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Clinical Microscopy > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

Urine Sx for routine screening, requires confirmatory testing based on diet and exercise

A

Random urine sx

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2
Q

Random urine Sx is affected by (2)

A

Diet

Exercise

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3
Q

Urine sx for ruling out orthostatic proteinuria

A

First morning urine

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4
Q

Urine Sx for pregnancy tests

A

First morning urine

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5
Q

Urine Sx for routine screening/confirmatory testing, collected immediately upon arising

A

First morning urine

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6
Q

Urine Sx which requires genital area to be washed, for bacterial cultures

A

Midstream clean catch

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7
Q

Urine sx: void in toilet-collect sx-finish voiding in toilet, for bacterial cultures

A

Midstream clean catch

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8
Q

For bacterial cultures, collected from catheter passed into bladder

A

Catheterized

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9
Q

T/F: if both urinalysis and culture required, perform culture first

A

True

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10
Q

Urine Sx: Px voids into toilet and begins timing, collects all urine during designated period, voids and collects urine at end of period

A

24-hour (timed) urine sx

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11
Q

Urine Sx which can provide quantitative results

A

24-hour (timed) urine sx

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12
Q

Changes in unpreserved urine

A 
Increased:
 pH
 Nitrite
 Bacteria
Decreased: 
 Bilirubin (oxidized to biliverdin)
 Urobiliogen (oxidized to urobilin)
 Glucose (glycolysis)
 Ketones (oxidized)
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13
Q

Normal urine volume

A

600-2000 mL/day

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14
Q

Decreased urine output

A

Oliguria

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15
Q

No urine output

A

Anuria

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16
Q

Increased urine output at night

A

Nocturia

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17
Q

Increased urine output >2.5 L/day

A

Polyuria

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18
Q

Oliguria urine output

A
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19
Q

Polyuria urine output

A

> 2.5 L/day

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20
Q

Increased urine output to excrete excess urine glucose

A

Diabetes mellitus

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21
Q

Increased urine output due to non-func insulin

A

Diabetes mellitus

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22
Q

Increased urine output caused by lack or dysfunctional anti-diuretic hormone

A

Diabetes insipidus

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23
Q

Results in polydipsia

A

Polyuria

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24
Q

Polyuria may be caused by (3)

A

Diabetes mellitus
Diabetes insipidus
Polydipsia

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25
Q

Normal color of urine

A

Yellow

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26
Q

Shades of yellow of urine are based on

A

Fluid consumption

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27
Q

T/F: Shades of yellow of urine are based on fluid consumption

A

True

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28
Q

Shades of yellow of urine vary from

A

Pale yellow (dilute) to dark yellow (concentrated)

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29
Q

Urine clarity terminology (5)

A 
Clear
Hazy
Cloudy
Turbid
Milky
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30
Q

T/F: Freshly voided normal urine is clear

A

True

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31
Q

Appearance of freshly voided normal urine

A

Clear

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32
Q

Appearance of refrigerated normal urine (2)

-also describe and explain each

A

A. White turbidity in urine
-w/ alkaline pH from amorphous phosphates and carbonates
B. Pink turbidity in urine
-w/ acidic pH from amorphous urates

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33
Q

T/F: white turbidity in urine may indicate presence of amorphous phosphates and carbonates

A

True

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34
Q

White turbidity in urine may indicate presence of

A

amorphous phosphates and carbonates

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35
Q

pH and color (of turbidity) of urine with amorphous phosphates and carbonates

A

Alkaline, white

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36
Q

T/F: pink turbidity in urine may indicate presence of amorphous urates

A

True

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37
Q

pink turbidity in urine may indicate presence of

A

amorphous urates

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38
Q

pH and color (of turbidity) of urine with amorphous urates

A

Acidic, pink

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39
Q

Non-pathologic causes of turbidity in urine (7)

A 
Powder and creams
Semen
Feces
Amorphous phosphates, carbonates, and urates
Radiographic contrast media
Mucus
Squamous epithelial cells
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40
Q

Pathologic causes of turbidity in urine ((6)

A 
RBCs
Abnormal crystals
Urothelial and renal tubular epithelial cells
Lipids (milky)
WBCs
Yeasts
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41
Q

Causes tribe clarity to appear milky

A

Lipids

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42
Q

Cause orange colored urine (2)

-describe also

A

A. Bilirubin
-produces yellow foam when shaken; abnormal liver func
B. Pyridium
-produces thick orange pigment which may interfere with reagent strip tests

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43
Q

Cause red colored urine (4)

-describe also

A

A. RBCs
-cloudy urine, + test for blood, microscopic: rbcs
B. Hemoglobinuria
-clear urine, + test for blood
C. Myoglobinuria
-clear urine, + test for blood, needs further testing
D. Prophyrins
- (-) test for blood, needs further testing

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44
Q

Cause black colored urine (2)

A

A. Oxidized RBCs, denature Hb
-clear urine, + test for blood
B. Melanin
-darkens upon standing

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45
Q

Screening test for renal tubular reabsorption of essential elements filtered by glomerulus

A

Specific gravity

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46
Q

Specific gravity is a ___ test for renal tubular ___ of essential elements filtered by ____

A

Screening test for renal tubular reabsorption of essential elements filtered by glomerulus

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47
Q

Glomerular filtrate specific gravity

A

1.010

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48
Q

T/F: Glomerular filtrate specific gravity is 1.010

A

True

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49
Q

It is the comparison of density of urine to that of d. H20

A

Specific gravity

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50
Q

Urine contains dissolved subs that produce density based on (2)

A

Size

Number

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51
Q

Used to measure specific gravity (3)

A

Reagent strip
Refractometer
Osmolarity (harmonic oscillation density)

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52
Q

Primary test for routine urinalysis

A

Reagent strip

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53
Q

T/F: Reagent strip is the primary test for routine urinalysis

A

True

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54
Q

Reagent strip is the __ test for ___ urinalysis

A

Primary, routine

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55
Q

Principle of reagent strip for determination of specific gravity

A

The # of hydrogen ions in a polyelectrolyte (pKa) is proportional to the # of ions in urine

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56
Q

T/F: reagent strip test for sp grav: The # of hydrogen ions in a polyelectrolyte (pKa) is proportional to the # of ions in urine

A

True

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57
Q

T/F: increased urine conc = increased hydrogenated released = low pH (acidic)

A

True

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58
Q

increased urine conc = ____ hydrogenated released = ___ pH ( )

A

increased urine conc = increased hydrogenated released = low pH (acidic)

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59
Q

Indicator on reagent strip for specific gravity

-also color range

A

Bromothymol blue

-yellow-green (acidic) to green-blue (alkaline)

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60
Q

Uses a prism to direct wavelength of light thru urine; light angle read on scale calibrated with d H20

A

Refractometer

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61
Q

Principle of refractometer

A

The concentration of dissolved subs in soln directs the velocity and angle of light passing thru soln

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62
Q

Refractometer uses a ___ to direct ___ of light thru the urine

A

Prism, wavelength

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63
Q

Measurement of the number of particles into which 1g molec wt of subs dissociates

A

Osmolarity

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64
Q

Osmolarity measures only

A

of particles (size not relevant)

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65
Q

T/F: Osmolarity is considered more representative of renal concentrating ability than sp grav because meas only # of particles and their size is not relevant

A

True

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66
Q

considered more representative of renal concentrating ability than sp grav because meas only # of particles and their size is not relevant

A

Osmolarity

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67
Q

Osmolarity is considered more representative of ___ than sp grav because meas only # of particles and their size is not relevant

A

Renal concentrating ability

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68
Q

Unit for reporting osmolarity

A

mOsm (milliosmoles)

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69
Q

Colligative properties meas in clin lab (2)

-describe each also

A

A. Freezing point depression
- 1 mole of NON-ionizing subs will LOWER freezing pt by 1.86。C
-volatile subs like alcohol can interfere
B. Vapor pressure depression
- actual measurement is dew point of urine
-uses microsamples on filter paper discs
-NO interference from volatile subs

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70
Q

T/F: in freezing point depression: 1 mole of NON-ionizing subs will LOWER freezing pt by 1.86。C

A

True

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71
Q

T/F: in freezing point depression:

volatile subs like alcohol can interfere

A

True

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72
Q

1 mole of NON-ionizing subs will LOWER freezing pt by __ 。C

A

1.86 。C

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73
Q

Temp at which vapor condenses to liq

A

Dew point

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74
Q

A Colligative property whose

actual measurement is dew point of urine

A

Vapor pressure depression

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75
Q

T/F: Vapor pressure depression: NO interference from volatile subs

A

True

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76
Q

Colligative property which uses microsamples on filter paper discs

A

Vapor pressure depression

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77
Q

Normal serum osmolarity

A

275-300 mOsm

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78
Q

T/F: normal serum osmolarity is 275-300 mOsm

A

True

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79
Q

T/F: fluid intake influences urine osmolarity

A

True

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80
Q

Influences urine osmolarity

A

Fluid intake

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81
Q

random serum to urine ratio =

A

1:1

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82
Q

Serum to urine ratio for controlled fluid intake

A

3:1

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83
Q

Clin sig of osmolarity

A

To determine ADH production or tubular response to ADH for diabetes insipidus

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84
Q

Used to determine ADH production or tubular response to ADH for diabetes insipidus

A

Osmolarity

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85
Q

Harmonic oscillation density is for

A

Osmolarity

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86
Q

an automated instrumentation passes a sound wave thru urine and records change in freq of sound wave, which is proportional to urine density

A

Harmonic oscillation density

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87
Q

Harmonic oscillation density principle

A

Change in freq of sound wave is proportional to urine density

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88
Q

Low specific gravity = __ pH

A

Alkaline

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89
Q

High specific gravity = __ pH

A

Acidic

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90
Q

Specific gravity is ___ to pH

A

Inversely proportional

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91
Q

Reagent strips: care and quality control (7)

A

Don’t refrigerate (RT

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92
Q

Reagent strips: technique (6)

A

Thoroughly mix sx (detect rbcs and WBC’s)
Warm refrigerated sx (enzyme rxns)
Briefly dip strip (prevent leaching out of rgt from strip)
Blot strip (prevent runover)
Observe timing instructions (rxn color change)
Relate chemical with physical and microscopic results

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93
Q

T/F: urine pH doesn’t reach 9.0

A

True

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94
Q

A reading of pH 9.0 indicates a ___ and should be ___

A

Old sx, recollected

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95
Q

Normal value of urine pH

A

4.5-8.0

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96
Q

Reagent strip principle for pH

A

Double indicator (methyl red and bromothymol blue)

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97
Q

Clin sig of urine pH measurement (2)

A

Detect acid-base disorders

ID of urinary crystals

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98
Q

Used to detect acid-base disorders

A

Urine pH

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99
Q

Used to identify urinary crystals

A

Urine pH

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100
Q

Urine pH test sources of error

2) and test correlations (3

A 
A. Old sx (+)
    Runover from adjacent strips
B. Nitrite
    Leukocyte esterase
    Microscopic
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101
Q

Urine protein: reagent strips measure primarily __

A

Albumin

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102
Q

NV of urine protein

A
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103
Q

Urine protein with 30 mg/dL or greater is considered

A

Clinical proteinuria

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104
Q

Clinical protein urea is considered when urine protein reaches

A

30 mg/dL or greater

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105
Q

T/F: Clinical protein urea is considered when urine protein reaches 30 mg/dL or greater

A

True

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106
Q

Urine protein: reagent strip principle

A

Protein error of indicators

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107
Q

Clin sig of meas urine protein (2)

A

Clinically significant proteinuria is primarily caused by glomerular or tubular disorders
Benign orthostatic proteinuria testing requires a first morning sx and a sx after Px has been active for 2 hrs. First sx should be neg while 2nd is positive

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108
Q

Requires different reagent strip capable of testing for only albumin at levels below 10 mg/dL

A

Microalbuminuria

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109
Q

Provides early detection of renal disease, especially in patients with diabetes

A

Microalbuminuria

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110
Q

Reagent strip which tests for albumin and creatinine, along with other routine strip tests, EXCEPT urobilinogen

A

Multistix PRO 11

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111
Q

Multistix PRO 11 reagent strip tests for

______, EXCEPT ___

A

Albumin and creatinine, along with other routine strip tests

Except urobilinogen

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112
Q

Multistix PRO 11 doesn’t test for this

A

Urobilinogen

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113
Q

Corrects hydration in a random sample to provide an estimate of the 24-hr microalbumin level

A

Albumin-to-creatinine ratio

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114
Q

Albumin-to-___ ratio corrects for ___ in a ___ urine sample to provide an estimate of the ____

A

Albumin-to-creatinine ratio corrects hydration in a random sample to provide an estimate of the 24-hr microalbumin level

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115
Q

Reagent strip: protein:
A. Sources of error (6)
B. Test correlations (4)

A 
A. Pyridium (+)
    High sp grav (+)
    Detergents (+)
    Chlorhexidine (+)
    Highly buffered alkaline urine (+)
    Microalbuminuria (-)
B. Blood
    Leukocyte esterase
    Microscopic
    Nitrites
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116
Q

Glucose: reagent strip principle

A

Glucose oxidase test (specific for glucose)

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117
Q

T/F: glucose oxidase test is specific for glucose

A

True

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118
Q

Renal threshold for glucose

A

160-180 mg/dL

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119
Q

Clin sig of measuring urine glucose (3)

A

Diabetes mellitus, gestational diabetes (placental hormones blocking insulin)
Hormonal disorders and stress block insulin production and action
Renal tubular disorders prevent tubular reabsorption of glucose

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120
Q

Glucose: clinitest principle

A

Reducing substances including glucose and other sugars can reduce copper sulfate (blue-green) to cuprous oxide (orange-red)

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121
Q

Color of copper sulfate in clinitest

A

Blue-green

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122
Q

Color of cuprous oxide in clinitest

A

Orange-red

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123
Q

May be used to test newborn urine for galactose

A

Clinitest

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124
Q

Clinitest may be used to test newborn urine for ___

A

Galactose

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125
Q

Reagent strip: glucose:
A. Sources of error (5)
B. Tests correlation (2)

A 
A. Oxidizing agent (+)
    Low temp (-)
    Increased ascorbic acid (+)
    Detergents (+)
    Old sx (-)
B. Protein
    Ketones
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126
Q

Intermediate metabolites of fat, acetoacetic acid, acetone, and beta-hydroxybutyric acid

A

Ketones

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127
Q

Ketones are ___ metabolites of __, __, __, and __

A 
Intermediate metabolites of
Fats
Acetoacetic acid
Acetone
Beta-hydroxybutyric acid
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128
Q

Ketones: reagent strip principle

A

Reaction of acetoacetic acid or acetone (with glycine) with sodium nitroprusside/ ferricyanide

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129
Q

clin sig of measuring ketones in urine (5)

A 
Malabsorption
Diabetes mellitus
Insulin therapy monitoring
Starvation
CHO loss
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130
Q

Reagent strip: ketones:
A. Sources of error (4)
B. Test correlations (1)

A 
A. Red urine (+)
    Old sx (-)
    Levodopa (+)
    Sulfhydryl medications (+)
B. Glucose
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131
Q

Blood: reagent strip: (+) reactions seen with (3)

A

Hematuria
Hemoglobinuria
Myoblobinuria

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132
Q

Blood: reagent strip principle

A

Pseudoperoxidase activity of Hb

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133
Q

T/F: Hb has pseudoperoxidase activity

A

True

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134
Q

Clin sig of detecting blood in urine sx

A

Hemoglobinuria and myoglobinuria can cause acute renal failure

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135
Q

T/F: Hemoglobinuria and myoglobinuria can cause acute renal failure

A

True

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136
Q

Bleeding within genitourinary system, including pyelonephritis, renal calculi, anticoagulants, glomerulonephritis, trauma

A

Hematuria

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137
Q

Hematuria is bleeding within genitourinary system, including (5)

A 
pyelonephritis
renal calculi
anticoagulants
glomerulonephritis
trauma
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138
Q

Intravascular hemolysis/ transfusion reactions, lysis of old RBCs by dilute alkaline urine

A

Hemoglobinuria

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139
Q

Rhabdomyolysis caused by prolonged coma, cholesterol statin drugs, muscle-wasting disorders, crush injuries

A

Myoglobinuria

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140
Q

Myoglobinuria is rhabdomyolysis caused by (4)

A

prolonged coma
cholesterol statin drugs
muscle-wasting disorders
crush injuries

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141
Q

Reagent strip: blood:
A. Sources of error (7)
B. Test correlations (2)

A 
A. Unmixed Sx (-)
    Crenated RBCs (-)
    Oxidizing agents (+)
    Menstrual contamination  (+)
    Bacterial peroxidases  (+)
    Increased ascorbic acid (-)
    Increased nitrite (-)
B. Color
    Microscopic
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142
Q

T/F: both bilirubin and urobilinogen are products of Hb degradation

A

True

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143
Q

Bilirubin: reagent strip principle

A

Disco reaction

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144
Q

Clin sig of detecting bilirubin in urine

A

Conj bilirubin enters the urine due to leakage of damaged liver or blocked bile duct

  • kidneys can’t filter unconj bilirubin
  • Px appears jaundiced
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145
Q

Trace the pathway of processing bilirubin and urobilinogen

A

RBCs- Hb- protoporphyrin- unconj bili- blood- liver- conj bilirubin- bile duct- intestine- stercobilinigen- urobilin- feces

Intestine may produce urobilinogen
Intestine- urobilinogen- blood- liver- bile duct- intestine- feces

Urobilinogen from intes may also travel from blood to kidney
Intestine- urobilinogen- blood- kidney

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146
Q

Bilirubin: reagent strip
A. Sources of error (6)
B. Test correlations

A 
A.  
Pyridium (+)
 Indican (+)
 Lodine (+)
 Increased ascorbic acid (-)
 Increased nitrite (-)
 Sx exposed to light (-)
B. Urobilinogen
    Color
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147
Q

T/F: some of conj bilirubin is converted to urobilinogen in the intestine

A

True

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148
Q

Organ where some of conj bilirubin is converted to urobilinogen

A

Intestine

149
Q

Amount of urobilinogen normally found in urine

A

1mg/dL

150
Q

Urobilinogen: principle
A. Multistix
B. Chemstrip

A

A. Multistix: Ehrlich’s reaction

B. Chemstrip: Diazo reaction

151
Q

Clin sig of meas urobilinogen in urine (3)

A

Early detection of liver disease and hemolytic disorders, constipation

152
Q

Urobilinogen: reagent strip
A. sources of error (10)
B. Test correlations (1)

A 
A. 
Highly pigmented urine (+)
Increased nitrates (-)
Multistix
Ehrlich's reactive compounds (+)
Chemstrip
Highly pigmented urine (+)
Old Sx (-)
Porphobilinogen (+)
Preservation in formalin (-)
Preservation in formalin (-)
B. 
 Bilirubin
153
Q

Detects presence of reductase-producing bacteria that can convert urinary nitrate to nitrite

A

Nitrite test (reagent strip)

154
Q

Nitrite test (reagent strip) principle

A

Diazo reaction

155
Q

Clin sig of detecting nitrite in urine

A

Early detection of UTI

156
Q

T/F: a + nitrite test should be accompanied by + leukocyte esterase test

A

True

157
Q

T/F: nitrite may be used to screen Sx for microbiology terming

A

True

158
Q

Nitrite: rgt strip
A. sources of error (8)
B. Test correlations (3)

A 
A. 
 Non-reductase-containing bacteria (-)
 Increased bacteria converting nitrite to nitrogen (-)
 No urinary nitrate (-)
 Early infection (-)
 Old Sx (+)
 High sp grav (no indication if + or -)
 Antibiotics
 Increased ascorbic acid (-)
 Highly pigmented urine (+)
B. 
 Leukocytes
 Microscopic
 Protein
159
Q

Detects presence of granulocytuc WBCs, including used WBCs

A

Leukocyte esterase

160
Q

T/F: leukocyte esterase detects presence of granulocytuc WBCs, including used WBCs

A

True

161
Q

Leukocyte esterase: rgt strip principle

A

Diazo rxn

162
Q

T/F: Leukocyte esterase rgt strip SHOULD be read 2 mins AFTER urine exposure

A

True

163
Q

Clin sig of leukocyte esterase test (3)

A

UTI, including with non-reductase-containing bacteria, parasitic and fungal organisms which yield neg nitrite test

164
Q

Leukocyte esterase: rgt strip:
A. sources of error (8)
B. Test correlation (3)

A 
A. 
 Oxidizing agents (+)
 Formalin (+)
 High protein and glucose (-)
 Increased ascorbic acid (-)
 Nitrofuration (+)
 Antibiotics (-)
 Highly pigmented urine (+)
 Inaccurate timing (-) **
B. 
 Nitrite
 Microscopic
 Protein
165
Q

Specific gravity: rgt strip:
A. sources of error
B. Test correlations

A 
A. 
 Increased protein (+)
 Highly alkaline urine (-)
 Add 0.005 to any urine with pH 6.5 or higher
B. 
 None
166
Q

Types of common urine Sx (5)

A 
Random 
First morning
Midstream clean catch
Catheterized
24-hour (timed)
167
Q

Control ability of kidney to clear waste products and maintain body’s water and electrolyte balance

A

Nephrons

168
Q

2 types of nephrons

-describe each

A

Cortical nephron
- in cortex of kidney; remove waste products and reabsorption nutrients
Juxtaglomerular nephron
- extend into the medulla; concentrate the urine

169
Q

Nephron found in cortex of kidney; remove waste products and reabsorption nutrients

A

Cortical nephron

170
Q

Nephron which extend into the medulla; concentrate the urine

A

Juxtaglomerular nephron

171
Q

Func of cortical nephron (2)

A

Remove waste

Reabsorption nutrients

172
Q

Func of Juxtaglomerular nephron

A

Concentrate the urine

173
Q

Trace the renal blood flow

A

Renal artery- afferent arteriole- efferent arteriole- proximal convoluted tubule capillaries- vasa recta/ loop of Henle- distal convoluted tubule capillaries- renal vein

174
Q

Normal renal blood flow

A

Approx 1200 mL/min

175
Q

Normal plasma flow

A

Approx 600-700 mL/min

176
Q

Non-selective filtration of plasma subs with MWs

A

Glomerular filtration

177
Q

MW of albumin

A

67,000 Da

178
Q

Controls filtration pressure

A

Renin-angiotensin-aldosterone system (RAAS)

179
Q

Trace RAAS

A

Find in book p 166 elsevier

180
Q

Renal tubular reabsorption:
Passive transport reabsorbs (2)
Active transport reabsorbs (4)

A 
Passive transport reabsorbs (2)
   Urea, water
Active transport reabsorbs (4)
   Glucose
   Amino acids
   Chloride
   Sodium
181
Q

Renal tubular concentration occurs in (2)

A

Ascending and descending loops of Henle

182
Q

Occurs in ascending and descending loops of Henle

A

Renal tubular concentration

183
Q

Removes non-filtered waste products from blood to the filtrate and maintains acid-base balance in body

A

Renal tubular secretion

184
Q

Renal tubular secretion is for (2)

A

Removing non-filtered waste products from blood to the filtrate and maintaining acid-base balance in body

185
Q

T/F: subs like medications are bound to plasma carrier proteins and are too large to be filtered

A

True

186
Q

T/F: medications bound to carrier proteins dissociate from them in the tubules and are then secreted into the filtrate

A

True

187
Q

T/F: small hydrogen molecules are easily filtered and must be returned to the blood

A

True

188
Q

Small hydrogen molecules combo with __ or __ secreted by ___ and are secreted back to the blood

A

phosphate ions or ammonia secreted by renal tubular cells

189
Q

T/F: Small hydrogen molecules combo with phosphate ions or ammonia secreted by renal tubular cells and are secreted back to the blood

A

True

190
Q

T/F: Small bicarbonate ions (HCO3-) are needed for the acid-base buffering system

A

True

191
Q

Small bicarbonate ions (HCO3-) are needed in this system

A

acid-base buffering system

192
Q

T/F: small bicarbonate ions (HCO3-) are easily filtered

A

True

193
Q

small bicarbonate ions (HCO3-) combo with __, producing __ that can be secreted back to blood

A

Hydrogen molecules

Bicarbonate (H2CO3)

194
Q

GFR normal value

A

120 mL/min

195
Q

Classic test for GFR

A

Creatinine clearance test

196
Q

Creatinine clearance test requires this kind of urine

A

Timed (24-hr) urine

197
Q

T/F: calculated GFR estimates (eGFR) doesn’t require a timed urine Sx

A

True

198
Q

Small molec produced at constant rate by ALL nucleated cells

A

Cystatin C

199
Q

T/F: Cystatin C is produced at CONSTANT rate by ALL nucleated cells

A

True

200
Q

T/F: Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by renal tubular cells

A

True

201
Q

Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by

A

Renal tubular cells

202
Q

Primary tests for renal tubular reabsorption

A

Serum and urine osmolarity

203
Q

Serum and urine osmolarity are primary tests for

A

Renal tubular reabsorption

204
Q

Meas ability of kidneys to respond to body’s hydration

A

Free water clearance test

205
Q

Creatinine clearance formula

A

C= (UxV)/P

206
Q

Free water clearance test formula

A

Cosm= [(Uosm)x(V)]/Posm

207
Q

Tubular secretion tests (2)

-describe each

A

Titratable acidity
-detects inability of proximal convoluted tubules to secrete hydrogen molecules
Urinary ammonia
-detects inability of proximal and distal convoluted tubules to produce ammonia

208
Q

Tubular secretion test which detects inability of proximal convoluted tubules to secrete hydrogen molecules

A

Titratable acidity

209
Q

Tubular secretion test which detects inability of proximal and distal convoluted tubules to produce ammonia

A

Urinary ammonia

210
Q

Enumerate rxn pads on rgt strip (in order) (10)

A
  1. Glucose
  2. Bilirubin
  3. Ketone
  4. Sp grav
  5. Blood
  6. pH
  7. Protein
  8. Urobilinogen
  9. Nitrite
  10. Leukocyte esterase
211
Q

Glomerular disorders due to post-streptococcal infection

A

Acute glomerulonephritis

212
Q

Enumerate glomerular disorders (10)

A 
A. Acute glomerulonephritis 
B. Goodpasture's syndrome
C. Wegner's granulomatosis
D. Henoch-Schönlein purpura
E. Membranous glomerulonephritis
F. Chronic glomerulonephritis
G. IgA nephropathy
H. Nephrotic syndrome
I. Minimal change disease
J. Focal segmental glomerulosclerosis
213
Q

Tubular disorders enumerate (3)

A

K. Acute tubular necrosis
L. Fanconi’s syndrome
M. Renal glycosuria

214
Q

Enumerate tubulointerstitial disorders (5)

A 
N. Cystitis
O. Acute pyelonephritis 
P. Chronic pyelonephritis 
Q. Acute interstitial nephritis
R. Renal lithiasis (calculi)
215
Q

Glomerular disorder which exhibits anti-glomerular basement membrane antibodies

A

Goodpasture’s syndrome

216
Q

Glomerular disorder which exhibits antineutrophil cytoplasmic antibody

A

Wegner’s granulomatosis

217
Q

Glomerular disorder primarily seen in children after respiratory infection

A

Henoch-Schönlein purpura

218
Q

Glomerular disorder which caused by autoimmune disorders

A

Membranous glomerulonephritis

219
Q

Glomerular disorder due to progression from previous disorders

A

Chronic glomerulonephritis

220
Q

Immune IgA complexes deposited in glomerular membrane

A

IgA nephropathy

221
Q

Circulatory disruption decreasing blood flow to kidney, increased serum lipids

A

Nephrotic syndrome

222
Q

Glomerular disorder seen in children after allergic reactions, heavy edema, good prognosis

A

Minimal change disease

223
Q

Glomerular disorder due to drugs of abuse and HIV

A

Focal segmental glomerulosclerosis

224
Q

Tubular disorders which may be due to hemoglobinuria, myoglobinuria, antibiotics

A

Acute tubular necrosis

225
Q

General failure of tubular reabsorption

A

Fanconi’s syndrome

226
Q

Failure of active transport of only glucose

A

Renal glycosuria

227
Q

Bladder infection; a tubulointerstitial disorder

A

Cystitis

228
Q

Tubular infection indicated by WBC casts

A

Acute pyelonephritis

229
Q

Structural abnormalities that affect normal tubular emptying, often in children

A

Acute interstitial nephritis

230
Q

Tubulointerstitial disorder which exhibits urine eosinophils, no bacteria, reaction to toxic medications

A

Acute interstitial nephritis

231
Q

Patient with severe back pain; pH varies with type of calculi

A

Renal lithiasis (calculi)

232
Q

Casts are composed of ____ aka ____ excreted by ____

A

Tamm-Horsefall protein, uromodulin

Renal tubular epithelial cells

233
Q

Composed of Tamm-Horsfall (uromodulin) protein

A

Casts

234
Q

Tamm-Horsfall protein aka

A

Uromodulin

235
Q

Uromodulin aka

A

Tamm-Horsfall protein

236
Q

Casts: when other urinary constituents are present, they are found in ___ or
___

A

Enmeshed in cast matrix or attached to cast matrix

237
Q

Where are casts formed

A

Distal convoluted tubules and collecting ducts (wider casts)

238
Q

Wider casts are formed in

A

Collecting ducts

239
Q

Casts are reported as

A

/LPF

240
Q

Colorless cast

A

Hyaline cast

241
Q

Hyaline casts:
A. sources of error (3)
B. Clin sig (5)

A 
A. 
Mucus
Increased light
Fibers
B. 
Congestive heart failure
Pyelonephritis
Exercise
Glomerulonephritis 
Stress
242
Q

RBC casts:
A. Appearance
B. Clin sig

A

A. Orange/red-containing RBCs

B. Glomerulonephritis, strenuous exercise

243
Q

WBC casts: clin sig

A

Pyelonephritis, acute interstitial nephritis

244
Q

RTE cells attached to cast matrix

A

Epithelial cell cast

245
Q

Epithelial cell cast:
A. Source of error
B. Clin sig

A

A. WBC casts

B. Renal tubular damage

246
Q

Bacterial casts:
A. Source of error
B. Clin sig

A

A. Granular casts

B. Pyelonephritis

247
Q

Granular casts:
A. Sources of error (2)
B. Clin sig (4)

A

A. Clumps of small crystals, columnar RTE cells

B. Glomerulonephritis, pyelonephritis, stress, exercise

248
Q

Highly refractive casts with jagged edges and notches

A

Waxy casts

249
Q

Waxy casts:
A. Sources of error (2)
B. Clin sig (2)

A

A. Fibers, fecal material

B. Stasis of urine flow, chronic renal failure

250
Q

Casts with fat droplets and oval fat bodies attached to cast matrix

A

Fatty casts

251
Q

Fatty casts:
A. Source of error
B. Clin sig

A

A. Fecal material

B. Nephrotic syndrome, DM, crush injuries

252
Q

Wider than normal casts

A

Broad casts

253
Q

Broad casts:
A. Sources of error (2)
B. Clin sig (2)

A

A. Fiber, fecal material

B. Extreme urine stasis, renal failure

254
Q

Small non-nucleated discs

A

RBCs

255
Q

RBC appearance on concentrated urine

A

Crenated

256
Q

RBC appearance on dilute urine

A

Larger empty cells (ghost cells)

257
Q

RBCs: regular (dysmorphic) shapes indicate

A

Glomerular bleeding

258
Q

RBC shape which indicate glomerular bleeding

A

Regular (dysmorphic) shapes

259
Q

RBC:
A. Sources of error (3)
B. Clin sig (4)

A 
A. 
Oil droplets
Air bubbles
Yeast cells
B. 
Renal calculi
Bleeding in urinary tract
Glomerulonephritis
Malignancy
260
Q

RBC: urinalysis correlations:

A clear red urine w/ + rgt strip for blood and no RBCs seen in microscope indicates (2)

A

Hemoglobinuria

Myoglobinuria

261
Q

Larger than RBCs and contain nucleus

A

WBCs

262
Q

WBC with multilevel nuclei and granules

A

Neutrophils

263
Q

WBC stained with Wright or Hansel stain

A

Eosinophil

264
Q

Eosinophil granules stained with Wright or Handel stain

A

Red

265
Q

Stains for Eosinophil

A

Wright

Hansel

266
Q

Neutrophils that have swollen in dilute urine, resulting in Brownian movement of granules in cytoplasm

A

Glitter cells

267
Q

Glitter cells are __ that have ___ in dilute urine, resulting in ___ movement of ___ in cytoplasm

A

Glitter cells are neutrophils that have swollen in dilute urine, resulting in Brownian movement of granules in cytoplasm

268
Q

WBC:
A. sources of error (3)
B. Urinalysis correlations (4)
C. Clin sig (3)

A 
A. 
Monocytes
RTE cells
mononuclear lymphocytes 
B. 
Sp grav
pH
nitrite
leukocyte esterase
C. 
Malignancy (mononuclear cells)
UTI (neutrophils)
Drug-induced interstitial nephritis (eosinophils)
269
Q

WBC seen in UTIs

A

Neutrophil

270
Q

WBC seen in drug-induced interstitial nephritis

A

Eosinophil

271
Q

WBC seen in malignancy

A

Mononuclear cells

272
Q

3 types of epithelial cells

A

Squamous epithelial cells
Transitional (urothelial) cells
RTE cells

273
Q

Largest cells in urine sediment

A

Squamous epithelial cells

274
Q

Represent normal sloughing of old lower genitourinary tract cells

A

Squamous epithelial cells

275
Q

T/F: squamous ep cells represent normal sloughing of old lower genitourinary tract cells

A

True

276
Q

Squamous ep cells represent normal __ of old __ genitourinary tract cells

A

Sloughing

Lower

277
Q

T/F: Folded squamous cells may resemble urinary casts

A

True

278
Q

Differentiates folded sq ep cells from urinary casts

A

With centrally-located nucleus

279
Q

Squamous cells covered with Gardnerella vaginalis, indicating a vaginal infection

A

Clue cells

280
Q

Clue cells are squamous cells covered with this bacteria, indicating a vaginal infection

A

Gardnerella vaginalis

281
Q

Transitional (urothelial) cells are found in (4)

A

Renal pelvis
Ureters
Bladder
Male urethra

282
Q

Epithelial cells normally seen after catheterization procedures

A

Transitional (urothelial) cells

283
Q

T/F: Transitional (urothelial) cells are normally seen after catheterization procedures

A

True

284
Q

3 dif forms of transitional (urothelial) cells

A

Spherical
Caudate
Polyhedral

285
Q

Transitional (urothelial) cell form which resembles renal tubular cells, except has centrally-located nucleus

A

Spherical

286
Q

Increased transitional cells may indicate

A

Malignancy

287
Q

RTE cells are found in (2)

A

Renal tubules

Collecting ducts

288
Q

T/F: RTE cell shape varies with location

A

True

289
Q

Rectangular with coarse granules and may resemble a cast (look for a nucleus)

A

Convoluted tubule cells

290
Q 
Convoluted tubule cells:
Shape-
Kind of granules-
Resemble this urinary sediment-
Differentiated from this urinary sediment-
A

Shape- rectangular
Kind of granules- coarse
Resemble this urinary sediment- cast
Differentiated from this urinary sediment- presence of nucleus

291
Q

Small and round, may resemble spherical transitional cells but have eccentric nucleus

A

Distal convoluted tubule cells

292
Q

Based on nucleus: Distal convoluted tubule cells vs. spherical transitional (urothelial) cells

A

Distal convoluted tubule cells
-eccentric nucleus
Spherical transitional (urothelial) cells
-centrally-located nucleus

293
Q

Cuboidal RTE cells with at least 1 straight edge and freq in clumps

A

Cells from collecting duct

294
Q

Cells from collecting duct are __ in shape RTE cells with at least __(#) __ edges and freq in clumps

A

Cuboidal

At least 1 straight edge

295
Q

T/F: more than 2 RTE cells per HPF is considered significant

A

True

296
Q

of RTE cells in HPF to be considered significant

A

> 2

297
Q

Clin sig of RTE cells (1)

A

Tubular necrosis, often from poisoning or viral infections

298
Q

Func of RTE cells

A

Absorb filtrate

299
Q

Bilirubin-stained RTE cells may indicate

A

Liver damage

300
Q

T/F: RTE cells may be bilirubin-stained (liver damage), contain hemosiderin granules (Hb) or lipids

A

True

301
Q

RTE cells that have absorbed lipids

A

Oval fat bodies

302
Q

T/F: oval fat bodies are highly refractile

A

True

303
Q

Oval fat bodies are seen in conjunction with

A

Free-floating lipids

304
Q

Oval fat bodies are RTE cells that have absorbed

A

Lipids

305
Q

Oval fat bodies confirmed by (3)

A

Staining with oil red O, Sudan III, or polarized microscope

306
Q

Clin sig of detecting oval fat bodies (3)

A

Nephrotic syndrome
DM
crush injuries

307
Q

Small spheres (cocci) and rod-shaped organisms

A

Bacteria

308
Q

Bacteria in urine should be accompanied by

A

WBCs

309
Q

Bacteria:
A. source of errors (3)
B. Clin sig

A

A. Amorphous phosphates, urates, old sx with high pH
B.
UTI

310
Q

Oval struc with buds or mycelia

A

Yeast

311
Q

Yeasts in urine should be accompanied by

A

WBCs

312
Q

Associated with acidic urine from Px w/ diabetes mellitus

A

Yeast

313
Q

Yeast is associated with __ urine from Px with __

A

Acidic

diabetes mellitus

314
Q

Yeast:
A. Source of error
B. Clin sig (3)

A 
A. RBCs 
B. 
Diabetes mellitus 
Immunocompromised Px
Vaginal infections
315
Q

Most common parasite in urine, exhibits flagellar movement in wet prep

A

Trichomonas vaginalis

316
Q

Common parasites in urine (3)

A 
Trichomonas vaginalis
Enterobium vermicularis (fecal contamination)
Schistosoma haematobium (urine parasite)
317
Q

Trichomonas vaginalis exhibits __ movement in wet prep

A

Flagellar movement

318
Q

Parasites:
A. Sources of error (2)
B. Clin sig

A

A. WBC, RTE cells

B. Sexually transmitted disease which is asymptomatic in males and causes vaginal infection in females

319
Q

Strands of protein secreted by glands and RTE cells

A

Mucus

320
Q

Mucus are strands of protein secreted by (2)

A

Glands

RTE cells

321
Q

Major protein in mucus

A

Tamm-Horsfall (uromodulin) protein

322
Q

Mucus: sources of error (2)

A

Clumps may resemble hyaline casts (look for the consistent shape of cast to differentiate)

323
Q

How to differentiate mucus from hyaline cast

A

look for the consistent shape of cast to differentiate

324
Q

T/F: mucus is of no clin importance

A

True

325
Q

Produced by the precipitation of urine solute affected by temp, solute conc, and pH

A

Crystals

326
Q

Crystal formation in urine is affected by (3)

A

Temp
Solute conc
pH

327
Q

T/F: crystals are more abundant in refrigerated urine sx

A

True

328
Q

Kind of microscopy which aids in crystal ID

A

Polarized microscopy

329
Q

Abnormal crystals are found only in (2)

A

Acidic and normal urine

330
Q

T/F: Abnormal crystals are found only in acidic and normal urine

A

True

331
Q

Normal crystals seen in acidic urine (3)

A

Amorphous urates
Calcium oxalate crystals
Utica acid crystals

332
Q

Uric acid crystals: appearance

A

Yellow-brown, flat-sided rhombic plates, wedges, or rosettes

333
Q

Uric acid crystals: sources of error

A

Cystine crystals

334
Q

How to differentiate uric acid crystals from cystine crystals

A

Uric acid crystals polarize while cystine crystals don’t

335
Q

Uric acid crystals: clin sig (2)

A

Lesch-Nyhan disease

Px receiving chemotherapy

336
Q

Crystals in acidic urine which appear yellow-brown flat-sided rhombic plates, wedges, or rosettes

A

Uric acid crystals

337
Q

Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment

A

Amorphous urates

338
Q

Brick-dust

A

Uroerythrin

339
Q

Uroerythrin

A

Brick-dust

340
Q

Amorphous urates: appearance

A

Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment

341
Q

Normal crystals seen in acidic urine and may also be in alkaline urine

A

Calcium oxalate crystals

342
Q

2 forms of calcium oxalate crystals

A

Dihydrate form
-envelope-shaped; clumps in urine may indicate renal calculi
Monohydrate form
-oval or dumbbell-shaped; presence may indicate ethylene glycol (anti-freeze) ingestion

343
Q

envelope-shaped calcium oxalate crystal; clumps in urine may indicate renal calculi

A

Dihydrate form of calcium oxalate crystal

344
Q

Oval or dumbbell-shaped calcium oxalate crystal; presence may indicate ethylene glycol (anti-freeze) ingestion

A

Monohydrate form of calcium oxalate crystal

345
Q

Disease associated with dihydrate form of calcium oxalate crystals

A

If in clumps: renal calculi

346
Q

Disease associated with presence of monohydrate form of calcium oxalate crystals

A

Ethylene glycol (anti-freeze) ingestion

347
Q

Normal crystals seen in alkaline urine (4)

A

Amorphous phosphate crystals
Calcium carbonate crystals
Ammonium biurate crystals
Triple phosphate crystals

348
Q

Coffin-lid shaped, associated with very high pH and bacteria found in old Sx

A

Triple phosphate

349
Q

Produce white ppt after refrigeration

A

Amorphous phosphate crystals

350
Q

With dumbbell and spherical shapes, produce gas with acetic acid

A

Calcium carbonate crystals

351
Q

2 shapes of calcium carbonate crystals

A

Dumbbell

Spherical

352
Q

Yellow-brown thorny apple-shaped, assoc with old Sx with bacteria

A

Ammonium biurate

353
Q

Artifacts in urine (5)

A 
Starch granules
Oil droplets
Air bubbles
Pollen grains
Fibers
354
Q

Abnormal crystals in urine (7)

A 
Cystine crystals
Ampicillin crystals
Tyrosine crystals
Cholesterol crystals
Sulfonamide crystals
Leucine crystals
Bilirubin crystals
355
Q

Hexagonal flat plates

A

Cystine crystals

356
Q

Inherited disorder that inhibits reabsorption of cystine by renal tubules

A

Cystinuria

357
Q

Rectangular plates with notches edges, highly birefringent under polarized light

A

Cholesterol crystals

358
Q

Cholesterol crystals are seen in refrigerated tribe and accompanied by (2)

A

Fatty casts and oval fat bodies

359
Q

Cholesterol crystals: clin sig

A

Nephrotic syndrome

360
Q

Yellow needle-shaped forms in clusters or rosettes

A

Tyrosine crystals

361
Q

Tyrosine crystals: clin sig

A

Severe liver disease

362
Q

Yellow-brown spheres with concentric circles

A

Leucine crystals

363
Q

Leucine crystals are seen in conjunction with

A

Tyrosine crystals

364
Q

Leucine crystals: clin sig

A

Severe liver disease

365
Q

Bright yellow clumped needles and granules

A

Bilirubin crystals

366
Q

Bilirubin crystals: clin sig

A

Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin

367
Q

T/F: bilirubin crystals clin sig:

Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin

A

True

368
Q

With needle, rosette, and rhombic shapes, in adequately hydrated Px

A

Sulfonamide crystals

369
Q

Tribe crystals which appear as colorless needles that form clumps after refrigeration, in inadeq hydrated Px

A

Ampicillin crystals

Clinical Microscopy (1 decks)

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