Urinalysis Flashcards
pH method
double indicator
what does the double indicator method for pH contain?
methyl red
bromthymol blue
false high pH
bacterial growth
clinical significance of high pH
veg diet Met / Resp alkalosis Renal tubular acidosis vomiting old specimen
clinical significance of low pH
protein diet
met / Resp acidosis
DM
dehydration
glucose method
double sequential
glucose oxidase then peroxidase
glucose false +
bleach
peroxide
glucose false -
ascorbic acid prolonged storage high ketones and SG acetoacetic acid salicylates
clinical significance of glucose
DM pancreatitis acromegaly cushings fanconi renal disease
bilirubin method
diazo
what type of bilirubin is being detected in the urine strip
conjugated (only kind that is in urine)
false + bilirubin
drug induced color change
false - bilirubin
ascorbic acid
high nitrate, storage
clinical significance of bilirubin
hepatitis, cirrhosis, other liver disorders, biliary obstruction
urobilinogen method
ehrlichs / diazo
false - urobilinogen
formalin
storage
light exposure
clinical significance of urobilinogen
early detection of liver disease, liver disorders, hemolytic disorders
protein method
error of indicators
protein reagent
tetra-bromophenol blue
false + protein and why
high pH (overwhelm acid buffer) color
false - protein
protein other than albumin
protein clinical significance pre renal
intravascular hemolysis
muscle injury
APR
MM
protein clinical significance renal
diabetic nephropathy
strenuous exercise
dehydration
hypertension
protein clinical significance post renal
LUTI
injury trauma
ketone method
nitroprusside reaction
false + ketone
color
levodopa
false - ketone
storage ascorbic acid
ketone clinical significance
diabetic acidosis starvation malabsorption/pancreatic disorders strenuous exercise vomiting AA
rbc method
pseudoperoxidase
false + rbc
menses
microbial peroxidase
soaps/detergent
false - rbc
ascorbic acid
high SG
clinical significance rbc
renal calculi
glomerulonephritis
pyelonephritis
trauma
clinical significance hemoglobin
transfusion reaction
hemolytic anemia
burns
infections
clinical significance myoglobin
muscular trauma
coma
convulsions
alcoholism
wbc method
leukocyte esterase
cleave ester = aromatic + diazo salt
false + wbc
color
vaginal contamination
soap / detergent
false - wbc
high glucose, protein, SG
drugs
nitrate method
diazo reaction
sulfanilamide
false + nitrate
color
storage
false - nitrate
ascorbic acid
acid pH
wbc clinical significance
bacterial UTI
inflammation of tract
screening of urine culture specimens
trich / chlamydia / yeast
nitrate clinical significance
cystitis
pyelonephritis
tests with false - due to ascorbic acid
glucose bilirubin ketones rbc nitrate
tests with false + due to soaps / detergent
wbc
rbc
glucose
false + SG
high protein, ketones
lactic acid
false - SG
high glucose, urea
acidic pH
clinical significance of high SG
renal tubular dysfunction
clinical significance of low SG
dilute urine
order of urine strip tests
glucose bilirubin ketone SG blood pH protein urobilinogen nitrite wbc
direct method of SG
urinometer
indirect methods of SG
refractometer
strip
what does the urinometer test measure?
solutes, glucose, protein
for what variables does the urinometer have to be corrected for
temperature
large amount of glucose and protein
what is the refractometer method testing?
ratio of velocity of light in solution vs velocity of light in air
is the degree of refraction proportional or inveresly proportional in the refractometer method?
proportional
what factors can affect the refractometer method?
protein and glucose
what does the strip test method detect?
only ionic solutes
confirmatory test for protein and principle
SSA cold precipitation (turbidimetric)
false + SSA
any substance precipitated by acid
is SSA or the strip more sensitive?
strip
confirmatory test for glucose and principle
clinitest
benedicts copper reduction
what does it mean if:
+ clinitest and neg strip
sugar other than glucose present or strip interference
confirmatory test for ketones and principle
acetest
diacetic acid and acetone
what does it mean if:
+ strip, - acetest
false +
confirmatory test for bilirubin and principle
ictotest
p-nitrobenzene-diazonium-p-toluenesulfonate
what is more sensitive: ictotest or strip?
ictotest
confirmatory test for urobilinogen and principle
ehrlichs
para-dimethylaminobenzaldehyde
how do you differentiate between hemoglobin and myoglobin in urine
chemical pad
2.8 g ammonium sulfate to urine= hgb precipitated
myoglobin stays in supernatant
test supernatant
what are the normal crystals in acidic urine?
uric acid
amorphous urates
calcium oxalate
what are the normal crystals in alkaline urine?
amorphous phosphates triple phosphate calcium phosphate ammonium biurate calcium carbonate
clinical significance of uric acid crystals
gout / leukemia patients under chemo
clinical significance of calcium oxalate
clumps = renal calculi mono= ethylene glycol
amorphous with pink sediment
urates
amorphous with white sediment
phosphates
crystals soluble in alkali
uric acid
amorphous urates
crystals soluble in dilute HCL
calcium oxalate
crystals soluble in dilute acetic acid
amorphous phosphates
calcium phosphates
triple phosphates
crystals soluble in acetic acid with heat
ammonium biurate
crystals soluble in gas from acetic acid
calcium carbonate
abnormal crystals
cystine cholesterol leucine tyrosine bilirubin sulfonamides ampicillin
clinical significance of cystine crystals
cystinuria
clinical significance of cholesterol crystals
nephrotic syndrome
liver disorder crystals
leucine
tyrosine
bilirubin
cystine crystals soluble in what?
ammonia
cholesterol crystals soluble in what?
chloroform
lecuine crystals soluble in what?
hot alkali
tyrosine crystals soluble in what?
alkali / heat
bilirubin crystals soluble in what?
acetic acid
HCL
NaOH
sulfonamides crystals soluble in what?
acetone
bacteria CS and source
UTI
bladder
squamous cells CS and source
N/A
vagina / urethra
tubular cells CS and source
tissue destruction, catheterization, heavy metals, hemoglobin/myoglobinuria, viral infections, pyelonephritis
proximal and distal convoluted tubules
described tubular cells
rectangular, columnar, round, oval, cuboidal
eccentric nucleus
describe transitional cells
spherical, caudal
central nucleus
transitional cell CS and source
few = normal, clumps= carcinoma
renal pelvis, calyces, ureters, bladder, male urethra
yeast CS and source
DM, immunocompromised, UTI, vaginitis
contaminant
trichomonas CS and source
vaginal inflammation
vagina
oval fat bodies CS and source
nephrotic syndrome, DM, tubular necrosis
kidney (RTE cells that absorbed lipids)
glitter cell CS and source
wbc in alkaline/hypotonic urine, granules move
kidney
ghost cell CS and source
dilute/alkaline urine RBC swell and lose hgb
kidney
red cells CS and source
renal ut disease, extrarenal disease, trauma, strenuous exercise, renal stone, cystitis
kidney
white cells CS and source
all renal disease and inflammation, UTI, cystitis, fever, strenuous exercise
kidney
significance of red urine
hgb rbc myoglobin porphyrin beets fuschin
significance of red-brown urine
hgb
rbc
myoglobin
significance of AMBER urine
bilirubin
biliverdin
urobilin
significance of yellow-orange urine
bilirubin
urobilin
pyridium
significance of bright yellow urine
vitamin c
significance of dark yellow urine
concentrated
bilirubin
urobilin
significance of brown-black urine
methmeglobin
homogentisic acid
melanin
significance of blue urine
indican
significance of green urine
old
pseudomonas
significance of port wine urine
porphyrin
findings in DM for: polyuria polydipsia SG Glucose Ketones
polyuria present polydipsia present SG increased Glucose increased Ketones increased
findings in DI for: polyuria polydipsia SG Glucose Ketones
polyuria present polydipsia present SG low Glucose Normal Ketones Normal
defect in DM
low insulin production
defect in DI
low ADH (decreased Water absorption)
Following findings are consistent with what condition:
increased BUN:Creat
mild proteinuria and blood
increased RBC, WBC, RTE, RBC casts
acute glomerulonephritis
Following findings are consistent with what condition: Mod elevated protein and blood low and fixed SG RBC WBC all casts RTE
chronic glomerulonephritis
Following findings are consistent with what condition:
marked protein, blood, oval fat bodies
increased casts, RTE, RBCs
nephrotic syndrome
Following findings are consistent with what condition: protein blood WBC and nitrate WBC RBC casts (bacterial, WBC, granular) RTE
acute pyelonephritis
Following findings are consistent with what condition: protein WBC low SG WBC casts (granular, waxy, broad) glucosuria
chronic pyelonephritis
Following findings are consistent with what condition: protein blood WBC nitrate bacteria RBC transitional cells
cystitis
Following findings are consistent with what condition:
cytotoxic antibody against glomerular membrane
viral respiratory infections
proteinuria
RBC casts
hematuria
Goodpasture syndrome
Following findings are consistent with what condition:
granuloma producing inflammation of small blood vessels
ANCA
hematuria
proteinuria
RBC casts
elevated BUN:creat
Wegeners
Following findings are consistent with what condition:
children after upper respiratory infections
mild to heavy proteinuria
hematuria
RBC casts
Henoch-Schonlein
Following findings are consistent with what condition: RTE cell damage mild proteinuria hematuria RTE cells RTE cell casts
acute tubular necrosis
Following findings are consistent with what condition:
tubular dysfunction
glycosuria
mild proteinuria
Fanconi
Bilirubin and urobilinogen levels in prehepatic conditions
bili- N
uro- increased
Bilirubin and urobilinogen levels in hepatic conditions
bili- positive
uro- increased / N
Bilirubin and urobilinogen levels in posthepatic conditions
bili- positive
uro- decreased / absent
what are the only analytes that increase in urine on standing?
bacteria
nitrate
pH
what factors must be present for cast formation?
protein, pH, solutes, flow rate
protein- Tamm Horsfall (increased under stress and exercise)
pH- acidic
solutes- Na and Ca
flow rate- stasis
mousy odor
phenylketonuria
rancid odor
tyrosinemia
sulphur odor
cystinuria
what cast can be seen with:
protein
blood
hyaline
CS of hyaline casts
glomerulonephritis pyelonephritis chronic renal disease CHF stress and exercise diabetic nephropathy
what cast can be seen with:
rbc (strip)
protein
blood
RBC
rbc cast CS
glomerulonephritis
strenuous exercise
what cast can be seen with:
wbc
protein
LE +
WBC
wbc cast CS
pyelonephritis
acute interstitial nephritis
what cast can be seen with: WBC LE + nitrate + protein bacteria
bacterial
bacterial cast CS
pyelonephritis
what cast can be seen with:
protein
RTE
epithelial
epithelial cast CS
renal tubular damage
what cast can be seen with: protein cell casts RBC WBC
granular
granular cast CS
glomerulonephritis
pyelonephritis
stress and exercise
what cast can be seen with: protein cell casts granular casts RBC WBC
waxy
waxy cast CS
stasis of urine flow
chronic renal failure
what cast can be seen with:
protein
free fat droplets
oval fat bodies
fatty
fatty cast CS
nephrotic syndrome
toxic tubular necrosis
DM
crush injuries
what cast can be seen with: protein WBC RBC granular casts waxy casts
broad
broad casts CS
extreme urine stasis
renal failure
what reacts with sodium nitroprusside in the ketone strip reaction
acetoacetic acid
what is the greiss reaction
nitrite at acid pH react with aromatic amine and forms a diazo salt
what is the normal creatinine level in urine
1.2 mg/24hrs
what is the functional unit of the kidney
nephron
what is renin released in response to
decreased blood volume, arterial pressure, sodium
vascular hemorrhage
increased potassium
aldosterone function
stimulate kidney to retain sodium and water
increase extracellular fluid
increase BP
normalize potassium levels
what is the initial ultrafiltrate specific gravity>?
1.010
what is the SG of isothenuric urine
1.010
what does it mean if a urine has a specific gravity of 1.010 or less?
renal tubular damage
where does urine concentration begin
descending and ascending loop of henle
RAAS pathway
Renin - angiotensin- angiotensin II- ADH and Aldosterone, and vasoconstriction of efferent and vasodilation of afferent arteriole
where does ADH originate from
hypothalamus
where does ADH act on and what does it do
distal convoluted tubule
Na reabsorption
where does aldosterone originate from
adrenal cortex
where does aldosterone act on and what does it do
collecting duct
water reabsorption
what does the vasoconstriction and vasodilation of the arterioles cause
Na reabsorption in proximal convoluted tubule
where is Na reabsorbed
proximal convoluted tubule
ascending loop of henle
distal convoluted tubule
what is lesch nyhan syndrom
purine disorder with massive excretion of urinary uric acid crystals
heme synthesis pathway
delta ALA Porphobilinogen Uroporphyrinogen Coproporphyrinogen Protoporphyrin Heme
what heme precursors are associated with acute intermittent porphyria
Delta ALA
PORpho
what heme precursors are associated with cutaneous symptoms
UR
COP
PROTO
elevated ALA / PORph condition
acute intermittent porphyria
Lead-ALA only
elevated URO condition
Porphyria cutanea tarda
Congenital erythropoietic porphyria
elevated COPro condition
congenital erythropoietic porphyria
variegate porphyria
elevated Proto condition
erythropoietic protoporphyria
in what porphyria conditions will the urine fluoresce
porphyria cutanea tarda
congenital erythropoietic porphyria
variegate porphyria
erythopoietic protoporphyria
symptoms of porphyrias
photosensitivity
pale
port wine urine
psychiatric symptoms
most common porphyria
porphyria cutanea tarda
watson schwartz principle
PBG will react with Ehrlichs reagent to form red color
watson schwartz differentiation
add chloroform to separate PBG and UBG
color in top layer (chloroform layer) watson schwartz
UBG
color in bottom layer watson schwartz
PBG
what contributes to SG but not osmolality and why
protein
osmolality- all substances that dissolve in urine (urea, uric acid, glucose, salts)
microalbumin strip principle
formation of a copper creatinine complex
false - microalbumin strip
ascorbate
EDTA
false + microalbumin
hemoglobin
drugs
what does it mean if:
+ glucose
= clinitest
true glycosuria
clinitest should not be used to confirm positive glucose
creatinine clearance formula
U x V / P x 1440 (min / 24 hours)
how to correct for body surface area in creatinine clearance formula
creat clear x 1.73 / area
