Urinalysis- MAcrocoscopic Flashcards
Red blood cells within the urine can come from any point along
the urinary tract.________________ red blood cells are often a sign of
glomerular disease.
Dysmorphic
The __________________, because it is the most concentrated,
is often the best specimen for analysis. Some procedures may require
a 12- or 24-hour urine sample.
first voided morning urine
Specific gravity and osmolality measurements reflect the
_________________. After a period of dehydration,
the osmolality should be three to four times that of plasma.
concentrating ability of the kidneys
**Proteinuria greater than_______________ **is seen in the nephrotic syndrome.
Although nephrotic syndrome is usually seen in primary renal disease,
it is occasionally seen in a systemic disease that affects the kidneys.
** 4 g/day**
Ketonuria can be seen in diabetic individuals. It can also be seen in
other states, such as____________________________
** febrile illness and cachexia.**
The dipstick nitrite and leukocyte esterase tests are used to help
___________________. Positive results should be confirmed
by microscopic analysis of the urine.
diagnose urinary tract infection
Urinary calculi are most commonly formed from _______________ Workup of
habitual stone formers should include analysis of both the urine and
the stone.
calcium.
The recommended capacity for the container is_______________-, which allow collection of the 12 mL specimen for microscopic analysis.
50mL
The specimen should be delivered within________________if not use refrigeration or chemical preservatives……
2 hours
Pediatric specimens are collected using clear__________________ to attach to the genital area.
plastic bags with adhesive
Odor: Ammonia-like
________________
(Urea-splitting bacteria)
Odor: offensive
________________
Old specimen, pus or inflammation
_______________
Glucose\
-Sweet
Fruity
__________
Ketones
Maple syrup-like
______________________
Maple Syrup Urine Disease
Colorless
Diluted urine
Deep Yellow
______
Concentrated Urine, Riboflavin
Yellow-Green
Bilirubin / Biliverdin
Red
Blood / Hemoglobin
Brownish-red
\
Acidified Blood (Acute GN)
Brownish-black
Homogentisic acid (Melanin)
The yellow color of urine is due to______________
. It is a product of endogenous metabolism.
Additional pigments are uroerythryn urobilin which are present in small amount.
urochrome
:
− Typically cells or crystals.
− Cellular elements and bacteria will clear by centrifugation.
− Crystals dissolved by a variety of methods.
− Microscopic examination will determine which is present.
Turbidity
Use to measure specific gravity in urine manually?
- Urinometer
- Refractometer
– Consists of a weighted
float attached to a scale that has
been calibrated in terms of urine
specific gravity.
– Displaces a volume of
liquid equal to its weightand has
been designed to sink to a level of
1.000 in distilled water.
– Less accurate than other methods
– Not recommended
– Uses large amounts of urine
READ 1st
The container must also be wide enough to allow it to float without touching the sides and from resting at the bottom.
Urinometer:
– Determines the concentration of dissolved particles
– Does by measuring the refractive index
o
It is a comparison of the velocity of light in air with the velocity of light in a solution.
– The specific gravity scale is calibrated in terms of the angles at which the light passes through the specimen.
– It uses a small amount of urine (1-2 drops).
Refractometer:
The blood level at which tubular re-absorption stops(renal threshold) for glucose is approximately______________
160-180 mg/dL
Uses and Limitations of Urine Glucose Detection Significance
________________
– Diabetes mellitus.
– Renal glycosuria.
What are the limitations of glucose reagent strip method?
Limitations
– Interference: reducing agents, ketones.
– Only measures glucose and not other sugars.
– Renal threshold must be passed in order for glucose to spill into the urine.
Other Tests
–_____________ test for reducing sugars.
CuSO4
Detection of Reducing Sugars* by CuSO4 Sugar Disease(s)
Galactose: Galactosemias
Fructose :Fructosuria, Fructose Intolerance, etc.
Lactose :Lactase Deficiency
Pentoses :Essential Pentosuria
Maltose: Non-pathogenic
* NOT Sucrose because it is not a reducing sugar.
It uses your_____________ which was developed in 1908 (copper sulfate, sodium carbonate, sodium citrate buffer)
Blue to orange/red
Benedict’s solution
Uses and Limitations of Urine Bilirubin Detection Significance
Increased direct bilirubin (correlates with urobilinogen and serum bilirubin)
Limitations
Interference: prolonged exposure of sample to light
Only measures direct bilirubin–will not pick up indirect bilirubin
Other Tests
– (more sensitive tablet version of same assay)
– Serum test for total and direct bilirubin is more informative
Ictotest
Significance of Test for Ketones
– Diabetic ketoacidosis
– Prolonged fasting
Limitations
– Interference: expired reagents (degradation with exposure to moisture in air)
– Only measures acetoacetate not other ketone bodies (such as in rebound ketosis).
Other Tests for Ketone
(more sensitive tablet version of same assay)
– Ketostix (more sensitive tablet version of same assay)
Other Tests for Ketone
– Serum glucose measurement to confirm
DKA
Specimens with a pH of 6.5 or higher will have _______________readings cause by interference with the Bromthymol blue indicator (the blue-green readings associated with an alkaline pH correspond to a low specific gravity reading). It is recommended to add 0.005 to specific gravity readings when the pH is 6.5 or higher.
decreased
Chemical tests for blood uses the_____________of hemoglobin to catalyze a reaction between hydrogen peroxide and the chromogen tetramethylbenzidine to produce an oxidized chromogen which has a green-blue color.
pseudoperoxidase activity
Uses and Limitations of Urine Blood Detection Significance
– Hematuria (nephritis, trauma, etc)
– Hemoglobinuria (hemolysis, etc)
– Myoglobinuria (rhabdomyolysis, etc)
Limitations
– Interference: reducing agents, microbial peroxidases
– Cannot distinguish between the above disease processes
Other Tests
– Urine microscopic examination
– Urine cytology
Uses and Limitations of Urine pH Detection Significance
– Acidic (less than 4.5): metabolic acidosis, high-protein diet
– Alkaline (greater than 8.0): renal tubular acidosis (>5.5)
Limitations
\
– Interference: bacterial overgrowth (alkaline or acidic)
– “run over effect” effect of protein pad on pH indicator pad
