Urine 4 Flashcards
hemoglobinuria
represents free hemoglobin in the urine
anything that increases RBC descrutction increases free hemoglobin
extravascular causes of hemolysis
drugs
crushing injuries
transfusion reactions
burns
intravascular causes of hemolysis
hemolytic anemia
myoglobinuria
represents free myoglobin in the urine
results from muscle trauma/destruction typically due to crushing injuries or MI
OCCULT BLOOD WITHOUT ELEVATED rbcS
microhematuria
increased RBCs although there is no urine color change
occult blood in urine could be due to?
UTI menses kidney stones appendicitis diverticulitis bladder stones rectal cancer that invades bladder
yellow urine and increased RBC
microhematuria
yellow urine and normal RBC
microhemaglobinuria
micromyoglobinuria
red/pink/smoky urine and increased RBC
hematuria
red/pink/smoky urine and normal RBCs
hemoglobinuria
myoglobinuria
leukocyte esterase
a screening test to detect WBCs in urine
a positive leukocyte esterase test indicates?
UTI
> __WBCs/HPF is 50% positive for UTI
> 5
> __WBCs/HPF is 90% positive for UTI
> 10
nitrites
normal is negative
testing for UTI
if there are nitrites in the urine, what does that mean?
bacteria in the urine (gram-)
usually due to ecoli, normal flora in GI
how should we not interpret negative nitrites?
abscence of bacteruria
the sample could have had not enough time to convert nitrates to nitrites in bladder
what are some infections that do not convert nitrate into nitrite?
staph and strep
urinary sediment
microscopic exam of urine
based on lab protocols, physcian request or abnormal findings
what is the best specimen for urinary sediment?
first morning urine
describe how urinary sediment works?
urine is centrifuged for 5 minutes and supernatant is discarded
sediment is resuspended and placed on slide
10 fields are examined and average number is reported
subjectivity is reduced by test standardization
WBCs normal for urinary sediment
0-3 WBCs/HPF
RBCs normal for urinary sediment
0-3 RBCs/HPF
TNTC
too numerous to count
RBCs in microscopic urinalysis is increased in?
GMN, PN, stones, tumor, infarction, trauma, lower UTI, extrarenal disease such as appendicitis, drug reactions, exercise, menses, etc
WBCs in microscopic urinarysis increased in?
renal and urinary tract diseases
(PN, cystitis, urethritis, UTI)
transient after exercise and with fevers
increase in number of WBCs suggest?
infection
how do we usually report urinary crystals/sediment
few, moderate or many
are crystals normally found in urine?
no, but if it sits long enough, then it could form
what do crystals in the urine indicate?
stone formation
characteristics of urine with crystals?
sandy/cloudy urine
acid crystals, alkaline crystals, amino acid crystals
alkaline crystals
amorphous phosphates
calcium carbonate
triple phosphate
acid crystals
calcium oxalate, uric acis
demographics for kidney stones
men
20-30 years
familial and hereditary tendiencies as well as dietary
inborn errors of metabolism (gout)
most kidney stones are mixed with?
phosphate
what are some ways to get kidney stones
supersaturation
decreased urine volume
pH factors
foreing body seed (crystals, bacteria, debris, clot, etc)
when do we usually discover kidney stones?
when they obstruct, cause an ulceration or you have hematuria
smaller stones may pass into ureters and produce colicky pain
where is the pain for a kidney stone?
kidney region and radiates into abdomen, genetalia and legs
symptoms of kidney stones
nausea, vomiting, sweating, frequent urge to urinate, pain
how to help with kidney stones
increase fluid intake to dilute urine
modify diet
manipulate pH of urine
cystoscopy, lithotripsy, surgery
what characteristics do crystals have in a urinary sediment
uric acid crystals seen in patient’s with high serum uric acid levels
phosphate crystals w/ parathyroid problems and malabsorption states
who has high serum uric acid levels?
people with gout
which amino acids indicated severe liver disease if they are in the UA
tyrosine
leucine
cysteine
how are epithelial cells reported?
rare occasional few moderate many \+1, +2, etc
why might someone have epithelial cells in their urine?
sloughing due to irritation
what kind of epithelial cells do we see in a UA?
squamous (assume this one if not specified)
transitional
renal epithelial
where is squamous epithelium found?
lower 1/2 of bladder and urethra
where is transitional epithelium found?
upper 1/2 of bladder and ureters
what does renal cell epithelium in a UA imply?
kidney disease
when might you assume someone have you a contaminated sample of urine?
if you have bacteria and epithelial cells with no other bacterial findings
yellow urine, slightly hazy, 7.2 pH, neg protein, 0.8 urobilinogen, neg occult blood, 2 RBC, 2 WBC, +bacterial, few epithelial cells
contamination
yellow urine, slightly hazy, 7.2 pH, neg protein, 0.8 urobilinogen, neg occult blood, 2 RBC, 20 WBC, +bacterial, few epithelial cells
infection
what are some symptoms of a UTI?
LBP, dysuria
a normal amount of mucous in the urine is?
negative
how is mucous reported?
scant moderate heavy few frequent many
significant mucous is usually associated with?
infection
