Urinalysis Flashcards

1
Q

GFR = best indicator of ___

A

overall renal function

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2
Q

best indicator of overall renal function = ?

A

GFR

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3
Q

GFR can depend on ___

A

hydration status

most of fluid reabs along with proteins to achieve homeostatic balance

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4
Q

3 parts of examining urine

A

1) UA and micro
- visual
- chemical
- microscopic

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5
Q

Urine specimens for urinalysis must be tested within ___

24 hr specimens are ___ for urinalysis testing

A

2 hours of specimen collection

unacceptable

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6
Q

for culture, you need a ___

if antibotic therapy is noted, lab will process with ___

A

midstream clean catch

longer incubation

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7
Q

urine collection for 24 hrs or timed cocmponents

A

1) preservatives

2) adequately pre-hydrate patient

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8
Q

procedure for 24 hr urine collection

A

1) void before begin
2) start collecting
3) exactly 24 hrs void one more time

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9
Q

criteria for specimen evaluation

A

1) label
2) preservative
3) voided v. suprapubic vs. cath
4) first morning void usu

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10
Q

Urinalysis method

A

1) mix specimen
2) observe physiochemical prop
3) perform reagent dipstick
4) centrifuge

automated

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11
Q
visual examination of 24 hour collection 
ddx polyria (> 2000 mL SG
A

1) decr ADH
2) defective renal salt/water reabsorption
3) osmotic diuresis (Diabetes)

1) prerenal, postrenal, or renal

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12
Q

yellow-green brown

orange-red brown

pink-red

dark brown/black

A

1) bile pigments = bilirubin
2) urobilinogen
3) hematuria, hemoglobin, myoglobin, porphyria
4) methemoglobin, rhbdo,

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13
Q

clarity (turbidity)

1) ddx chyluria
2) ddx lipiduria

A

1) lymphatic flow obstruction = filariasis

2) fat globules in nephrotic syndrome, trauma

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14
Q

recommendations for reagent strips

1) check
2) test urine ___
3) urine samples at ___ temp
4) follow exact ___ for each chem test

A

1) check manufacturer’s directions with lot #
2) test urine ASAP
3) urine samples at room temp
4) timing recommendations

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15
Q

define specific gravity

specific gravity measures ___

ddx SG 1.035

A

proportion of dissolved solids per volume (urea, NaCl, sulfate, phosphate)

concentrating ability of kidneys

1) polydipsia, diuretic, diabetes
2) dehydration, diabetes, proteinuria, CHF, addison’s

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16
Q

define osmolality

after dehydration, osmolality …

usu __ in parallel with specific gravity unless ___

A

of particles of solute/volume

incr to 3-4x plasma

incr
glucose/protein

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17
Q

specific gravity > 1.01 suggests…

isothenuria 1.008-1.012 suggest…

A

intact tubular function and PRE-RENAL

renal tubular dysfunction = renal tubular acidosis

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18
Q

hallmark of renal tubular acidosis is..

A

alkaline urine

or with UTI = urea splitting organism (proteus)

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19
Q

definition of proteinuria

normal daily value

ddx proteinuria

A

> 150 mg/dL or btwn 2+ - 3+

postural proteinuria
proteinuria in elderly
nephrotic syndrome
overflow = multiple myeloma

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20
Q

caveats of protein

A

1) dipstick method sensitive to albumin only NOT GLOBULIINS
2) alkaline = falsely low results
3) bence jones = multiple myeloma

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21
Q

glucose is usually ___ in urine

A

undetectable

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22
Q

glucose in kidney caveats
1) filtered by ___ and nearly entirely ___

2) positive in …
3) false positive if ___
4) vitamin C can lead to …
5) copper reduction test

A

1) glomerulus; absorbed
2) diabetes, pregnancy, endocrine, pancreatic
3) collection jar open
4) false negative
5) for reducing sugars in pediatric patients –> TLC

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23
Q

ketones normally ___

positive anytime when ___

A

1) undetectable

2) incr in lipid metabolism (diabetes, alcoholism, cirrhosis, exercise)

24
Q

ddx of ketones

signs of nondiabetic ketonuria

A

diabetic ketonuria

fever, vomiting, cachexia

25
Q

dipstick tests for peroxidase-like activity of hemoglobin ___

hemosiderin present when …
hemosiderin indicates …

A

interference from vitamin C

2-3 days after hemolytic episode
renal tubules catabolize hgb to ferritin and hemosiderin

26
Q

if no RBCs in urine

if free RBCs in urine

if RBC casts in urine

A

free hgb or myoglbin

non-glomerula hematuria

glomerular hematuria
if renal dysfunction –> nephritic syndrome

27
Q

if you see incr urinary bilirubin (dark urine)

if you see incr early urinary bilirrubin or incr later urobilinogen

if see incr urobilinogen

A

obstruction to blood flow

liver damage, hepatitis, cholestasis

hemolysis, hemolytic anemia

28
Q

if nitrate reduced to nitrite

A

indirect test for UTI

29
Q

positive result for nitrite suggests ___ in urine
combine with ___ to definitvely diagnose UTI

negative nitrite test means…

A
gram neg (high specificity) unless container has been open to air 
leukocyte esterase

does not rule out (low sensitivity)

30
Q

___ is an indirect measure of # of neutrophils in urine

A

leukocyte esterase

more sensitive but less specific for UTI (anything that incr leukocyte (vag infection) will incr leukocyte esterase

31
Q

leukocyte esterase has higher ___ but lower ___ for UTI in comparison to nitrite

A

sensitivity

specificity

32
Q

other sources of neutrophils from UA

or esterases

A

vaginal secretions, glomerulonephritis

eosinophils –> false positive

33
Q

3C’s and O of microscopic examination of urine

A

Cells = epithelial, RBC, WBC
Casts = cellular, noncellular
Crystals
Organisms (bacteria)

34
Q

Dysmorphic, distorted RBC suggests… often with ..

Pyuria does not prove ____ indicates ___

renal tubular epith cells indicate

oval fat body indicates

A

glomerular origin
RBC casts

infection, indicates inflammation

renal diseases

nephrotic syndrome

35
Q

Casts are due to ___

A

Tamm-Horsfall protein congealed

36
Q

Hyaline casts are …

A

nonspecific (dehydration, exertion)

37
Q

Waxy casts assoc with …

A

advanced chronic renal failure

38
Q

red cell casts suggest

A

glomerular disease

39
Q

WBC casts suggest

A

inflamm (pyelo, AIN, interstitial nephritis)

40
Q

tubular casts suggest

A

ATN
viral disease
drug exposure

41
Q

granular casts suggest

A

immune complexes

42
Q

fatty casts suggest

A

nephrotic syndrome

43
Q

crystals are very ___

diagnostically significant?

A

common

NO

44
Q

URIC ACID CRYSTALS …

A

chemo

Lesch-nyhan

45
Q

calcium oxalate

A

ethylene glycol toxicity

46
Q

triple phosphate “coffin lids”

A

proteus UTI

47
Q

cystine crystals

A

cystinuria in pediatric

48
Q

RBC can come from ..

dysmorphic RBC sign of disease affect…

A

any point in urinary tract

high in urinary tract (NOT URETER, BLADDER, URETHRA)

49
Q

because it is most concentrated, the ___ is preferred specimen for analysis

A

first morning voided urine

50
Q

some tests require a timed 12-24 hr urine sample but these are not suitable for ___

A

routine urinalysis

51
Q

__ and ___ reflect concentraitng ability of kidneys

A

specific gravity

osmolality

52
Q

after a period of dehydration, the osmolality should be ___ times plasma

A

3-4x

53
Q

proteinuria greater than __ indicates nephrotic syndrome but may be systemic disease

A

> 3.

54
Q

__ seen in diabetic individuals but also in ___

A

ketones

high fever, cachexia, fasting

55
Q

the __ and ___ tests used to help identify UTI

positive results confirmed by ___

A

nitride
leukocyte esterase

microscopic analysis of urine and culture