Urine Analysis Flashcards
What is urine and describe the path it takes to be excreted
Waste products ( urea, ammonia , creatinine, etc electrolytes) which are filtered out of the blood by the kidneys. The urine then travels through the ureter and is stored in the bladder to be then excreted via the urethra.
What is a urine dipstick
A strip which is dipped into a urine sample( all squares need to be submerged) and then laid flat for 30-60 seconds. The reagents on the dipstick can react with substances from the urine to cause colour changes
What does dark urine indicate?
Dark urine may indicate dehydration, while red or brown urine may suggest blood
What does cloudy urine suggest ?
Cloudy urine may suggest infections or the presence of crystals
What might unusual odours in urine suggest?
Unusual odours can indicate infection or metabolic disorders
What is the normal specific gravity range for urine?
1.002 - 1.035
What does a specific gravity greater than 1.035 suggest ?
Overhydration, kidney disease or diabetes
What does a low specific gravity (less than 1.002) suggest?
Dehydration or highly concentrated urine
What is the normal pH range of urine?
4.5- 8.0
What does acidic urine indicate?
Acidic urine can indicate metabolic acidosis ( too much acid in blood)
What does alkaline urine suggest?
Alkaline urine can suggest a urinary tract infection (UTI)
What does the presence of proteins in urine indicate?
It can indicate kidney disease, strenuous exercise, or diet influence
What does glucose in the urine signify
It can indicate diabetes
What can ketones in urine indicate
When glucose levels are low, the liver breaks down fats to release ketones as a source of energy. High levels of ketones ( ketonuria) may signal uncontrolled diabetes (not enough insulin so build up of ketones in the blood) , diabetic ketoacidosis and alcohol abuse.
What do nitrites in urine suggest
A bacterial infection
What does leukocyte esterase in urine indicate ?
A urinary tract infection (UTI) or inflammation as nitrites and leukocytes are produced in the body when fighting an infection.
What does the presence of blood in urine indicate
It can indicate kidney stones (as large kidney stones get trapped in your ureter meaning that less pee can travel down= impacts kidneys ability to filter blood )
Can also indicate infection , trauma or cancer
What might cells found in the urine suggest in a microscopic examination?
The presence of red blood cells, white blood cells, and epithelial cells
What do casts in urine indicate in microscopic examination?
Cylindrical structures formed in the renal tubules, indicating kidney disease
What does the presence of crystals in urine indicate in microscopic examination?
Kidney stones or metabolic disorders
What does the presence of microorganisms in urine suggest in microscopic examination?
Bacterial infection, yeast infection, or parasites
What are symptoms that indicate a lower urinary tract infection (LUTS) (7)
. Hesitancy
. Frequent urination
. Dysuria ( burning sensation/ pain when passing urine )
. Haematuria ( blood in urine )
. Lower abdominal pain
. Flank pain ( right and left sides of the mid back )
. Cloudy urine
What are the key vital signs to check during clinical examination for a patient with a lower urinary tract infection? (4)
. Heart rate
. Respiratory rate
. Blood pressure
. Temperature
What are the main areas checked in abdominal examination?
- tenderness in the suprapubic region (just below belly button ) and tenderness in the flank regions
What symptoms are associated with upper urinary tract infections? (6)
. Fever/chills
. Flank pain
. Nausea
. Vomiting
. Dysuria
. Frequent urination
What are the symptoms of kidneys stones? (5)
. Severe flank pain
. Haematuria
. Nausea
. Vomiting
. Dysuria
What symptoms are associated with vaginitis? (3)
. Vaginal discharge
. Itching/ irritation
. Dysuria
What are common symptoms of pelvic inflammatory disease PID (5)
. Lower abdominal pain
. Fever
. Abnormal vaginal discharge
. Dysuria
. Pain during intercourse
What symptoms are seen in acute prostatitis? (5)
. Fever/chills
. Perineal pain
. Dysuria
. Urinary urgency
. Painful ejaculation
What are symptoms of sexually transmitted infections STIs (5)
. Dysuria
. Foul smelling Urethral discharge
. Genital sores
. Pelvic pain
. Fever
What symptoms indicate benign prostatic cancer? (3)
. Haematuria (blood in urine )
. Dysuria ( painful urination )
. Pelvic/ back pain
What symptoms indicate bladder cancer (2)
. Dysuria
. Haematuria
What is the purpose of a urine dipstick in UTI diagnosis
It’s quick, inexpensive, and used as an initial screening, especially in women under 65 with lower urinary tract symptoms
In which cases is a urine dipstick generally not needed according to NICE guidelines?
In uncomplicated ( low risk of treatment rejection ) UTIs in females under 65 with one symptom of a UTI.
What is considered the gold standard for UTI diagnosis?
Urine microscopy, culture and sensitivity MC&S
When should a urine sample be obtained in the context of antibiotic treatment?
Before starting antibiotics
What does a positive dipstick result for nitrite or leukocyte and red blood cells indicate?
It likely indicates a urinary tract infection (UTI)
If a urine dipstick is negative for nitrite but positive for leukocyte, what does this suggest ?
A UTI is equally as likely as an alternative cause for symptoms
What does a negative result for all nitrite, leukocyte and RBCs on a dipstick test suggest?
A UTI less likely, and an alternative cause for symptoms should be considered
What is a normal glucose concentration in urine ?
In normal urine, glucose level should be low, 0-0.8mmol/L
High urine glucose levels (glucosuria) >1.39 mmol/L may signal endocrine abnormality e.g. diabetes mellitus (type 1/2) , or pregnancy
What do high levels of bilirubin indicate?
The liver breaks down red blood cells and releases bilirubin into bile. If bilirubin levels are elevated ( bilirubinuria) this may indicate a sign of liver disease or that the bile is not draining properly into the small intestine
What do high levels of urobilinogen indicate?
Bacteria in the intestines make urobilinogen from bilirubin (a component of bile ). Elevated levels of urine urobilinogen suggests that it has entered the urinary tract from the bloodstream which suggests there could be liver disease.
What is non visible Haematuria?
Positive blood in the absence of nitrites or leukocytes(microscopic )
When does non visible Haematuria need further investigation? (3)
. Age 60 or above with unexplained non-visible Haematuria and either Dysuria or raised white blood cell count on a blood test, you should be referred for further investigation to rule out bladder cancer.
. Persistent or recurrent Haematuria even after UTI treatment- further investigation warranted
. Risk factors for malignancy- if there are risk factors such as a history of smoking, exposure to certain chemicals, or family history of urothelial cancer, further investigation is needed
Nephrotic syndrome
1. What is nephrotic syndrome
2. What are the symptoms
3. What will be present in urine dipstick test
- Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood
- Symptoms include: fatigue, swelling in legs, frothy (bubbly) urine
- Presence of protein indicates nephrotic syndrome
Renal stones
1. What are symptoms of of renal stones
2. What may be present in blood
- Symptoms include: severe flank pain
- Blood- as renal stones sit inside your kidneys, decreasing reabsorption of blood.
Hepatitis
1. What is hepatitis
2. What are the symptoms
3. What would be present in urine
- Hepatitis is the term used to describe inflammation of the liver. It’s usually the result of a viral infection or liver damage caused by drinking alcohol.
- Symptoms include: Right upper quadrant abdominal pain, fatigue , yellowing of skin and eyes (as liver cannot get rid of bilirubin- gives yellow pigment)
- Blood in urine
