URINALYSIS PROCEDURES Flashcards
What test fits these clinical reasons
(a) An important indicator of health
(b) Cost-effective in-vitro diagnostic test
(c) Non-invasive procedure
(d) Simple to perform
Urinalysis testing
Uranalysis is used to detect and assess what?
1) Renal function/disorder
2) Endocrine or Metabolic function/disorder
3) Urinary tract infection
4) Systemic diseases
What are the Methods of Urine Collection
(1) Non-instrumented Collection
(2) Instrumented collection
These are what method of urine collection?
(a) First-morning void
(b) Random urine specimen
(c) Clean catch urine specimen
(d) 24-hour urine specimen
Non-instrumented Collection
These are what method of urine collection?
(a) Urethral Catheteration
(b) Suprapubic Needle Aspiration
(c) Catheterization and Bladder Irrigation
Instrumented
Urine specimens should be analyzed while fresh, preferably within how long?
1-2 hours
If unable to test the urine specimen at time of delivery, refrigerate the specimen ____ after collection.
3-6 hours
If left at room temperature, it will begin to decompose and deliver _______ .
inaccurate results
Specimens left at room temperature will soon begin to decompose, mainly due to the presence of __________
bacteria in the sample
Urea splitting bacteria produces ammonia, which then combines with hydrogen ions to ____________.
increase pH of the urine
If glucose is present, the bacteria may use it as a source of energy resulting in…
negative glycosuria
True/False
Certain urinary elements, such as blood cells and casts, will deteriorate if left standing with of preservative.
False
Without any kind of preservative
What type of Non-instrumented Collection:
(a) Most concentrated
(b) Increase number of abnormal elements
(c) Decreased deterioration of formed elements
(d) Recommended specimen for chemical and microscopic examination
First-morning void
What type of Non-instrumented Collection:
(a) Collected anytime
(b) Most convenient and most common
(c) Can detect abnormalities but not as sensitive as first morning void
Random urine specimen
What type of Non-instrumented Collection:
(a) Specimen of choice for bacterial cultures.
1) May perform cultures within 12 hours after collection, only if specimen was refrigerated.
2) Genitalia must be cleaned with mild antiseptic solution
3) Collect midstream in a sterile container
Clean catch urine specimen
What type of Non-instrumented Collection:
(a) Gives quantitative results
(b) Preservatives may be needed
24-hour urine specimen
What type of instrumented collection?
(a) Not recommended for bacteriologic examination
(b) Use only if no other way to collect urine
(c) Commonly used on marked obese patient with difficulty in urine collection
Urethral Catheteration
What type of instrumented collection?
(a) In place of catheterization for obtaining a single urine sample
(b) Inserting the needle directly into the distended bladder
(c) Avoids vaginal and urethral contamination
(d) Performed for Bladder outlet obstruction (urinary retention)
Suprapubic Needle Aspiration
What type of instrumented collection?
(a) Utilizes vigorous transcatheter agitation of the bladder.
1) 50-72 mL saline inserted into bladder.
2) Bladder content is then removed for cytologic study.
(b) This method yields optimum cellular sample of bladder epithelium.
(c) Urine Sample Analysis:
1) Physical
2) Chemical
3) Microscopic
Catheterization and Bladder Irrigation
how much saline is inserted into the bladder for transcatheter agitation?
50-72 mL
Urine Sample Analysis covers what 3 things?
1) Physical
2) Chemical
3) Microscopic
Physical analysis of urine covers what?
(1) Volume
(2) Color
(3) Turbidity
(4) Odor
(5) Specific gravity
Physical analysis of urine covers what?
(1) Volume
(2) Color
(3) Turbidity
(4) Odor
(5) Specific gravity
chemical analysis of a urine covers what?
- Glucose
- Ketones
- occult blood
- bilirubin
- urobilinogen
- pH
- protein
- nitrate
- Leukocyte esterase (LE)
Indicator of urine odors
Sweet or fruity smell
Ketones
Indicator of urine odors
Pungent smell -
due to ammonia produced by bacteria
Indicator of urine odors
Maple syrup
“Maple syrup urine disease” a congenital metabolic disorder
Indicator of urine odors
Musty or Mousy
Infant with phenylketonuria
Indicator of urine odors
Sweaty feet
Isovaleric acidemia, presence of butyric or hexanoic acid in urine
Indicator of urine odors
ammonia odor
Urine that has been standing for a long time
Due to breakdown of urea by bacteria.
True/False
Odor of the urine is considered to be of special diagnostic importance
False
IS NOT
Causes what turbidity?
1) Amorphous phosphate
2) Amorphous carbonate
Turbid Alkaline urine
Causes what turbidity?
1) Amorphous urates
2) A pinkish turbidity frequently indicates the presence of urates
Turbid Acidic urine
True/False
Turbidity
Normal urine is clear
True
True/False
Color is dependent on pigment (urochrome) concentration
True
Normal color for urine
straw (light yellow) to dark amber
Diagnostic significance of urine color:
Blue green
Methylene blue (Used as dye or stain in diagnostics procedure)
Diagnostic significance of urine color:
Dark orange
Pyridium (used for UTI infection)
Diagnostic significance of urine color:
Milky white
caused by chyle
Diagnostic significance of urine color:
Olive green to brown black
Phenols (poisonous compound used for
antimicrobial agent)
Diagnostic significance of urine color:
Yellow to brown (turning greenish with foam when shaken)
Presence of bile
Diagnostic significance of urine color:
Red or red-brown (Smokey appearance)
presence of blood
Normal volume in a 24-hour period ranges from….
-The average is about…..
600-2000 mL
1500 mL
What does these directly relate to
1) Fluid intake
2) Temperature and climate
3) Amount of perspiration that occurs.
urine output volume
Specific gravity
(a) Random urine: _________
(b) 24-hour urine: _________
(a) Random urine: 1.003-1.035
(b) 24-hour urine: 1.015-1.025
Chemical analysis.
Normal urine is _____ for glucose.
Negative
Chemical analysis.
________ will appear in the urine once the threshold level of 160-180 mg/dL in the blood is exceeded.
Glucosuria
What may indicate diabetes mellitus, or any condition that causes hyperglycemia
Glucose in urine
Normal urine is _____ for ketones
negative
______ presence of ketones in urine as a result of incomplete fatty acid utilization.
Ketonuria
True/False
ketones may indicate diabetes mellitus
True
What is seen on a UA with these issues
a) Decreased intake of carbohydrates (starvation)
b) Decreases utilization of carbohydrates (diabetes mellitus)
c) Digestive disturbance or dietary imbalance (high fat diet, low carbohydrate diet)
d) Eclampsia
e) Prolonged vomiting
f) Diarrhea
Ketosis - increase ketone in blood and urine
_____ is increase ketone in blood and urine
Ketosis
Normal urine is _____ for occult blood
negative
Occult blood May cause the sample to appear
red and “smoky”.
Presence of blood is termed
hematuria
These issues may show up with what on UA
a) Damage/trauma to the kidney or urinary tract.
b) Renal diseases such as:
(1 Glomerulonephritis
(2 Malignant hypertension
(3 Polycystic kidney disease.
c) May also be due to menstrual contamination or exercise
Intact RBCs present in the urine
Normal urine is ______ for bilirubin
negative
Any condition that causes _____ will result in appearance of bilirubin in urine.
jaundice
What color will the urine be if there is bilirubin?
Yellow to brown (turning greenish with foam when shaken).
Bilirubinuria indicates
1) Hepatocellular disease
2) Intra or extra-hepatic biliary obstruction
Urobilinogen
Normally present in the urine in concentrations of….
1 EU or less.
Urobilinogen – small urobilinogen amounts up to _____ is normal
1 mg/dL
Urobilinogen
Any increase indicates _____ and ____
liver disease and hemolytic disease.
The range for pH is ___to ___, but since it averages around ____ , it is usually slightly acidic
4.6 to 8.0
avg 6.0
These issues may cause acidic or alkaline urine?
1) Respiratory and metabolic acidosis.
2) UTI by E. coli.
3) Uremia.
4) Severe diarrhea.
5) Starvation.
acidic urine
These issues may cause acidic or alkaline urine?
1) UTIs caused by Proteus and Pseudomonas species.
2) Respiratory and metabolic alkalosis.
alkaline urine
Normal urine is ____ for protein.
negative
What is an important indicator of renal disease.
Protienurea
Proteinuria mainly occurs by two mechanisms:
1) Glomerular damage.
2) Defect in the reabsorption process of the tubules.
What type of proteinuria?
a) Polycystic kidneys.
b) Chronic pyelonephritis.
c) Inactive chronic glomerulonephritis
d) Benign orthostatic proteinuria.
Minimal proteinuria (<0.5 g/day):
What type of proteinuria?
a) Nephrosclerosis.
b) Tubular interstitial disease.
c) Preeclampsia.
d) Multiple myeloma.
e) D diabetes nephropathy.
f) Malignant hypertension.
g) Pyelonephritis with hypertension.
h) Toxic nephropathies.
Moderate proteinuria (0.5-3.5 g/day)
What type of proteinuria?
a) Glomerulonephritis.
b) Lupus nephritis.
c) Amyloid disease.
d) Lipoid nephrosis.
e) Intercapillary Glomerulosclerosis.
f) Severe venous congestion of the kidney.
Severe proteinuria (>3.5 g/day)
Normal urine is ______ for nitrites
negative
What is is formed by breakdown of nitrates by organisms that cause UTIs.
Nitrite
True/False
E. coli can cause nitrates to show up on UA
True
What is Bacteriuria
presence of bacteria in urine, indicative of UTI
Normal urine is negative for LE, which detects esterase released by the ______ in the urine.
neutrophils
True/false
Leukocyte esterase is an enzyme
True
__________ is associated with an inflammatory process in or around the urinary tract (i.e. UTI, acute glomerulonephritis)
Leukocyturia
These are what values?
(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
Critical Values
Normal/Abnormal/Critical
Protein- Negative to trace
Normal
Normal/Abnormal/Critical
pH-4.6 to 8.0
Normal
Normal/Abnormal/Critical
RBC- 0-3 HPF (High Power Field)
Normal
Normal/Abnormal/Critical
WBC 0-2 HPF
Normal
Normal/Abnormal/Critical
Bacteria- Negative to trace
Normal
Normal/Abnormal/Critical
Epithelial cells 0-1 HPF
Normal
Normal/Abnormal/Critical
Strong positive test for glucose and ketones
Critical
Normal/Abnormal/Critical
Glucose on urine dipstick >1000 mg/dL with small, medium, or large ketones
Critical
Normal/Abnormal/Critical
Urine colony count >50,000 colonies/mL if a single organism
Critical
______ Proteinuria <0.5g/day may be caused by:
1) HTN
2) Lower UTI
3) Fever
4) Exercise
Mild
________ proteinuria 0.5-3 g/day may be the result of:
1) CHF
2) Chronic glomerulonephritis
3) Acute glomerulonephritis
4) Diabetic nephropathy
5) Pyelonephritis
Moderate
_______ proteinuria > 3 g/day is the result of:
1) Amyloid
2) Chronic glomerulonephritis (severe)
3) Diabetic nephropathy
4) Lupus nephritis
Significant
Persistent pH greater than 7.0 are associated with
calcium carbonate,
calcium phosphate
magnesium-ammonium phosphate stones;
