Urinalysis

Question 1

What is the normal urinary specific gravity?

Answer 1

1.010 isotonic

Question 2

What are the max and minimum urine specific gravities?

Answer 2

1. 002 max dilute

1. 030 max concentrate

Question 3

What is the normal urine pH range?

Answer 3

5.0-6.5

Question 4

What is the pH in metabolic acidosis?

Answer 4

<5.3

Question 5

What does a high urine pH above 7.5 suggest?

Answer 5

UTI with urea splitting bacteria

Question 6

What does glycosuria in the presence of normal blood glucose suggest?

Answer 6

Proximal tubule dysfunction, e.g., Fanconi syndrome

Question 7

What does nitrite in urine suggest?

Answer 7

Should be absent so suggests UTI. Nitrate is normal though

Question 8

What does leukocyte esterase in urine mean?

Answer 8

Probably UTI

Question 9

What is the normal max protein excretion in urine per day?

Answer 9

<150mg/day

Question 10

Which protein(s) is directly measured by the urinalysis?

Answer 10

Albumin

Question 11

What test can be done to measure all proteins in the urine?

Answer 11

Sulfosalicylic acid

Question 12

What does a positive urine anion gap suggest?

Answer 12

Renal tubular acidosis

Question 13

What does a negative anion gap suggest (urine)?

Answer 13

GI issues

Question 14

What results would lead you to think rhabdo or hemolysis?

Answer 14

Positive Hgb or myoglobin with negative RBC

Question 15

How can you distinguish renal vs. non-renal hematuria?

Answer 15

Only renal will have:
Dysmorphic RBCs in sediment
RBC casts
No clots
Usually heavy proteinuria

Question 16

What do renal tubular epithelial cells in the urine suggest?

Answer 16

Acute tubular necrosis

Question 17

When do hyaline casts appear in the urine?

Answer 17

Normal to have a few

Could indicate volume depletion

Question 18

What are the matrixes of all casts made of?

Answer 18

Tamm-Horsfall protein, made in thick ALH

Question 19

What do waxy casts look like and suggest?

Answer 19

Large and dense; white line on border; sharp broken ends

Renal failure - chronic kidney disease

Question 20

What shape are uric acid crystals?

Answer 20

Rhombi/hexagons

Question 21

What do calcium oxalate crystals look like and suggest?

Answer 21

“Envelope” / diamonds

suggests stones

Question 22

Triple phosphate crystals - appearance and meaning?

Answer 22

“Coffin lids” or gold bars

Suggest infection

Question 23

Cystine crystals - appearance and meaning

Answer 23

Kids: inherited cystinuria
Adults: dense kidney stones

Question 24

Lipiduria is pathonemonic for what?

Answer 24

Heavy proteinuria of NEPHROTIC syndrome

Question 25

Lipiduria crystal appearance

Answer 25

Maltese cross in polarized light

Question 26

What do granular casts indicate?

Answer 26

Breakdown of cellular debris; not pathonemonic for anything

Question 27

RBC casts suggest….

Answer 27

glomerulonephritis