W2 Urinalysis (Felkins) — Skills OSCE

Question 1

Dark red urine after working out?
Thick and cloudy?

Answer 1

Rhabdo
UTI

Question 2

Leukocyte esterase suggests?

Answer 2

—chemical release by lysed neutrophils and macrophages
—presence of WBCs
—infection
—not normal
—have to do a clean catch

Question 3

+ nitrites

Answer 3

+ leukocyte esterase = UTI

—from nitrite producing bacteria
—E Coli

Question 4

+ Proteinuria

Answer 4

—CKD
—pre-eclampsia
—nephrotic syndrome
—dipstick only picks up albumin
—protein should be reabsorbed, not filtered out

Question 5

Albumineuria

Answer 5

Reported as trace +1, +2, +3
Do a 24 urine collection
Albumin to creatinine lab ratio

Question 6

Glycosuria

Answer 6

—inability for kidney to reabsorb in PCT despite normal plasma glucose concentration
—overflow of glucose related to high plasma glucose concentration
—could be first indication of pancreatic cancer because they don’t have the insulin to absorb it

Question 7

Bilirubinuria

Answer 7

—dipstick right away
—light breaks down bili
—liver disease

Question 8

Urso bili oven

Answer 8

—fresh urine sample
—liver disease

Question 9

Ketones

Answer 9

—ask about diet, indicates low carb diet, starvation
—fresh specimen

Question 10

Examination the urine sediment
Cells

Answer 10

All patients with Acute Kidney Injury

RBCs: Indicate injury or inflammation: UTIs, obstruction, trauma, tumor

WBCs: infection, consider inflammation if neg culture but + neutrophils

Epithelial cells:
Squamous — normal shedding into the urine
Transitional-small amounts — normal, large — tubular damage
Renal epithelial

Question 11

Cellular casts

Answer 11

Casts —cylindrical structures
—formed in the renal tubule
—urine stasis, low pH and high urine concentration
—can dislodge from the lumen and be dislodged from the urine
—generally pathological

Cellular Casts
RBC casts
—Always indicate an abnormal
—Reflect damage to the glomerulus: ⭐️Glomerulonephritis, HTN emergency
—Microscopic bleeding in the kidney

WBC casts
—Underlying kidney infection- pyelo
—Glomerular inflammation
—acute interstitial nephritis

Renal Tubular Epithelial casts
—Excessive kidney disease, shock, renal ischemia, heavy metal poisoning • Sloughing off of the tubular lumen

Question 12

Non-cellular casts
Granular
Hyaline
Waxy
Fatty

Answer 12

Granular casts
• ⭐️“Muddy brown casts” is a type of granular cast
= Acute tubular necrosis, acute kidney disease
• Chronic kidney disease

Hyaline casts
• Small amount is normal
• Only composed of the protein matrix
• Increased amounts: dehydration, strenuous exercise, AKI

Waxy casts
• Non specific
• ESRD (end stage renal disease)

Fatty casts
• Nephrotic syndrome

Question 13

Crystals
Microorganisms
Urinary lipids

Answer 13

Crystals
• Naturally produced solids seen in urine
• ↑ as urine cools
• small amounts = normal
• large amounts = kidney stones and hypercalcemia
• Gout vs septic joint, or cellulitis?

Microorganisms
• Bacteria-
• few may be normal
• ↑ =infection
• Yeast
• Parasites- UTI or STD
• ex-Trichomonas vaginalis

Urinary lipids
• Nephrotic syndrome
• ⭐️Oval fat bodies — a lot of damage to the glomerulus from nephrotic syndrome. Becomes trapped in a fatty cast = “Maltese cross” appearance

Question 14

know the microscopy findings in urine