Urinalysis (Coderes) Flashcards
Red quadrant in NFPA hazard classification:
Flammability hazard
E in RACE:
Extinguish
Glucose is reabsorbed in what part of the nephron?
PCT
Urine odor in acute tubular necrosis (ATN):
Odorless
Principle of automated reagent strip readers:
Reflectance photometry
Reagents used in Split Fat Stain procedure:
Sudan III and 36% acetic acid
Source of anti-hCG in pregnancy test kits:
Rabbit
Renal stone — yellow, brown, greasy and resembles old soap:
Cystine
Dilution of a slightly bloody CSF spx:
1:200
Counting chamber used for undiluted semen spx:
Makler
Spx in Diagnex tubeless (Diagnex blue) test:
Urine
SG of 9% sucrose using refractometer:
1.034 (NaCl = 1.022; K2SO4 = 1.015)
Bronchial asthma:
Dittrich’s plugs
Charcot leyden crystals
Curschmann’s spirals
Creola bodies
Enzyme added to reduce viscosity of synovial fluid:
0.05% hyaluronidase
Amniotic fluid test for HDN:
OD 450
Tumor markers for urinary blood cancer:
NMP and BTA
Mx that forms a halo of light around an object:
Phase contrast
Centrifuges are calibrated every:
3 months
Positive color in the MPS paper test:
Blue
Precipitated with tyrosine crystals if alcohol is added to urine:
Leucine
Part of nephron that resembles a sieve:
Glomerulus
Renal threshold for glucose:
160 to 180 mg/dL
Urine pH in renal tubular acidosis (RTA):
Alkaline
Urine color in melanuria:
Brown
SG range detected by urine reagent strip readers:
1.000 to 1.030
Ehrlich unit:
Urobilinogen
NV for albumin excretion rate (AER):
0 to 20 ug/min
Addis count — specimen and preservative:
12H urine; formalin
Oval fat bodies are seen in:
Nephrotic syndrome
Colorless needles that tend to form bundles following refrigeration:
Anpicillin
Anti-glomerular basement membrane Ab is seen in:
Good pasture syndrome
Crystal in Fanconi syndrom:
Cystine
Preservation of urine culture:
Refrigeration
Documentation of proper sample ID:
Chain of custody
11th pad:
Ascorbic acid (causes interferences in BB LNG: Blood, Bilirubin, Leukocytes, Nitrite, Glucose)
Least commonly encountered renal stone:
Cystine calculi
Precipitated with tyrosine crystals if alcohol is added to urine:
Leucine
Hands are not visibly soiled:
Alcohol based hand rub (sanitizer)
Chain of infection:
IREMES
- Infectious agent
- Reservoir
- Exit portal
- Mode of transmission
- Entry portal
- Susceptible host
Best way to break an infection:
Handwashing (Happy Birthday song 2x)
Biohazard symbol:
3 dark bordered circles joined together
NFPA symbol:
You (Yellow = Reactivity)
Were (White = Specific)
Born (Blue = Health)
Right (Red = Flammability)
Yellow quadrant:
Reactivity/Stability (SUVSM)
Blue quadrant:
Health (NSHED)
Degree of hazards:
01234 = NSMSEx
Chemical spills:
Large amounts of water for 15 minutes
Fire:
RACE Rescue Actuvate Close Extinguish
Fire extinguisher:
PASS Pull Aim Squeeze Sweep
Type A fire:
Paper/word (ordinary combustibles)
Extinguish with WATER
Type B fire:
Flammable liquid (B = basa)
Extinguish with halon foam
Type C fire:
Electrical equipment (CURYENTE)
Extinguish with halon (recommended)
Type D fire:
Flammable metals
Extinguish with Metal X
Type E fire:
Arsenal fire
Allowed to burn out
Type K fire:
Cooking media (KITCHEN)
Extinguish with liquid
Type of fire for dry chemicals extinguisher:
Type A/B/C fire
Basic structural and functional unit of kidney:
Nephron
Renal blood flow:
1200 mL/min
Renal plasma flow:
600 to 700 mL/minute
Filtered plasma with 1.010 SG and (-) for albumin:
Glomerular filtrate
Non selective filter of glomerulus:
MW < 70 000 Da
First ti be affected in renal disease:
Tubular reabsorption
Major site of reabsorption:
PCT
Reabsorbs SWAGU (salt, water, amino acids, glucose, urea)
Water reabsorption:
ADH/Vassoprein (prod. by hypothalamus, stored in post. pituitary gland)
Sodium reabsorption:
Aldosterone
ADH deficiency:
Diabetes insipidus
ADH excess:
SIADH
Renin acts on:
Angiotensinogen
ACE acts in:
Angiotensin I
Angiotensin II causes:
Vasoconstriction (⬆️ BP)
Release of ADH/Aldosteron (⬆️ Water/Salt reabsorption)
Used to evaluate GFR:
Clearance tests (Urea, Creatinine, Inulib, Cystatin C)
Used to evaluate tubular reabsorption:
Concentration tests (Fishbetg, Mosenthal, SG, Osmolality)
Creatinine clearance:
(UV/P)(1.73/A)
Gold standard for clearance tests:
Inulin
Cockgroft and gault variables:
Age, sex, and body weight in kg
MDRD variables:
Ethnicity, BUN, serum albumins
Concentration test wherein px is deprived of fluid for 24H:
Fishberg test (SG > 1.026)
Major organic component:
Urea
Major inorganic component of urine:
Chloride (Cl > Na > K)
Principal salt in urine;
NaCl
Bacterual culture spx for OPD:
Midstream clean catch
Bacterial culture for bed ridden px:
Catheterized spx
Three glass technique:
• If 3rd spx is 10x > than 1st spx
Prostatic infection
Three glass technique:
• 2nd specimen serves as
Control
Three glass technique:
• If all 3 specimens contain WBCs and bacteria
UTI
Urine spx for nitrite determination:
4H/first morning
Urobilinogen determination:
Afternoon urine spx (2 to 4 PM)
Drug specimen:
• urine volume
30 to 45 mL (60 mL container capacity)
Drug specimen:
• Temperatures within 4 minutes
32.5 to 36.7’C
Drug specimen:
• Prevent soeciment adulteration
Blueing agent
Increased in unpreserved urine:
pBaON pH Bacteria Odor Nitrite
Least affected urine parameter:
Protein
Disintegrates in alkaline urine:
Casts
Preservative that prevents bacterial growth for 24H:
Refrigeration
Bacteriostatic preservative:
Boric acid
Excellent sediment preservative; for addis count:
Formaldehyde
Used for urine cytology:
Saccomanno’s fixative (50% ethanol + 2% carbowax); 50 mL urine
Polyuria:
> 2000 mL/24H
DM (⬆️ SG due to glucose)
DI (⬇️ SG due to dilution)
Oliguria:
<599 mL/24H
Dehydration
Anuria:
<100 mL/24H
Nocturia:
> 500 mL at night
Pregnancy 🤰
Rough indicator of hydration:
Urine color
Major urine pigmenth:
Urochrome (yellow)
Deposits in AU and UA crystals:
Uroerythrin (pink)
Color of urobilinogen:
Colorless
Brown when oxidized
Yellow foam / tea colored urine:
Bilirubin
Brown/black urine color upon air exposure:
Melanin
Few particulates, print easily seen:
Hazy
Many particulates, print blurred:
Cloudy
AP and carbonates:
Alkaline urine
RBCs, AP, carbonates:
Soluble in dilute acetic acid
AU, UA crystals:
Soluble with heat
Lipids, lymphatic fluid, chyle:
Soluble in ether
Fruit odor:
DN
Normal urine odor:
Aromatic
Cabbage odor:
Methionine malabsorption
Rotting fish odor:
Trimethylaminuria
Pungent odor:
Asparagus due to methymercaptan
Odorless urine:
Acute tubular necrosis
SG > 1.040:
Radiographic dye
Urinometer correction:
• Below 20’C
-0.001
Urinometer correction:
• Above 20’C
+0.001
Correction for 1 g/dL glucose:
-0.004
Correction for 1 g/dL protein:
-0.003
SG of distilled water:
1.000
SG if 5% NaCl:
1.022
SG if 9% sucrose:
1.034
Yellow IRIS (harmonic oscillation):
2 mL (of 6 mL)
White foam in urine when shaken:
Protein
NV of albumin:
<159 mg/day for 24H
Temperature at which BJP precipitates and dissolves:
Precipitates at 40 to 60’C
Dissolves at 100’C
Test for microalbuminuria:
Micral test (EIA)
First morning (-) 2H after standing (+)
Orthostatic proteinuria
First morning (+) 2H after standing (+)
Clinical proteinuria
Negative SSA:
No inc. turbidty (<6 mg/dL)
Trace SSA:
Noticeable turbidity (6 to 30)
1+ SSA:
Turbidity (30 to 100)
2+ SSA:
Turbidity + grabulation (100 to 200)
3+ SAA:
Turbidity + granulation + flocculation (200 to 400)
4+ SSA:
Clumps (>400)
⬆️ Blood glucose
⬆️ Urine glucose
Hyperglycemia assocuated
Normal blood glucose
⬆️ urine glucose
Renal-associated due to impaired tubular reabsorption (Fanconi’s syndrome)
Sensitivity of glucose reagent strip;
100 mg/dL
False (+) for glucose strip:
Oxidizing agents (detergents)
False (+) for copper reduction test (clinitest/benedict’s):
Reducing agents (ascorbic acid)
False (-) for copper reduction test (clinitest/benedict’s):
Oxidizing agents (detergents)
To prevent pass through phenomenon in Clinitest:
Use 2 gtts urine
Major ketone but not detected in reagent strip:
Beta-hydroxybutyric acid (78%)
Tablet test for ketones:
Acetest
Cloudy red urine:
Hematuria
Glomerulonephritis
Clear red urine
Hemoglobinuria
Seen in Intravascular hemolysis
Clear ted urine (reddish brown)
Myoglobinuria seen in rhandomyolysis
Differentiate Hgb vs Mgb:
Blondheim’s test (Ammoniym sulfate)
Precipitated hgb + (-) blood strip:
Hemoglobin
Myoglobin in supernatang + (+) blood strip:
Myoglobin
Tablet test for bilirubin:
Ictotest
⬆️ UB
(-) urine bilirubin (CB)
3+ urine urobilinigen
Prehepatic jaundice (EVH)
⬆️UB/CB
-/+ urine bilirubin (CB)
2+ urine urobilinogen
Hepatic jaundice (liver damage)
⬆️CB
3+ urine bilirubin (CB)
(-) urine urobilinigen
Posthepatic jaundice (bile duct obstruction = ❌ of Urobilinog n)
Watson-Schwartz Test:
• Soluble in chloroform + butanol
Urobilinogen (R: CB)
Watson-Schwartz Test:
• Insoluble in chloroform + butanol
Phorphobilinogen (R: UU)
Watson-Schwartz Test:
• Inoluble in chloroform
• Soluble in butanol
Other ehrlich reactive conpounds (R: UB)
Rapid screening test for phorphobilinogen:
Hoesch test (inverse ehrlich)
Interference contrast microscopy:
Can be adapted to BF Mx
Nomarski:
Differential
Hoffman:
Modulation
Differentiates WBCs and RTE cells:
Toluidine blue
Stains TAG and neutral fat, but NOT cholesterol:
Oil Red K + Suand III
IDs urinary eosinophils:
Hansel’s stain (Eosin Y + Methylene blue)
Glitter cells (neutro) are seen in:
Hypotonic urine
RBC in hypertonic urine:
Crenate and shrink
RBC un hypotonic urine:
Swell and lyse
Dysmorphic, with projections, fragmented RBCs:
Glomerular membrane damage
Largest cell:
Squamous EC
Centrally located nucleus;
Seen following catheterization:
Transtional EC (Urothelial)
Most clinically significant cell with eccentric nucleus:
RTE cell
> 2 RTE/HPF:
Tubular injury
Nonlipid filled RTE cell seen in acute tubular necrosis:
Bubble cell
Most frequent parasite encountered in urine:
T. vaginalis
Blood fluke with terminal spine that causes hematuria:
S. harmatobium
Bladder cancer:
NMP
BTA
CYFFA 21-1
Most common fecal contaminant:
E. vermicularis
Major constituent of casts:
Tamm Horafall protein (uromodulib)
Sequence of casts:
HCGW
- Hyaline
- Cellular
- Granular (coarse, then fine)
- Waxy
- Broad*
Prototype cast:
Hyaline casts
Casts seen in strenuous exercise:
Hyaline cast
RBC cast
Granular cast
Casts seen in Glomerulonephritis:
Hyaline casts
RBC cast
Granular cast
Casts seen in pyelonephritis:
Hyaline cast
WBC cast
Cast NOT stained by Sternheimer-Malbin stain:
Fatty cast
Cast seen in nephrotic syndrome:
Fatty casts
Final degenerative form of all types of cast:
Waxy cast
Renal failure casts:
Broad casts
Brick dust / yellow brown granules / pink sediment crystal
Amorphous urates
Most pleomorphic crystal; lemon shaped:
Uric acid crystal
Crystal seen in ethylene glycol poisoning:
Monohydrate CaOx (whewelitte)
Envelope / pyramidal CaOx:
Dihydrate / Wheddelite CaOx
Cigarette butt appearance crystal
Calcium sulfate
Normal acidic crystals:
AU UA CaOx Ca sulfate Hippuric acid
Normal alkaline crystals:
AP Ammonium biurate Triple PO4 / Struvite Ca PO4 / Apatite Ca carbonate
White precipitate crystal
Amorphous phosphates
Thorny apples; seen in old spx:
Ammonium biurate
Crystal: Prism shaped Coffin lid Feathery appearance Fern leaf
Triple PO4 / Struvite
Flat plate, thin prism crystal
Resemble sulfonamide crystals:
Calcium PO4 / Apatite
All abnormal urine crystals are:
Seen in acidic urine
Yellow brown Soluble in ammonia Insoluble in HCl Birefringent (-) cyanide-nitro rxn
Uric acid crystal
Colorless
Soluble in ammonia + HCl
(+) cyanide-nitro rxn
Cystine crystal
Rectangular plates, with nocthed ends
Staircase pattern
Nephrotic syndrome
Cholesterol crystal
Similar to chole crystals:
Radiographic dye (SG > 1.024)
Colorless to yellow needles crystal:
Tyrosine crystal
Concentric circles and radial striations;
Precipitated with tyrosine after adding alcohol:
Leucine crystal
Needles/granules, bright yellow crystal:
Bilirubin crystal
Sheaves of wheat
Petals
Mistaken as CaPO4 crystal
(+) Lignin test
Sulfonamide crystal
Colorless needle crystal:
Ampicillin
Crystals seen in liver disease:
Tyrosine, Leucine, Bilirubin crystals
Spheres with dimpled center; maltese cross:
Starch
Maltese cross formation:
OFFS
Oval fat body
Fatty casts
Fat droplets
Starch granules
⬆️ Amino acid in blood and urine
Overflow aminoaciduria: PKU, MSUD
Normal amino acid in blood
⬆️ amino acid in urine due to tubular reabsorption
Cystinuria
Fanconi’s syndrome
(-) Phenylalanin hydroxylase
Mousy odor
PKU
Bacillus subitilis + beta2-thienyalanine
(+) Growth
(-) NG
Guthrie Bacterial Inhibition test
Rancid butter odor of urine:
Tyrosinemia
(-) Homogentistic acid
Darkens after becoming alkaline
Alkaptonuria
Overproliferation of melanocytes
Darkens upon air exposure
Melanuria
⬆️Leucine, Isoleucine, Valibe
2,4-DNPH test
MSUD
Sweaty feat odor:
Isovaleric acidemia
Renal type aminoaciduria due to defective tubular reabsoprtion of COLA (Cystine, Ornithine, Leucine, Arginine):
Cystinuria with sulfur odor urine
Inborn error of metabolism with cystine deposits:
Cystinosis
(-) Homocystine
(+) Ag nitroprusside
Homocystinuria
Mucopolysaccharide accumulate in cornea of eye
Skeletal abn + metal retardation
Hurler syndrome
Sex linked recessive
Skeletal abn + mental retardation
Hunter syndrome
Sanfilippo syndrome
Mental retardation only:
CTAB test:
(+) white turbidity
Lead poisoning urine color:
Colorless
CDc recommended test for lead poisoning:
FEP
Immune complexes
Group A Streptococcus (S. pyogenes)
APGN
Immune complexes
Systemic immune disorder (SLE)
Form crescents
Rapidly progressive (crescentic) glomerulonephritis
Anti-glomerular basement membrane Ab
Goodpasture syndrome
Anti-neutrophilic cytoplasmic auto-Ab (ANCA)
Wegener’s grabulomatosis
⬇️ platelets ff. viral respi infxn
Henoch Schönlein Purpura
Thickening of glomerular basement membranr ff. IgG immune complexes deposition
Membranous glomerulonephritis
Cellular proliferation that forms tram tracks
Membranoproliferatuve glomerulonephritis
Marked decrease in renal function
Waxy and broad vasts
Chronic glomerulonephritis
Deposition if IgA
Berger’a disease
Disruption of electrical charges
Massive loss of proteins and lipids
Nephrotic syndrome
Disruption of podocytes in children
Nil disease
Disruption of podocytes in certain numbers and aread
FSGS
Most common cause of EARD
Deposition of glycosylated proteins
Disbetic nephropathu / Kimmelstiel-Wilson Dae
Lamellated and thinning of glomerular basement membrane
Alport syndrome
Damage to RT cells
Acute tubular necrosis
Lower UTI (bladder)
Cysititis
Upper UTI (renal tubules/interstitium) WBC casts
Pyelonephritis
Major constituent of renal calculi
Hard, dark, rough
Calcium oxalate calculi
Yellow to brown, moderately hard
Uric acid / Urate calculi
Greasy, old soap like
Least common
Cystine calculi
Pale friable stone
Phosphate calculi
Branching or staghorn shaped in urinary infections
Triple PO4 calculi
Conditions favoring the formation of renal calculi:
pH
Chemical composition
Urinary stasis
Primary urinalysis finding in renal lithiasis:
Microscopic hematuria
Conditions favoring the formation of renal calculi:
pH
Chemical composition
Urinary stasis
Primary urinalysis finding in renal lithiasis:
Microscopic hematuria
