Urinanalysis Flashcards
Normal urine color is due to?
Urochrome
Red urine color is due to?
- beets,
- blood,
- chemotherapy;
- ex-lax → laxative, seen when people have eating disorder
- hemoglobinuria,
- propofol(used when people of colonoscopy),
Orange urine
- Vit. C
- Rifampin
- Phenazopyridine
Green Urine
- Asparagus
- Propfolol
- Utis
- Methylene blue → agent to used to reverse toxicities of some agents
Purple Urine
uti patients with catheters
Brown Urine
fava beans,
levodopa,
metronidazole,
hepatobiliary disease
Black Urine
alkaprotienuria, melanoma
What is the name of the test called when you physically test the urine on a refractometer ? What does it test for?
Specific Gravity-test for the concentration of solutes of the urine– a really conc. urine will have a increased specific gravity
What does the chemical analysis dipistick test for?
Chemical analysis (dipstick)
Holy God Kate Loves NAPS
- Heme (Blood)
- Glucose
- Ketones
- Leukocyte esterase
- Nitrate
- Albumin (protein)/urobilinogen/bilirubin
- pH
- Specific Gravity
Serum glucose >180 results in?
Serum glucose >180 results in spilling
glucose into urine
Normal findings? Appearance Color Odor pH Protein Specific gravity
clear Yellow (amber) Aromatic 4.6-8.0 0-8 mg/dL 1.005– 1.030
Normal findings? Leukocyte esterase Nitrates Ketones Bilirubin Urobilinogen Glucose
negative none none none 0.01-1 Ehrlich unit/mL none
The term for glucose in the urine?
glycosuria
What are casts?
“mold” like a cast, from inside renal tubule (solid), tells you if some disease is in the kidney
Findings of calcium oxalate in the urine would be represented of ?
Nephrolithiasis
Findings of uric acid in the urine would be represented of ?
- TLS (tumor lysis syndrome)→ really agressive chemo so the dead tumor cells will be in the urine
- hyperuricosuria
Findings of Magnesium Ammonium Phophosphate in the urine would be represented of ?
staghorn calculi
Findings of Cystine in the urine would be represented of ?
cystinuria
What of cells would you find in a urine microscopic exam?
- RBCs (Hematuria)
- WBCs (Pyuria)
- Transitional Epithelial→ bladder cells
- Renal Tubular epithelial cells
- Squamous epithelial cells→ contamination
IF you find • Squamous epithelial cells it is an indicator of ?
contamination
Casts are?
cylindrical particles formed
from coagulated proteins in renal tubules
What are the different kind of casts you can find and what does each mean? ( 6 types of casts)
Hey Ryan, Wait, Wanna FM
Hyaline Cast -non specific, heavy
exercise, diuretics
• RBC Cast –glomerulonephritis, vasculitis
• WBC cast –acute pyelonephritis, tubule
interstitial nephritis
- Waxy cast –Advanced renal failure
- Fatty Cast –nephrotic syndrome
• Muddy-brown granular cast -acute
tubular necrosis
What are normal finding each category in the urine?
- Crystals
- Casts
- WBCs
- RBCs
- RBC Casts
- Squamous Epi
- none
- none
- 0-4 per low power field (lpf)
- <3
- none
- Less than 15-20/hpf
Urinalysis Indicators of Infection ?
• Bacteria • Leukocyte Esterase positive • WBCs > 10 • Nitrate positive • RBCs → can be caused by inflammation • Ph increased (can indicate infection)
Urine culture
Quantitative vs. Qualitative difference?
• Quantitative
→ Colony count evaluation
• Qualitative
→ Presence of bacteria
Lumbar puncture indications?
Diagnostic: • CNS infections • Inflammatory Processes • Subarachnoid hemorrhage • Cytologicand protein analysis (ex: malignant cells getting into CSF-ex: Lymphoma)
Therapeutic:
• Deliver medications
• Relieve symptoms of a few specific causes of increased ICP (ex: hydrocephalus)
What would be C/I’s of reasons why you shouldn’t preform a lumbar puncture
• Local Skin Infection • Suspected mass lesion • Raised ICP • Bleeding Diathesis • Coagulopathy → Platelet count less than 50,000 → Platelet dysfunction → INR greater than 1.4 • Poor Patient Cooperation → pt. can't stay in fetal position
Describe the equipment involved in lumbar puncture?
Spinal needle • Three way stopcock • Manometer • Connecting Tube • Four Specimen Tubes • Local Anesthesia • Syringes and needles for local anesthesia • Sterile Gloves • Antiseptic Solution
Where do you inject a lumbar needle and what is important about the collection of the CSF?
Collection: • Four tubes labeled #1-4 → normally shouldn't be blood in tuber number 4 • Order of collection is important • L3 –L4 • L4 -L5
→ less chance of spinal cord injury in these spots
How much CSF do you collect in each tube and do you do with each tube?
Four Tubes • Collect approx. 4-8 ml total.
• Tube 1 –Collect Cell Count and Differential
• Tube 2 –Glucose and Protein
• Tube 3 –Culture and Gram Stain
→ *** cultures only check for bacteria
• Tube 4 –Cell Count and Differential
**Cultures
What tests should you consider if you suspect a CSF infection?
Consider: • AFB or TB PCR • Cryptococalantigen and indiaink • Fungal culture • VDRL • Lyme Antibody • PCR for Viruses (EBV, HSV, CMV, VZV, HHV-6)
If there is blood in all four tubes you should suspect ?
subarachnoid hemorrhage→
bleeding between the arachnoid and the Pia matter
Subdural hematoma (SDH) occurs because of
- result of the countercoup injuries
- result of venous bleeding stretching of bridging veins
Bacterial vs. Viral : CSF analysis
Appearance?
Glucose?
Gram Stain?
Appearance:
B: Turbid
V: Clear
Glucose:
B: <2.2
→ bacteria will eat the sugar so it will be low
V: Normal
Gram Stain:
B: Positive
V: Normal
Subarachnoid Hemorrhage vs. Traumatic Tap:
- CSF pressure?
- Duration of bleeding?
-Centrifugation?
CSF Pressure:
TP: Low
SH: High
Duration of when CSF is withdrawn:
TP: Decreases when CSF is withdrawn→ will normally see blood in 1st tube b/c you stuck a needle into their back
SH: No change in color when CSF is withdrawn→ blood in all 4 tubes
Centrifugation:
TP: clear fluid
SH: Xanthochromia
Synovial Fluid Analysis Indications?
- Joint pain • Joint swelling • Joint effusion
* Must take context of clinical history and presentation
Synovial Fluid Analysis
look at picture on desktop
Physical analysis of urine looks at
color
appearance
specific gravity
What are the two parts to complete an urinalysis
Chemical tests
Sediment tests (microscopic)
