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clin lab med exam 2 > urine > Flashcards

urine Flashcards

1
Q

what is turbidity of urine

A

“cloudiness” of urine

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2
Q

list the components of a urine dipstick

A
  • pH
  • specific gravity
  • glucose
  • keytones
  • protein
  • blood
  • nitrite
  • leukocyte esterase
  • biliruben
  • urobilinogen
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3
Q

urine pH has what relationship to serum pH

A

parallels

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4
Q

which value is described as acidic pH? alkaline pH?

A
  • acidic: 4.5-5.5
  • alkaline: 6.5-8
  • a pH out of these ranges is not possible; pH > 8 indicates overgrowth of urease producing bacteria
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5
Q

List some causes of alkaline urine

A
  • urea-splitting organisms
  • standing urine
  • fruit/vegetables
  • metabolic or respiratory alkalosis
  • meds
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6
Q

List some causes of acidic urine

A
  • large intake of meat
  • cranberries, plums, prunes
  • metabolic or respiratory acidosis
  • meds
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7
Q

urine will have what specific gravity compared to water

A
  • specific gravity of water = 1
  • urine will have higher specific gravity due to dissolves substances, primarily urea, sodium, and chloride
    • the more concentrated, the higher the specific gravity
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8
Q

with kidney disease, the ability to concentrate the urine may be lost and the specific gravity may become fixed at what value? why this value? what is this called?

A
  • 1.010
  • SG at the initial plasma filtrate at the glomerulus
  • isosthenuria
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9
Q

what is oliguria in terms of urine volume

A

< 500 cc/24 hrs

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10
Q

what is anuria in terms of urine volume

A

< 100 cc/ 24 hours

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11
Q

when plasma glucose is above what, the renal threshold is exceeded and patient will spill glucose into urine

A

150-180 mg/dl

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12
Q

false negatives of glucose urine dipstick can be caused by

A
  • ascorbic acid
  • aspirin
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13
Q

what are products of incomplete fat metabolism occurring when carbohydrate stores are diminished

A

keytones

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14
Q

presence of keytones in urine may indicate what

A
  • acidosis
    • DKA
    • rapid weight loss
    • fasting
    • starvation
    • pregnancy
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15
Q

Normal urinary protein excretion should be < 150 mg/24 hours .list the breakdown of what protein is excreted in the urine

A
  • 30% albumin
  • 30% globulins (iron/oxygen binding proteins)
  • 40% tamm-horsefall protein
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16
Q

how does specific gravity alter dipstick result of protein

A
  • high specific gravity: may show higher protein level
  • low specific gravity: may show lower protein level
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17
Q

urine dipstick may be falsely positive for protein if

A
  • high alkaline urine
  • high specific gravity
  • pyridium present
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18
Q

moderately increased albumin in urine is a prognostic indicator for kidney disease in what conditions?

A
  • Diabetes
  • HTN
  • cardiovascular disease
  • post-streptococcal glomerular nephritis
  • ** this test refers to urinary excretion of albumin that is below the detection capability of urine dipstick but above upper limit of normal for healthy individuals
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19
Q

what tests are done to assess for moderately increased albumin

A
  • 24 hour urine collection
  • urinary albumin/creatinine ratio (most practical)
    • normal: < 30 mg albumin/gram urinary creatinine
    • microalbuminuria: 30-300 mg/g creatinine
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20
Q

dipstick detects presence of RBCs or hemoglobin from RBCs

A

lysed

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21
Q

urine dipstick can have fast negative for blood due to

A

ascorbic acid

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22
Q

urine nitriate test detects

A
  • bacteria that are capable of reducing nitrates to nitrite
  • 50% sensitive in Dx UTI
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23
Q

urine dipstick can have false negatives for nitrite due to

A
  • urine in bladder for < 4 hours
  • patient’s diet is deficient in nitrates
  • bacteria which do have necessary enzymes
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24
Q

urine dipstick can have false positives for leukocyte esterase from

A
  • vaginal contamination
  • trichomonads
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25
Q

function of leukocyte esterase

A
  • detects leukocytes in urine, can detect lysed WBCs
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26
Q

what is biliruben

A
  • product of RBC breakdown carried to liver in unconjugated form (indirect)
  • conjugated in the liver (direct)
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27
Q

route of biliruben once it is conjugated

A
  • excreted from liver via bile duct
  • goes into small intestine and is converted by bacterial flora to urobilinogen
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28
Q

biliruben and urobilinogen are both normally excreted where

A
  • stool
  • thus dipstick is normally negative for both of these
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29
Q

urine turns what color in the presence of biliruben

A

brown

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30
Q

biliary obstruction can cause which to appear in urine: bilirubin or urobilinogen

A

bilirubin

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31
Q

hemolytic disease can cause which to appear in urine: bilirubin or urobilinogen

A

urobilinogen

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32
Q

microscopic UA is done to view the urinary

A

sediment

33
Q

WBC and RBC are reported as the number per

A

high power field

34
Q

casts are reported as the number per

A

low power field

35
Q

what type of cell in urine appears as refractile disks with hypertonicity of the urine, and have a “crenated” shrunken appearance

A

RBC

36
Q

what number of RBCs in the urine is abnormal

A

> 3

37
Q

causes of hematuria by in age 0-20 yo

A
  1. glomerulonephritis
  2. UTI
  3. congenital anomaly
38
Q

causes of hematuria by in age 20-40

A
  • UTI
  • calculi
  • bladder CA
39
Q

causes of hematuria by in age 40-60

A
  • UTI
  • bladder CA
  • calculi
40
Q

causes of hematuria by in age > 60 in males

A
  • BPH
  • bladder, prostate, or kidney CA
  • UTI
41
Q

causes of hematuria by in age > 60 in females

A
  • UTI
  • bladder or kidney CA
42
Q

centrifuge shows sediment red urine, then red or brown urine is caused by

A

hematuria

43
Q

centrifuge shows supernatant red urine, then red or brown urine is caused by

A
  • unknown, do dipstick heme
    • if negative:
      • beets, phenazopyridine
    • if positive
      • myoglobin
      • hemoglobin
44
Q

how can you differentiate between myoglobin and hemoglobin as cause of red, brown urine

A
  • plasma color (centrifuge a blood sample)
    • clear: myoglobinuria
    • red: hemoglobinuria => hemolysis
45
Q

what cells in urine have lobed nuclei and refractile cytoplasmic granules

A

WBCs

46
Q

what value of WBC in urine is suspicious for UTI

A

10-20 WBCs/HPF

  • >20WBC usually indicates UTI
47
Q

bacteria is reported as what in urine microscopy

A

0-4+

48
Q

what can happen to bacteria count if urine collection stands out for a period of time without being refrigerated

A

more bacteria will grow

49
Q

what are oval fat bodies

A
  • degenerated tubular cells containing abundant lipid
  • indicative of glomerular disease
50
Q

what exhibit “maltese cross” configuration by polarized light microscopy

A

oval fat bodies

51
Q

squamous epithelial cells in urine indicate

A
  • contaminated specimen
    • skin or external urethral origin
52
Q

where are urine casts formed

A

only in the distal convoluted tubule

53
Q

what are hyaline casts. what are they indicative of

A
  • pale and slightly refractile, are common findings in normal urine
  • composed of tamm-horsfall protein secreted by tubule cells
54
Q

RBC casts are indicative of

A

glomerulonephritis or vasculitis

55
Q

WBC casts are indicative of

A

acute pyelonephritis

56
Q

renal tubular cell casts are indicative of

A

injury to the tubular epithelium

57
Q

what are granular/waxy casts

A

broken down tubule cast

58
Q

uric acid crystals in urine are seen with

A
  • acidic urine
  • secondary to hyperuricemia
59
Q

cystine crystals in urine are seen with

A
  • cystinuria
  • rare genetic cause of kidney stones
60
Q

struvite crystals in urine are seen with

A
  • alkaline urine
  • secondary to infection by urease-producing bacteria
61
Q

calcium oxylate crystals in urine are seen with

A
  • independent of pH
  • cause kidney stones
  • monohydrate/dihydrate
62
Q

what is the most reliable method for determining if infection exists

A

urine culture

  • >100,000 coloinies is consistent with infection
63
Q

elevated potassium may be caused by what 4 things

A
  1. false elevation
  2. inadequate excretion by kidneys
  3. redistribution from ICF to ECF
  4. excess administrations
64
Q

what is pseudohyperkalemia

A
  • artificatually high K+ due to
    • hemolysis due to poor venipuncture tenchinque
    • should recheck K+ value
65
Q

what are some causes of inadequate excretion of K+

A
  1. renal failure
  2. medications that inhibit K+ excretion
    1. aldosterone antagonists
    2. K+ sparing diuretics
    3. ACE-I/ARB
  3. hypoaldosteronism
    1. adrenal insufficiency
    2. congenital adrenal hyperplasia
    3. NSAIDs
66
Q

what are some causes of redistribution of K+

A
  1. tissue damage
  2. acidosis (decrease in H+ raises serum K+)
  3. decreased insulin
67
Q

what are the clinical features of hyperkalemia

A
  • generally occur > 7
  • A FACT
  • Arrhythmias
  • Flaccid paralysis
  • Ascending muscle weakness
  • Conduction abnormalities
  • T waves (peaked)
68
Q

treatment options for rapid correction of hyperkalemia

A
  • IV calcium chloride
  • maneuvers to shift K+ from ECF to ICF
    • sodium bicarb
    • D50W + insulin IV
69
Q

treatment options for slow correction of hyperkalemia

A
  • loop or thiazide diuretics
  • hemodialysis
70
Q

causes of hypokalemia

A
  1. inadequate intake
  2. GI tract loss
  3. renal loss
  4. redistribution from ECF to ICF
71
Q

causes of inadequate K+ intake

A
  • meds that promote K+ los
    • thiazide, loop diuretics
72
Q

what form of GI loss causes hypokalemia

A
  • upper GI
    • vomiting, NG suction
    • causes metabolic alkalosis which promotes renal potassium loss
73
Q

causes of hypokalemia due to renal loss

A
  • diuretics
  • bicarb excretion
  • mineralocorticoid excess
    • hyperaldosteronism
    • cushings syndrome
74
Q

causes of hypokalemia due to redistribution from ECF to ICF

A
  • metabolic alkalosis
  • insulin administration
  • B-adrenergic agonists (albuterol) induce cellular uptake of K+ and promote insulin secretion
  • hypokalemic periodic paralysis
75
Q

clinical features of hypokalemia

A
  • YOU CRAMP
  • hYpOkalemia U waves
  • Cramping
  • Respiratory failure, Rhabdomyolysis
  • Anorexia, N/V
  • Muscle weakness
  • Paralysis
76
Q

if potassium is low, what lab value should be checked

A
  • magnesium
  • hypomagnesemia will cause potassium excretion
77
Q

urine potassium < 20 meq/d suggests

A
  • extrarenal/redistribution
78
Q

urine potassium > 20 meq/d suggests

A

renal losses

79
Q

rapid correction of hypokalemia

A
  • cardiac monitor
  • IV potassium chloride
  • check K+ every 2-4 hours

clin lab med exam 2 (5 decks)

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