Urinalysis DIAL Flashcards
What are the 7 test on a standard dipstick?
Glucose Ketones Leukocyte esterase Nitrate pH Protein Specific gravity
What are the 3 components of a normal urinalysis?
Physical examination
Chemical examination
Microscopic examination
How is a proper urinalysis sample collected?
Clean genitals
Do a mid-stream catch
Do not let sit for longer than 1 hour
Glucose positive implications?
Diabetes mellitus
Ketone positive implications?
Diabetic ketosis
Starvation
Leukocyte esterase positive implications?
WBC presence either as whole or lysed cells UTI
Leukocyte esterase negative implications?
No UTI and further microscopic and or urine culture is not necessary
Nitrate positive implications?
Indicates that bacteria may be present in significant numbers
What bacteria will cause a positive nitrate test?
Gram negative rods such as E. coli
Protein positive implications?
Nephrotic syndrome
Nephritic syndrome
Specific gravity implications?
Determined by presence of solutes and directly proportional to urine osmolality
Significance of bilirubin in the urine?
Liver dysfunction Biliary obstruction (large amounts of soluble conjugated bilirubin can enter blood then filter)
Significance of urobinogen in the urine?
Hepatitis
Hemolytic anemia
(liver cannot uptake all of the urobinogen due to dysfunction in hepatitis or overwhelmed in anemia)
What can urine sodium values tell you?
Hypervolemia
Edema
Hyponatremia
What would low urine sodium levels tell you?
Early obstruction uropathy
Oliguria of acute glomerular nephritis
What would high urine sodium levels tell you?
Diuretics
Emesis
Hypothyroidism
Syndrome of inappropriate antidiuretic hormone (SIADH)
What can urine potassium levels tell you?
Hypokalemia
What can cause low urine potassium levels tell you?
Significant decrease in serum plasma potassium over several days
What do high urine potassium levels tell you?
Hyperaldosteronism
How is a urine specimen prepared and examined microscopically?
10-15 mL centrifuged for 5-10 minutes decant the supernate leaving .2-.5 mL with the sediment, take sediment and resuspend pour it onto a glass slide and coverslip it
What does the presence of dysmorphic RBCs in the urine tell you? Why?
Glomerulonephritis
Odd shaped because they squeeze through glomerular structure
Renal tubular epithelial cells in urine:
Nephrotic syndrome
Smaller than TECs
Ovoid fat bodies in urine:
Endogenous fats droplets
Maltese cross when seen under polarized light microscopy
Transitional epithelial cells in urine:
Renal pelvis, ureter or bladder
Large nuclei
Squamous cells in urine:
Possible contamination of specimen with skin flora
Where are casts formed?
Distal convoluted tubule
Collecting duct
How are urinary casts formed?
Tamm-Horsfall protein (Mucoprotein) secreted in the TAL, DCT is glue that holds constituents together
Hyaline casts:
Protein cast with long, thin tails formed at TAL DCT junction
RBC casts:
Glomerulonephritis or severe tubular damage
WBC casts:
Acute pyelonephritis
Glomerulonephritis
Inflammation of kidney
Granular or waxy casts:
Cellular casts remain in the nephron for some time before they are flushed into the bladder urine, the cells may degenerate to become a coarsely granular cast, later a finely granular cast, and ultimately, a waxy cast
Broad casts:
From damaged and dilated tubules seen in end-stage chronic renal disease
Common crystals seen in healthy patients?
Calcium oxalate
Triple phosphate
Amorphous phosphates
Uncommon crystals seen in patients?
Cystine
Tyrosine
Leucine
Where are cystine crystals found?
Neonates with congenital cystinuria or severe liver disease
Where are tyrosine crystals found?
Congenital tyrosinosis or marked liver impairment
Where are leucine crystals found?
Severe liver disease or MSUD
