Urinalysis & Body Fluids Flashcards
what is the average daily output of urine for a health individual?
800-2000 mL
increased urine output common seen in DM and Insipidus
polyuria
decreased daily urine output seen in kidney disease and end-stage liver failure
oliguria
complete cessation in urine flow
anuria
frequent urination at night
nocturia
when is a urine test performed after the specimen has been collected?
room temp, within 2 hours
what does a large amount of yellow foam in urine indicate?
bilirubin
what does dark urine indicate? (2)
concentrated urine
dehydration
what does amber urine indicate? (2)
concentrated urine
bilirubin
what does bright red urine indicate?
hemoglobin
RBCs
what does dark red urine indicate? (2)
myoglobin
beets
what does red-purple urine indicate?
porphyrins
what does dark brown/black urine indicate?
melanin
alkaptonuria
what does green and blue urine indicate? (2)
pseudomonas
medications
what does orange urine indicate?
phenazopyridine (UTI medication)
what is the normal pH for health fresh voided urine?
5-6
what does alkaline urine indicate? (3)
UTI
renal disease
vegetarian
what does acidic urine indicate? (4)
starvation
diarrhea
diabetes mellitus
respiratory disease
what is measured to determine the state of the kidneys or state of hydration?
specific gravity
how relationship does specific gravity have with urine output?
inversely proportional
what measurement tells us the amount of dissolved substances in a solution?
specific gravity
measure of solute concentration by testing freezing point depression of a solution
osmolality
what does increased osmolality indicate? (3)
DM
dehydration
addison’s disease
what does decreased osmolality indicate? (3)
DI
hydration
pyelonephritis
measured to determine kidney/tubule function and reabsorption
protein
what is a protein measurement sensitive and specific to?
albumin
testing for conditions of the urinary tract and renal function
blood
what could a positive result of blood in the urine indicate? (3)
glomerular damage
interstitial nephritis
kidney/bladder infections/disease
what does hemoglobinuria indicate?
intravascular hemolysis
transfusion reaction when RBCs lyse and are released into the urine
intravascular hemolysis
what does myoglobinuria in urine indicate?
rhabdomyolysis
use to detect the presence of nitrite-reducing bacteria
nitrite
what is the preferred urine collection to test nitrite?
clean catch, first void
how are positive results of nitrite confirmed? (2)
urine microscopy
urine culture
use to detect WBCs, specifically neutrophils, being excreted in the urine
leukocyte esterase
what does a positive result of leukocyte esterase indicate?
pyuria - infection or inflammation anywhere in the GU system
how is a positive leukocyte esterase confirmed?
urine microscopy
urine culture
what does a positive nitrite and positive leukocyte esterase indicate?
bacterial infection
what could a negative nitrite and positive leukocyte esterase indicate? (4)
STI
trichomonas
yeast
virus
what does glucosuria without hyperglycemia indicate?
pregnancy
fanconi’s sydrome
what does glucosuria with hyperglycemia indicate? (4)
DM
hyperthyroidism
strokes
tumors
what is increased due to DM, starvation, diet, high protein diet, alcoholism, strenuous exercise, pregnancy, or fanconi’s syndrome?
ketones
what urine test is an indication of liver function
bilirubin
what type of bilirubin can be excreted in the urine?
conjugated
what urine test could pick up ANY type of liver disease?
urobilinogen
in which 2 conditions is urobilinogen increased?
hepatitis
cirrhosis
in which condition is urobilinogen decreased?
post-hepatic obstructions
an analysis of the sediment in the urine
microscopic analysis
urine under the microscope shows retractile green biconcave disks. what are they?
RBCs
what do RBCs have to look like to indicate bleeding in the urinary tract?
spikey
urine under the microscope shows granular cells containing nuclei. what are they?
WBCs
what does eosinophils in the urine indicate?
interstitial nephritis
what do squamous epithelial cells in the urine indicate?
contamination
what do clue cells in the urine indicate?
bacterial vaginosis caused by gardnerella vaginalis
what do transitional epithelial cells in the urine indicate?
damage to the urinary tract
what do renal tubular epithelial cells in the urine indicate? (2)
renal disease
tubular damage
renal epi’s containing lipid globules
oval fat bodies
what do oval fat bodies in the urine indicate?
nephrotic syndrome
urine under the microscope shows motile/non-motile green refractile small rods. what are they?
bacteria
what should we do next if a patient tests positive for bacteria in the urine?
urine culture
urine under the microscope shows green, refractile, small, ovoid snowmen. what are they?
budding yeast
urine under the microscope shows long branches with buds. what are they?
pseudohyphae
what does a positive result of yeast in urine indicate? (3)
vaginal contamination
fungal kidney infection
diabetes
what should we do next if a patient tests positive for yeast?
urine culture
urine under the microscope shows flagellated motile protozoa moving in a rapid jerky motion. what are they?
trichomonas vaginalis
urine under the microscope shows large eggs with terminal spine. what is it?
schistosoma haemtobium
what infects the urinary bladder and causes bladder cancer?
schistosoma haemtobium
urine under the microscope shows pinworm eggs. what are they?
enterobius vermicularis
what kind of infection does enterobius vermicularis cause?
perianal infection
urine under the microscope shows motile/non-motile oval bodies with a long tail, which may be confused with mucus. what are they?
sperm
what characteristic in urine can be explained by the presence of sperm?
cloudy urine
microscopic clusters of particles wrapped in tamm-horsfall protein matrix, formed in distal convoluted tubule and collecting duct
urinary casts
what do casts in the urine indicate?
upper urinary tract infections (kidney)
urine under the microscope shows transparent, colorless and cylindrical casts that present after strenuous exercise. what are they?
hyaline casts
urine under the microscope shows granulated hyaline casts that can indicate renal disease. what are they?
granular casts
what does RBC casts in urine indicate?
acute glomerulonephritis
what does WBC casts in the urine indicate?
pyelonephritis
what microscopic finding in urine can help us different between lower and upper UTI?
WBC cast
what kind of urinary infection presents with cast + bacterial infection?
upper urinary infection
what kind of urinary infection presents with NO casts + bacterial infection?
lower urinary infection
what does fatty casts in the urine indicate? (2)
nephrotic syndrome
high protein
urine under the microscope shows broad casts with blunt ends, fissures, and cracks. what is it?
waxy cast
what does waxy casts in the urine indicate? (2)
end stage renal disease
urine stasis
crystals are formed in response to what?
precipitated urine salts
acidic crystals that present as granular brick dust and can make the urine appear pink
amorphous urates
acidic crystals that present as octahedral or oval shapes
calcium oxalate
what does calcium oxalate in the urine indicate? (2)
ethylene glycol poisoning
UTI
acidic crystals that are yellow-brown and irregular shapes
uric acid
what does uric acid in the urine indicate?
gout
alkaline crystals that are white granular masses and indicate alkaline urine
amorphous phosphates
alkaline crystals that are colorless prisms “coffin lids” and indicate a UTI
triple phosphate
alkaline crystals that are yellow-brown spicules “thorny apples”
ammonium biurate
abnormal crystal that is a colorless hexagonal plate, and indicates cystinuria, amino acid disorder, and is present with increased renal calculi formation
cysteine
abnormal crystal that is colorless, fat, rectangular plates with notches, and indicates nephrotic syndrome
cholesterol
abnormal crystal that is fine, colorless needles in clusters
tyrosine
abnormal crystals that are yellow spheres with radial striations
leucine
tyrosine and leucine are typically seen together. what do they indicate?
severe liver disease
abnormal crystals that are yellow-brown clumped needles or granules
bilirubin
what does bilirubin in urine indicate?
liver disease
what is collected during a sterile procedure and is sent to the lab asap?
body fluids
what do lymphocytes in body fluids indicate?
viral infection
what is collected via lumbar puncture and is collected in a 4 tube system?
cerebral spinal fluid
what does bright red CSF indicate?
subarachnoid hemorrhage
CSF appears turbid, has elevated opening pressure, WBCs >1000, protein >200, and glucose <40. what does this patient have?
bacterial meningitis
CSF appears clear, has normal opening pressure, WBC <300 with lymphocytes, protein <200, and normal glucose. what does this patient have?
viral meningitis
CSF appears clear, has normal-elevated opening pressure, WBCs <500, protein >200, and normal-low glucose. what does this patient have?
fungal meningitis
collection of viscous fluid from joint cavities
synovial fluid
collection of synovial fluid is a differential diagnosis for what?
arthritic pain
what do synovial fluid crystals called monosodium urate, that look like fine needles, indicate?
gout
what do synovial fluid crystals called CPPD, that are bulky, indicate?
pseudogout
how is vaginal fluid sampled?
wet prep via endocervical swab and gram stain
vaginal fluid that has potassium hydroxide added to the wet mount to isolate yeast/fungal elements
KOH prep
a regular wet mound of vaginal fluid tests for what? (4)
trichomonas
yeast
WBCs
clue cells
which sample should be collected and kept warm until testing can be performed?
seminal fluid
why are seminal fluid levels checked? (3)
fertility
vasectomy success
forensic
performed to diagnose genetic and developmental conditions
amniotic fluid
what kind of stain is used for amniotic fluid to identify fetal hemorrhage?
kleihauer-betke stain
what kind of test is used for amniotic fluid to identify open neural tube defects?
alpha fetoprotein (AFP)
what kind of test is used for amniotic fluid to identify maturation of the fetal lung?
lecithin sphingomyelin (L/S ratio)
what kind of test of amniotic fluid is used to detect premature rupture of the fetal membrane?
fern test
what type of body fluid is used for a fern test?
vaginal secretions
