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MLT Clinical Practicums > Urinalysis Study Guide > Flashcards

Urinalysis Study Guide Flashcards

1
Q

Under what magnification are urine cells enumerated?

A

400x

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2
Q

How may, too numerous to count, rbc’s is dispersed so other sediment can be evaluated?

A

2% acetic acid

lyse rbc’s

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3
Q

Casts and ? go hand in hand in a urine sediment

A

protein

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4
Q

Possible causes of false negative dipstick test for blood

A

ascorbic acid
high SG
high nitrite

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5
Q

Which crystals appear in acid urine

A

KNOW

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6
Q

Which crystals appear in alkaline urine

A

KNOW

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7
Q

Can indicate congenital cystinosis or cystinuria, tend to deposit in tubules as calculi resulting in renal damage

can be caused by pyelonephritis, diet high in animal fat and protein

A

Cystine crystals

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8
Q

Indicates liver disease

formed when large amounts of bilirubin is present in urine

A

Bilirubin crystals

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9
Q

Indicates aminoaciduria or severe liver disease

very water soluble so rarely seen

A

Leucine crystals

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10
Q

Indicates aminoaciduria or severe liver damage

water soluble so rarely seen, but found more often than leucine

A

Tyrosine crystals

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11
Q

Rare: aways accompanied by large protein and other fats

seen in nephrotic syndrome and conditions resulting in chyluria: rupture of lymphatic vessels in renal tubules

A

Cholesterol crystals

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12
Q

Non pathologic, except in large amounts seen in gout and conditions of purine metabolism (cytotoxic drugs)

crystals form as body tries to rid itself of excess in the blood caused by overweight, rich diet, exposure to lead or genetic predispostition

A

Uric acid crystals

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13
Q

Non pathologic; with ingestion of high oxalate foods but also seen in ingestion of antifreeze and severe renal disease

oxalic acid (metabolite of ascorbic acid) will combine with Ca2+ in urine to form. . .

A

Calcium oxalate crystals

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14
Q

Rare

Indicates larege doses of the antibiotic

A

Ampicillin

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15
Q

Not clinically significant

might be seen in ethylene glycol (antifreeze) intoxication, or exposure to toluene in atmosphere

A

Hippuric acid

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16
Q

Extremely rare; indicates overdose if seen; salicylic acid

excess excreted in urine and may crystalize in acid urine

A

Aspirin

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17
Q

Rare; renal damage uncommon

original drug was insoluble and formed cyrstals in renal tubules. Current drugs are soluble

A

Sulfonamide

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18
Q

Not clinically significant; mistaken for cholesterol

form in acid urine as body excretes the dye

A

X-ray media

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19
Q

No clinical significance but can be associated with UTI in alkaline urine

ammonium combines with magnesium and phosphate in alkaline urine to form “coffin lid” crystals

A

Triple phosphate

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20
Q

Not clinically significant unless found in fresh urine (very rare). Can be mistaken for sulfanomide.

forms as urine ages. check collection time of specimen

A

ammonium biurate

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21
Q

No clinical significance. Can be mistake for bacteria

seen after lare consumption of vegetables

A

Calcium carbonate

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22
Q

Not clinically signficant. enhanced when urine has been refrigerated

Only distinguished by acetic acid or heating to 60C

A

Amorphous urate - dissolves when heated

Amorphous phosphate - does not dissolve when heated

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23
Q

Increased indicates renal bleed, either glomerular or tubular. Associated with casts and proteinuria

Indicates glomerularnephritis, pyelonephritis, cystitis, calculi, tumors, or trauma. If no cast or proteinuria, bleed is below the kidney or may be contamination

A

RBCs

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24
Q

Increased indicates inflammation of urinary tract

indicates bacterial/parasitic infections or renal diseases *ex; glomerularnephritis, chlamydia, mycoplasmosis, TB, trich, mycoses)

A

WBCs

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25
Q

Hard to differentiate from other WBC

Indicates acute interstitial nephritis (AIN) or chronic UTI

A

Eosinophils

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26
Q

Normally present in urine in small amounts. Not normally distinguished from WBCs but large amount is significant.

Present in inflammatory conditions, such as acute pyelonephritis or in renal rejection transplant.

A

Lymphocytes

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27
Q

Increased viral conditions

drawn to site of inflammation resulting from renal infection or immune reactions

A

Monocytes, Macrophages

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28
Q

Indicates inflammation or renal damage if found in large amounts.

Can be UTI. Clusters/sheets seen after catheritization but if no instrumentation used, indicates pathological process

A

Transitional epithelial

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29
Q

Not clinically significant

Indicates specimen contamination

A

Squamous epithelial

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30
Q

Increased in acute ischemic or toxic renal tubular disease

indicates heavy metal or drug toxicity

A

Convoluted renal tubular epithelial

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31
Q

Very significant

All types of renal disease, such as, mehpritis, acute tubular necrosis, kidney transplant rejection, salicylic acis poisoning

A

Collecting duct renal epithelial

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32
Q

Indicates glomerular dysfunction with renal tubular cell death and leakage or plasma into urine. Associated with casts and protein

Renal tubular cells become engorged with fats from tubular lumen or own degenerating intracellular lipids

A

Oval fat bodies

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33
Q

Indicates viral infection affecting newborns with liver, spleen and blood disorders, and adults with Hodgkins, leukemia and aplastic anemia

Viral inclusions found in nucleus of renal tubular epithelial cells

A

Cytomegalic Inclusion bodies

CMV

34
Q

Normal in low numbers. High numbers can indicate strenuous activity, dehydration, fever, stress, renal disease or congestive heart failure

Composed of homogenous Tamm-Horsfall protein matrix and formed within tubules

A

Hyaline cast

35
Q

Indicates urinary stasis

Formed when granular cast degenerates as it sits in renal tubule

A

Waxy cast

36
Q

Finely granular in low numbers can be normal. Coarse granular and broad granular indicates poor prognosis. Associated with renal tubular epithelial cells and proteinuria

coarse granular results from degeneration of renal cells and other casts. Broad granular indicates renal damage

A

Granular cast

37
Q

Renal failure, increase amount is poor prognosis

Cast forms in dilated convoluted tubules or collecting ducts indicating severe urinary stasis

A

Broad cast

38
Q

Indicates renal tubular disease. Associated with proteinuria and granular casts

Become incorporated into the T-H matrix as it sits in tubule (urinary stasis)

A

Renal tubular epithelial cast

39
Q

Diagnostic of intrinsic renal disease. Associated with proteinuria. Occasionally found in healthy people 24-48 hours after contact sports

glomerular and tubular damage

A

RBC cast

40
Q

Indicates renal inflammation or infection

Glomerularnephritis will also have rbc casts, pyelomephritis with also have proteinuria and heamturia

A

WBC cast

41
Q

Not often ID’ed because difficult to see, diagnostic of pyelonephritis

Usually contains WBC so often reported as WBC cast

A

Bacterial cast

42
Q

Significant in renal pathology: nephrotic syndrome or severe crush injury

Usually contained with hyaline or granular matrix and associated with proteinuria

A

Fatty cast

43
Q

Sulfonamide and Ca oxalate most common. associated with hematuria

Any substance present in tubular lumen can be in casts

A

Hemosiderin

44
Q

Pigments cast

A

Hgb, myoglobin: yellow to brown, with hematuria
Bilirubin: yellow to brown in all urine & sediment
Urobilinogen: yellow-golden urine but not sediment
Phenazopyridine: urinary pain killer, brown to reddish brown

45
Q

Hydrogen peroxide, H2O2, reacts with tetramethylbenzidine, chromogen, in presence of hemoglobin or myoglobin to produce oxidized chromogen and water

A

Occult blood

46
Q

Oxidized dye, yellow, reacts with hydrogen ions to produce hydrogen and reduced dye, green-blue

A

pH

47
Q

An indicator dye added to protein in presence of pH 3.0 will produce a blue-green color as hydrogen ions are released from indicator dye

A

Protein

48
Q

With acid pH, urine reacts with para-arsanilic acid to form a diazonium compound, which in turn couples with 1,2,3,4-tetrahydrobenzo(h)quinolin-3-ol to produce a pink color

A

Nitrite

49
Q

Glucose oxidase catalyzes the oxidation of glucose in urine to forma hydrogen peroxide and gluconic acid. The hydrogen peroxide then oxidizes the chromogen on the pad in the presence of the peroxidase

A

Glucose

50
Q

What is the reason for a negative dipstick on glucose and a positive clinitest?

A

reducing substance other than glucose present; galactose, sucrose

51
Q

Acetoacetic acid in an alkaline medium reacts with sodium nitroprusside (nitroferricyanide) to produce a color change from beige to purple

A

Ketones

52
Q

React with Ehrlich’s reagent (para-dimethylaminobenzaldehyde) to form a red colored compound, light orange to dark pink

A

Urobilinogen

53
Q

Reacts with a diazonium salt (diazotized 2,4-dichloroaniline) in acid medium to form an azodye, color change from light tan to beige

A

Bilirubin

54
Q

Cleaves ester to form an aromatic compound which then combines with diazonium salt in acid pH to produce an azodye, color change from beige to violet

A

Leukocyte esterase

55
Q

Ionic solutes in urine cause protons to release from a polyelectrolyte. As protons are released, the pH decreases and produces a color change of the bromthymol blue indicator from blue green to yellow green.

A

SG

56
Q

How may amorphous be dispersed so other sediment may be evaluated?

A

2% acetic acid to rid amorphous phosphate

heat to 60C to get rid of amorphous urate

57
Q

What organism may be found in the urine of diabetics?

A

yeast

58
Q

What type of specimen provides an overall picture of the patients health?

A

Random specimen

59
Q

can run routine analysis up to 24 hours

A

refrigeration

60
Q

preserves urine for longer time at RT; routine analysis

A

Commercial transport tubes; boric acid

61
Q

preserves sediment, inhibits bacteria and yeast

A

Thymol

62
Q

cellular preservation, will cause false-negative in blood and uro tests; used in cytology

A

Formalin

63
Q

cellular preservation; used in cytology

A

Saccomanno’s fixative

64
Q

Unacceptable preservatives for urine

A

Acids; HCl, glacial acetic acid

Sodium carbonate

65
Q

What is the clinical sign of BIL and URO in a urine specimen?

A

BIL: not normal, can indicate hep, cirrhosis or biliary obstruction, but neg in chronic disease

URO: increased amount can indicate hep, cirrhosis or hemolytic states(PA). Decreased in chronic liver disease(cannot report negative URO) small amount is normal

66
Q

What is the SG of normal urine?

A

1.002-1.030

67
Q

What is the significance of ketones in the urine?

A

indicates fat metabolism resulting from starvation or deficiency in COH metabolism

68
Q

How is urine osmolality determined?

A

measured by freezing point depression or vapor pressure osmometer. Unaffected heavy molecules, all solute contribute equally. Normal value is 275-900 mOsm/kg of water

69
Q

What are the findings on the dipstick with a UTI?

A

protein: small

70
Q

What are the findings on the dipstick with a HTR?

A

elevated URO but not bile

71
Q

Count of # of WBC, RBC, and casts in a 12 hr overnight period when a pt is not eating or drinking: used to follow progress of renal disease, not commonly done

A

Addis count

72
Q

Ability of a test to pick up the lowest level of pathological concentrations, but not normal urine levels

A

Sensitivity

73
Q

Ability of test to react specifically to the substance being tested and no other

A

Specificity

74
Q

Neutrophils in hypertonic solution swell causing Brownian movement in cytoplasmic granules

A

Glitter cells

75
Q

What urinary crystals appear in more forms than any other crystal?

A

uric acid

76
Q

How may RBC and yeast, plus WBC and renal epilthelial cells be differentiated?

A

acetic acid: lyses RBC but not yeast, WBC or RE and it will accentuate the nuclei of WBC

Toluidine blue also accentuates the nuclei of WBC

RE have lg dense nuclei and polygonal shape

Yeast vary in size but are not concave and are usually budding

77
Q

What sugar is a nonreducing sugar?

A

sucrose

any sugar with an aldehyde group or can form one

78
Q

How may myoglobin and hemoglobin be differentiated?

A

80% ammonium sulfate precipitation: Hgb precipitates out of solution but myoglobin remains soluble

79
Q

What is the best way to find urinary casts in a microscopic field?

A

low power, dim light

80
Q

What is the most common constituent of renal calculi?

A

Calcium oxalate

MLT Clinical Practicums (12 decks)

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