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F15 Lab diagnosis Lect > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What are some non-pathological causes that might change the color of your urine?

A

Beets, rhubarb make urine red

Riboflavin (B2) makes urine yellow

Drugs may also affect the color of urine (ex: rifampin; sulfasalazine; phenazopyridine can make urine orange)

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2
Q

What are some pathological causes that will change urine color?

Red or red/brown:
Orange/Amber:
Green:
Brow/Black:
Colorless:
A

Red or red-brown: Hematuria-intact RBC in urine; Hemoglobinuria-lysed cells in urine

Orange or Amber: Bilirubinuria-jaundice (liver disease)

Green: Infection-Pseudomonas

Brown-Black: Melanin-melanoma

Colorless: very dilute-maybe very hydrated OR they don’t have the ability to concentrate their urine => DM or DI

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3
Q

What are the possible causes of cloudy urine?

A

White blood cells, bacteria, Amorphous urates (acidic), Amorphous phosphates (alkaline), Epithelial cells, Hyperuricosuria (purine rich)

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4
Q

What can cause urine to look hazy?

A

mucus, protien

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5
Q

What can cause urine to look milky?

A

Fat/lipids

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6
Q

What can cause urine to look smoky?

A

Red Blood cells

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7
Q

Specific Gravity
What does it tell you?
What is the normal range?

A

Reflects kidney’s ability to concentrate urine (no solutes will = SG of 1, like water)

Normal range: 1.010-1.025

SG tends to decrease with age as the kidneys lose the ability to concentrate urine

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8
Q

Increased Specific Gravity (above 1.025) could indicate:

A 
!Diabetes Mellitus-glycosuria!
Proteinuria -nephrotic syndrome
Drug side effects
Dehydrated
SIADH
CIF
Toxemia of Pregnancy
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9
Q

Decreased Specific Gravity (below 1.010) could indicate:

A 
!Diabetes Insipidis (decr. ADH)!
Chronic Renal Disease (may be consistently at 1.010, Isosthenuria)
Very Hydrated
Diuretics
Glomerulonephritis
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10
Q

Describe a scenario in which the UA Dip: Specific Gravity test can have high false positive rate:
Scenarios that have a low false positive rate:

A

The test can have either high false positives or low false positives depending on the situation.

High False positives: Proteinuria will cause over estimation of kidneys concentrating ability (due to abnormally high protein in urine incr. conc.)

Low False positives: Highly buffered alkaline urine tends to lower the SG on the dip sticks

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11
Q

Ketones are formed from:

A

the metabolism of Fatty acids and fats

-Happens as a result of altered carbohydrate metabolism

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12
Q

Increased Ketones in the blood lead to:

A
  • Electrolyte imbalance
  • Dehydration
  • Acidosis and eventual coma
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13
Q

Increased ketones will be seen in urine when:

A
  1. Diabetes mellitus
  2. Increased metabolic states
    - hyperthyroidism
    - fever
    - pregnancy
    - fasting
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14
Q

When are nitrites going to be present in the urine?

A

in a urinary tract infection

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15
Q

What is the normal pH range for the Urine? normal value?

A
  1. 5-8.0

6. 0 is most average normal value

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16
Q

After a meal, your urine will be _______ (pH wise)?

A

more alkaline…this is called the “alkaline wave” after meals

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17
Q

How do kidneys help maintain the pH of the body?

A

Reabsorption of Na+ and excretion of H+ in the kidneys serves to control the acid-base balance of the body

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18
Q 
Causes of proteinuria include
Functional:
Renal:
Pre-Renal:
Poste-Renal:
A

Functional:

  • sever muscular exertion
  • Pregnancy
  • Orthostatic proteinuria

Renal:

  • Glomerulonephritis
  • Nephrotic syndrome
  • Renal tumor or infection

Pre-Renal:

  • Fever
  • Hypertension
  • Renal hypoxia

Post-Renal:
-Contamination with vaginal secretions

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19
Q 
What are the normal amounts/ranges for all of the following on a UA dipstick test?
Glucose
Protein
Bilirubin
etc...
A

UNF

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20
Q

What does increased Bilirubin indicate?

A

Likely an obstruction, blocking bilirubin from getting into the small intestine, leaking back into circulation and being filtered by the kidneys

Gallstones
Bile duct obstruction (Intrahepatic or Extrahepatic)
Cholestasis: drugs, pregnancy
acute hepatitis
Congenital Defects in bilirubin metabolism

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21
Q

What is typically the best time to take a urine sample and why? What are the disadvantages of taking urine at this time?

A

First void urine (first morning pee)

Advantages: most concentrated urine; good for testing protein, bilirubin, nitrites, and ability to concentrate urine

Disadvantages: bad for testing for casts, which deteriorate overnight in the bladder

*Random time specimens are most typically obtained in office due to convenience

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22
Q

How many mL of plasma are filtered through the kidneys every day?

How much urine is generated daily, from this filtration process?

A

170,000 mL of plasma are filtered through the kidneys daily producing:
1,000-1,800 mL of urine daily

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23
Q

The concentration or dilution of urine occurs in the….

Concentration of Urine is influenced by….

A

Loop of Henle, Distal Tubules, and collecting ducts (NOT in PCT)

Influenced by BP, ADH, acid-base balance, hydration/fluid balance, nutrient intake

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24
Q

Urinalysis can reveal information about: (what can it be useful for detecting)

A 
Kidney and liver function
Metabolic processes
Infx dz
Nutritional status
Occult dz (otherwise hidden disease)
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25
Q

List some occult diseases that can be picked up on urinalysis:

A 
glomerulonephritis
Hypertensive Nephropathy
Renal failure
DM
End stage renal Dz
Urinary tract neoplasm
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26
Q

When would you be likely to use a urinalysis in your office?

A

Urinalysis is a useful tool to rule things in and out for patients presenting with:

  • abdominal pain
  • Back pain
  • Dysuria
  • Urinary frequency
  • Urinary urgency
  • Hematuria

Routine monitoring of patients with:

  • chronic renal disease
  • liver disease
  • High BP
  • Diabetes

Or just as a part of routine screening:

  • annual check-up (now discouraged)
  • family Hx of renal dz
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27
Q

What is dysuria?

A

Painful urination

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28
Q

What is hematuria?

A

presence of blood in urine

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29
Q

____________ is the major cause of end stage renal disease.

A

Diabetes

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30
Q

Accurate results for a urinalysis require analysis within _____, if sample is kept at room temp.

Or ________ if refrigerated.

A

within 1 hour

  • Cells and casts will degenerate over time
  • Bacterial overgrowth will alter test results

Or 4 hours if refrigerated

31
Q

How would you instruct your patient to collect their own urine sample?

A

Give them instructions to follow a CCMS (Clean Catch Mid-Stream) collection process:

1) clean the urethra with mild antiseptic, wipe three times, each time using a new clean antiseptic wipe (you will use three wipes for one collection!)
2) begin urinating into the toilet
3) pause mid-stream
4) Then pee into the container to collect at least 7 ml and pause when sufficiently filled
5) and finish urinating into toilet

This method decreases potential contamination from: skin, vaginal cells, and bacteria

32
Q

What pathologies can cause changes in the way urine smells?

Sweet or fruity:
Foul or pungent:
Musty:
Fruity/Grape juice:
Maple syrup:
A

Sweet or fruity: Uncontrolled diabetes (ketonuria)
Foul or pungent: Bacterial infx (ammonia)
Musty: Phenylketonuria (PKU)
Fruity/Grape juice: Pseudomonas infx
Maple syrup: Maple syrup Urine Disease

33
Q

With a UA dipstick, there are 10 squares that detect levels of what 10 things:

Some have recently added an 11th tab to test for ________ which, if present, can cause false readings for many of the other tabs.

A 
Glucose
Bilirubin
Ketones
Specific Gravity
Blood 
pH
Protein
Urobilinogen
Nitrites
Leukocyte Esterase

11th tab is for Ascorbic Acid (Vit C)

34
Q

Glucose is normally filtered through the glomerulus and then FULLY reabsorbed in the proximal convoluted tubules. However, when the blood-glucose levels reach _________, there is so much glucose that the transporters in the PCT are overwhelmed and glucose will show up in the urine, a condition termed ___________

A

160-180 mg/dL

glucosuria

35
Q

You detect glucosuria in your UA. Some possible conditions that could cause this are:

A 
Diabetes Mellitus
Cushing's Syndrome
Pheocromocytoma
Acromegaly
Chronic Pancreatitis
Drugs
36
Q

Having a positive glucose test on the UA dipstick doesn’t necessarily indicate glucose in the urine….List the false positive and 3 false negatives that can skew the test:

A

False Positives: Oxidizing agents

False Negatives: Ketones, Aspirin, Ascorbic Acid

37
Q

There are three main ketones:
beta-hydroxybuturate
acetoacetic acid
acetone

Which of these does the UA dipstick detect? Which of these is most prevalent in DKA?

A

UA dip only detects acetoacetic acid

In DKA, Beta-hydroxybutyrate is the predominant ketone (so the strength of rxn may not correlate with severity of acidosis)

38
Q

What is DKA?

A

Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat breaks down, waste products called ketones build up in the body.

39
Q

In testing for ketones, What are some causes of False positives? False Negative?

A

False Positives:

  • Drugs (phenylketone compounds, Phthalein compounds, Levodopa metabolites)
  • Highly pigmented urine

False Negatives:
-Prolonged air exposure (b/c ketones volatize)

40
Q

What components of the blood do dipsticks detect? (hint: there are three)

A
  1. Free hemoglobin: lysed RBCs
  2. Hemoglobin: intact RBCs
  3. Myoglobin (muscle protein)
41
Q

Describe the difference between Hemoglobinuria and Hematuria:
How does each appear on the Dipstick test?

A

Hemoglobinuria is the presence of free hemoglobin (free b/c RBC’s have been lysed) ; appears as homogenous color change

Hematuria is when intact RBC’s are present in urine; appears as spotted regions

42
Q

Blood in the urine could come form numerous sources. List around 5:

A 
Glomerular disease
Kidney Stones 
Trauma
Pyelonephritis
Cystitis
Bladder cancer
Prostate cancer
Menstrual blood
Contamination
Myocardial Infarction
Exercise Hematuria
43
Q

What are some things that could cause false positives for the blood test? False Negatives?

A

False Positives:

  • Myoglobinuria
  • Menstrual blood

False Negatives:

  • Ascorbic Acid
  • Nitrites
44
Q

On the dipstick, the protein square is located right next to the pH square. How might this affect the results of the pH test?

A

the buffers on the protein square (3.0pH) can spill over into the pH square causing the urine to seem more acidic than it actually is

45
Q

What can cause a high pH on the UA dip test?

A 
Alkalosis (metabolic or respiratory)
UTI (proteus or pseudomonas)
Vomiting
Gastric Suction
Renal Tubular Acidosis
Diet (vegetarians, high citrus intake)
46
Q

What can cause a low pH on the UA dip test?

A 
Acidosis (metabolic or respiratory)
Diabetes Mellitus
COPD
Starvation
UTI (e coli)
Diet (high meat intake, high cranberries)
47
Q

Transient Proteinuria can sometimes occur with:

A

Fever, stress, exercise, or congestive heart failure

48
Q

What can cause false positives on the protein UA dip test? False Negatives?

A

False Positives:

  • Vaginal secretions
  • Hematuria
  • Pyridium
  • Highly Alkaline Urine

False Negatives:
-Dilute Sample

49
Q

The dipstick is most sensitive to what protein?

A

Only sensitive to ALBUMIN

50
Q

Describe how old RBC’s are broken down and excreted:

A

IN THE BLOOD:
120 day old RBC is lysed releasing => hemoglobin, which is lysed => heme + globin, then heme => biliverdin => unconjugated bilirubin, which goes to the liver

IN THE LIVER
bilirubin is conjugated, secreted by hepatocytes into bile => excreted into small intestine => bacterial proteases convert it to urobilinogen (90% excreted in feces further conjugated to stercobilin, 10% goes into circulation and a small amount of that is extracted by kidneys into urine)

51
Q

What are some sources of False Negatives on the Bilirubin UA dip test?
False Positives:

A

False Negatives:

  • Ascorbic Acid
  • Light exposure
  • Nitrites

False Positives:

  • Fecal contamination
  • Rx: Pyridium Indicans
52
Q

The normal level of urobilinogen in the urine is _______.
Increased Urobilinogen is likely due to:
Decreased:

A

0.2-1.0 mg/dL
Increased levels:
Intravascular hemolysis
Intestinal Obstruction

Decreased Levels:
occurs, but the dipstick can’t detect it

53
Q

What can cause false positives for Urobilinogen on the UA dip test?
False Negatives:

A

False Positives:

  • Fecal contamination
  • pigmented drug metabolites
  • Beets

False Negatives:

  • Antibiotics
  • Prolonged air exposure
  • Formaldehyde
54
Q

Many gram- bacteria produce ___________ (enzyme) that will cause nitrites to show up in the urine during a UTI.

A

Nitrate reductase

Nitrate -> Nitrite

(humans are incapable of producing nitrites)

55
Q

What can cause false Positives on the Nitrite UA dip test?

False Negatives?

A

False Positives:

  • Pyridium
  • Beets
  • Bacterial Growth in old samples (4hr or more)

False Negatives:

  • Ascorbic acid
  • Low nitrate diet
  • High SG
56
Q

UA dip: Leukocyte Esterase is a screen to detect:

Positive results indicate:

A

detects WBC’s in urine

Positive results indicate likelihood of urinary tract infx
-patients may be asymptomatic even with a significant infx

57
Q

Least three things that could cause pyuria:

What is pyuria?

A

Pyuria = presence of pus in urine

UTI’s
Appendicitis
Pancreatitis

58
Q

Leukocyte esterase UA dip, False positives and false negatives?

A

False positives:
-Vaginal Secretions

False negatives:

  • Glucose
  • Protein
  • Increased SG
59
Q

In microscopic examination of urine samples, the urine is centrifuged and the sediment is examined for formed elements such as:

A 
Epithelial cells
RBC's
WBC's
Mucus
Bacteria
Casts
Crystals
Yeast

Artifacts, including starch or talc crystals, fibers
Trichomonas vaginalis
Eggs of schitosoma haemotobium
Pinworms eggs

60
Q

Most bacteria found in urine (which is normally sterile and without bacteria) will be gram - or gram +?

A

gram-, due to proximity of G.I. tract

61
Q

List three types of epithelial cells that you may find in the urine under microscopic examination:

A

Squamous (SEC) - contaminant from lower GU [large, flat, fried egg cells]
Transitional (TEC) - line the urinary tract from the renal pelvis to the proximal two thirds of the urethra [round, pear-shaped, tail-like projections, large round nucleus]
Renal (REC) - From renal tubules, large numbers indicate tubular damage, pyelonephritis and other renal disease or trauma [slightly larger than WBC, flat, cuboidal or columnar, one large nucleus]

62
Q

What are urinary casts and where do they form?

A

Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. Cigar shaped. They form in the Distal and Collecting tubules.

63
Q

In order for casts to form the urine pH must be ______ (acidic or basic?) and the urine must be (dilute or concentrated?).

Their formation is usually associated with some degree of ________ and _______

A

acidic, concentrated (will dissolve in alkaline urine)

Their formation is usually associated with some degree of proteinuria and urinary stasis.

64
Q

Hyaline casts are a conglomeration of __________.

A

Conglomeration of protein, an indication of protenuria.

there may be an occasional cast in normal urine, many = path

65
Q

Hyaline casts are primarily made of this protein, ________, which is a globulin and therefore, not detected on dipstick.

A

Tamm-horsfall protein

66
Q

Short term protenuria can be caused by:

A

Strenuous exercise
Orthostatic proteinuria
Fever

67
Q

Chronic proteinuria and urinary casts are associated with:

A

Glomerulonephritis
Pyelonephritis
CHF (congestive Heart Failure)
CRF (Chronic Renal Failure)

68
Q

Red blood cell casts indicates what physiologically? List some conditions that would result in RBC Casts:

A

Pathological; indicate bleeding in the kidney in association with reduced urine flow

  • Glomerulonephritis (PSGN=Post-Streptococcal Glomerulonephritis)
  • SBE, Sub-acute Bacterial Endocarditis
  • Renal Infarcts, vasculitis, Sickle cell anemia
  • SLE, malignant hypertension, Goodpasture’s Syndrome
69
Q

What do WBC casts indicate?

A

Infectious of inflammatory dz’s affecting the kidney
Presence of casts excludes the lower urinary tract as the source of infx or inflammation
-Acute pyelonephritis
-Glomerulonephritis
-Lupus nephritis

70
Q

Renal tubular epithelial (RTE) cell casts

A

found following diseases that damage tubule epithelium such as:

  • nephrosis
  • AMyloidosis
  • Heavy metal or other poisoning
  • Glomerulonephritis
  • Acute tubular necrosis
  • Pyelonephritis
71
Q

Microscopic Other Casts
Granular-
Waxy or “broad”-
Fatty-

A

Granular- degenerated cellular casts
Waxy or “broad” - degenerated granular casts, chronic destructive renal diseases. often termed “renal failure casts”
Fatty- contain fat. Seen in chronic renal diseases, nephrosis, nephrotic syndrome

72
Q

Microscopic crystals in urine:

  1. Are they pathological?
  2. Types seen depend on ______
  3. UTI’s caused by proteus are associated with formation of __________
A
  1. Not necessarily pathologic (dietary influences)
  2. urine pH
  3. Proteus UTI’s => triple phosphate crystals
73
Q

What constitutes abnormal findings for microscopic Examination at a 400x and 200x for the following:

Per High Power Field (HPF, 400x)-
erythrocytes
leukocytes
renal tubular cells
bacteria

Per Low Power Field (LPF, 200x)-
hyaline casts or granular cast
squamous cells (indicative of contaminated specimen)
Any other cast (RBC’s, WBC’s)

The presence of any of the following is abnormal:

A 
Per High Power Field (HPF, 400x)-
erythrocytes >3
leukocytes >5
renal tubular cells >2
bacteria >10

Per Low Power Field (LPF, 200x)-
hyaline casts or granular cast >3
squamous cells (indicative of contaminated specimen) >10
Any other cast (RBC’s, WBC’s) >0 (any at all are abnormal)

The presence of:
fungal hyphae or yeast, parasite, viral inclusions
pathological crystals (cystine, Leucine, tyrosine)
Large number of uric acid or Calcium oxalate crystals

F15 Lab diagnosis Lect (6 decks)

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