Urinalysis Flashcards
When to order urinalysis?
Abdominopelvic pain, back/flank pain, painful/frequent urination, change in color, med compliance
What does urinalysis test for?
Glucose, nitrite, ketones, myglobin
First morning test
compare kidney function when laying down
Microscopic components
WBC, RBC, epithelial cells, casts, crystals, microorganisms
Chemica reagents
Protein, glucose, ketone, bilirubin, pH, blood, nitrite, leukocyte esterase, urobilinogen, specific gravity
Normal Urine
Start colored/yellow and clear
What does yellow color come from?
Urochrome-byproduct of hemoglobin breakdown
Transparency Grades
Clear, slightly cloudy, cloudy, turbid (can’t see through)
Cloudy-turbid=WBC/bacteria (UTI), fecal contamination, prostatic fluid, seminal vesicle fluid, vaginal secretions
Causes of foamy urine
Protein, bilirubin, pneumaturia (air in urine-rectal vesicle fistula)
Leukocytes
Pyuria
normally negative
presence of WBC, suggests UTI
Nitrites
Normally negative
Positive=Ecoli (UTI), kelbsiella, proteus, staph, pseudomonas
Nitrate reduced to nitrite by bacteria
*does not test for streptococcus
Urobilinogen
Low-heptobiliary obstruction
High-liver disease, hemolytic disease, excessive exposure of bilirubin to intestinal bacteria
Protein
Detects albumin
normally negative
Dipstick highly specific but insensitive (may not detect up to 300mg)
Causes-stress, dehydration, pregnancy, exercise, fever
serious causes-hypertension, diabetes w/ CKD, glomerular damage, multiple myeloma
pH
Normal 4.5-8
increases with UTI and over time
Blood
Normally negative
Causes-UTI, exercise, pyelonephritis, glomerular nephritis, renal/bladder cancer, menses
Excessive muscle breakdown>myoglobin (trauma, MI, rhabdomyolosis)
Do microscopic after dipstick to determine blood vs myoglobin
Specific gravity
Increased (concentrated)-dehydration, decreased RBF, glycosuria, proteinuria
Decreased (dilute)-overhydration, diabetes insipidus, chronic renal failure
Ketones
Normally negative
Product of fat catabolism
Causes-diabetic ketoacidosis, fasting/starvation/vomiting, exercise, dehydration
Diabetic ketoacidosis
increased lipolysis from decreased insulin in cells
Bilirubin
normally negative
Foam test=positive
Follow-up with liver function to find cause of bilirubin
Glucose
Normally negative
Seen when BS is over 180
Renal disorders/diabetes
Normal microscopic
No bacteria/casts/crystals, occasional epithelial cells
Chronic Kidney Disease
Rarely reversible
Progressive decline in renal function due to hypertrophy of nephrons, continues even after treated-less nephrons so they’re working harder causing them to die out also
RBC association
Pylonephritis, cystitis, ureterlithiasis, GU malignancy, renal cyst, acute kidney injury
WBC association
Infections, renal inflammatory processes (nephritis)
