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Renal Module > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What is the beginning of the assessment/diagnosis of kidney disease?

A

Urinalysis

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2
Q

What can urinalysis tell you in the assessment of kidney disease?

A

a) prerenal, intrinsic renal, postrenal
b) acute or chronic onset
c) glomerular vs tubular etiology
d) inflammatory or non-inflammatory process
e) associated with systemic disease or not

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3
Q

What are the steps in the optimal urinalysis technique? (4)

A
  1. Obtain fresh sample (analysis w/in 60 minutes) clean catch midstream collection
  2. Centrifugation to produce supernatant and urinary pellet (sediment)
  3. Supernatant for chemical analysis (urinary dipstick)
  4. Sediment for light microscopy
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4
Q

What are the two ways to analyze urinary concentration? How are they determined?

A
  1. Specific Gravity→determined by the number AND weight of solutes in solution
  2. Osmolality→determined ONLY by the number of solutes in solution
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5
Q

When is specific gravity not a marker of urine concentration? Specific examples?

A

When there are abnormal numbers of heavy solutes in urine→glycosuria, contrast media (these cause very high urine specific gravity and aren’t true reflections of urine concentration)

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6
Q

What is the maximum dilute urinary specific gravity and what urine osmolality does this normally correspond to? Isosthenuria specific gravity (isotonic urine)? Maximum concentrated specific gravity?

A
  1. Max dilute SG= 1.002→ ~50-100 mosm/kg
  2. Isosthenuria=1.010→ ~300mosm/kg
  3. Mac conc=1.0303→ ~1200 mosm/kg
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7
Q

What is the normal range of urinary pH? What is urinary pH is metabolic acidosis?

A

Normal→5.0-6.5

MetAcidosis→ pH<5.3

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8
Q

What does a urine pH>7.5-8.0 indicate?

A

It suggests UTI with urea splitting bacteria (usually gram neg’s→PROTEUS, E coli)

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9
Q

What is urinary pH an reflection of?

A

dietary intake and the state of the person’s acid-base system

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10
Q

What is the normal value of glucose in urine? How is urine glucose assessed? What causes glycosuria?

A

Normal urine glucose is negative; dipstick;
Hyperglycemia causes the filtered load of glc to be greater than the reabsorptive capacity of the PT, resulting in glycosuria

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11
Q

Glycosuria in the presence of normal blood glucose (renal glycosuria indicates what?

A

Proximal tubular dysfunction→Fanconi Syndrome (which is associated with mulitple myeloma)

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12
Q

What is the normal urine level of ketones? When are ketones present in the urine?

A

Normally ketones are negative in urine, but can be present during:
1. Fasting 2. Diabetic ketoacidosis 3.Alcoholic KA

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13
Q

How do fasting, DKA, and AKA cause ketonuria?

A

Increased plasma ketoanions lead to filtered load exceeding proximal tubular reabsorptive capacity, resulting in ketonuria

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14
Q

How are urinary ketones detected?

A

Dipstick specific for acetone and acetoacetate

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15
Q

What is useful about looking for urinary bilirubin?

A

It’s an assessment tool for abnormal hepatobiliary function

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16
Q

In what form is bilirubin excreted in the urine? Why? Which form of bilirubin is not found in the urine? Which bilirubin metabolic byproduct is excreted in the urine?

A

Conjugated (direct) bilirubin is found in the urine bc it is water soluble.
Unconjugated (indirect) bilirubin is not found in the urine bc it’s water insoluble.
Urobilinogen (metabolic byproduct) is also found in the urine.

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17
Q

Under what condition is bilirubin excreted in the urine? How is it detected?

A

Elevated levels of plasma conjugated bilirubin lead to urinary excretion (hyperbilirubinemia) (liver disease???)
Another feature detected by the urinary dipstick

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18
Q

Is nitrite normally found in the urine?

A

No, nitrite is absent in normal urine

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19
Q

How does nitrite end up in the urine? What does this suggest?

A

Nitrate (which is normally excreted in the urine) is converted to nitrite which appears in the urine when there is a UTI with nitrate reducing bacteria (Gram NEGATIVE bacteria)

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20
Q

What are the most common uropathogens?

A

Gram Negative Bacteria

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21
Q

Is leukocyte esterase present in normal urine?

A

No

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22
Q

How is urinary leukocyte esterase detected?

A

A dipstick that detects a neutrophil-specific enzyme →Leukocyte esterase

23
Q

When is the urine positive for leukocyte esterase? Specific examples?

A

When there are increased numbers of neutrophils in the urine; such as in UTI’s or inflammatory renal diseases such as Lupus nephritis

24
Q

What is the normal level of daily protein excretion? What is this protein made up of?

A

Normal protein excretion= <150mg/day

Tamm-Horsfall protein (major), LMW proteins, and micro-amounts of albumin as well

25
Q

What are the 3 ways to measure urinary protein excretion? Which ones are quantitative?

A
  1. Urinary dipstick→ semi-quantitative (0-4+ scale)
  2. 24hr Collection→ quantitative (g/hr)
  3. Spot Urine Sample (ratio of urine protein over creatinine, both in mg/dl)
26
Q

How does a spot urine sample ratio of 5 correspond to in a 24ht urine collection?

A

Ratio of 5= ~5 g/24hr

27
Q

When is the heaviest proteinuria found?

A

When its glomerular proteinuria

28
Q

What does glomerular proteinuria reflect?

A

Reflects increased permeability of the glomerular capillary wall for protein

29
Q

What is the most abundant protein found in the urine in glomerular proteinuria? How is this detected?

A

Albumin; dipstick specific for albumin

30
Q

What test detects all proteins in the urine?

A

Sulfosalicyclic acid test, graded on same scale as albumin dipstick test

31
Q

What does a proteinuria value of 3+ or 4+ suggest?

A

Nephrotic proteinuria

32
Q

What value indicates proteinuria in a 24h collection?

A

3.5g/24hr

33
Q

What happens in tubular proteinuria?

A

LMW proteins are filtered and normally reabsorbed by pinocytosis in the PT. But in tubular proteinuria, failure to reabsorb these LMW proteins reflects proximal tubular dysfunction

34
Q

What is overflow proteinuria?

A

Excess production of LMW proteins increases the filtered load so that exceeds the reabsorptive capacity of the PT

35
Q

What is an example of overflow proteinuria?

A

Light chain proteinuria in multiple myeloma

36
Q

What would the results be on an albumin dipstick and sulfosalicyclic acid test for a patient with overflow proteinuria?

A

Dipstick would be negative or very weakly positive for albumin, but you would get a strongly positive sulfsalicyclic acid test

37
Q

What additional urinary parameters are measured? (look at notes on slide)

A
  1. Measurment of urinary electrolytes (Na, K, Cl)
  2. Urinary osmolality (assessment of water handling)
  3. Urinary anion gap (assessment of hyperchloremic metabolic acidosis)
  4. Urinary creatinine and urea nitrogen
  5. Urinary Ca2+, P, and uric acid (to look for causes of nephrolithiasis)
38
Q

What are the normal urine levels for RBCs and blood?

A

Normal urine has 0-2rbc/hpf and urine dipstick negative for blood

39
Q

What is the most common cause of positive dipstick for blood?

A

the presence of RBC’s in urinary sediment

40
Q

What else is the blood dipstick to?

A

Hemoglobin and myoglobin, but the urinary sediment will be negative for RBCs in these cases

41
Q

In hematuria of renal origin (renal hematuria), what are the characterisitics of a) dispstick b) sediment c) presence/absence of casts d) presence/absence of clots e) presence or absence of proteinuria?

A

a) dipstick positive
b) RBCs in sediment, some DYSMORPHIC
c) RBC CASTS
d) absence of clots
e) often associated with proteinuria

42
Q

In hematuria of extra-renal origin (extra-renal hematuria), what are the characterisitics of a) dispstick b) sediment c) presence/absence of casts d) presence/absence of clots e) presence or absence of proteinuria?

A

a) dipstick positive
b) RBCs in sediment, NORMAL shape
c) NO RBC CASTS
d) clots may be present
e) Absence of heavy proteinuria

43
Q

What are crenated RBCs?

A

RBCs that look battered; loss of cell volume by RBCs due to being in more concentrated supernatants→ water got sucked out

44
Q

What is the normal urine level of WBCs? How are urinary WBCs distinguished?

A

Normal urine: 0-4 WBC/hpf
WBCs have granular cytoplasm, irregular nucleus, and have a glitter cell appearance in urine with active infection
They are bigger than RBCs but smaller than epithelial cells

45
Q

What causes elevated levels of WBCs in urine? Which is most common?

A

UTI (most common), pyelonephritis, allergic interstitial nephritis, intense glomerulonephritis (SLE)

46
Q

What do squamous epithelial cells in the urine look like? Where are they found?

A

Very large, plate-like cells with abundant cytoplasm and small nucleus; they are found lining the lower urinary tract (urethra) and are also predominant in urine if there’s a lot of vaginal contamination of the urinary sample

47
Q

What do squamous epithelial cells indicate regarding the renal condition of the patient?

A

Not much of anything

48
Q

What is the most common cause of renal tubular epithelial cells in the urine?

A

ATN (also with other acute tubular injuries)

49
Q

What is the only normal cast found in the urine? When are they found?

A

Hyaline cast; found in a normal person in states of volume depletion (after running a marathon)

50
Q

What do hyaline casts in urine look like?

A

ghost cells with density similar to that of the fluid that surrounds them

51
Q

What forms the matrix of hyaline casts?

A

Tamm-Horsfall protein

52
Q

What do urinary casts represent?

A

precipitates of protein and cells forming in the lumen of tubules (collecting ducts)

53
Q

What forms the matrix of all urinary casts? Where is it made?

A

Tamm-horsfall protein produced by TALH cells

54
Q

What is the shape and what else can urinary casts contain?

A

Cylindrical shape with distinct margins; may contain cellular debris (granular

Renal Module (13 decks)

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