Urine 2 Flashcards
what type of UTIs require concurrent car?
upper UTI
what type of UTI is most common?
lower UTI
acidic urine usually creates what kind of stones?
xanthine
cysteine
uric acid
alkaline urine usually creates what kind of stones?
calcium carbonate
calcium phosphate
magnesium phosphate
dipsticks are mainly sensitive to?
albumin
how is albumin reported
negative trace 1+ 2+ 3+ 4+
what is normal for albumin in the urine?
normal- negative, trace (>150mg/day)
protein uria is used synonymously with?
albuminuria
protein uria is a primary indicator of?
renal disease
positive dipstick test needs to be confirmed with?
sulfosalicylic acid test
when doing an SSA, what does the tech check for?
the amount of turbidity
what do protein s in the urine indicate?
stress or dysfunction
physiological or pathological in etiology
proteinuria because of kidney disease usually indicates?
upper UTI diabetes glomerulonephritis nephrotic syndrome preclampsia trauam
what can lead to protein uria
strenuous exercise exposure to cold (shivering) large abdomen (pregnancy, preclampsia) dehydration febrile illness
what do you do if you suspect proteinuria but they exercise?
have them not exercise for a few days, then take another UA
do NOT sign their sports physical
orthostatic proteinuria
patient displays normal urine when supine and protein uria standing
what do you do for orthostatic protein uria?
have them lie down for 1 hour and recheck urine, may be exaggerated lumbar lodosis, which leads to renal congestion
orthostatic proteinuria is more common in?
adolescents
preclamsia may become severe with?
headache, visual changes, liver enlargement, severe proteinuria, intrauterine growth retardation, convulsions, coma, etc
proteinuria could be from?
intense exercise heart conditions CNS lesions blood disorders drug therapy systemic disorders (diabetes) collagen disorders (lupus, scleroderma) septicemia (microorganisms in blood) nephrotic syndrome multple myeloma
nephrotic syndrome
+4 protein in urine
urine may appear frothy
they have severe edema around the eyes
nephrotic syndrome is associated with?
toxins
bee stings
severe infections
polycystic kidney
what should always be run on those with +4 protein?
Bence Jones test
when should a bence jones test be considered?
if there is suspected muliple myeloma
what is multple myeloma
malignant proliferation of plasma cells (a type of WBC)
what are bence jones proteins?
kappa or lambda light chain part of immunoglobulins that get into the urine
what test do you order to look for bence jones proteins?
urine protein electrophoresis
urine immunofixation
boil, chemicals, immunoelectrophoresis
will a routine urinalysis detect bence jones proteins?
no
what are some symptoms of muliple myeloma?
nausea, confusion, polyuria (hypercalcemia renal insufficiency)
fatigue (anemia, renal insufficiency)
bone pain (bone lysis, pathological fx)
bleeding (thrombocytopenia)
infections (immune deficiency)
neurological complaints (path fx)
confusion, dizziness, blurred vision (hyperviscosity)
describe the process of finding out if someone has bence-jones proteins.
+SSA test, -dipstick test
M spike in protein electrophoresis of blood and urine
CRAB
signs of multiple myeloma C- calcium (elevated) R- (renal failure/dysfunction) A- anemia B- bone lesions
how do you determine between osteoporosis, lytic mets or multiple myeloma?
history/clnical presentation
old films
if not helpful, do labs (CBC, ESR, C-RP, BCP, UA)
if the labs look like lytic mets, what happens next?
bone scan
MRI
biopsy
if the labs look like multiple myeloma, what happens next?
protein electrophoresis of blood and urine
skeletal survey
MRI of anything that looks weird or is painful
biopsy
are bone scans indicated with multiple myeloma?
no
what will you see in a patient that you suspect may have multple myeloma?
unexplained anemia
kidney dysfunction
high ESR
high serum protein (raised immunoglobulin)
serum free light chain assay
another test that can be useful in diagnosis and monitoring of patient’s response to treatment
serum protein electrophoresis (SPEP)
measures the amount of M-protein in serum
urine protein electrophoresis (UPEP)
measures the amount of M-protein in urine
immunofixation electrophoresis
measures the type of M-protein in serum and urine
MGUS
Monoclonal
Gammopathy fo
Undetermined
Significance
Dx criteria of MGUS
serum M protein <3g/dL
bone marrow plasma cells <10%
no CRAB
dx criteria
of smoldering multiple myeloma
serum M protein >3g/dL
bone marrow plasma cells >10%
no CRAB
dx criteria of multiple myeloma
serum M protein >3g/dL
bone marrow plasma cells >10%
CRAB
