Urine Examination

Question 1

Urine examination gives window into _____

Answer 1

• Damage to glomerular filtration barrier
• Inflammation or neoplastic tissue lining urinary tract
• Toxic Ingestion

Question 2

what are the methods used to examine urine

Answer 2

Inspection
Dipstick Test
Urine Microscopy 
Quantification of Protein 
Urine Biochemistry

Question 3

What things would you INSPECT in urine

Answer 3

Colour

• Red/Pink: blood- haematuria or myoglobin
• Brown: Bile pigments
• Dark: Concentrated

Odour

• Offensive: UTI
• Sweet smell: Diabetes

Sediment

• Frothy
• Cloudy or debris- UTI

Question 4

What would you look for in a DIPSTICK test in urine

Answer 4

Semiquantitative Urinalysis

• Dipstick analysis- non visible haematuria picked up
• Non visible haematuria - blood in urine
• Microalbuminaemia is not picked up

Question 5

what is URINE MICROSCOPY used for

Answer 5

Useful in confirming NON visible haematuria

specific abnormalities in certain conditions

Question 6

what is QUANTIFICATION OF PROTEIN used for in urine analysis

Answer 6

if protein is detected- it is important to quantify it to work out the cause

Question 7

what URINE BIOCHEMISTRY used for in urine analysis

Answer 7

Measures conc of electrolytes in urine
Useful for: working out cause of acid/base balance disturbance. Confirms if kidneys are responding to reduced sensed volume

Question 8

what is thee definition of kidney injury disease

Answer 8

Reduced eGFR and detection and quantification of protein in the urine with or without blood

Question 9

what is acute kidney injury (AKI)

Answer 9

rapid decrease in GFR in hours or days with kidney dysfunction resulting in oliguria or anuria

Question 10

what is chronic kidney disease

Answer 10

Prescence of reduced GFR for 3 months and or albuminuria with or without blood

Question 11

what are the causes of AKI

Answer 11

Ineffective blood supply

- eGFR is low due to ineffective blood supply to kidneys which is due to blood loss (glass in arm).

Question 12

what is kidney histology in Acute tubular necrosis

Answer 12

• Tubules sloughing off into lumen (shedding)

- irregularly shaped

Question 13

what is oliguria a sign of

Answer 13

warning sign of impending acute tubular necrosis if left untreated

Question 14

how to treat oliguria

Answer 14

Dialysis

Raise GFR

Question 15

what are the pre renal causes of CKD

Answer 15

Diseases of the arterial supply:

• Main renal arteries
• Small renal arteries
• Following haemorrhage

Question 16

what are the renal causes of CKD

Answer 16

Glomerular diseases- Diabetic nephropathy
Tubulointerstitial diseases:
- Congenital- autosomal dominant polycystic kidney disease
- Chronic nephrotoxin ingestion
- Autoimmune

Question 17

what are the post renal causes of CKD

Answer 17

Obstructive uropathy:

• Bladder outflow- prostate enlargmeent
• Vesico ureteric junction: bladder cancer
• Ureters

Following AKI

Question 18

what are the stages of CKD

Answer 18

Stage 1: Normal GFR >90ml/min/1.72m2
Stage 2: Early CKD, GFR 60-89ml/min/1.72m2
Stage 3: Moderate CKD, GFR 30-59 ml/min
Stage 4: Severe CKD, GFR 15-29ml/min/1.72m2
Stage 5: End stage renal disease GFR <15ml/min1.72m2

Question 19

what does the prescence of nitrites in urine analysis suggeest

Answer 19

Bacterial UTI present