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clin lab > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What does anuria mean?

A

no urine output

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2
Q

What does oliguria mean?

A

less than 500 mL/day

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3
Q

What does nocturia mean?

A

greater than 500 mL/night (not to be confused with nocturnal frequency)

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4
Q

What does polyuria mean?

A

greater than 2L/day (not necessarily abnormal if someone is really hydrating themselves)

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5
Q

How often do children urinate compared to adults?

A

3-4x the volume of an adult per kg of body weight

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6
Q

What are the 3 descriptors of abnormal urination?

A

frequency
urgency
dysuria

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7
Q

Is urine odor part of urinalysis?

A

No

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8
Q

How is urine order normally described?

A

Faintly aromatic- due to presence of volatile acids

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9
Q

What could caused abnormal urine aroma?

A 
Vitamins
Drugs
Foods (ex: asparagus)
Metabolic disorders (diabetes)
Bacterial contamination
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10
Q

What does CCMS stand for?

A

Clean Catch Midstream Specimen

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11
Q

What is the reason for CCMS

A

To avoid contamination of the voided specimen by organisms in areas adjacent to the urethral meatus and harbored in the distal urethra

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12
Q

For a urine sample collection are males or females instructed to cleanse the area 3x with separate towelettes?

A

Females

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13
Q

When is the best time to collect urine? Why?

A

First morning urination

  • most concentrated
  • bladder incubated
  • best for specific gravity, nitrite, protein, and microscopic examination of the urine sediment
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14
Q

What is the most convenient and commonly used timing of urine collection?

A

Random specimen

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15
Q

Why would you do a 24hr specimen collection?

A

This is necessary for quantification of various analytes

- protein, calcium, hormones & their metabolites

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16
Q

When should the urine be analyzed after the collection?

A

Within one hour

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17
Q

Why should the urinalysis be done within an hour of the collection?

A

To avoid deterioration of:

  • formed elements (casts & WBCs)
  • bilirubin & urobilinogen (will decompose when exposed to light)
  • glucose (metabolized by bacteria & blood cells)
  • ketones (evaporate)
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18
Q

What do you do if you can’t do the urinalysis directly after the collection?

A

Refrigerate or use a preservative to prevent bacterial overgrowth

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19
Q

When doing an urinalysis, do you document the color and appearance of the urine?

A

Yes

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20
Q

_____ reagent strip results exceed the quantities which are normally present in urine

A

Positive

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21
Q

What are the 10 factors that are tested during the chemical examination of a urnialysis?

A 
pH
specific gravity
protein
glucose
ketones
urobilinogen
bilirubin
leukocyte esterase
nitrite
blood (hemoglobin)
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22
Q

What are the 7 factors that are tested during the microscopic examination of a urinalysis?

A 
RBCs
WBCs
Epithelial cells
Crystals
Casts
Micro-organisms
Amorphous sediment
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23
Q

What is considered normal for color of urine?

A

Colorless to amber yellow

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24
Q

What could cause colorless urine?

A
  • random specimen

- decreased renal function

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25
Q

What could cause dark yellow urine?

A
  • concentrated urine- due to dehydration

- bilirubin- hepatobiliary

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26
Q

What could cause red urine?

A
  • blood- urinary tract bleeding
  • hemoglobin- intravascular hemolysis
  • food dyes- strawberry twizzler overdose
  • beets- healthy diet
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27
Q

What could cause brown urine?

A
  • acid hematin- blood/hgb

- bilirubin- hepatobiliary

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28
Q

What are the 3 words used to describe appearance of urine?

A

Hazy
Cloudy
Milky

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29
Q

What are the formed element that cause a hazy/cloudy/or milky urine? (8)

A 
Amorphous sediment
Epithelial cells
RBCs & WBCs
Micro-organisms
Crystals
Spermatozoa
WBC casts & WBC clumps
Fat (chyluria)
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30
Q

What is a normal urine pH?

A

4-8

ideally 6

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31
Q

What causes acidic urine?

A

normal “western” diet
ketosis
systemic acidosis

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32
Q

What causes alkaline urine?

A

Vegetarian/vegan diet/ high level of citrus fruit
Postprandial specimen (“alkaline tide”)
Stale/unrefrigerated specimen
Urinary tract infection

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33
Q

What is normal for specific gravity of urine?

A

1.005-1.035

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34
Q

What is specific gravity used to evaluate?

A

The concentrating and excretory power of the kidneys

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35
Q

How would a true kidney function test be standardized?

A

Water deprivation for 16 hours prior to test

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36
Q

Why is first morning specimen more ideal than random specimen?

A

Because first morning specimen will be concentrated, where as random specimens will tend to be more dilute

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37
Q

What could cause the urine to be more concentrated?

A
  • decreased fluid intake
  • first morning specimen
  • solutes in the urine such as glucose & ketones
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38
Q

What types of protein can show up in urine? (6)

A
  • Albumin
  • Globulins
  • Hemoglobin
  • Fibrinogen
  • Nucleoproteins
  • Bence Jones protein (paraproteins)
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39
Q

Which type of protein is the most common & significant health concern?

A

Albumin

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40
Q

If albumin is found in urine, what could this indicate?

A

Kidney pathology

- especially glomerular damage, results in albumin escaping from the plasma into filtrate

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41
Q

What does functional proteinuria mean?

A

This is proteinuria associated with fever, exposure to extreme temps, excessive exercise, or emotional stress. Tends to be minimal amounts (less than 500mg/day) of protein lost.

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42
Q

What is organic proteinuria?

A

Proteinuria associated with demonstrable systemic disease or renal damage & often results in greater than 500mg/day of protein loss.

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43
Q

Is there more protein lost with organic or functional proteinuria?

A

Organic

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44
Q

What are the 3 categories of proteinuria sites of origin?

A
  • pre-renal
  • renal
  • post-renal
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45
Q

What are the 3 categories of proteinuria according to quantity lost per day?

A
  • minimal (less than 0.5)
  • moderate (0.5- 4.0)
  • marked (greater than 4.0 gm)
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46
Q

What are some cause of minimal proteinuria?

A
  • vigorous exercise in healthy people
  • severe emotional or thermal stress
  • postural/orthostatic proteinuria
  • pregnancy
  • early affects of kidney dysfunction
  • lower UTI
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47
Q

What are some causes of moderate proteinuria?

A
  • chronic glomerulonephritis
  • pyelonephritis
  • diabetic nephropathy
  • multiple myeloma]
  • pre-eclampsia
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48
Q

what are some causes of marked proteinuria?

A
  • acute & chronic glomerulonephritis
  • diabetic nephropathy
  • nephrotic syndrome & nephrosis
  • lupus nephritis
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49
Q

What conditions might you suspect when finding glucosuria with hyperglycemia?

A
  • endocrine disorders
  • -> diabetes mellitus
  • -> cushing’s syndrome
  • -> thyrotoxicosis
  • exocrine pancreatic disease
  • drug associated (steroids)
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50
Q

What conditions might you suspect when finding glucosuria without hyperglycemia?

A
  • renal tubular disease

- late (normal) pregnancy

51
Q

If ketones in urine are reported normal what does that mean?

A

This means that there are no ketones detected in urine= normal

52
Q

What might cause ketones to be detected in urine?

A
  • inadequate carbs in diet
  • -> successful weight loss diet
  • -> malnutrition
  • -> defect in carb metabolism
  • -> diabetes mellitus
  • defect in carb absorption
53
Q

Is it normal to find bilirubin in urine?

A

NO

54
Q

Bilirubin is a catabolite of _____, and urobilinogen is a catabolite of _________.

A
  • heme

- bilirubin

55
Q

What are some causes of bilirubinuria?

A
  • intrahepatic obstruction (ex: hepatitis)

- extrahepatic obstruction (ex: stone in common duct)

56
Q

What type of bilirubin is excreted by the kidney?

A

ONLY CONJUGATED bilirubin

57
Q

What is observed when someone has bilirubinuria? What is this associated with?

A

Conjugated hyperbiliruinemia

associated with hepatobiliary pathologies

58
Q

What could lead to increased urinary urobilinogen?

A
  • hemolytic diseases

- hepatic diseases

59
Q

What could lead to decreased urinary urobilinogen?

A
  • biliary obstruction
60
Q

What is leukocyte esterase?

A

Cytoplasmic enzyme of neutrophils.

61
Q

For leukocyte esterase what would cause the reagent strip to turn positive?

A
  • significant numbers of WBCs, either lysed or intact
62
Q

What can leukocyte esterase detected indicate?

A

UTI (very sensitive for this)
Vaginal contamination
Conditions causing heavy mucus discharge & irritation as with Trichomonas infestation

63
Q

What are 3 causes of pyuria?

A
  • inflammation within urinary tract
  • infection within the urinary tract
  • sterile pyuria (WBCs with negative bacteriologic evaluation)
64
Q

What are some infective causes of sterile pyuria?

A
  • viruses
  • fungi
  • atypical or fastidious organisms (ex: chlamydia)
65
Q

What are some non-infective causes of sterile pyuria?

A
  • systemic & localized diseases (ex: malignant hypertension, systemic inflammatory disease)
  • structural & physiological abnormalities of GU tract (ex: stones, polycystic kidneys)
  • certain drug treatments
  • recent antibiotic treatment
66
Q

What could nitrite in urine indicate?

A

UTI- very specific indicator of this, but lacks sensitivity

67
Q

Will RBCs or hemoglobin turn a reagent strip positive?

A

Yes

68
Q

What is hemoglobin uria?

A

the presence of hemoglobin in the urine with the origin being from the circulation (ie. intravascular hemolysis)

69
Q

With hemoglobinuria would RBCs be seen in the urinalysis?

A

No

70
Q

What is hematuria?

A

the presence of RBCs in the urine (exceeding normal) which are leaking into the urinary tract (ex: kidney through urethra)

71
Q

What does isolated hematuria refer to?

A

Hematuria without casts or proteinuria

72
Q

What does nephronal hematuria refer to?

A

Hematuria with casts and proteinuria

73
Q

What are examples of conditions in which you might see isolated hematuria?

A
  • normal individuals (menstrual contamination, following vigrorous exercise)
  • trauma to urinary tract
  • lower urinary tract infections (cystitis)
  • hypertension
  • bleeding disorders
  • kidney pathology (stones, tumors)
74
Q

What are examples of conditions in which you might see nephronal hematuria?

A
  • acute glomerulonephritis
  • chronic glomerulonephritis
  • rheumatoid diseases
75
Q

How might ascorbic acid affect urinalysis?

A
  • adequate amounts may cause reduced positives or false negatives for blood, leukocyte esterase, glucose, nitirite, urobilinogen, and bilirubin
76
Q

During microscopic examination of urine, what does the low power field allow you to visualize?

A
  • amorphous sediment
  • epithelial cells
  • casts
  • crystals
77
Q

During microscopic examination of urine, what does high power field allow you to visualize?

A
  • bacteria

- blood cells (RBCs & WBCs)

78
Q

What could clumps of WBCs mean when seen in the urine?

A
  • could indicate kidney or bladder infection- but symptoms must guide you
79
Q

On high power field what is the normal number of blood cells visualized?

A 
RBCs= 0-4/hpf
WBCs= 0-4/hpf
80
Q

If squamous epithelial cells are found in urine sample, what may this indicate?

A
  • urine not collected via CCMS technique- especially in women
  • could be from distal urethra &/or female vulva
81
Q

Where are transitional epithelial cells found within the urinary tract?

A
  • renal pelvis to proximal urethra
82
Q

What are increased number of transitional epithelial cells found in urine indicative of?

A

Conditions of the bladder, such as infection or malignancy

83
Q

What might be an indicator of bladder cancer?

A

Morphologically abnormal urothelium= large number of transitional epithelia exhibition unusual morphology

84
Q

Where are renal tubule epithelial cells derived from?

A
  • nephron to collecting tubules
85
Q

What do increased numbers of renal tubule epithelia indicate?

A

Tubular necrosis

Tubular damage in variety of renal tubular disorders

86
Q

For both transitional epithelia & renal tubule epithelia could be considered normal for these cells to be found in urine?

A

Yes- but it’s when there are increased numbers of either that there is an indication of pathology.

87
Q

What are the most common crystals found in urine?

A

calcium oxalate, uric acid, and triple phosphate

88
Q

When is the finding of crystals in urine clinically significant?

A

When the crystals appear in acidic or (occasionally) neutral pH urine

89
Q

What is the finding of calcium oxalate crystals in acidic urine associated with?

A
  • diet rich in oxalic acid
  • may be calcium urinary stones
  • may be hypercalcemia (could be from hyperparathyroidism)
  • ingestion of high doses of ascorbic acid in certain individuals
  • may be in neutral pH; rarely in slightly alkaline
90
Q

What is the finding of uric acid crystals in acidic urine associated with?

A
  • from dietary origin from foods rich in purine
  • acute febrile episodes
  • patients with hyperuricemia
    ( gout, leukemia, cancer patients with chemotherapy)
91
Q

Which types of crystals are more likely to be found in acidic urine? (low pH)

A

Calcium oxalate crystals

Uric acid crystals

92
Q

What crystals are more likely to be found in neutral or alkaline urine?

A

Triple phosphate crystals

93
Q

What are triple phosphate crystals found in urine indicative of?

A
  • this is considered clinically normal
94
Q

What are 2 types of amorphous sediment, and what is the clinical significance of this sediment in urine?

A
  • Urates
  • Phosphates
  • No clinical significance
95
Q

When are urates observed in urine?

A
  • acid pH urine
96
Q

When are phosphates observed in urine?

A
  • alkaline pH urine
97
Q

What is the most commonly observed urinary cast?

A

Hyaline cast

98
Q

What does a hyaline cast consist of?

A
  • Tamm-Horsfall protein (a normal secretion within the tubules)
  • IgA
99
Q

When found alone, what does the finding of a hyaline cast indicate?

A

Nothing- clinically significant when found without other casts

100
Q

With what types of conditions might you see hyaline casts?

A
  • glomerulonephritis
  • pyelonephritis
  • chronic renal disease
101
Q

What might cause someone to have an increased number of hyaline casts?

A
  • following strenuous exercise
  • dehydration
  • heat exposure
  • emotional stress
102
Q

True or False. Finding just one RBC cast in a urinalysis is nothing to worry about.

A

False- this is very significant

103
Q

What is an RBC cast indicative of?

A
  • associated with glomerulonephritis

an acute inflammatory process within the kidney

104
Q

What happens to an RBC cast if there is a significant delay between formation and appearance in the urine?

A

It breaks down into a hemoglobin cast

105
Q

If an RBC cast breaks down into a hemoglobin cast, what can this indicate?

A
  • significant stasis of filtrate flow

- this would look like a homogenous appearing red colored cast without distinct cells observed within the protein matrix

106
Q

What is the presence of a WBC cast in urine indicative of?

A
  • most often associated with pyelonephritis

- even just one is very important clinically

107
Q

What type of cast will form when tubular epithelium is damaged due to a variety of glomerular and tubular conditions?

A
  • epithelial cast
108
Q

What type of cast is a disintegrated white cell cast or epithelial cast?

A

Granular cast- either coarsely or finely granular

- could also be a waxy cast- more advanced stages of disintegration

109
Q

Which type of cast requires significant urine stasis within the tubules in order to form?

A

Granular cast

110
Q

Which type of cast is the most advanced stage of disintegrating cellular cast?

A

Waxy cast

111
Q

What type of cast signals existing or impending renal failure?

A

Waxy cast

112
Q

With what condition will there be very wide (broad) casts?

A

Chronic Kidney disease

113
Q

A broad cast is a form of what other type of cast?

A

Waxy

114
Q

Where do broad casts form?

A

Collecting tubules

115
Q

Where are all types of urinary casts formed?

A

ONLY IN THE KIDNEYS

116
Q

What 3 types of microorganisms can be found in urine?

A
  • bacteria
  • yeast
  • protozoa
117
Q

What might increased numbers of bacteria (in the absence of squamous epithelium) indicate?

A

Urinary tract infection

- especially if accompanied by pyuria

118
Q

If bacteria is found in urine and you suspect a UTI, what are the next necessary steps to take?

A

a urine culture & sensitivity

  • identify to bug
  • colony count
  • sensitivity
119
Q

What conditions might cause yeast to be found in urine?

A
  • diabetics
  • patients taking prolonged antibiotics
  • estrogens for ERT or OCA
  • NOT a UTI
  • mainly women with vaginal yeast infection
120
Q

What is the most common protozoa observed in urinalysis?

A

Trichomonas vaginalis

121
Q

What is the certain consideration to diagnose trichomonas vaginalis via urinalysis?

A

Requires freshly voided warm urine sample

122
Q

What is the clinical significance to finding spermatozoa in either a male or females urine?

A

None

123
Q

What might increased amount of mucus found in a females urine indicate?

A

vaginal contamination

- may be some inflammation within the urinary tract

124
Q

What does mucus in urine appear like?

A

thread-like material- may be reported as mucus threads

clin lab (2 decks)

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