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clinical microscopy > Urine Analysis > Flashcards

Urine Analysis Flashcards

1
Q

What does the kidney eliminate?

A

excess body water
waste products of metabolism (i.e.: urea and creatinine)
foreign substance (drugs, vitamins, antibiotics)

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2
Q

Other functions of kidney

A
  • Retention of substances necessary for normal body function (e.g. proteins, amino acids, glucose)
  • Regulation of electrolyte balance and osmotic pressures of the body fluids (e.g. sodium chloride, phosphates
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3
Q

Composition of urine

A

95% water (1000 ml to 1500 ml/24 hr) 5% solute (60 g/24 hr)

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4
Q

Urine solutes and equivalents

A
  • Urea – most of nitrogen excreted (10g/day)
  • Sodium Chloride (NaCl) – 5 to 20g/day
  • Potassium – 70 mEq/day
  • Sulfate – organic or inorganic, 2g/day
  • Phosphates – 1 g/day
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5
Q

Urine also contains small amounts of these:

A

• Sugars – pentoses
• Intermediary metabolites – oxalic acid, citric acid, pyruvate
• Free fatty acids and trace amounts of cholesterol
• Hormones – ketosteroids, estrogens, aldosterone, pituitary
gonadotropins
• Biogenic amines – catecholamines and serotonin metabolites
• Vitamins – ascorbic acid
• Porphyrins (trace amounts)
• Crystals – in concentrated urines; uric acid and phosphate
crystals (causes kidney stones)

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6
Q

Formed elements seen in urine

A

− Red Blood Cell (erythrocytes)
− White Blood Cell (leukocytes)
− Renal tubular epithelial cells (of the kidney)
− Transitional epithelial cells (of the kidney)
− Squamous epithelial cells (of the urethra)

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7
Q

Other substances present in urine

A

uric acid, creatinine, amino acids, ammonia and traces of proteins, glycoproteins, enzymes and purines

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8
Q

ideal urine specimen for isolation of anaerobes because it bypasses normal flora of urethra

A

Suprapubic aspiration

also: clean-catch midstream specimens

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9
Q

This method of specimen collection is used for specimens from children, infants and toddlers

A

collection bags

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10
Q

This method of specimen collection may cause staphylococcal infections (i.e.: S.epidermidis, S. saprophyticus)

A

Indwelling catheters

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11
Q

Other methods of specimen collection

A

straight catheterization

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12
Q

method used in clean-catch midstream specimens

A

• Clean urethral area with a series of sponges, soap, and clean water
• Retract skin folds (labia or prepuce) before voiding
→ To avoid contamination of epithelial cells
• The first-void urine is passed into the toilet to clear the urethra
• Collect the midstream specimen
• Continue voiding

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13
Q

urine needed for chemical and microscopic examination

A

voided specimen

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14
Q

urine needed for protein and microscopic examination of sediments

A

concentrated specimen (preferable; i.e.: morning urine)

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15
Q

Where is urine after a meal needed?

A

glucose examination

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16
Q

24-hour urine is usually used for

A

quantitative analysis

also for protein

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17
Q

Urine needed for bacteriologic examination

A

Voided mid-stream or catheterized specimen

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18
Q

Why is first morning urine collected?

A

counts increase overnight in bladder and organisms are concentrated

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19
Q

Why is fluids not forced in patients during time of collection

A

may dilute urine = false negative results, decrease count to <10^5 CFU/ml

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20
Q

Method of specimen collection for asymptomatic patients

A

Collect three consecutive early morning specimens

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21
Q

Important considerations in urine collection

A
  • Containers (should be washed with detergent and rinsed well with water and dried; for ordinary urinalysis; sterile containers = bacteriologic examination)
  • Deterioration of specimen (Should be collected in a dry, clean container; Should be examined when freshly voided)
  • Storage
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22
Q

Consequences of detrioration of specimen

A
  • RBC and WBC destroyed by hypotonicity of urine
  • Casts decompose
  • Bacterial contamination
  • Decreased pH
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23
Q

This preserves sediments but interferes with test for protein

A

one crystal of thymol/ 10-15 ml. of urine

*one drop formalin/ 10 ml. urine also preserves sediments

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24
Q

The preservation method of freezing is used for

A

bilirubin, urobilinogen, or ketones

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25
Q

Preservative tablets are used for

A

routine screening; preserves glucose and other constituents

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26
Q

Container used for speciment transport

A

sterile, wide-mouthed, screw-capped

  • anaerobic transporter for suprapubic aspirate
  • urine bag for pediatric patients
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27
Q

Temperature at which specimen is transported

A

immediately refrigerated 4C or preserved

needed for culturing urine

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28
Q

If urine is not cultured, tubes are transported with

A

boric acid
glycerol
Na formate (and sometimes formalin)

*preserves bacteria without refrigeration for 24 hrs. when >10^5 CFU/ml is present in the initial urine specimen

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29
Q

General considerations during specimen transport

A

→ Transport urine to the lab as soon as possible after collection
→ Culture urine specimens within 2 hours after collection, or refrigerate and culture them within 8 hours whenever possible
→ Refrigerated urine specimens may be held for < 24 hrs.

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30
Q

Considerations for repeat specimen collection

A

• Request repeat specimen when:
→ There is no evidence of refrigeration and the specimen is more than 2 hours old
→ The collection time and method of collection have not been provided
• If an improperly collected, transported, or handled specimen cannot be replaced, document in the final report that specimen
quality may have been compromised

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31
Q

Procedure for routine urinalysis

A
  1. Number the urine specimens and the corresponding request
  2. Number the 15mL centrifuge tube corresponding to urine sample
  3. Mix each specimen thoroughly and place 12 mL to corresponding
    centrifuge test tube. (Note the color, turbidity and pH reactions)
  4. Measure specific gravity
  5. Centrifuge for 5 minutes at 1500 to 25000 rpm
    • Use supernatant for testing of proteins, glucose and
    reducing substances
    • Use sediments for microscopic exam
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32
Q

Physical tests involved in macroscopic examination in routine urinalysis

A

Color, character (clarity of appearance), odor, urine volume, osmolality and specific gravity

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33
Q

normal color of urine

A

yellow and straw to amber-colored urine

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34
Q

Why is urine yellow?

A

urochrome pigment and small amounts of urobilins

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35
Q

[Abnormal findings of urine] orange urine is due to

A

concentrated urine

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36
Q

[Abnormal findings of urine] DEEP YELLOW URINE is due to

A

Riboflavin

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37
Q

[Abnormal findings of urine] amidopuride drugs causes this color of urine

A

bright orange

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38
Q

[Abnormal findings of urine]urobilin causes this color of drugs

A

orange-brown

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39
Q

[Abnormal findings of urine]greenish-orange urine is due to

A

bilirubin

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40
Q

[Abnormal findings of urine] smokey urine is due to

A

RBCs

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41
Q

[Abnormal findings of urine] What causes wine red urine?

A

hemoglobin pigments

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42
Q

[Abnormal findings of urine] What causes brown to black urine?

A

melanina

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43
Q

[Abnormal findings of urine] an almost colorless urine is due to

A

dilute urine

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44
Q

[Abnormal findings of urine] A reddish orange in alkaline solution is caused by

A

rhubarb or serra

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45
Q

[Abnormal findings of urine] a urine which is dirty green on standing is caused by

A

excess indicant

46
Q

T or F: Urine is normally turbid

A

False, essentially clear

47
Q

An abnormal cloudy urine is due to

A
  • Phosphates,
  • carbonates
  • Prostatic fluid
  • Urates, uric acid
  • Mucin, mucus threads
  • Leukocytes
  • Calculi
  • Red cells (“smoky”)
  • Clumps, pus, tissue
  • Bacteria, yeast
  • Radiographic dye
  • Spermatozoa
48
Q

An abnormal milky urine is caused by

A
  • Many neutrophils (pyuria)
  • Lipiduria (fat)
  • Opalescent
  • Chyluria
  • Emulsified paraffin
49
Q

Normal odor of urine

A

Faint aromatic

50
Q

Abnormal odor of urine

A
  • Odorless (acute renal failure)
  • Characteristic urine odors in ingestion of asparagus or thymol
  • Urine odors associated with amino acid disorders
51
Q

A sweaty feet odor urine is due to this amino acid disorder

A

Isovaleric and glutaric academia

52
Q

This amino acid disorder causes maple syrup urine odor

A

Maple syrup urine disease

53
Q

Methionine malabsorption (amino acid disorder) causes this urine odor

A

Cabbage, hops

54
Q

A mousy urine is caused by this amino acid disorder

A

Phenylketonuria

55
Q

Urine in Trimethylaminuria smells like

A

Rotting fish

56
Q

Tyrosinemia (amino acid disorder) causes

A

rancid odor urine

57
Q

What is the average daily urine volume?

A

1200-1500 ml (adults) *average range: 600-2000 ml; night urine: 400 ml

58
Q

Daily urine volume for all ages

A

Newborn: 20-350 ml
1 year old: 360-600 ml
10 yrs old: 750-1500 ml
Adults: 750-2000 ml

59
Q

An increase in urine volume, indicated by more than 2000 ml in 24 hours or polyuria is due to

A 
− Excessive intake of water
− Increase salt intake and high protein diet
− Certain drugs with diuretic effect such as caffeine,
alcohol, and thiazides
− Intravenous saline or glucose
− Pathologic states
o Diabetes mellitus
o Diabetes insipidus
o Chronic renal failure
60
Q

A decrease in urine volume is due to

A

− Dehydration
− Renal ischemia
− Renal disease
− Obstruction”

61
Q

This physical test gives an indication of urinary solute concentration

A

Osmolality and Specific gravity

*In critical conditions, measurement of osmolality of urine and plasma is preferred over specific gravity

62
Q

What is the normal specific gravity of urine?

A

1.005-1.030 (most samples: 1.010-1.025; normal adults with normal diet: 1.016-1.022/24 hours)

63
Q

An isosthenuric urine would have this specific gravity

A

1.010 (hyposthenuric: <1.007)

64
Q

normal osmolality range for urine

A

800-1400 mOsm/kg water (normal diet: 800)

65
Q

These physical tests are the best indicators of hydration status

A

urine color and volume (dark amber urine= dehydrated; hematuria (visible/not-visible; red to pinkish color)

66
Q

Not visible hematuria might be due to

A

calculi of urinary tract, UTI, trauma or malignancy

67
Q

This physical test is helpful for determining hydration status AND KIDNEY FILTRATION FUNCTION

A

Specific gravity (high in dehydrated with particles like glucose in urine)

68
Q

Turbid urine might be due to

A

pyuria (urine with pus); presence of protein, UTI

69
Q

T or F: sweet or foul odor: food and medications; odor: dehydration

70
Q

[Chemical methods] General methods involve

A

Reagent Strip Methodology (convenient; with standards)

Confirmatory tests

71
Q

These are properties measured by chemical methods

A

pH in urine
Protein in urine
Reducing substances
Glucose

72
Q

It is reflection of the ability of the kidney to maintain normal hydrogen ion concentration in plasma and extracellular fluids

A

pH in urine (normal: 4.6-8.0)

73
Q

What does a pH of 5.5 and below signify?

A

tubule mechanisms of acidification are intact

74
Q

What produces acid urine?

A

− Diet high in meat protein and some fruits

− Drugs: ammonium chloride, methionine, methenamine, mondelate or acid phosphatase

75
Q

T or F: a diet high in certain fruits and vegetables produces acid urine

A 
False, alkaline urine
*Other causes of alkaline urine:
− Drugs: sodium bicarbonate, potassium citrate,
acetacolamide
− Conditions involving failure to acidify urine:
o Renal tubular acidosis
o Early pyelonephritis
o Primary aldosterone secretory tumor
o Hypokalemia
76
Q

How much protein is usually found in urine?

A

150 mg/24 hr. (1/3 albumin with remaining protein, globulin)

77
Q

Methods used in identifying protein in urine

A

Reagent strip method (sensitive to albumin)

Acid-precipitation test (detects all proteins and indicates the presence of globulins)

78
Q

Confirmatory tests for protein in urine

A 
Sulfosalicylic acid methods (Quali + semi-quanti)
Quantitative methods (more useful in diagnosing kidney d.)
79
Q

How much urine and 10& sulfosalicylic acid in 50% methanol is used in sulfosalicylic acid methods?

A

3 ml. (+ for protein: cloudy ppt at the junction of 2 fluids)

80
Q

This is a rough tests and at best an approximate guide to the amount of sugar

A

Benedict’s Qualitative Test (see table of results in trans)

81
Q

Test for acetone and acetoacetic acid

A

Rothera’s test (a+aa = purple color with alkaline sodium nitroprusside)

82
Q

Test for total urobilinogen and urobilin

A

Schlesinger’s test

83
Q

Principle for schlesinger’s test

A

urobilinogen is oxidized with alcoholic solution of zinc acetate producing a green fluorescent complex

84
Q

Test for BILIRUBIN

A

Fouchet’s test

85
Q

Test with principle of BaCl2 + Urine > Barium Sulfate (pt)
o Bilirubin is adsorbed then filtered
o F’s ferric chloride is added which produces Biliberon (greenish-blue)

A

Fouchet’s test

86
Q

What are the factors affecting appearance of glucose in urine?

*Methods: Reagent strip (based on specific glucose oxidase and peroxidase method)

A

− Blood level
− Glomerular blood flow
− Tubular reabsorption rate
− Urine flow

87
Q

Confirmatory tests for glucose in urine

A

Confirmatory tests for glucose in urine

88
Q

What is the test for other sugars?

A

Chromatography

89
Q

Microscopic examination in routine urinalysis involves

A

Increased RBC in urine, Increased WBC in urine, Crystals, Epithelial cells, Casts, abnormal cells and other formed elements

90
Q

Normal amount of rbcs in urine

A

0-2 rbcs per high power field or 3-12/microliter

91
Q

Renal diseases associated with increased rbc in urine

A 
> Glomerulonephritis  >Renal vein thrombosis
> Lupus nephritis 
> Trauma
> Calculus  
> Hydronephrosis
> Acute infections 
> Polycystic kidney
> Tuberculosis 
> Acute tubular necrosis
92
Q

These lower urinary tract diseases causes increased rbc in urine

A

> Acute and chronic infxn
Calculus
Tumor
Stricture

93
Q

Extrarenal diseases which increase rbc in urine

A

> Acute appendicitis
Tumors of pelvis and rectum
Diverculitis
Salpingitis

94
Q

Normal amt of WBC in urine

A

less than 20 leukocytes per high power field

95
Q

Abnormalities which causes increased wbc in urine

A 
→ Clumping of WBCs
→ Pyuria (Increased number of leukocytes, primarily neutrophils; seen in almost all renal diseases of the urinary tract; fevers and after strenuous activity)
→ Renal disease 
> Bacterial: acute and chronic pyelonephritis
→ Calculous disease
→ Bladder tumors
→ Acute inflammatory disease
→ Chronic inflammatory disease
96
Q

Bacterial renal disease in increased wbc in urine is due to

A

acute and chronic pyelonephritis

> Non-bacterial: acute glomerulonephritis & nephritis

97
Q

T or F: Crystals are usually present in freshly voided urine

98
Q

These crystals are significant if found

A 
− Calcium oxalate
− Uric acid
− Urates
− Cystine
− Tyrosine
− Leucine
99
Q

T or F: phosphates, calcium carbonate and ammonium urate crystals are found in alkaline urine

100
Q

These conditions lead to INCREASE IN RENAL TUBULAR EPITHELIAL CELLS

A 
→ Malignant nephrosclerosis
→ Acute glomerulonephritis
→ Acute tubular necrosis
→ Papilitis
→ Acute renal allograft rejection urates (gout)
101
Q

What would an increase in transitional epithelial cells suggest?

A

transitional cell carcinoma of pelvis or ballder

102
Q

What would an increase in SQUAMOUS epithelial cells suggest?

A

little diagnostic significance

103
Q

These are translucent, colorless gels from protein in the tubules or nephrons

104
Q

Why are they called casts?

A

When proteins are concentrated in the tubules, and the person does not urinate, then the proteins would harden, and would have the shape of the tubule when excreted.

105
Q

Different classifications of casts

A

→ Matrix (Hyaline and Waxy cast)
→ Inclusions (Granules, fat globules or fatty casts, hemosiderin granules, crystals, melanin granules)
→ Pigments (Hemoglobin, myoglobin, bilirubin, drugs)
→ Cells (erythrocytes and RBC elements, leukocytes, renal tubular EC, mixed cells, bacterial)

106
Q

[Matrix class of cast] A hyaline cast is observed in

A 
− Acute glomerulonephritis
− Malignant hypertension
− Chronic renal disease
− Congestive heart failure
− Diabetic nephropathy
107
Q

T or F: A waxy cast (matrix) is found in localized nephron obstruction and oliguria

108
Q

This inclusion almost always indicate significant renal disease

A

Granules (seen in pyelonephritis, viral disease, chronic lead intoxication)

109
Q

This inclusion is commonly seen in heavy PROTEINURIA; a feature of nephrotic syndrome

A

Fat globules or fatty casts

110
Q

T or F: Melanin granules are found in tubular damage

A

false, crystals

111
Q

Pigments and where they are seen

A

Hemoglobin: tubular bleeding
Myoglobin: muscle damage
bilirubin: obstructive jaundice

112
Q

Abnormal cells and other formed elements found in microscopic examination in routine urinalysis

A
  • Tumor cells
  • Viral inclusion cells
  • Platelets
  • Bacteria, fungi, parasites
  • Contaminants
  • Artifacts (Cotton, hair and other fibers, granules of starch, oil droplets)

clinical microscopy (1 decks)

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