Urinalysis and Body Fluids Exam 1 Flashcards
Two dominant manifestations of acute glomerulonephritis and give examples of various causes of this condition:
- Proteinuria ex. streptococcal infection
- Hematuria with RBC casts
i. e streptococcal infection, immune complex diseases.
* chronic glomerulonephritis is a slow progressing disease.
What are two clinical manifestations of acute tubular necrosis and what is it often associated with:
Manifestations: -decreased urine flow
-inability to produce urine
-loss of many tubular epithelial cells into
urine
Often associated with reduced blood supply to renal tubes.
3 manifestations of nephrotic syndrome
- proteinuria
- Hypoproteinemia (low protein in blood)
- edema (fluid retention)
common causes of urinary obstruction
- stones
- tumors
- congenital malformation
- stricture from infection
explain pyelonephritis
severe kidney infection that often originates from a bladder infection.
What are 2 main clinical findings in urine that may indicate diabetes mellitus and what would you expect to see in regards to SG
Glucose (glycosuria) Ketone bodies (ketonuria)
Both high SG/high volume
Unconjugated Bilirubin
Not found in the urine. Travels to the liver where it is separated from albumin and is insoluable in water.
i.e. free or indirect
Conjugated Bilirubin
Conjugated in the liver by esterfication with glucuronic acid. water soluble.
i.e. direct bilirubin and bilirubin diglucronide
Urobilinogen
conjugated bilirubin travels to the bile duct to the small intestine. 99.9% excreted into feces. Absorbed into the intestinal mucosa and travels back to the liver.
Healthy patient bilirubin and urobilinogen
bilirubin-negative
urobilinogen- normal or decreased
Hemolytic disease bilirubin and urobolinogen
bilirubin- negative
urobolinogen-normal or increased
Hepatic Disease bilirubin and urobolinogen
bilirubin- positive or negative
urobolinogen-normal or increased
Biliary obstruction bilirubin and urobolinogen
bilirubin- positive
urobolinogen- low or absent
PKU
Lack phenylalanine hydroxylase for the conversion of phenylalanine to tyrosine
Phenylalanine accumulates and it’s metabolite phenylpyruvic acid appears in the urine
mousy odor
*phentest = dark green/blue green color
alkaptonuria
-Lacks homogenistic acid oxidase. Homogenistic acid accumulates in the blood and body fluids and is found in urine.
-urine darkens upon standing
Occurs in middle-age
*clinitest-orange
maple syrup disease
Lacks enzyme needed in branched-chain amino acid metabolism. Excessive accumulation of valine, leu one, insole icons and their keto & hydroxy acid in urine, blood, CSF. Causes keto acidosis, vomiting, seizure and lethargy.
*acetest-purple
urine smells like burnt sugar
Fanconi’s syndrome
- proximal convuluted tuble function is impaired
- failure to reabsorb glucose, water, phospurus, potassium and calcium
cystinuria
-cystine crystals in the urine
-inability of renal tubes to reabsorb cystine as well arginine, lysine and ornithine due to inherited trait.
Frequent cystine calculi(stones)
galactosemia
-lack of enzyme necessary to convert galactose to glucose
-detected in early infancy as diarrhea, vomiting and failure to thrive occurs
Positive on clinitest and negative on dip stick for glucose.
Define hematuria and name some conditions that may cause it:
presence of an abnormal # or RBC’s which often accompanies disease or the urinary system
- glomarular disease
- tubular disease
- vascular disease
Physical changes that occur as urine specimen remains at room temperature
- color darkens or changes
- clarity decrease
- odor-foul smelling
Chemical changes that occur as urine specimen remains at room temperature
pH-increase urobilinogen-decrease
glucose-decrease nitrates-increase
-ketones-decrease
bilirubin-decrease
Microscopic changes/cellular changes that occur as urine specimen remains at room temperature
blood cells-decrease
casts-decrease
bacteria-increase
thichomonads- decrease
state the time limit for examination of urine specimens held at room temerature
no longer than an hour
Explain what addis count is used for, the duration of the collection,and the preferred status of the urines pH and concentration.
- used to follow renal disease
- 12 hr. over night period
- low pH high concentration
Define catheterization and suprapubic aspiration and state when and on what patients each is used.
- Catheter-insert a sterile catheter through the urethra into the bladder.
- used on elderly, immoblile patients and pediatrics.
- Suprapubic aspiration- using sterile needle and syringe the abdominal wall is punctured and urine is aspirated from the bladder.
- used when an individual can NOT pas urine
Name three characteristics of urine routinely recorded in the physical examination of urine:
- color
- clarity
- odor
Identify the urine preservative in each of the following descriptions
a. gives a false positive for albumin in a protein precipitation(turbidity) test *thymol
b. best for the preservation of bacteria
* Refrigeration
c. preserves the cellular elements *formalin
Name the reactions of the Multisitix for which time is not critical and state the total time required to read all reactions of the Multistix.
Protein and pH can be read after the others ones needing to be read at 60 secs. Total time required is 2 mins.
List the ten tests performed in the chemical analysis of urine.
- glucose
- ketones
- bilirubin
- SG
- nitrate
- uribiliogen
- blood
- protein
- pH
- Leucocyte
State the abnormal colors of urine and state a cause for the colors
amber-excessive urobilinogen/billirubin pink/red-blood brown-myoglobin blue/green infection UTI Orange food or drugs
List the constitutes of urine that may cause a cloudy appearance:
- Increased WBC’s
- Increased bacteria
- mucus
- amorphous
- crystals
What may cause large amounts of white or yellow foam in the urine when shaken?
white=protein
yellow=bilirubin
Correlate abnormal odors of urine with their cause:
Sweet-ketone production
pungent, fetid-UTI
burnt sugar- maple syrup disease
PKU- mousy odor
rancid tyrasinemia
state the specific gravity range of normal urine
1.002-1.030
State the type of urine container and/or urine specimen the following tests should be collected in:
a. urine culture-sterile or clean catch
b. overall patient health-random collection
c. Addis count-12 hr overnight period
d. postprandial urine-2-3 hrs after eating
e. protein-morning
f. GFR(glomerular filtration rate or renal clearance)-24 hr
g. glucose (quantitative)-24 hr
name the 3 substances that might be present in urine that may cause high specific gravity readings
protein
glucose
radio graphic dyes
Define refractive index
Ratio of the velocity of light and air to the velocity of light in the solution
Define osmolality
Expresses concentration as the # of solutes present.
Not concerned with large heavy molecules.
Define specific gravity
# of solutes per volume of solution Concerned with the size of molecules
name the two constituents urine contribute the most to its specific gravity
Sodium chloride and uria
Name one condition that may be responsible for an abnormally low specific gravity
Diabetes insipidus
Oliguria
Decreased urine excretion less than 400mL/day
-related to obstruction, infection and dehydration
Volume low SG high
Anuria
no urine excreted
Obstruction, tumor,
hyposthenuria
urine can not be concentrated due to lack of water absorbtion. Has low specific gravity
-diabetes insipidus
polyuria
increased urine
- diabetes mellitus, drugs and renal disease being the cause
- more than 3L/day
nocturia
increased urine at night
Kidney disease
isosthenuria
fixed SG at 1.010 unable to concentrate or dilute urine
- chronic renal disorders
hypersthenuria
high SG and increased urine flow
- nephrotic syndrome with proteinuria and dehydration
- diabetes mellitus with glycoseria
state the cause of refrigerated urine specimens becoming cloudy
Increased amorphous crystals
name a property that is utilized in the determination of urine osmolality
freezing point
state the normal volume of urine excreted by the average adult in a 24 hr. period
600-1800mL normal urine
1200mL-1500mL average
Correlate the color of urine to whether the urine is dilute of concentrated, i.e. fluid intake
*colorless-yellow-dilute-high fluid intake or increased urine excretion due to diabetes normal
*dark yellow-concentrated-related to low fluid intake or dehydration
Most concentrated is 1st morning urine
