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Visceral Disorders > Urine > Flashcards

Urine Flashcards

1
Q

What type of lab should you make sure you use in practice?

A

CLIA approved lab

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2
Q

What does CLIA stand for?

A

Clinical laboratory improvement amendments

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3
Q

How do chiropractors use lab tests?

A
  1. Establish baseline data
  2. Screening
  3. Determine diagnosis or prognosis
  4. Monitor progress
  5. Make decision regarding second opinion
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4
Q

What are the signs and symptoms to order a UA?

A
  1. Low back pain
  2. Painful urination
  3. Hematuria
  4. Suprapubic pain
  5. Urethral or vaginal discharge
  6. Frequent urination
  7. Inability to urinate
  8. Polydipsia
  9. Polyphagia
  10. Physical and wellness screening
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5
Q

What percent of cardiac output per fuse threw the kidneys every minute?

A

25%

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6
Q

What do kidneys play a role in regarding balance in the body?

A
  1. Water balance
  2. Acid-base balance
  3. Electrolyte balance
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7
Q

What hormones/enzymes do the kidneys play a role in the production of?

A
  1. Erythropoietin

2. Renin

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8
Q

What is the purpose of erythropoietin?

A

Stimulate RBC production

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9
Q

What is the purpose of renin?

A

Controlling blood pressure

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10
Q

What three parts does a routine UA consist of?

A
  1. Physical properties
  2. Chemical properties
  3. Microscopic properties
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11
Q

What is the functional unit of the kidney?

A

Nephron

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12
Q

What is the oldest clinical lab procedure?

A

UA

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13
Q

What are some of the old names for people who examined urine?

A

Urine gazers
Pisse-prophets
Urinomancers

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14
Q

At what point does the glomerular filtrate become urine?

A

After it leaves the distal convoluted tubule

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15
Q

What are the principle solutes of urine?

A

Urea, sodium, chloride, potassium, creatinine, uric acid, ammonia

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16
Q

How much does the body excrete daily?

A

60 grams of dissolved material/24 hours

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17
Q

What percent of the amount excreted daily is urea?

A

One half

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18
Q

What percent of urine is water?

A

95%

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19
Q

What percent of urine is dissolved solids?

A

5%

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20
Q

What is polyuria?

A

Excessive urine output - >2000 ml/24 hours

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21
Q

What is oliguria?

A

Below normal urine output - <500ml/25 hours

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22
Q

What are some of the causes of oliguria?

A

Renal tubule dysfunction, end stage renal disease, obstruction, edema, dehydration, diarrhea, vomiting, shock

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23
Q

What is anuria?

A

Absence of urine

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24
Q

What are some of the causes of anuria?

A

Renal failure, obstruction, heart attack

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25
Q

What is polydipsia?

A

Excessive water intake

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26
Q

What is the best practice for collecting a urine specimen?

A

Early morning, midstream clean catch

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27
Q

When is the urine most concentrated?

A

Morning

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28
Q

Why is the morning the best time for a urine specimen?

A

Most concentrated

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29
Q

How soon after a urine sample is given does decomposition begin?

A

Within 30 minutes at room temperature or 4 hours if refrigerated

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30
Q

What is the most common and convenient sample?

A

Random sample

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31
Q

How soon after collection should testing begin?

A

Immediately or within 2 hours if at room temperature

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32
Q

How long is the sample good for testing with a preservative?

A

24 hours

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33
Q

What changes occur in unpreserved urine over time?

A

Color becomes darker, turbidity increases, odor is more foul smelling, pH increases, glucose, ketones, bilirubin and urobilinogen decrease, nitrites and bacteria increase, RBCs lyse, WBCs and casts disintegrate.

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34
Q

What does color roughly indicate in urine?

A

Degree of hydration and concentration

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35
Q

What color range is considered normal in urine?

A

Straw to amber or light yellow to dark yellow

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36
Q

What is red, dark brown urine found with?

A

Excessive hemoglobin, RBC, myoglobin

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37
Q

What is red or dark brown urine associated with?

A

Menses, UTI, malignancy, prostate, etc.

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38
Q

What is the smoky urine associated with?

A

Blood, hemoglobin, myoglobin

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39
Q

What in a diet can affect urine?

A

Beets, drugs, rhubarb, Vit C, carrots

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40
Q

What conditions are found with orange colored urine?

A

Dehydration from fever, vomiting, certain foods (rhubarb, Vit C, carrots), medications.

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41
Q

What conditions are found with bright yellow urine?

A

Excessive B vitamins

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42
Q

What conditions are found with black urine?

A

Alkaptonuria and melanin problems like malignant melanoma.

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43
Q

What conditions are found with colorless urine?

A

Diabetes insipidus associated with decrease pituitary ADH, over hydration associated with low SpG.

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44
Q

What conditions are brownish yellow/green urine found with?

A

Liver problems, check bilirubin and urobilinogen

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45
Q

What other signs/symptoms can possibly be seen with liver problems?

A

Jaundice of skin and sclera

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46
Q

What conditions are associated with milky urine?

A

Hyperlipidemia

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47
Q

What is normal turbidity?

A

Clear

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48
Q

What if the urine is slightly hazy? What should be done?

A

Usually normal but check sediment

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49
Q

What is cloudy urine associated with?

A

Crystals usually insignificant but could be pus, bacteria, RBCs, spermatozoa

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50
Q

What issue could be associated with hazy/cloudy urine

A

Infection

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51
Q

What issue is associated with white frothy urine?

A

Proteins

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52
Q

What issue is associated with yellow frothy urine?

A

Bilirubin/bile

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53
Q

What would the lab need to do if the urine is hazy/cloudy/frothy?

A

Look at the urinary sediment

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54
Q

What does the specific gravity measure?

A

Ability of the kidneys to concentrate the urine

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55
Q

What is the inability to concentrate urine an early sign of?

A

Renal disease

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56
Q

What is the normal range for specific gravity?

A

1.015 - 1.035

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57
Q

What is hyposthenuria?

A

Low specific gravity

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58
Q

What is hypersthenuria?

A

High specific gravity

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59
Q

What is isoshenuria?

A

1.010 SpG - same as protein free plasma and signifies the end of renal failure

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60
Q

What is increased specific gravity an indicator of?

A

Concentrated urine, dehydration, decreased renal blood flow (heart failure, renal artery stenosis)

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61
Q

What is decrease specific gravity an indicator of?

A

dilute urine, decreased concentration, over hydration, glomerulonephritis, pyelonephritis, diabetes insipidus, renal failure

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62
Q

What is consider an abnormal urine smell?

A

Foul, fishy, fruity, sweet, feces

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63
Q

What is a foul/fishy odor an indicator of?

A

UTI

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64
Q

What is a fruity/sweet odor an indicator of?

A

Diabetes mellitus/ketosis

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65
Q

What is feces odor an indicator of?

A

Asparagus, enterobladder fistula

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66
Q

What is the pH an indicator of?

A

Renal or lung disease

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67
Q

What is consider normal range for pH for urine?

A

4.5 - 7.5

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68
Q

What is considered acidic urine?

A

pH <7

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69
Q

What is considered neutral urine?

A

pH 7

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70
Q

What is considered alkaline urine?

A

pH > 7

71
Q

What happens to urine’s pH as it stands?

A

Becomes more alkaline as it stands due to bacterial growth and breakdown of urea

72
Q

If a diet is high in animal protein, is the urine more acidic or alkaline?

A

Acidic

73
Q

If a diet is high in citrus fruits and vegetables, is the urine more acidic or alkaline?

A

Alkaline

74
Q

What is acidic pH an indicator of physiologically?

A

Emphysema, metabolic acidosis, diabetes mellitus, large amounts of cranberries and meats in diets.

75
Q

What is alkaline pH an indicator physiologically?

A

Hyperventilation, metabolic alkaline, UTI, large amounts of vegetables and citrus fruits in diet.

76
Q

What term is used synonymously with proteinuria?

A

Albuminuria

77
Q

How is protein/albumin reported as in urine?

A

Negative, trace, 1+, 2+ 3+, 4+

78
Q

What is normal of proteins in the urine?

A

Negative

79
Q

What normally prevents protein from entering the urine?

A

Glomerulus

80
Q

What is proteinuria a primary indicator of?

A

Renal disease

81
Q

If the screen test is found to be positive with protein, what is the test to confirm this?

A

SSA

82
Q

What does proteinuria because of kidney disease usually indicate?

A

Upper UTI

83
Q

What are some reasons there may be protein in the urine?

A

Diabetes, glomerulonephritis, nephrotic syndrome, preeclampsia, trauma, strenuous exercise, exposure to cold, dehydration, febrile illness, large abdomen, pregnancy increase abdominal pressure

84
Q

What is orthostatic proteinuria?

A

Patient displays normal urine when supine and displays proteinuria when standing

85
Q

How should one handle a patient presenting with orthostatic proteinuria?

A

Have the patient lie down for one hour and recheck urine

86
Q

What population is orthostatic proteinuria more commonly seen in?

A

Adolescents

87
Q

What is orthostatic proteinuria often associated with?

A

Exaggerated lumbar lordosis, renal congestion

88
Q

What is preeclampsia?

A

Toxemia associated with pregnancy especially 3rd trimester

89
Q

What signs/symptoms are associated with preeclampsia?

A

Proteinuria and increased blood pressure, if severe with headache, visual changes, liver enlargement, severe proteinuria, intrauterine growth retardation, convulsions, coma, etc.

90
Q

What pathologies are associated with proteinuria?

A

Heart conditions, CNS lesions, blood disorders, drug therapy, systemic disorders (diabetes), collagen disease (SLE, scleroderma), septicemia

91
Q

What is commonly associated with massive proteinuria?

A

Nephrotic syndrome

92
Q

What rating does nephrotic syndrome show up as?

A

4+ proteins

93
Q

What appearance does urine with nephrotic syndrome have?

A

Frothy white

94
Q

What signs/symptoms would someone with nephrotic syndrome have?

A

severe edema, especially around the eyes

95
Q

What test should be run on all patients with 4+ proteins?

A

Bence Jones test

96
Q

What does the Bence Jones test test for?

A

Multiple myeloma

97
Q

What would you suspect if a patient had back pain, lytic changes, punched out lesions of the skull, rain drop skull, and pathological fractures?

A

Multiple myeloma

98
Q

What is multiple myeloma?

A

Malignant proliferation of plasma cells

99
Q

What is the most common malignancy of bone?

A

Mets

100
Q

What is the most common primary malignancy of bone?

A

Multiple myeloma

101
Q

What is the most common pediatric malignancy of bone?

A

Osteosarcoma

102
Q

What test is used to look for Bence Jones proteins?

A

Urine protein electrophoresis

103
Q

What are some signs/symptoms of Multiple Myeloma?

A

nausea, confusion, polyuria, hypercalcemia, renal insufficiency, fatigue, anemia, bone lysis, pathological fractures, thrombocytopenia, immune deficiency, dizzy, blurred vision, hyper viscosity

104
Q

What population is multiple myeloma more commonly found in?

A

Older adults

105
Q

If multiple myeloma is suspected and the dipstick is negative for Bence Jones proteins, what confirmatory test should be done?

A

Protein electrophoresis

106
Q

What does CRAB stand from in relation to multiple myeloma?

A 
C = calcium (elevated)
R = renal failure
A = anemia
B = bone lesions
107
Q

What is the labs pathway for lytic mets?

A

X-ray –> Bone Scan –> MRI –> Biopsy

108
Q

What is the labs pathway for multiple myeloma?

A

X-ray –> PEP –> Skeletal Survey (x-ray all axial skeleton) –> MRI –> Biopsy

109
Q

IS a bone scan useful in multiple myeloma?

A

No, it is not indicated for patients with multiple myeloma as it is purely lytic

110
Q

What are the different classifications of possible to definite multiple myeloma?

A

MGUS (could turn to MM)
Smoldering MM
MM

111
Q

What is the normal level for glucose in urine?

A

Negative

112
Q

What is the confirmation test for glucose in the urine?

A

Clinitest

113
Q

What is the renal threshold value for glucose in the urine?

A

140-180 mg/dl

114
Q

What are hyperglycemia and glucosuria commonly due to?

A

Diabetes mellitus, endocrine disorders (acromegaly), pancreatic problems (tumor, pancreatitis), adrenal disorders (Cushing’s), hyperthyroidism, pregnancy, stress, CNS disorders, tumor hemorrhage, stroke, obesity, liver disease, exercise, certain drugs

115
Q

What are ketones a result of?

A

Lack of available sugar getting to the cells due to lack of insulin

116
Q

What is a byproduct of fat metabolism?

A

Ketones

117
Q

How are ketones reported?

A

Negative, trace, small, moderate, large (1+, 2+, 3+, 4+)

118
Q

What is the normal level of ketones in urine?

A

Negative

119
Q

What are the different ketones?

A

acetone, betahydroxybutric acid, acetoacetic acid

120
Q

What are ketones in the urine usually due associated with?

A

Poorly controlled diabetes mellitus and may warn of impending diabetic coma

121
Q

Under what conditions would you possibly see ketones in urine?

A

Diabetes mellitus, fasting/starvation, low carb/high protein diet, dehydration, electrolyte imbalance, alcoholism, babies and kids with fever

122
Q

What level of bilirubin in urine is normal?

A

Negative

123
Q

Where is most bilirubin formed in?

A

Recticuloendothelial system (spleen, liver, marrow)

124
Q

Which type of bilirubin cannot pass the glomerular filter (not water soluble)?

A

Unconjugated

125
Q

When bilirubin is acted on by bacteria it becomes what?

A

Urobilinogen

126
Q

What gives feces its brown color?

A

Stercobilinogen

127
Q

What does conjugated bilirubin in urine indicate?

A

Obstruction of bile from liver (gall stones, tumor, liver inflammation) or liver dysfunction

128
Q

What is the appearance of urine that contains bilirubin?

A

Dark yellow, yellow foam

129
Q

What color are feces if there is a biliary obstruction?

A

Pale

130
Q

What is the normal range for urobilinogen?

A

0.1 - 1.0 mg/dl

131
Q

What do abnormal urobilinogen suggest?

A

liver problems

132
Q

What type of bilirubin is prehepatic?

A

Unconjugated

133
Q

What is the main cause of biliary obstruction?

A

Gallstones

134
Q

What is expectant management regarding gallstones?

A

“Wait and see” since the patient has no symptoms, the risks of surgical and non surgical treatments outweigh the benefits.

135
Q

What is the normal level of occult blood in urine?

A

Negative

136
Q

What may be the cause of hematuria?

A

Kidney or bladder calculi, damage to kidney or urinary tract, malignancy, menses, trauma, exercise

137
Q

What may be the cause of hemoglobinuria?

A

Breakdown of RBCs

138
Q

What may be the cause of myoglobinuria?

A

Myocardial infarct or muscle damage

139
Q

What are some external causes of hemolysis?

A

Drugs, crushing injuries, transfusion reactions, burns

140
Q

What are some internal causes of hemolysis?

A

Hemolytic anemia

141
Q

What is yellow colored urine with increased RBC?

A

Microhematuria

142
Q

What is yellow colored urine with normal RBC?

A

Microhemoglobinuria or micromyoglobinuria

143
Q

What is red, pink, smoky colored urine with increased RBC?

A

Hematuria

144
Q

What is red, pink, smoky colored urine with normal RBC?

A

Hemoglobinuria or myoglobinuria

145
Q

What does leukocyte esterase test for?

A

WBCs in urine

146
Q

What does positive leukocyte esterase indicate?

A

UTI

147
Q

What is the normal level for nitrites in urine?

A

Negative

148
Q

What do positive nitrites in urine indicate?

A

Bacteria, screening for UTI

149
Q

What is the normal for RBCs in urine?

A

0-3

150
Q

What is the normal for WBCs in urine?

A

0-3

151
Q

What does increase WBCs imply?

A

Infection

152
Q

How are levels of urinary sediment/crystals reported as?

A

Few, moderate, or many

153
Q

What appearance do crystals/sediment give to the urine?

A

Sandy, cloudy

154
Q

What do crystals in the urine indicate a possibility of?

A

Stone formation

155
Q

What population is more likely to develop renal calculi?

A

Males, 23-30 years old

156
Q

What element do most renal calculi contain?

A

Calcium

157
Q

What are the reported levels of epithelial cells?

A

Rare, occasional, few, moderate, many or 1+, 2+, 3+, etc.

158
Q

What type of cells should you assume are the type unless reported differently?

A

Squamous cells

159
Q

What part of the urinary tract are squamous cells found in?

A

Lower half of bladder and urethra

160
Q

What type of epithelial cells are found in the upper half of the bladder?

A

Transitional

161
Q

What would epithelial cells with no other findings indicate?

A

contamination particularly vaginal

162
Q

What does renal cell epithelium imply if found in urine?

A

Kidney disease

163
Q

What is the normal for urinary sediment/mucous?

A

Negative

164
Q

How is mucous reported as?

A

Scant, moderate, heavy, few, frequent, many

165
Q

What is mucous usually associated with?

A

Infection

166
Q

What anatomy do casts give a picture of?

A

Nephron

167
Q

What is a cast?

A

congealed protein that acts as a mold of its origin, kidney specific protein

168
Q

What do casts indicate?

A

Upper UTI

169
Q

What type of casts can normally found?

A

granular and hyaline, 0-2/LPF, with no other findings

170
Q

What is an indicator of glomerulonephritis?

A

RBC casts

171
Q

If a patient has RBC casts in urine and recently had a sore throat, what would likely be the cause and the diagnosis?

A

Strep throat and glomerulonephritis

172
Q

What would be an indicator of pyelonephritis?

A

WBC casts

173
Q

What type of infection is pyelonephritis or glomerulonephritis?

A

Upper UTI

174
Q

What type of infection is cystitis and urethritis?

A

Lower UTI

Visceral Disorders (1 decks)

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