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Urinalysis Flashcards

1
Q

What does the urinalysis important for?

A
  • Discovering disease in the urinary tract
  • Estimate renal function
  • Clues as to what causes renal dysfunction
  • Some systemic diseases cause alterations in urine constituents
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2
Q

What is included in a standard urine panel?

A
  • Appearance
  • pH
  • Specific gravity
  • Protein
  • Glucose
  • Ketones
  • Nitrites
  • Leukocyte esterase
  • Urobilinogen
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3
Q

When is appearance of urine reported? What is normal appearance?

A

When it is abnormal

-Should be pale, dark yellow, and clear

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4
Q

What does urine have in it if it is turbid

A
  • Excessive cellular material or protein

- or from crystallization or precipitation of salts

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5
Q

When do salts precipitate?

A

When urine is basic (should be acidic)

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6
Q

If the specimen clears with the addition of small amounts of acid, what is the cause?

A

-Precipitation of salts

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7
Q

What can cause red or brown urine?

A
  • Hemoglobin
  • Myoglobin
  • Fresh beets
  • Pyridium (causes dark orange urine)
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8
Q

What acidifies glomerular filtrate of plasma

A

Renal tubules and collecting ducts from a pH of 7.4 to 5-6

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9
Q

When will you see a pH of 6 or more

A
  • Alkalosis

- If the acidifying mechanism of the kidney fails

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10
Q

What happens to urine if it is left standing

A

-Become alkaline due to bacterial growth

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11
Q

What is directly proportional to urine osmolarity

A

Specific gravity

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12
Q

What does specific gravity measure

A

The ability of the kidney to dilute or concentrate the urine

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13
Q

What diseases cause the inability to concentrate the urine?

A
  • Diabetes insipidus

- Severe hyperthyroidism

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14
Q

What prevents the majority amount of large materials to escape from the blood into the urine

A

Glomerular membrane

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15
Q

What is normal protein excretion

A

150mg/24 hours

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16
Q

What defines proteinuria

A

Protein excretion more than 150mg per day

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17
Q

What classifies severe proteinuria

A

more than 3.5mg/24 hours

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18
Q

What causes severe proteinuria

A

Nephrotic syndrome

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19
Q

+1 protein=

A

200-500 mg/24 hours

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20
Q

+2 protein=

A

500-1500 mg/24 hours

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21
Q

+3 protein=

A

1.5-5 g/24 hours

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22
Q

+4 protein=

A

greater than 5g/24

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23
Q

What is the dominant constituent in proteinuria and why?

A
  • Albumin

- Because it is the smallest

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24
Q

What abnormal protein usually appears in the urine in patients with multiple myeloma

A

Bence jones proteins

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25
What are the 2 types of proteinuria
1. Functional - not associated with systemic or renal disease 2. Organic - associated with systemic disease or renal pathology
26
What are examples of functional proteinuria
- Severe muscular exertion | - Pregnancy
27
What are examples of organic proteinuria
- Pre-renal - Renal - Postrenal
28
Describe pre-renal organic proteinuria
- Not due to renal disease - Problem occurs before reaching the kidney - Fever - Sepsis - Hypertension - Bence Jones proteins
29
Describe renal organic proteinuria
- Primary kidney disease - Glomerulonephritis - Nephrotic syndrome
30
Describe post-renal organic proteinuria
- Protein is added to the urine farther down the urinary tract - Infection of the ureter - Cystic - Urethritis/prostatitis - Contamination with vaginal secretions
31
What is commonly seen in urine contamination with vaginal secretions
High number of squamous epithelial cells
32
What is the most common cause of glucosuria
Diabetes mellitis
33
What is the normal renal threshold for glucose before it starts spilling over into the urine
180 mg/dl
34
T/F- Individuals can vary in their tubular transfer reabsorptive capacities
True
35
If reabsorptive capacity is low, the patient will spill glucose at (higher/lower) levels -what causes this
Lower | -Pregnancy and the exposure to carbon monoxide and lead cause it
36
What are examples of ketones
- Acetone - Acetoacetic acid - Beta-hydroxyl butyric acid
37
What is the major cause of increased ketones
- Carbohydrate restriction | - impaired carbohydrate metabolism
38
What muscle types can utilize a limited amount of ketones as an energy source when glucose is insufficient
- Skeletal | - Cardiac
39
T/F- After a certain point, metabolic capacity is exceeded and excess ketone bodies are excreted by the kidney
True
40
Ketosis is...
When ketones accumulate in the plasma
41
Many bacteria produce an enzyme called...
reductase
42
What does reductase do?
Converts nitrates to nitrites
43
A positive nitrite test indicates that...
bacteria may be present in the urine
44
What is the sensitivity of the nitrite test
50%
45
What is the gold standard test for urine
Urine culture
46
T/F-The nitrite test can enhance the sensitivity of the leukocyte esterase test to detect urinary tract infections
True
47
This is an enzyme found in the cytoplasm of neutrophils
Esterase
48
When is a positive leukocyte esterase test seen?
-When there are WBC as whole or lysed cells in the urine
49
What does positive leukocyte esterase indicate?
Pyuria
50
How sensitive is leukocyte esterase test in detecting urinary tract infections
80-90% sensitive
51
Can leukocyte esterase differentiate between WBC from the urinary tract or vaginal secretions?
Nope
52
What is produced from the conjugated bilirubin by metabolic activity of bacteria in the intestine followed by reabsorption into the blood steam
Urobiliogen
53
When can conjugated bilirubin be seen?
Secondary to biliary tract obstructions
54
Extrahepatic =
Common bile duct obstruction
55
Intrahepatic=
Liver cell injury (cirrhosis or hepatitis)
56
When is a microscopic analysis of urine completed
After the urine has been centrifuged
57
What is the presence of RBC in the urine called
Hematuria
58
What are causes of hematuria
- Glomerular damage - Tumors - Kidney trauma - Nephrolithiasis - Urinary tract infections
59
When can contamination with RBC occur
During menses or catheriziation (especially if you have prostate problems)
60
How can RBC look
- Normal shape - Swollen (dilute urine) - Crenated (concentrated urine)
61
When are squamous epithelial cells typically seen
Contamination with normal skin flora
62
These are protein conglomerates that outline the shape of the renal tubules in which they were formed
Protein casts

Clin Lab (23 decks)

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