Urine 3 Flashcards
what is the normal amount of glucose that should be in the urine?
none
how do you test for glucose in the urine?
dipstick test
what is the confirmstion test for any reducing sugar glucose, fructose or galatose?
clinitest
what happens if the dipstick test is positive for sugar in the urine?
get a fasting blood sugar and correlate to history (family history, over weight, >40 yo, polyuria, polydipsia, etc)
describe what happens to sugar in the kidneys
it is filtered by glomeruli and reabsorbed in proximal tubules
what is renal thereshold value?
AKA blood threshold value
140-180mg/dL
diabetics could have a higher than normal value
how much glucose the kidney can handle before spilling over into the urine
when might you see glucosuria?
diabetes
after eating high carb meal
kidney disease affecting renal rubules
describe renal glycosuria
glucose in urine because of kidney disease affecting the renal tubules
may lower RTV
RTV
renal threshold value
hyperglycemia and glucosuria are due to?
diabetes mellitus endocrine disorders (acromegaly) pancreatic problems (tumor, pancreatitis) adrenal disorders (Cushings) hyperthyroidism pregnancy stress CNS disorders tumor, hemorrhage stroke disturbances of metabolism (burns, infections, MI, obesity) liver disease exercise certain drugs
when do we see ketones? what are ketones?
when there is a lack of available sugar getting to cells due to lack of insulin
ketones are a byproduct of fat metabolism
how are ketones reported?
negative, trace, small moderate or large amounts (1+,2+,3+,4+)
what is considered normal ketones?
negative
what do ketones include?
acetone
beta hydroxybutric acid
acetoacetic acid
what are ketones in the urine associated with?
poorly controlled diabetes mellitus
may warn of an impending diabetic coma
diabetes mellitus positive labs?
ketones and sugars in urine
possible fruity odor in urine
how could one with diabetes mellitus have ketones in urine?
fasting, starvation
low carb, high protein diet
dehydration
high levels of ketones indicate?
body is using fat as major source of energy
what other ways can a patient have ketones in the urine?
electrolyte imbalance
alcoholism
babies and children with fever
in nondiabetic patients, ketonuria indicates?
reduced carb metabolism and excessive fat metabolism
what is the normal level of bilirubin in the urine?
negative
most bilirubin is formed in? Why?
reticuloendothelial system (spleen, liver, marrow) as a breakdown product of RBC hemoglobin released from senescent RBCs
indirect/unconjugated bilirubine
prehepatic
broken down RBC hemoglobin released from senescent (biological aged) RBCs
what can unconjugated bilirubin not do?
pass glomerular filter because it isn’t water soluble
describe what the reticuloendothelial system does
releases bilirubin into blood stream
binds with albumin to transport it to the liver
it is then conjugated with glucuronic acid to become direct/conjugated bilirubin (water soluble)
what does the liver do with the direct/conjugated bilirubin?
excretes it into the bile that goes to the small intestine
how does bilirubin become urobilinogen?
when bacteria acts upon it
what happens to urobilinogen?
reduced to stercobilinogen (color to feces)
what does conjugated bilirubin in the urine indicate?
obstruction to flow of bile from the liver
gallstones, tumor, pancreatic cancer, liver inflammation/infection
what are the signs of bilirubin in the urine?
urine is dark and may have yellow foam (if shaken)
jaundice
pale colored feces
bilirubinuria is associataed with?
elevated serum conjugated bilirubin which is an indicator of liver dysfunction or biliary obstruction
abnormal bilirubin values may indicate?
pre-hepatic problems
hepatic problems
post hepatic problems
pre-hepatic problems
unconjugated bilirubin doesn’t appear in urine
anemia
excessive breakdown of RBC
hepatic (liver disease) problems
hepatitis
cirrhosis
obstruction of biliary duct
toxic liver damage
post-hepatic problems
biliary tree obstruction
a positive test for urine bilirubin confirms that any raised plasma levels are from?
conjugated hyperbilirubinemia
urobilinogen formation
lysed RBC free hemoglobin indirect unconjugated bilirubin liver direct conjugated bilirubin intestines with bile and acted on bacteria becomes urobilinogen and stercobilinogen kidney urobilinogen
what are normal levels of urobilinogen in the urine?
0.1-1.0mg/dL
what is urobilinogen?
by-product of hemoglobin metabolism with bilirubin breakdown in the intestine
what does abnormal urobilinogen test indicate?
liver problems
what kind of bilirubin is prehepatic
unconjugated
what does conjugated/direct bilirubin do?
combines with bile in the GI tract acted on by bacteria in the colon to become urobilinogen and stercobilinogen
where does stercobilinogen go?
goes to give feces color
some is released back into circulation and re-extreted in the bile
some is absorbed by the kidneys and passed out in urine
urobilinogen in the urine indicates?
liver disease
hemolytic condtions
why does urobilinogen get put into te urine with liver disease?
urobilinogen is not re-excreted in the bile, therefore there are increased levels in the urine
why does urobilinogen get put into the urine with hemolytic disorders?
the amount of unconjugated bilirubin that is present in the blood increases, causing an increase in hepatic extretion of conjugated bilirubin, resulting in increased amounts of urobilinogen that in turn causes an increase in reabsorption, recirculation and renal extretion
increased urobilinogen in the urine indicates?
overburdening of liver excessive RBC breakdown increased urobilinogen production re-absorption (large hematoma) restricted liver function hepatic infection poisoning liver cirrhosis
decreased values after urobilinogen indicates?
failure of bile production
obstruction of bile passage
urobilinogen and bilirubin levels in the urine are where in normal people?
urobilinogen <1unit
bilirubin none
urobilinogen and bilirubin levels in the urine are where in liver/biliary disease
urobilinogen increased
bilirubin positive
urobilinogen and bilirubin levels in the urine are where in biliary tract obstruction
urobilinogen low (partial obstruction)/absent (complete obstruction) bilirubin positve
urobilinogen and bilirubin levels in the urine are where in prehepatic disease/hemolytic anemia
urobilinogen increase
bilirubin negative/normal
signs of liver/biliary tract disease
dark yellow/brown/green colored urine \+ bilirubin \+ urobilinogen discomfort, mid back pain jaundice of skin and sclera increased liver enzymes grey/white stools usually caused by gallstone
what should you do with someon you suspect has gallstones, but doesn’t have symptoms?
expectant management
wait and see until they start having symptoms
what should you do with someone who has gallstones and has symptoms?
if they are a good surgical candidate, they will get a cholecystectomy
if they aren’t, then they will get nonsurgical therapy
normal blood in urine?
no blood in urine
what would make you suspect blood in the urine?
smoky colored urine
cloudy urine
if there is blood in the urine, what could it possibly be?
hematuria, hemoglobinuria, myoglobinuria
hemoglobinuria, myoglobinuria
+OB (red urine)
normal RBC
+OB, yellow urine
micromyoglobulinuria
microhematuria
microhemoglobinuria
blood in urine could indicate?
kidney and bladder calculi
damage to kidney or urinary tract
hemoglobinuria indicates?
breakdown of RBCs
myoglobinuria indicates?
MI
muscle damage
hematuria
urine is light red yellow to fairly dark red, smoky
blood or RBCs in urine
may be an early indicator of renal disease
hematuria may be due to?
malignancy, infection, stones, menses, trauama, exercise
inkids, 1/3 of hematuria is idiopathic
elevated RBCs, +OB
hematuria
