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Laboratory Part 2 > Urinalysis Procedures > Flashcards

Urinalysis Procedures Flashcards

1
Q

Urinalysis is a screening test that can assess and detect what disorders?

A

1) Renal function/disorders
2) Endocrine or metabolic function/disorders
3) UTI
4) Systemic diseases

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2
Q

What are clinical reasons for doing a UA?

A

It’s an important indicator of health.

It screens for diseases/disorders.

It is a cost-effective in-vitro diagnostic test.

Non-invasive.

Simple to do.

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3
Q

What are the four non-instrumented collection methods?

A

1) First morning void.
2) Random.
3) Clean catch.
4) 24 hour.

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4
Q

What are the three instrumented collection methods?

A

Urethral catheterization.

Suprapubic needle aspiration.

Catheterization and bladder irrigation.

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5
Q

How soon should urine be analyzed, and how long can it be refrigerated if you can’t test it in time?

A

Analyze within 1-2 hours OR refrigerate for 3-6 hours.

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6
Q

What happens to urine if it is left at room temperature?

A

It will decompose and give inaccurate results.

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7
Q

What does urea splitting bacteria do to urine?

A

It produces ammonia which combines with hydrogen ions and increases the pH of urine.

-pH changes will dissolve any casts present.

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8
Q

How does a false negative glycosuria occur?

A

Bacteria uses glucose in urine as a source of energy.

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9
Q

What happens to certain urinary elements, like blood cells and casts, if they’re left standing in urine?

A

They will deteriorate unless a preservative is used.

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10
Q

Preservation Method: Freezing

A

Advantage: No cost to transport or store, simple to perform.

Disadvantage: May destroy formed elements.

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11
Q

Preservation Method: Toluene

A

Advantage: Preserves acetone, diacetic acid and proteins by floating on top of urine and making an airtight seal.

Disadvantage: Flammable, difficult to separate from specimen.

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12
Q

Preservation Method: Thymol

A

Advantage: Inhibits bacteria and fungus.

Disadvantage: False positive for protein.

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13
Q

Preservation Method: Chloroform

A

Advantage: Preserves urine aldosterone levels.

Disadvantage: Settles to the bottom of containers.

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14
Q

Preservation Method: Formaldehyde

A

Advantage: Preserves urinary sediments/cells.

Disadvantage: Interferes with glucose evaluation.

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15
Q

Preservation Method: Hydrogen Chloride

A

Advantage: Stabilizes steroids.

Disadvantage: Hazardous liquid and fumes. Formed elements are destroyed.

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16
Q

Preservation Method: Boric Acid

A

Advantage: Preserves chemical and formed elements.

Disadvantage: Uric acid may precipitate.

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17
Q

Preservation Method: Preservation Tablet

A

Advantage: Preserves urine for dipstick chemical analysis and sediment evaluation if transportation is necessary.

Disadvantage: Unsuitable for sodium, potassium, and hormone analysis.

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18
Q

First Morning Void

A

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

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19
Q

Random Urine Specimen

A

1) Collect at any time.
2) Most convenient and most common method.
3) Can detect abnormalities but not as sensitive as first morning void.

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20
Q

Clean Catch Specimen

A

1) Specimen of choice for bacterial cultures.
2) May perform cultures within 12 hours after collection if specimen was refrigerated.
3) Genitals must be cleaned with mild antiseptic solution.
4) Collect mid-stream in a sterile container.

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21
Q

24 Hour Specimen

A

1) Gives quantitative results.
2) Preservatives may be needed.
- Make sure to mark start and end time.

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22
Q

What type of instrumented collection is not suggested for bacteriologic examination and should only be used if there’s no other way to collect urine?

A

Urethral catheterization

-Commonly used on markedly obese patients with difficulty in urine collection.

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23
Q

What type of urine collection is used in place of catheterization for collecting a single urine sample?

A

Suprapubic Needle Aspiration.

  • Avoids vaginal and urethral contamination.
  • Method of choice for infants and young children.
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24
Q

What type of collection method is used for bladder outlet obstruction (urinary retention), to confirm positive cultures from disposable bags, and prior to the institution of specific therapies?

A

Suprapubic Needle Aspiration

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25
Q

What urine collection method yields an optimum cellular sample of bladder epithelium?

A

Catheterization and Bladder Irrigation

Utilizes vigorous transcatheter agitation of the bladder. 50-72mL saline inserted into the bladder, then bladder contents are removed for cytologic study.

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26
Q

What are the urine sample analyses for catheterization and bladder irrigation?

A

Physical

Chemical

Microscopic

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27
Q

What are the five components of physical analysis of urine?

A

1) Volume
2) Color
3) Turbidity
4) Odor
5) Specific Gravity

28
Q

Discuss urine normal volume in 24 hours. What is the range and average amount? What is the amount directly related to?

A

Range: 600-2000mL

Average: 1500mL

Related to:

  • Fluid intake
  • Temperature and climate
  • Amount of perspiration
29
Q

What gives urine its color?

A

Pigment concentration, known as urochrome.

30
Q

Diagnostic significance of urine colors

A

1) Blue green - Methylene blue (dye or stain for diagnostic procedures)
2) Dark orange - Pyridium (UTI medication)
3) Milky white - chyle
4) Olive green to brown black - Phenols (poisonous compound used for antimicrobials)
5) Yellow to brown that turns greenish with foam when shaken - bile and/or bilirubin
6) Red or red-brown with a smoky appearance - presence of blood

31
Q

Turbid Alkaline and Acidic urine causes

A

Turbid Alkaline

  • Amorphous phosphate
  • Amorphous carbonate

Turbid Acidic

  • Amorphous urates
  • Pinkish turbidity indicates urates
32
Q

Normal urine has a characteristic odor due to what substance?

It develops the odor of ammonia due to what reason?

A

Characteristic odor from volatile acids.

Ammonia odor is caused due to breakdown of urea by bacteria when urine is left standing too long.

33
Q

Urine odor indicators

A

Sweet or fruity - ketones

Pungent - ammonia from bacteria

Maple syrup - “maple syrup urine disease” (congenital metabolic disorder)

Musty or mousy - infant with phenylketonuria

Sweaty feet - isovaleric acidemia, presence of butyric or hexanoic acid in urine

34
Q

Specific gravities of random and 24 hour urine

A

Random: 1.003 - 1.035

24 hour: 1.015 - 1.025

35
Q

The quantity of glucose in urine is dependent upon what?

A

Blood glucose level

Rate of glomerular filtration

Degree of tubular reabsorption

36
Q

Normal urine is negative for glucose. What can the presence of glucose indicate?

A

DM or any condition causing hyperglycemia.

37
Q

When will glucosuria appear in urine?

A

Once the threshold level of 160-180mg/dL in the blood is exceeded.

38
Q

Ketonuria (ketones in urine) results from what?

A

Incomplete fatty acid utilization. Ketones are not normally found in urine. This may indicate DM.

39
Q

Ketosis

A

Increased ketones in blood and urine. Found in conditions associated with:

1) Decreased carb intake (starvation).
2) Decreased utilization of carbs (DM).
3) Digestive disturbance or dietary imbalance (high fat or low carb diets).
4) Eclampsia.
5) Prolonged vomiting.
6) Diarrhea.

40
Q

Occult blood in urine may cause the sample to appear how, and how is it termed?

A

May appear red and smoky, and is termed hematuria.

41
Q

Intact RBCs in urine may indicate

A

Damage or trauma to the kidney or urinary tract

Renal diseases such as:

  • Glomerulonephritis
  • Malignant hypertension
  • Polycystic kidney disease

May be due to menstrual contamination or exercise

42
Q

Conditions causing jaundice will cause what substance to appear in urine, and will turn the urine what color?

A

Bilirubin, yellow to brown that turns greenish and foamy when shaken. NOT NORMALLY FOUND IN URINE.

Bilirubinuria indicates:

  • Hepatocellular disease
  • Intra or extra-hepatic biliary obstruction
43
Q

Is urobilinogen normally found in urine?

A

Yes, in small concentrations of less than 1 EU. Amounts up to 1mg/dL is normal.

An increase indicates liver and hemolytic disease.

44
Q

What is the normal range of urine pH, and is it acidic or alkaline?

A

4.6-8.0, average is 6.0 which makes it slightly acidic.

45
Q

What pathologic conditions may cause acidic urine?

A

1) Respiratory and metabolic acidosis.
2) UTI from E. coli. ***
3) Uremia.
4) Severe diarrhea.
5) Starvation.

46
Q

What pathologic conditions cause alkaline urine?

A

1) UTIs caused by Proteus or Pseudomonas species. ***

2) Respiratory or metabolic alkalosis.

47
Q

What substance in urine is an important indicator of renal disease?

A

Protein. It is not normally present in urine. Proteinuria mainly occurs via two methods:

  • Glomerular damage.
  • Defect in the reabsorption process of the tubules.
48
Q

How are nitrites formed in urine?

A

They are not normally found in urine, but are formed by the breakdown of nitrates by organisms that cause UTIs like E. coli.

-Bacteriuria is the presence of bacteria in urine and is indicative of a UTI.

49
Q

What is an indirect test for bacteriuria that is related to the presence of leukocytes?

A

Leukocyte esterase

Normal urine is negative for LE. They detect esterase that is released in urine by neutrophils.

50
Q

Leukocyturia is related to what conditions?

A

Inflammatory processes in or around the urinary tract, such as a UTI or acute glomerulonephritis.

51
Q

Most UAs consist of what components?

A

Macroscopic analysis (appearance)

Chemical analysis (dip stick)

Microscopic analysis (looking for formed elements)

52
Q

What are the normal UA results?

A

1) Color is clear to yellow.
2) Leukocyte esterase is negative.
3) Nitrites are negative.
4) Urobilinogen is ≤ 1.0 mg/dL.
5) Protein is negative to trace.
6) pH is 4.6 - 8.0.
7) Blood is negative.
8) Specific gravity is 1.003 - 1.035.
9) Ketones are negative.
10) Bilirubin is negative.
11) Glucose is negative.
12) RBCs are 0-3 HPF (High Power Field).
13) WBCs are 0-2 HPF.
14) Epithelial cells 0-1 HPF.
15) Casts are dependent on the type.
16) Bacteria is negative to trace.

53
Q

UA is a strong positive test for glucose and ketones. What are the critical values?

A

Glucose on urine dipstick >1,000 mg/dL with small, medium or large ketones.

Urine colony count of >50,000 colonies/mL in a single organism.

54
Q

How much protein can a normal adult excrete in urine per day, and what is proteinuria defined as?

A

10-100mg/day.

Proteinuria: loss of >500mg/day.

55
Q

Persistent pH above ___ is consistent with what conditions?

A

Above 7.0.

Calcium carbonate, calcium phosphate, magnesium-ammonium phosphate stones.

56
Q

Persistent pH below ___ is consistent with what conditions?

A

5.5

Cystine and uric acid stones.

57
Q

An increase in urobilinogen may be a result of what conditions?

A

Hemolytic anemia, cirrhosis or viral hepatitis.

Urobilinogen is absent in total biliary obstructions.

58
Q

Bilirubin is commonly seen in patients with what condition?

A

Obstructions of the bile duct.

59
Q

Dipsticks can detect as little as ___ RBCs HPF, and a finding of >__ RBCs HPF is considered abnormal.

A

As few as 1-2.

> 3 abnormal.

They are dependent on the presence of Hgb, RBCs and myoglobin in urine. All positive dipsticks must be further evaluated.

60
Q

A normal healthy person may have RBCs in their urine after exercise. Persistent RBCs in urine may indicate:

A

1) Glomerulonephritis
2) Kidney stones
3) Cancer
4) Infection

61
Q

What cell in urine is highly suggestive of rhabdo?

A

Myoglobin

62
Q

What is an indirect test for UTIs that can give semi-quantity estimates of pyuria?

A

Leukocyte Esterase and WBCs tested with a dipstick.

Potentially significant pyuria is >3 WBCs HPF.

63
Q

What is another direct indicator of a UTI, and is an indication of bacterial infection due to the breakdown of nitrates into nitrites by the bacteria?

A

Nitrites in urine

64
Q

Why is glucose normally absent in urine? When is the body’s ability to reabsorb glucose exceeded?

A

Because glucose is filtered by the kidneys and is almost completely reabsorbed in the proximal tubule.

Glucose levels of 180mg/dL.

65
Q

What substances in urine are suggestive of uncontrolled DM-I?

A

Ketones and ketonuria along with glucose (glycosuria).

66
Q

Microorganisms are not normally found in urine. What should your first consideration of the cause be?

A

Contamination.

67
Q

_ epithelial cell per HPF is considered normal.

An increased number may indicate what conditions?

A

1 cell per HPF.

Acute tubular necrosis or inflammation seen in glomerulonephritis.

Laboratory Part 2 (3 decks)

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