, color, clarity, and odor
macroscopic exam
The process is performed without instruments, using only the unaided eyes and nose
macroscopic exam
It is the urine produced over 24 hours, which usually ranges from 0.8 Liters (800 ml) to 2 Liters (2000 ml).
urine volume
) can indicate possible chronic kidney disease.
low urine volume/oliguria
can indicate diabetes, increased fluid intake, or possible kidney disease.
high urine volume/polyuria
The color of urine is
pale yellow
can result from particular foods, dehydration, infections, organ dysfunction, and medications
urine color changes
color of urine due to medications, carotene, b vitamins, or bilirubin
orange
Refers to its turbidity or transparency,
urine clarity
is usually translucent (clear) but can become increasingly opaque or cloudy as the number of solid particles in the urine increases.
urine
A high concentration of crystals (related to dehydration, certain foods, or urine pH), white blood cells (related to urinary tract infections), or elevated glucose (related to diabetes) can cause the urine to become ___
cloudy
result from elevated glucose or ketones in the urine due to diabetes
what smell of urine
sweet or fruity
result from dehydration, which increases urine concentration
what kind of urine
ammonia
result from urinary tract infections, medications, or certain foods
what kind of urine odor
pungent or foul
is a procedure to determine ifcells,crystals,casts, andmicroorganismsare present in the urine.
microscopic exam
If performed manually, the examination begins by placing about 10 milliliters of urine in a glass tube, then centrifuging the contents for about 5 minutes.
microscopic exam
appear in the urine when particular substances become too concentrated, and they aggregate to form larger solids, often due to dehydration.
crystals
are relatively large cylindrical structures, each having a matrix made of glycoproteins (Tamm-Horsfall proteins).
casts
are usually not in the urine (presence indicate Urinary Tract Infections).
microorganisms
