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Class 22010 Lab > URINALYSIS PROCEDURES > Flashcards

URINALYSIS PROCEDURES Flashcards

1
Q

What is an important screening test to test and asses:

  1. Renal function/disorder
  2. Endocrine or Metabolic function/disorder
  3. UTI
  4. Systemic diseases
A

Urinalysis

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2
Q

What is a cost effective in-vitro diagnostic test that is simple to perform?

A

Urinalysis

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3
Q

What method of urine collection are these?

  1. First morning void
  2. Random urine specimen
  3. Clean catch urine specimen
  4. 24-hour urine specimen
A

Non-instrumented collection

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4
Q

What method of urine collection are these?

  1. Urethral catheteration
  2. Suprapubic Needle Aspiration
  3. Catheterization and Bladder irrigation
A

Instrumented collection

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5
Q

How quickly should urine specimens be analyzed?

A

Fresh, preferably within 1-2 hours

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6
Q

If unable to test the urine specimen at the time of delivery, how long can you refrigerate the specimen after collection?

A

3-6 hours

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7
Q

What happens if a urine specimen is left at room temperature?

A

It will begin to decompose and deliver inaccurate results

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8
Q

What is the reason for the decomposition of urine specimens left at room temperature?

A

Presence of bacteria

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9
Q

What produces ammonia and then combines with hydrogen ions to increase the pH of urine?

A

Urea splitting bacteria

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10
Q

True or False

If glucose is present, the bacteria may use it as a source of energy resulting in false negative glycosuria.

A

True

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11
Q

True or False

Certain urinary elements, such as blood cells and casts, will deteriorate if left standing without any kind of preservative.

A

True

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12
Q

What method of Non-instrumented collection is this?

  1. Most concentrated
  2. Increase number of abnormal elements
  3. Decreased deterioration of formed elements
  4. Recommended specimen for chemical and microscopic examination
A

First morning void

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13
Q

What method of Non-instrumented collection is this?

  1. Collected anytime
  2. Most convenient and most common
  3. Can detect abnormalities but not as sensitive as first morning void
A

Random urine specimen

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14
Q

What method of Non-instrumented collection is this?

  1. Specimen of choice for bacterial cultures
    a. may perform cultures within 12 hours after collection, only if specimen was refrigerated
    b. genitalia must be cleaned with mild antiseptic solution
    c. collect midstream in a sterile container
A

Clean catch urine specimen

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15
Q

What method of Non-instrumented collection is this?

  1. Gives quantitative results
  2. preservatives may be needed
A

24-hour urine specimen

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16
Q

What method of Instrumented collection is this?

  1. Not recommended for bacteriological examination
  2. Use only if no other way to collect urine
  3. Commonly used on marked obese patient with difficulty in urine collection
A

Urethral Catheterization

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17
Q

What method of Instrumented collection is this?

  1. In place of catheterization for obtaining a single urine sample
  2. inserting the needle directly into the distended bladder
  3. avoids vaginal and urethral contamination
  4. performed for bladder outlet obstruction (urinary retention)
A

Suprapubic Needle Aspiration

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18
Q

What method of Instrumented collection is this?

  1. Utilizes vigorous transcatheter agitation of the bladder
    a. 50-72 ml saline inserted into the bladder
    b. bladder content is then removed for cytologic study
  2. This method yields optimum cellular sample of bladder epithelium
  3. Urine sample analysis
    a. physical
    b. chemical
    c. microscopic
A

Catherization and Bladder irrigation

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19
Q

What is the normal urine volume in a 24 hour period?

A

600-2000ml

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20
Q

What is the average urine amount daily?

A

1500ml

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21
Q

What is directly related to urine output?

A
  1. Fluid intake
  2. Temperature and climate
  3. Amount of perspiration that occurs
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22
Q

What does the color of urine depend on?

A

pigment (urochrome) concentration

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23
Q

What is the normal color of urine?

A

straw (light yellow) to dark amber

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24
Q

True or False

Ingested foods or medications don’t affect urine color

A

False

Urine color may vary because of ingested foods or medications

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25
Q

A blue-green urine color may suggest what?

A

methylene blue

used as a dye or stain in diagnostic procedures

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26
Q

A dark orange urine color would suggest what?

A

Pyridium

used for UTI infections

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27
Q

A milky white urine color would suggest what?

A

Caused by chyle

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28
Q

An olive green to brown/black urine color would suggest what?

A

Phenols

poisonous compound used for antimicrobial agent

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29
Q

A yellow to brown (turning greenish with foam when shaken) urine color suggests what?

A

presence of bile

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30
Q

A red or red-brown urine color would suggest the presence of what?

A

blood

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31
Q

Turbid Alkaline urine is due to what?

A
  1. Amorphous phosphate

2. Amorphous carbonate

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32
Q

Turbid acidic urine is due to what?

A
  1. Amorphous urates

2. a pinkish turbidity frequently indicates the presence of urates

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33
Q

True or False

Normal urine has a characteristic odor due to volatile acids

A

True

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34
Q

Urine that has been standing for a long time develops what kind of smell due to the breakdown of urea by bacteria?

A

ammonia

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35
Q

True or False

The odor of urine is considered very diagnostically important

A

False

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36
Q

A sweet or fruity smell to urine is an indicator for what?

A

Ketones

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37
Q

A pungent smell with urine is usually due to what?

A

ammonia produced by bacteria

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38
Q

A maple syrup smell to urine would indicate what?

A

“Maple syrup urine disease” a congenital metabolic disorder

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39
Q

A sweaty feet smell to urine is indicative of what?

A

Isovaleric acidemia, presence of butyric or hexanoic acid in urine

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40
Q

What is the specific gravity for Random Urine?

A

1.003-1.035

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41
Q

What is the specific gravity of 24-hour Urine?

A

1.015-1.025

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42
Q

True or False

Normal urine is negative for glucose

A

True

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43
Q

The quantity of glucose in the urine is dependent on what?

A
  1. Blood glucose level
  2. Rate of glomerular filtration
  3. Degree of tubular reabsorption
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44
Q

What will appear in the urine once the threshold level of 160-180mg/dL in the blood is exceeded?

A

Glucosuria

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45
Q

The presence of glucose in the urine may indicate what disease?

A

May indicate diabetes mellitus or any other conditions that cause hyperglycemia

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46
Q

True or False

Normal urine is positive for ketones

A

False

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47
Q

What is the presence of ketones in the urine as a result of incomplete fatty acid utilization?

48
Q

Can the presence of ketones in the urine indicate Diabetes Mellitus ?

49
Q

What is known as an increased ketone level in blood and urine?

50
Q

Ketosis is found in conditions associated with what?

A
  1. Decreased carbohydrate intake (starvation)
  2. Decreased utilization of carbohydrates (diabetes mellitus)
  3. Digestive disturbances or dietary imbalance (high fat diet, low carbohydrate diet)
  4. Eclampsia
  5. Prolonged vomiting
  6. Diarrhea
51
Q

Is normal urine negative for occult blood?

52
Q

The presence of blood in the urine can cause the sample to appear what?

A

red and “smoky”

53
Q

The presence of blood in the urine is referred to as what?

54
Q

Intact RBC’s present in the urine may indicate what?

A

Damage/trauma to the kidney or urinary tract

55
Q

Intact RBC’s present in the urine may indicate renal diseases such as what?

A
  1. Glomerulonephritis
  2. Malignant hypertension
  3. Polycystic kidney disease
56
Q

Is normal urine usually negative for bilirubin?

57
Q

Any condition that causes jaundice will result in the appearance of what in the urine?

58
Q

Bilirubinuria indicates what?

A
  1. Hepatocellular disease

2. Intra or extra-hepatic biliary obstruction

59
Q

What is the normal concentration for Urobilinogen in the urine?

A

1 EU or less

60
Q

True or False

Small urobilinogen amounts up to 1mg/dL is normal

61
Q

An increase in urobilinogen is indicative of what?

A

liver disease and hemolytic disease

62
Q

What is the pH range for urine and what is the average?

A
  1. Range: 4.6 - 8.0
  2. Average: 6.0

usually slightly acidic

63
Q

These are pathological conditions that can cause what?

  1. Respiratory and metabolic acidosis
  2. UTI by E. Coli
  3. Uremia
  4. Severe Diarrhea
  5. Starvation
A

Acidic Urine

64
Q

These are pathological conditions that can cause what?

  1. UTI’s caused by Proteus and Pseudomonas species
  2. Respiratory and metabolic alkalosis
A

Alkaline urine

65
Q

Is normal urine negative for protein?

66
Q

What is an important indicator for renal disease?

A

Protein in the urine

67
Q

Proteinuria mainly occurs by two mechanisms, what are they?

A
  1. Glomerular damage

2. Defect in the reabsorption process of the tubules

68
Q

What are associated diseases due to proteinuria?

A
  1. Minimal Proteinuria
  2. Moderate Proteinuria
  3. Severe Proteinuria
69
Q

What are these associated with?

  1. Polycystic kidneys
  2. Chronic pyelonephritis
  3. Inactive chronic glomerulonephritis
  4. Benign orthostatic proteinuria
A

Minimal proteinuria (<0.5 g/Day)

70
Q

What are these associated with?

  1. Nephrosclerosis.
  2. Tubular interstitial disease.
  3. Preeclampsia.
  4. Multiple myeloma.
  5. D diabetes nephropathy.
  6. Malignant hypertension.
  7. Pyelonephritis with hypertension.
  8. Toxic nephropathies.
A

Moderate proteinuria (0.5-3.5 g/day)

71
Q

What are these associated with?

  1. Glomerulonephritis.
  2. Lupus nephritis.
  3. Amyloid disease.
  4. Lipoid nephrosis.
  5. Intercapillary Glomerulosclerosis.
  6. Severe venous congestion of the kidney.
A

Severe proteinuria (>3.5 g/day)

72
Q

Is normal urine negative for nitrites?

73
Q

What is formed by the breakdown of nitrates by organisms that cause UTI’s (E. Coli)

74
Q

What is the presence of bacteria in urine, indicative of UTI?

A

Bacteriuria

75
Q

True or False

Esterase is an enzyme

76
Q

True or False

Normal urine is negative for Leukocyte Esterase, which detects esterase released by neutrophils in the urine

77
Q

What is an indirect test for bacteriuria ?

A

Leukocyte Esterase

78
Q

What is associated with an inflammatory process in or around the urinary tract?

(UTI, acute glomerulonephritis)

A

Leukocyturia

79
Q

What is a common clinical tool for the evaluation of various renal and nonrenal problems?

80
Q

What lab consist of a macroscopic analysis (appearance), chemical analysis (dip stick) and a microscopic analysis looking for formed elements?

81
Q

In a normal UA what are the results for the following?

  1. Color
  2. Leukocyte esterase
  3. Nitrite
  4. Urobilinogen
A
  1. Color - clear to yellow
  2. Leukocyte esterase - Negative
  3. Nitrite - Negative
  4. Urobilinogen - < or equal to 1.0 mg/dL
82
Q

In a normal UA what are the results for the following?

  1. Protein
  2. pH
  3. Blood
  4. Specific gravity
A
  1. Protein - negative to trace
  2. pH - 4.6 to 8.0
  3. Blood - negative
  4. Specific gravity - 1.003-1.035
83
Q

In a normal UA what are the results for the following?

  1. Ketones
  2. Bilirubin
  3. Glucose
  4. RBC
A
  1. Ketones - negative
  2. Bilirubin - Negative
  3. Glucose - Negative
    12 RBC - 0-3 HPF (high power field)
84
Q

In a normal UA what are the results for the following?

  1. WBC
  2. Epithelial Cells
  3. Casts
  4. Bacteria
A
  1. WBC - 0-2 HPF
  2. Epithelial Cells - 0-1 HPF
  3. Casts - Depends on the type
  4. Bacteria - Negative to trace
85
Q

What are some critical values with a UA?

A
  1. Strong positive test for glucose and ketones
  2. Glucose on urine dipstick >1000 mg/dL with small, medium, or large ketones
  3. Urine colony count >50,000 colonies/mL if a single organism
86
Q

A healthy adult may excrete very small amounts of protein a day, about how much is that?

87
Q

Clinical proteinuria is defined as the loss of how much protein a day?

A

> 500mg/day

88
Q

These are all causes of what?

  1. HTN
  2. Lower UTI
  3. Fever
  4. Exercise
A

Mild proteinuria <0.5g/day

89
Q

These are all causes of what?

  1. CHF
  2. Chronic glomerulonephritis
  3. Acute glomerulonephritis
  4. Diabetic nephropathy
  5. Pyelonephritis
A

Moderate proteinuria 0.5-3 g/day

90
Q

These are all causes for what?

  1. Amyloid
  2. Chronic glomerulonephritis (severe)
  3. Diabetic nephropathy
  4. Lupus nephritis
A

Significant proteinuria > 3 g/day

91
Q

A persistent pH in the urine greater than 7.0 is associated with what?

A

calcium carbonate, calcium phosphate and magnesium-ammonium phosphate stones

91
Q

A pH in the urine below 5.5 is associated with what kind of stones?

A

cystine and uric acid stones

91
Q

Is urobilinogen normally present?

92
Q

An increase in what may be the result of hemolytic anemia, cirrhosis, or viral hepatitis?

A

Urobilinogen

93
Q

Urobilinogen is absent in what?

A

Total biliary obstructions

94
Q

A dark yellow or greenish brown color of urine generally suggests bilirubin in
the urine seen in patients with what?

A

Obstructions of the bile duct

95
Q

Dipsticks for testing blood in urine are dependent on the presence of what?

A
  1. RBC’s
  2. Hemoglobin
  3. Myoglobin
96
Q

A dipstick can detect as few as how many RBC’s HPF?

A

1-2 RBC’s HPF

97
Q

True or False

All positive dipsticks require further evaluations

98
Q

True or False

The presence of >3 RBCs HPF is considered normal

99
Q

Persistent RBCs in the urine may be indicative of what?

A
  1. Glomerulonephritis
  2. Kidney stones
  3. Cancer
  4. Infection
100
Q

Myoglobin may also lead to a false positive with dipsticks and is highly suggestive of what?

A

Rhabdomyolysis

101
Q

Many dipsticks can detect the presence of leukocyte esterase in urine and give a semi-quantities estimate of pyuria, thus can be considered an indirect test for what?

102
Q

Potentially significant pyuria is defined as what?

A

3> WBCs HPF

103
Q

What indicates bacterial infection, due to breakdown of nitrates to nitrites by the bacteria?

104
Q

The presence of nitrite in the urine is another indirect indicator of what?

105
Q

Although glucose is filtered in the kidneys it is almost completely reabsorbed in the proximal tubule so that glucose is generally absent in urine. However when glucose reaches a level of _____ in the blood, the ability to reabsorb is exceeded

106
Q

Glycosuria is suggestive of what?

107
Q

Ketones and Ketonuria along with glucose in the urine is suggestive of what?

A

Uncontrolled type 1 diabetes

108
Q

What should the first consideration be when microorganisms are found in the urine?

A

Contamination

109
Q

With epithelial cells in the urine, 1 cell HPF is considered normal, however an increased number of cells may be indicative of what?

A

Acute tubular necrosis or inflammation as seen in glomerulonephritis.

110
Q

Phenylketonuria is what?

A

Mousy urine

111
Q

What is know as an increased urine output?

112
Q

What is known as a decreased urine volume?

113
Q

What is known as no urine output?

Class 22010 Lab (7 decks)

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