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Diagnostic Studies, Unit III > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

Urinalysis

(define, 2 advantages, 2 uses)

A

Def: fluid biopsy of the urinary tract that analyzes the physical, chemical, and microscopic** **components of urine

Advantages:

  1. Non-invasive
  2. Relatively low cost

Uses:

  1. Dx/monitor renal/urinary tract disease
  2. Detect metabolic/systemic diseases indrectly related to kidneys
    • (ex - diabetes is often dx c + GLU on urine dipstick)
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2
Q

Urine Composition

(4 parts, 4 variation factors)

A

Components:

  1. Water (main component)
  2. Oranic substances
    • Urea, creatine, uric acid, glucose, protein, hormones, vitamins, metabolized meds
  3. Inorganic substances
    • Primarily chloride, sodium, potassium
  4. Non-dissolved substances
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3
Q

Common Kidney/Urologic Conditions

(8)

A
  1. Glomerular Diseases
  2. Nephrotic Syndrome
  3. Hematuria/Hemoglobinuria
  4. Transfusion Reaction
  5. Azotemia (increased urea nitrogen)
  6. Diabetes
  7. Urinary Tract Infection (UTI)
  8. Liver Function
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4
Q

Urinalysis Process

(3 steps)

A
  1. Direct visual observation for the following
    • color
    • clarity
    • quantity
  2. Chemical testing via dipstick
  3. Microscopic analysis
    • ​automated
    • manual
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5
Q

Urine Color Analysis

(normal, 2 abnormals)

A

Normal - pale yellow to dark yellow or amber

Abnormal -

  • Red/Red-brown: food coloration, drugs, hemoglobin, myoglobin
  • Black/Brown: malignant melanoma, alkaptonuria
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6
Q

Urine Turbidity

(4 causes, concurrent observation)

A

Causes:

  1. Cellular material
  2. Protein
  3. Crystals
  4. Radiographic dye

Concurrent Observation: increased specific gravity

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7
Q

Specific Gravity

(testing method, what’s analyzed, normal plasma and urine values)

A

Method:

  1. Dipstick analysis
  2. Refractometer

Analyzed:

  1. Urine density (compared to water density)
  2. Ultimately, renal integrity
    • ex - if sp gravity <1.022 after 12 hour food/water fast, possible renal concentrating disability

Normals:

  • Urine = 1.002-1.035
    • >1.035 indicates contamination or high glucose
  • Plasma = 1.010
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8
Q

Factors Affecting Urine Volume

(4, evaluation)

A

Evaluation: via 24 hr urine test

Factors:

  1. Fluid intake
  2. Fluid loss from non-renal sources
  3. Variations in ADH secretion
  4. Excretion of inc dissolved solids (salts, glucose, etc)
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9
Q

Abnml Glucose Volume

(2 categories, 2/1 causes)

A

Polyuria: >2000 mL/day

  • Diabetes (mellitus or insipidus)
    • see picture
  • ADH suppressors
    • diuretics
    • caffeine
    • alcohol

Oliguria: <500 mL/day

  • Dehydration (hypovolemia, perspiration, severe burns)
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10
Q

Urine Dipstick Analytes

(10)

A

Vary in result time from 30 seconds to 2 minutes

  1. pH
  2. Protein
  3. Glucose
  4. Ketones
  5. Blood
  6. Bilirubin
  7. Urobilinogen
  8. Nitrite
  9. Leukocyte Esterase
  10. Specific gravity
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11
Q

Reagent Strip Preparation Considerations

(3)

A
  1. Sample must be thoroughly mixed
  2. Fresh sample (<1-2 hr old or refridgerated)
  3. Timing consideration on results (results appear b/w 30s and 2 min depending on test)
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12
Q

Dipstick Analysis Specimen Integrity

(major specimen change, results on values)

A

Major Specimen Change: bacterial multiplication

Value changes

  • Increased analytes (false positives)
    • ​color
    • turbidity
    • pH
    • nitrite
    • bacteria
    • odor
  • Decreased analytes (false negatives)
    • ​glucose
    • ketones
    • bilirubin
    • urobilinogen
    • RBC
    • WBC
    • casts
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13
Q

Dipstick Abnormal Results

(4 conditions, 4/2/2/2 results)

A

This may be the first indcation of disease

  • Renal function
    1. Specific gravity
    2. Protein
    3. pH
    4. Blood
  • UTI
    1. Nitrite
    2. Leukocyte esterase
  • Carbohydrate metabolism
    1. ​Glucose
    2. Ketones
  • Liver function
    1. ​Bilirubin
    2. Urobilinogen
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14
Q

Leukocyte Esterase Dipstick Test

(function, normal result, timing)

A

Normal: negative (not a quantitiative test)

Timing: 2 minutes for results

Functions: detect WBCs in urine

  • Bacterial and non-bacterial UTI
    • ex - Trichomonas, Chlamiydia, yease, interstitial nephritis
  • Urinary tract inflammation
  • Urine cultre screening (in conjunction c nitrite, but a better predictor than nitrite)
  • Detects lysed cells
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15
Q

Nitrites

(normal result, function, false readings - 2 categories, 3/3 specifics)

A

Normal: negative (non-numerical value)

Function: detect nitrite reducing bacteria

False Readings:

  • False Negatives
    • nonreductase-containing bacteria
    • high [asorbic acid] (vitamin C supplimentation)
    • high specific gravity
  • False positives
    • old specimens (bacterial multiplication)
    • highly pigmented urine
    • contaminated collection
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16
Q

Urobilinogen

(normal, function, 2 clinically significant links)

A

Normal: 0.01-1.0

Function: quatify urobilinogen, the reabsorbed and converted intestinal bilirubin

Clinical significance:

  1. Early liver disease detection - hepatitis, cirrhosis, carcinoma
  2. Hemolytic disorder detection - excess bilirubin converted to urobilinogen, which reciruclates to liver
    • ​negative bilirubin c strong positive urobilinogen
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17
Q

Protein

(normal values, function)

A

Normal: <10 mg/dL or 100 mg/24 hr

Function: proteinuria is most indicative of renal disease

  • detect filtered low melecular weight serum proteins
  • proteins evaluated
    • albumin (smallest)
    • globulin
    • hemoglobin
    • fibrinogen
    • nucleoproteins
    • Bence Jones proteins
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18
Q

Clinical Significance, Proteinuria

A
  • Presence of protein in urine does not always indicate renal disease, BUT, additional testing is indicated to determine pathological condition
  • Clinical proteinuria = 30 mg/dL, 300 mg/24 hr
  • Variety of causes
    • Prerenal
    • Renal
    • Postrenal
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19
Q

Prerenal Proteinuria

(def, physiology, laboratory presentation)

A

Definition: Excess uremic protein due to plasma disease, not renal disease

Physiology: Transcient inc in low molecular wt plasma PRO, acute phase reactants, exceed reabsorptive capacity so they travel to urine

  • Ex - high Bence Jones pro in multiple myeloma

Presentation: Unless the proteinuria is concentrated to albumin, this will not appear on reagent strip. Protein-specific screening is indicated

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20
Q

Prerenal Tubular Disorders

(4)

A
  1. Intravascular hemolysis
  2. Muscle injury
  3. Acute phase reactants
  4. Multiple myeloma
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21
Q

Renal Proteinuria

(2 types, definitions, classification)

A
  1. Glomerular proteinuria
    • ​​def - damage to glomerular membrane, increasing pressure on filtration mechanism
    • classification - up to 4g uremic PRO/day
  2. Tubular proteinuria
    • ​​def - tubular damage that affects reabsorptive ability
    • classification - proteinuria significantly less dramatic than glomerular proteinuria
22
Q

Glomerular Proteinuria

(2 pathophysiological categories, 2/4 causative agents)

A
  • **Glomerular membrane damage, abnl substances deposit there **
    1. ​SLE
    2. Streptococcal glomerulonephritis
  • Increased pressure on filtration mechanism
    1. ​​HTN
    2. Strenuous exercise
    3. Dehydration
    4. Pregnancy, preeclampsia
23
Q

Glomerular Proteinuria Presentation

(2 categories)

A
  • Benign proteinuria (transcient)
    1. ​cold exposure
    2. exercise
    3. dehydration
    4. hyperthermia
  • Orthostatic proteinuria: benign (vertical) postural proteinuria from increased pressure on renal vn
    • frequently detected on random specimen
    • prevention
      • empty bladder before bed
      • collect specimien immediately on arising
24
Q

Tubular Proteinuria

(definition, 1 subtype c 7 causes, laboratory presentation)

A

Definition: tubular damage affecting rabsorptive ability

  • Acute tubular necrosis, caused by
    1. ​toxic substances
    2. shock
    3. trauma
    4. crushing injury
    5. heavy metal exposure
    6. viral infection
    7. Fanconi syndrome (generalized proximal confoluted tubule defect)

Presentation: proteinuria significantly milder than glomerular proteinuria

25
Postrenal Proteinuria Causes | (6)
1. Protein added in the lower urinary and genitourinary tract 2. Microbial infections causing inflammations and release of interstitial fluid protein 3. Menstrual contamination 4. Semen / Prostatic fluid 5. Vaginal secretions 6. Traumatic injury
26
Urine pH (normal/abnormal values, phys signiciance)
_Signif_: kidneys are major regulators of acid-base balance _Numbers_: overall 4.6-8.0, avg 6.0 [**no absolute values are assigned**] * first morning specimen = 5-6 * postprandial (post-meal) specimen = more alkaline * normal fresh urine **cannot reach 9**, this indicates bacteria-contaminated urine
27
Dietary Urine pH Changes | (3)
Meat = acid pH Vegetables = alkaline pH * Exception = cranberry juice Medications for urinary tract infection * Maintain an acid pH
28
Urine pH Clinical Significance | (7)
1. Respiratory/metabolic acidosis or ketosis 2. Respiratory or metabolic alkalosis 3. Defects in renal tubular acid/base secretion and reabsoption - renal tubular acidosis 4. Renal calculi formation 5. UTI tx 6. Crystal precipitation/identification 7. Specimen integrity determination
29
Urine Blood analysis (function, normal, false results, indication of results)
_Function_: assess kidney or urinarty tract damage better than microscopic exam _Normal_: negative _False Results_: * Negative: high asorbic acid (Vitman C), crenated RBC's * Positive: menstrual contam, oxidizing detergents (improper container cleaning) _Result Interpretetation_: 1. Hematuria * ​intact RBC's * cloudy red urine * sources * infectious disease * renal disorders * renal system trauma 2. Hemoglobinuria * ​broken RBC, hemoglobin exposed * clear red urine * sources * transfusion rxn * severe burns * hemolytic anemia * paradoxical hemoglobinuria 3. Myoglobinuria * ​heme-containing protein in muscle tissue * clear red/brown urine * sources * tissue wasting disease * severe trauma
30
Crenated RBC
RBC that lost its fluid
31
Hemoglobinuria vs Myoglobinuria | (5 comparisons)
1. Both produce clear, red urine 2. Both are toxic to renal tubules 3. Hemoglobin causes red plasma; with myoglobin plasma is clear 4. Increased CK enzymes with myoglobin 5. Both will produce positive dipstick results
32
Specific Gravity from Dipstick | (differentiation from refractometer)
1. No interference (large molecules, glucose, urea, radiographic dye, plasma expanders), therefore **preferred method of SG evaluation** 2. Slight elevation from PRO that can be calculated out 3. Decreased readings c urine \>6.5 * ​interferes c indicator * correction - lab adds 0.005 to reading
33
Ketones (function, normal values, deviations from normal)
_Function_: indicate level of fat metabolism _Normal_: negative _Positive Results - Ketonuria_: appear in urine when fat is broken down to glucose for energy * DM (may indicate acidosis) * Vomiting (loss of CHO) * Starvation/malabsorption/low CHO diet
34
Bilirubin | (function, normal value)
_Function_: **early indicator of liver disaese or biliary obstruction**, shows amount of RBC breakdown _Normal_: negative
35
Clinical Significance, Positive Bilirubin (general, 3 specific)
*Bilirubin appears in urine c bile duct obstruction and liver disease* * **Obstruction**: bilirubin backup into circulation (no urobilinogen formation) * **Liver Disease**: conjugated bilirubin leaks back into circulation from damaged liver; some bilirubin passes to intestine * **Hemolytic disease**: increased _unconjugated_ bilirubin indicates jaundice. * *bilirubin = negative* * *urobilinogen = positive *
36
Glucose (normal, false results, clinical significance)
_Normal_: \<0.5 g/day in a 24 hr specimen _False Results_: * Negative - high ascorbic acid (vitamin C) * Positive - oxidizing detergents (improper container cleaning) _Clinical Significance_: * **Major DM screening test** * Gestational diabetes * Renal threshold = 160-180 mg/dL * Excess urine blood sugar = glycosuria
37
Gestational Diabetes | (pathophys, results)
_Pathophys_ * Placental hormones block insulin action * High fetal GLU stresses fetal pancreas _Results_ * fat baby * mother is prone to type II DM later
38
Nondiabetic glycosuria | (5 causes)
1. **Hormonal disorders**: pancreatitis, pancreatic cancer, acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma 2. **Hormones**: glucagon, epinephrine, cortisol, thyroxine, growth hormone oppose glucose 3. **Insulin**: converts glucose to storage glycogen 4. **Hormones**: glycogen back to glucose 5. **Epinephrine**: inhibits insulin; seen with stress, cerebral trauma, and myocardial infarction
39
Renal Glycosuria | (4 causes)
1. Tubular reabsorption disorder 2. End-stage renal disease 3. Fanconi syndrome 4. Temporary lowering of renal threshold in pregnancy
40
Clinical Significance, Urine Glucose | (11)
1. Hyperglycemia-Associated 2. Diabetes mellitus 3. Pancreatitis 4. Pancreatic cancer 5. Acromegaly 6. Cushing syndrome 7. Hyperthyroidism 8. Pheochromocytoma 9. Central nervous system damage 10. Stress 11. Gestational diabetes
41
Microscopic Urinalysis (1 goal c 10 specifics, procedural notes)
_Goal_: Identify insoluble substances (formed elements) 1. RBC 2. WBC 3. Epithelial cells 4. Casts 5. Bacteria 6. Yeast; parasites 7. Mucus 8. Spermatozoa 9. Crystals 10. Artifacts _Procedural notes_: * Some labs automate this but others do not * Less standardized than dipstick * Time consuming, esp when done manually
42
Microscopic Screening Correlations | (7 screenings)
See picture
43
Microscopic Urinalysis Reporting
* Consistent within laboratory * Rare, few, moderate, many, or full field or 1+, etc. – **semiquantitative** * Casts: average per lpf * RBCs, WBCs: average per hpf * Epithelial cells, crystals, etc., in semiquantitative terms
44
Microscopic Eval RBC's | (normal value, pathology indications)
_Normal_: 0-3 or 5/hpf _Indications_: * Damage to glomerular membrane or vascular injury to GU tract * More cells = more damage
45
Macroscopic vs Microscopic Hematuria
**Macroscopic - **Cloudy, red urine, advanced disease, trauma, acute infection, coagulation disorders **Microscopic - **Clear urine, early glomerular disease, malignancy, strenuous exercise, RENAL CALCULI confirmation
46
Microscopic Eval, WBC's | (normal values, pathology indicatons)
_Normal_: \<5/hpf\* (more in females) _Pathology_: Inc urine WBC = **pyuria** * May enter thru glomerulus, trauma, amoeboid migration * **Report presence of bacteria ** * Infections * cystitis * pyelonephritis * prostatitis * urethritis * Glomerulonephritis * Lupus erythematosus * Interstitial nephritis * Tumors \*high power field
47
Epithelial Cells | (3 types, clinical significance)
1. Squamous 2. Urothelial (transitional) 3. RTE - *most clinically significant* * ​indicate tubular necrosis * fragments indicate severe destruction * some causes * heavy metals * drug toxicity * heomglobin * myoglobin * viral infections * pyelonephritis * transplant rejection * salicylate poisoning
48
Microscopic Urinalysis, Casts
* Incresed concentration of solutes, diminished urinary flow, acid pH * Hyaline * Protein in nature; common in athletes (1-2 nl), fever, glomerulo/pyelonephritis * Granular * Renal disease * Waxy * Renal failure
49
Microscopic Urinalysis, Crystals | (formation, three types c significance)
_Formation_: temperature/solute concentration/pH dependent precipitation of urine solutes * salts * organic compounds * medications _Crystal types_: * Calcium oxalate * most common component of renal calculi * normal finding in lithiases * Liver disease crystals * leucine * tyrosine * bilirubin * Cystine * metabolic disorder
50
Microscopic Urinalysis, Microorganisms | (3)
1. Bacteria 2. Yeast 3. Trichomonas (parasite)

Diagnostic Studies, Unit III (6 decks)

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