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Urinalysis Flashcards

1
Q

Types of common urine specimens

A

Random, first morning, midstream clean catch, catheterized, 24-hour (timed), drug screening.

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2
Q

first morning urine is for

A

confirmatory test for orthostatic proteinuria and pregnancy.

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3
Q

for bacterial cultures

A

midstream clean catch and catheterized

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4
Q

provide quantitative results

A

24 hour (timed) urine

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5
Q

strictly follow chain-of-custody form requirements

A

Drug screening

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6
Q

Test specimens within

A

2 hours of collection

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7
Q

_____________ specimens that cannot be tested within 2 hours

A

Refrigerate

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8
Q

increased results in unpreserved urine

A

pH, nitrite, bacteria

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9
Q

decreased results in unpreserved urine

A

Glucose - glycolysis,
Ketones - Oxidation,
Bilirubin - Oxidation to biliverdin,
Urobilinogen - oxidation to urobilin.

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10
Q

normal urine volume

A

600 to 2000 mL/day

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11
Q

decreased urine output

A

oliguria, less than 400mL/day

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12
Q

no urine output

A

anuria

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13
Q

increased urine output at night

A

nocturia

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14
Q

increased urine output

A

polyuria, greater than 2500 mL/day

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15
Q

increased urine output to excrete excess urine glucose is seen in

A

Diabetes mellitus

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16
Q

increased urine output caused by lack or dysfunction of antidiuretic hormone (ADH) is seen in

A

Diabetes insipidus

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17
Q

polyuria results in

A

polydipsia

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18
Q

normal urine color is

A

yellow

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19
Q

Seen in refrigerated normal urine

A

White turbidity - urine with alkaline pH from amorphous phosphates and carbonates.

Pink rabidity - urine with an acid pH from amorphous urates.

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20
Q

Nonpathologic turbidity

A 
squamous epithelial cells,
mucus,
amorphous phosphates,carbonates, and urates,
semen,
feces,
radiographic contrast edia,
powder and creams.
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21
Q

Pathologic turbidity

A 
RBCs,
WBCs,
yeast,
urothelial and renal tubular epithelial cells,
abnormal crustals,
lipids (milky).
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22
Q

Specific gravity is a

A

screening test for reneal tubular reabsorption of essential elements filtered by the glomerulus

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23
Q

specific gravity is based on the fact that glomerular filtrate ha a specific gravity of

A

1.010

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24
Q

urine contains dissolved substances that produce density by their

A

size and number

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25
Q

principle of sp. gr. in reagent strip

A

based on the number of hydrogen ions released from a polyelectrolyte (pKa) is proportional to the number of ions in the urine.

increased urine concentration = increased hydrogen ions released = low pH

the indicator on the strip is bromothymol blue

reaction - yellow-green (acid) - green-blue (alkaline)

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26
Q

principle of refractometer

A

the concentration of dissolved particles in a solution determines the velocity and angle of light passing through a solution.

the refractometer uses a prism to direct a wavelength of light through the urine, the angle of the light can be read on a scale calibrated with distilled water.

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27
Q

considered more representative of renal concentrating ability than specific gravity

A

osmolarity, because it measures only the number of particles and their size is not relevant.

measurement is the number of particles into which 1gram MW of a substance dissociates.

ex: Nonionizing urea (MW 60) = 1 particle, ionizing NaCl (MW 58.5) = 2 particles.

reported in milliosmoles (mOsm)

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28
Q

Colligative properties measured in the clinical laboratory

A

freezing point depression and vapor pressure depression.

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29
Q

describe freezing point depression

A

one mole of nonionizing substance will lower the freezing point 1.86 oC.
Volatile substances such as alcohol can interfere.

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30
Q

Describe vapor pressure depression

A

Actual measurement is the dew point (temperature at which vapor condenses to a liquid) of the urine sample.

Uses microsamples on filter paper discs. Care must be taken to avoid evaporation.

No interference from volatile substances.

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31
Q

Normal serum osmolarity

A

275 t0 300 mOsm

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32
Q

urine osmolality is influenced by

A

fluid intake

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33
Q

random serum-to-urine osmolarity ratio is

A

1:1

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34
Q

controlled fluid intake should reach

A

1:3

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35
Q

Osmolarity is used to

A

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

uses harmonic oscillation density?

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36
Q

automated instrumentation principle on osmolarity

A

it passes a sound wave through the urine and records the change in frequency of the sound wave, which is proportional to the urine density

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37
Q

briefly dip reagent strips to prevent

A

leaching or reagents from strip

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38
Q

thoroughly mix specimens for

A

detection of RBCs and WBCs

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39
Q

warm refrigerated specimens for

A

enzyme reactions

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40
Q

blot strip while removing from urine to

A

prevent runover

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41
Q

observe manufacturer timing instructions in

A

reaction color changes

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42
Q

the pH of fresh urine does not reach

A

9.0.

a reading of 9.0 indicates an old specimen that should be recollected.

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43
Q

urine pH normal value

A

4.5 to 8.0

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44
Q

pH reagent strip principle

A

double indicator (methyl red and bromothymol blue)

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45
Q

clinical significance of urine pH

A

detection of systemic acid-base disorders.

identification of urinary crystals.

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46
Q

reagent strips measure primarily what protein

A

albumin

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47
Q

urine protein NV is

A

10 mg/dL

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48
Q

considered clinical proteinuria

A

30 mg/dL or greater

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49
Q

reagent strip principle for protein

A

the protein error of indicators

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50
Q

clinical significance of urine protein

A

clinically significant proteinuria is primarily caused by glomerular or tubular disorders.

Benign orthostatic proteinuria testing requires a first morning and a specimen after the patient has been active for 2 hours. The first specimen should be negative and the second specimen positive.

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51
Q

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

A

microalbumin

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52
Q

microalbumin is used to

A

provide early detection of renal disease, particularly in patients with diabetes.

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53
Q

The __________ tests for microalbumin and creatinine, along with all other routine strip tests, except urobilinogen

A

Multistix PRO 11 reagent strip

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54
Q

_______ corrects for hydration in a random sample to provide an estimate of the 24-hour microalbumin level

A

Albumin-to-creatinine ratio.

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55
Q

glucose reagent strip principle

A

Glucose oxidase test (specific for glucose)

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56
Q

the renal threshold for glucose is

A

160 to 180 mg/dL

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57
Q

urine glucose clinical significance

A

Diabetes mellitus, gestational diabetes (placental hormones blocking insulin)

Hormonal disorders and stress block insulin production and actions.

Renal tubular disorders prevent tubular reabsorption of glucose.

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58
Q

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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59
Q

clinitest can be used in

A

testing newborn urine for galactose

*high levels will pass through the reaction and go from blue-green to orange-red to blue-green. carefully observe the reaction.

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60
Q

ketones are

A

intermediate metabolites of fat:

acetoacetic acid, acetone, and B-hydroxybutyric acid.

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61
Q

urine ketone principle

A

reaction of acetoacetic acid or acetone (with glycine) with sodium nitroprusside/ferricynade

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62
Q

urine ketone clinical significance

A

Diabetes mellitus, monitoring of insulin therapy, starvation, malabsorption, and loss of carbohydrate (vomiting)

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63
Q

urine blood positive reactions are ssen with

A

hematuria, hemoglobinuria, and myoglobinuria

64
Q

urine blood principle

A

pseudoperoxidase activity of hemoglobin

65
Q

urine blood CS

A

both hemoglobinuria and myoglobinuria can cuase acute renal failure.

Hematuria - bleeding within the genitourinary system, including renal calculi, trauma, anticoagulants, glomerulonephritis, and pyelonephritis.

hemoglobinuria - intravascular hemolysis/ transfusion reactions, lysis of old RBCs by dilute alkaline urine.

Myoglobinuria - Rhabdomyolysis caused by muscle-wating disorders, crush injuries, prolonged coma, and cholesterol statin drugs.

66
Q

products of hemoglobin degradation

A

bilirubin and urobilinogen

67
Q

urine bilirubin principle

A

diazo reaction

68
Q

urine bilirubin CS

A

conjugated bilirubin enters the urine as a result of leakage from a damaged liver or blocked bile duct.

The kidneys cannot filter unconjugated bilirubin.
Patients will appear jaundiced.

69
Q

Some of the conjugated bilirubin is coverted to _______________ in the intestine

A

urobilinogen.

Then it circulates in the blood to the liver and passes through the kidneys.

70
Q

normal urobilinogen in urine

A

1 mg/dL

71
Q

urine urobilinogen principle

A

multistix - Ehrlich’s reaction.

chemstrip - diazo reaction.

72
Q

urine urobilinogen CS

A

early detection of liver disease and hemolytic disorders, constipation.

73
Q

urine nitrite detects

A

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

74
Q

urine nitrite principle

A

diazo reaction

75
Q

urine nitrite CS

A

early detection of urinary tract infection.

a positive nitrite test should be accompanied by a positive leukocyte esterase test.

may be used to screen specimens for microbiology testing.

76
Q

leukocyte esterase detects

A

the presence of granulocytic WBCs, including lysed WBCs.

77
Q

urine leukocyte esterase principle

A

Diazo reaction: the leukocyte esterase reagent strip reaction should be read 2 minutes after urine exposure.

78
Q

urine leukocyte esterase CS

A

UTI, including with non-reductase-containing bacteria and parasitic and fungal organisms that would have a negative nitrite test.

79
Q

casts are composed of what protein

A

Tamm-Horsfall (uromodulin) protein excreted by renal tubular epithelial cells

80
Q

casts are formed in the

A

distal convoluted tubule and collecting ducts (wider casts)

81
Q

casts are reported as

A

number per low-power field

82
Q

RBCs appear _____ in concentrated urine

A

crenated

83
Q

RBCs appear _________ in dilute urine

A

larger empty cells (ghost cells)

84
Q

______________ indicate glomerular bleeding

A

regular (dysmorphic) shapes)

85
Q

RBCs sources of error

A

oil droplets, air bubbles, yeast cells (look for budding)

86
Q

Urine RBCs clinical significance

A

glomerular membrane damage,
Blleding in the urinary tract,
renal calculi,
malignancy

87
Q

hemoglobinuria or myoglobinuria is indicated by

A

a clear red urine with a positive reagent strip RBC and no RBCs in the microscopic analysis

88
Q

Eosinophils have red granules when stained with

A

Wright or Hansel stains

89
Q

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

A

Glitter cells

90
Q

describe glitter cells

A

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

91
Q

WBCs sources of error

A

renal tubular epithelial cells, mononuclear lymphocytes, and monocytes

92
Q

WBC urinalysis correlations

A

leukocyte esterase, nitrite, pH, and specific gravity (glitter cells)

93
Q

WBCs CS

A

UTI (neutrophils),
Drug-induced interstitial nephritis (eosinophils),
malignancy (mononuclear cells)

94
Q

largest cells in the urine sediment

A

Squamous cells.
-represent normal sloughing of old lower genitourinary tract cells.

*folded squamous cells may resemble urinary casts (look for a centrally located nucleus)

95
Q

squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection

A

Clue cells

96
Q

Describe clue cells

A

squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection

97
Q

Transitional (urothelial) cells are found in

A

renal pelvis, ureters, bladder and male urethra.

normally seen after catheterization procedures (often seen in clumps)

98
Q

forms of transitional cells

A

spherical, caudate, and polyhedral.

Spherical cells resemble renal tubular cells, except they have a centrally located nucleus.

99
Q

increased transitional cells may indicate

A

malignancy

100
Q

Renal tubular epithelial cells are found in

A

renal tubules and collecting duct.

cell shape vary with location.

Convoluted tubule cells are rectangular with coarse granules and may resemble a cast (look for a nucleus)

Distal convoluted tubule cells are small and round, may resemble spherical transitional cells buth have an eccentric nucleus.

Cells from collecting duct are cuboidal with at least one straight edge ad are frequently seen in clumps.

101
Q

Renal Tubular Epithelial cells (RTE) CS

A

more than two RTE cells per HPF is significant.

Tubular necrosis, often from poisoning or viral infections.

RTE cells absorb filtrate and may be bilirubin stained (liver damage), contain hemosiderin granules (hemoglobin) or lipids.

102
Q

RTE cells that have absorbed lipids

A

Oval fat bodies

103
Q

describe oval fat bodies

A

RTE cells that have absorbed lipids.
highly refractile.
Seen in conjunction with free-floating lipids.

confirm staining with oil red O, Sudan III, or polarized microscopy.

104
Q

oval fat bodies CS

A

Nephrotic syndrome, diabetes mellitus, and crush injuries.

105
Q

bacteria should be accompanied by

A

WBCs

106
Q

bacteria sources of error

A

amorphous urates, phosphates, and old specimens with a high pH

107
Q

bacteria CS

A

UTI

108
Q

oval structures with buds or mycelia

A

yeast

109
Q

describe yeast

A

oval structures with buds or mycelia

110
Q

yeast should be accompanied by

A

WBCs

111
Q

Yeast is associated with

A

acidic urine from patients with diabetes mellitus

112
Q

yeast source of error

A

RBCs

113
Q

yeast CS

A

DM, immunocompromised patients, vaginal infections

114
Q

parasites in urine

A

Trichomonas vaginalis, Schistosoma haematobium, Enterobius vermicularis (fecal contamination)

115
Q

describe Trichomonas vaginalis

A

exhibits rapid flagellar movement in wet preparations

116
Q

urine parasites source of error

A

WBCs and renal tubular epithelial cells

117
Q

urine parasites CS

A

sexually transmitted disease that is asymptomatic in males and causes a vaginal infection in females

118
Q

strands of protein secreted by glands and renal tubular epithelial cells

A

Mucus

119
Q

describe mucus

A

strands of protein secreted by glands and renal tubular epithelial cells

120
Q

major protein of mucus

A

Tamm-Horsfall (uromodulin) protein

121
Q

Mucus sources of error

A

clumps may resemble hyaline casts (look for the consistent shape of a cast)

122
Q

Mucus CS

A

Mucus is of no clinical significance

123
Q

precipitation of urine solutes affected by temperature, solute concentration, and pH

A

Crystals

124
Q

describe crystals

A

precipitation of urine solutes affected by temperature, solute concentration, and pH

more abundant in refrigerated specimens.

polarized microscopy aids in their identification

abnormal crystals are found only in acidic or normal urine.

125
Q

normal crystals seen in acidic urine

A

Uric acid crystals, amorphous urates, calcium oxalate

126
Q

normal crystals seen in alkaline urin

A

triple phosphate crystals, amorphous phosphate crystals, calcium carbonate crystals, ammonium biurate crystals

127
Q

abnormal crystals

A

cysteine, cholesterol, tyrosine, leucine, bilirubin, sulfonamide, ampicillin

128
Q

yellow-brown, flat sided rhombic plates, wedges, and rosettes

A

uric acid crystals

129
Q

describe uric acid crystals

A

yellow-brown, flat sided rhombic plates, wedges, and rosettes

130
Q

uric acid crystals SOE

A

cysteine crystals (uric acid crystals polarize and cysteine crystals do not polarize)

131
Q

uric acid crystals CS

A

patients receiving chemotherapy, Lesch-Nyhan disease

132
Q

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

A

amorphous urates

133
Q

describe amorphous urates

A

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

134
Q

describe calcium oxalate crystals

A

may also be seen in alkaline urine

The dehydrate form is envelope shaped; clumps in fresh urine may indicate renal calculi.

The monohydrate form is oval or dumbbell shaped; presence of this form indicates ethylene glycol (anti-freeze) ingestion

135
Q

coffin-lid shaped

A

triple phosphate crystals

136
Q

describe triple phosphate crystals

A

coffin-lid shaped

associated with a very high pH and bacteria found in old specimens

137
Q

produce a white precipitate after refrigeration

A

amorphous phosphate crystals

138
Q

dumbbell and spherical shapes. produce gas with acetic acid

A

Calcium carbonate crystals

139
Q

describe calcium carbonate

A

dumbbell and spherical shapes. produce gas with acetic acid

140
Q

yellow-brown thorny apple-shaped crystals.

A

ammonium biurate crystals

141
Q

describe ammonium biurate crystals

A

yellow-brown thorny apple-shaped crystals.

associated with old specimens with bacteria.

142
Q

hexagonal flat plates

A

cystine crystals

143
Q

describe cystine crystals

A

hexagonal flat plates.
an inherited disorder that inhibits the reabsorption of cystine by the renal tubules (cystinuria); renal calculi form at an early age

144
Q

rectangular plates with notched corners, highly birefringent under polarized light

A

cholesterol crystals

145
Q

describe cholesterol crystals

A

rectangular plates with notched corners, highly birefringent under polarized light.

seen in refrigerated urine and accompanied by fatty casts and oval fat bodies.

Nephrotic syndrome.

146
Q

yellow needle-shaped forms in clusters or rosettes

A

tyrosine crystals

147
Q

describe tyrosine crystals

A

yellow needle-shaped forms in clusters or rosettes.

Severe liver disease.

148
Q

yellow-brown spheres with concentric circles

A

Leucine crystals

149
Q

describe leucine cystals

A

yellow-brown spheres with concentric circles.

seen in conjunction with tyrosine crystals. seen in sever liver disease.

150
Q

bright yellow clumped needles and granules

A

bilirubin crystals

151
Q

describe bilirubin crystals

A

bright yellow clumped needles and granules.

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

152
Q

needle, rosette, and rhombic shapes

A

sulfonamide crystals

153
Q

describe sulfonamide crystals

A

needle, rosette, and rhombic shapes.

inadequately hydrated patients taking sulfonamide medications.

154
Q

colorless needles that form clumps after refrigeration

A

ampicillin crystals

155
Q

describe ampicillin crystals

A

colorless needles that form clumps after refrigeration.

inadequately hydrated patients taking ampicillin

cm (17 decks)

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