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Renal II Cumulative Final > Urinalysis: Visual, Dipsticks, and Microscopy > Flashcards

Urinalysis: Visual, Dipsticks, and Microscopy Flashcards

1
Q

AR inherited condition in which a BCKDC deficiency leads to a buildup of BCAAs (leucine, isoleucine, and valine) and their toxic byproducts (ketoacids) in the blood and urine unless dietary intake is carefully managed

A

Maple-syrup-urine syndrome

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2
Q

Long known for its pungent effects on the urine, approximately 25% of the population reports having pungent pee after eating this due to the breakdown of its sulfurous amino acids into volatile/odorous compounds. Interestingly, this breakdown happens in all people so everybody’s urine stinks, but only a fraction of the population expresses the gene needed to smell it

A

asparagus

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3
Q

In ancient times this disease was diagnosed based on the sweet smell and taste of a person’s urine, while others would pour it in the sand and see if it attracted ants

A

diabetes mellitus

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4
Q

Having a urinary tract infection and/or kidney stones can impart this smell to urine in part due to breakdown of protein by bacteria

A

ammonia

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5
Q

A patient has very foamy urine suggesting the presence of protein. The urine dipstick is negative, but a sulfasalicylic acid test does indicate the presence of protein. The protein in this instance is referred to as “Bence-Jones” protein. This finding is a classic (i.e., Step 1) means of illustrating this disorder

A

multiple myeloma

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6
Q

A urine dipstick specific gravity of 1.025 (on a scale of 1.000-1.030) indicates what?

A

Urine is highly concentrated

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7
Q

What is likely indicated by a urine pH of 6?

A. Pt has diabetic ketoacidosis
B. Pt has respiratory acidosis
C. Bicarb is being lost in urine
D. Fixed acid is being excreted as ammonium
E. The pt has been vomiting
F. Pt has been hyperventilating
A

D. Fixed acid is being excreted as ammonium

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8
Q

What does a negative reading for urine dipstick leukocytes indicate?

A. There’s only eosinophils in the urine
B. The urine bacteria have consumed the leukocytes
C. The pt has infection w/o inflammation
D. A high-power field likely has 3-5 neutrophils

A

D. A high-power field likely has 3-5 neutrophils

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9
Q

On urine dipstick blood/Hgb analysis: what is suggested if the urine is brown, the dipstick is positive for blood, but there’s no RBCs visible by microscopy?

A. Myoglobinuria
B. Intravascular hemolysis
C. Urine contains a dye
D. Nephrotic syndrome
E. Nephritic syndrome
F. Analgesic nephropathy
A

A. Myoglobinuria

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10
Q

What is indicated by a positive nitrite test in urine?

A. Urine contains urea
B. Urine contains uric acid
C. Urine contains creatinine
D. Urine contains a gram negative organism

A

D. Urine contains a gram negative organism

[positive nitrite associated with E.coli, Klebsiella, Proteus, Enterobacter, Citrobacter, and Pseudomonas]

Note that negative result does not rule out UTI, because some bacteria that cause UTI are incapable of nitrate—>nitrite conversion (like Staph, Strep, and Haemophilus)

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11
Q

What is suggested by a result of 50 mg/dL on urine dipstick analysis for ketones?

A. Pt is consuming a low fat diet
B. Pt has nephrogenic diabetes insipidus
C. Pt has diabetic ketoacidosis
D. Pt likely has hypoglycemia
E. Pt is an alcoholic
F. Pt has gouty nephropathy
A

C. Pt has diabetic ketoacidosis

[ketonuria may be seen with uncontrolled diabetes, diabetic ketoacidosis, severe exercise, starvation, vomiting, and pregnancy]

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12
Q

What is indicated by the presence of bilirubin in the urine?

A. Glomerular filtration barriers are compromised
B. Disseminated intravascular congestion
C. Pt has liver disease
D. Pt has iron deficiency
E. Pt is constipated
A

C. Pt has liver disease

[other causes of bilirubin in the urine: obstructive hepatobiliary conditions; liver diseases include hepatitis]

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13
Q

What is suggested by a urobilinogen level of 4 mg/dL on urine dipstick analysis if all other values are within normal limits?

A. High protein diet
B. Rhabdomyolysis
C. Biliary tract obstruction
D. GI superinfection with C.diff
E. Hemolytic disease
A

E. Hemolytic disease

[increased urobilirubin levels are associated with excessive hemolysis, liver parenchymal diseases, constipation, and intestinal bacterial overgrowth]

Note that DECREASED urobilirubin levels would indicate obstructive biliary disease or severe cholestasis

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14
Q

What is likely when pt has 1000 mg/dL of protein in the urine?

A. Nephritic syndrome
B. Nephrotic syndrome
C. Liver protein production is greater than PCT reabsorptive capacity
D. Post-strep glomerulonephritis
E. High protein diet
A

B. Nephrotic syndrome

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15
Q

What does a urine dipstick of 100 mg/dL glucose indicate?

A. Pt has type II DM
B. Pt has central diabetes insipidus
C. Filtered load of glucose is greater than PCT reabsorptive capacity
D. Excess glucose is being secreted by DT
E. Glomerular filtration barrier has been compromised

A

C. Filtered load of glucose is greater than PCT reabsorptive capacity

[glucose in the urine most commonly indicates diabetes mellitus but can also be seen in pregnancy]

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16
Q

What type of crystals are found in the urine of animals/humans infected with ammonia-producing organisms?

A

Triple phosphate crystals (struvite)

2 types:
Common form = “coffin lid”
Rapidly precipitated form

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17
Q

Are struvite crystals primarily found in alkaline or acidic urine?

A

Alkaline

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18
Q

What types of crystals/urinary sediment are found chiefly in alkaline urine?

A 
Ammonium urate
Struvite
Calcium phosphate
Amorphous phosphates
Calcium carbonate
19
Q

What type of crystals/sediment are found chiefly in acidic urine?

A 
Uric acid (football shape)
Sodium urate
Calcium oxalate (envelope shape)
Sulfonamide
Amorphous urates
Leucine
Tyrosine (fine delicate needles)
Cystine (hexagon shape)
20
Q

Cystine, tyrosine, and leucine are among the abnormal crystals of _____ origin

A

Metabolic

21
Q

Urinary casts form via precipitation of the ______ mucoprotein secreted by distal nephron cells, the function of which is not fully understood

A

Tamm-Horsfall

22
Q

What does it mean to see RBC containing casts in the urine?

A

There is damage to glomerular endothelial cells

23
Q

What does it mean to see epithelial casts in the urine?

A

Epithelial casts form when tubule cells die and slough off

24
Q

What does it mean to see WBC casts in the urine?

A

WBC casts form when there is tubulointerstitial nephritis

25
Q

Blue urine causes

A

Methylene blue dye (common in some medications, e.g., Viagra), indomethacin, amitryptiline, triamterene, cimetidine (IV), promethazine (IV)

Blue diaper syndrome = tryptophan malabsorption

26
Q

What vitamin tends to give urine a bright/fluorescent yellow color?

A

Riboflavin (B2)

27
Q

What might red urine indicate?

A

Food — beets, blackberries, rhubarb

Drugs — propofol, chlorpromazine, thioridazine, ex-lax

UTIs, nephrolithiasis, hemoglobinuria (rhabdomyolysis), porphyrias

28
Q

Causes of orange urine

A

Carrots, Vit C

Drugs — rifampin, phenazopyridine

29
Q

Green urine causes

A

Asparagus

Drugs — vitamin B, methylene blue, propofol, amitriptyline

UTIs

30
Q

Cause of purple urine

A

Bacteriuria in pts with urinary catheters (purple urine bag syndrome)

31
Q

Brown urine causes

A

Fava beans

Drugs — levodopa, metronidazole, nitrofurantoin, primaquine, chloroquine, methocarbamol, senna

Medical conditions — Gilbert syndrome, tyrosinemia, hepatobiliary dz

32
Q

Black urine causes

A

Alkaptonuria

Malignant melanoma

33
Q

White urine causes

A

Propofol

Chyluria, pyuria, phosphate crystals

34
Q

The urinary dipstick only detects the presence of _____ and no other proteins

A

Albumin

Thus it is very specific, but not a sensitive test for proteinuria — this is especially important to note in pts with diabetes because the urine dipstick is insensitive for microalbuminuria

Also important to note that urine concentration may alter results!

35
Q

Because the urinary dipstick protein results can be inaccurate, a more accurate test is the _____

A

Sulfosalicylic acid test (SSA) — detects all proteins in the urine at any amounts, including albumin, globulin, and Bence Jones proteins

36
Q

What type of urinary casts may be seen in healthy individuals?

A

Hyaline casts [may be increased after strenuous exercise or with diuretic therapy]

37
Q

Red cell casts are nearly diagnostic of _____ or _____

A

Glomerulonephritis or vasculitis

38
Q

White cell casts and pyuria are most commonly seen with _____ and _____

A

Tubulointerstitial nephritis
Acute pyelonephritis

[WBC casts are also seen with renal tuberculosis and vaginal infections]

39
Q

Muddy brown granular casts are diagnostic of what?

A

Acute tubular necrosis

40
Q

Waxy and broad casts are consistent with ____

A

Advanced renal failure

41
Q

Fatty casts and lipiduria, with typical “maltese-cross” appearance on polarized microscopy, are commonly seen with _____ syndrome

A

Nephrotic

42
Q

Calcium oxalate crystals and AKI is seen with ____ ingestion

A

Ethylene glycol

43
Q

The presence of large amounts of uric acid crystals and AKI is seen with ____ _____ syndrome

A

Tumor lysis

[may also be seen with gout]

Renal II Cumulative Final (20 decks)

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