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AUBF Lec > Chemical Determination Of Urine > Flashcards

Chemical Determination Of Urine Flashcards

1
Q

Glucose

Reading Time: Principle: Positive Color

A

30 seconds: Double sequential enzyme reaction: Green to Brown

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2
Q

Bilirubin

Reading Time: Principle: Positive Color

A

30 seconds: Diazo reaction: Tan or pink to violet

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3
Q

Ketones

Reading Time: Principle: Positive Color

A

40 seconds: Sodium nitroprusside reaction (Legal’s Test): Purple

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4
Q

Specific Gravity

Reading Time: Principle: Positive Color

A

45 seconds: PKa change of a polyelectrolyte: Blue (SG 1.000) to yellow (SG 1.030)

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5
Q

Protein

Reading Time: Principle: Positive Color

A

60 seconds: Protein (Sorensen’s) error of indicators: Blue

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6
Q

pH

Reading Time: Principle: Positive Color

A

60 seconds: Double indicator system: Orange (pH 5.0) to Blue (pH 9.0)

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7
Q

Blood

Reading Time: Principle: Positive Color

A

60 seconds: Pseudoperoxidase activity of hemoglobin
Uniform green/blue (Hgb or Mb) Speckled/spotted (intact RBCs)

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8
Q

Urobilinogen

Reading Time: Principle: Positive Color

A

60 seconds: Ehrlich reaction
Red

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9
Q

Nitrite

Reading Time: Principle: Positive Color

A

60 seconds: Greiss reaction
Uniform Pink

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10
Q

Leukocytes

Reading Time: Principle: Positive Color

A

120 seconds: Leukocyte esterase
Purple

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11
Q

Reagent Strip Technique (4)

A
  1. Dip the reagent strip in a well-mixed urine (uncentrifuged) (Room temperature) not more than 1 second
  2. Blot the edge of the reagent strip on disposable absorbent pad
  3. Wait for each reading time to be reach
  4. Compare the color per parameter.
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12
Q

Care for Reagent Strips
Store in?
Store below?
Do not?

A

opaque , tightly closed container

30°C (RT)

freeze

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13
Q

Automated Reagent Strip
Readers principle

A

Light reflection from the test pads decreases in proportion to intensity of color produced by
the concentration of the test substance

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14
Q

Specific Gravity is Influenced by the

A

number and size of particles in solution

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15
Q

Normal SG (random)

A

1.003-1.035 (random)

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16
Q

When SG <1.003

A

Not a urine (except in D.I)

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17
Q

When SG >1.040

A

Radiographic dye present
(improve visibility of internal structures for X-ray)

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18
Q

SG = 1.010 is referred to as

A

Isosthenuria

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19
Q

SG < 1.010 (diluted) is referred to as

A

Hyposthenuria

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20
Q

SG > 1.010 (concentrated) is referred to as

A

Hypersthenuria

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21
Q

Urinometry (Urinometer/Hydrometer)

Reading:
Calibration Temperature:
Requires temperature correction:
- Below 3°C=
- Above 3°C=
Requires correction for Glucose and protein:
- 1 g/dL Glucose=
- 1 g/dL Protein=
Urine volume required:
Calibration:

A

Reading: LOWER MENISCUS Calibration Temperature: 20 °C Requires temperature correction:
❑ Below 3°C= =-0.001
❑ Above 3°C= +0.001
Requires correction for Glucose and protein:
❑ 1 g/dL Glucose= -0.004 (subtract)
❑ 1 g/dL Protein= -0.003 (subtract) Urine volume required: 10- 15 mL
Calibration:
❑ Potassium sulfate (K2SO4) solution= add 20.29g K2SO4 to 1 L of Water=SG should always be 1.015

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22
Q

Indirect method based on refractive index

A

Refractometry (Refractometer/TS Meter)

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23
Q

Do Refractometry (Refractometer/TS Meter) requires temperature correction?

A

No

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24
Q

Refractometry (Refractometer/TS Meter) requires correction for?

A

Glucose and Protein

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25
Q

Refractometry (Refractometer/TS Meter)
Calibration:
Distilled water: SG=
3% NaCl:
5% NaCl:
9% Sucrose:

A

Calibration:
Distilled water: SG= 1.000
3% NaCl: 1.015 ± 0.001
5% NaCl: 1.022 ± 0.001
9% Sucrose: 1.034 ± 0.001

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26
Q

RI calculation

A

light velocity of air/ light velocity solution

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27
Q

True or false: Specimens with very high SG readings can be diluted and retested

A

True

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28
Q

Reagent Strip Reaction for Specific Gravity: Principle

A

Change in pKa (dissociation constant of a polyelectrolyte)

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29
Q

Reagent Strip Reaction for Specific Gravity: Reagents

A

Multistix: Poly (methyl vinyl ether/ maleic anhydride) bromthymol blue
Chemstrip: Ethyleneglycoldiaminoethylethertetraacetic acid bromthymol blue

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30
Q

Reagent Strip Reaction for Specific Gravity: Interferences

False (+):
False (-):

A

False (+): high concentration of protein
False (-): Highly alkaline urines (>6.5)

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31
Q

Urine: Low Specific Gravity

A

specimen not concentrated, kidney disease.

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32
Q

Urine: High Specific Gravity

A

first morning, certain drugs

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33
Q

Urine: Random specimen SG

A

(1.003 to 1.032)

34
Q

Urine: 24 hours specimen SG

A

(1.015 to 1.025)

35
Q

Severe renal tubular damage, sp. Gravity is fixed at

A

1.010 =isothenuric

36
Q

Based on frequency of soundwave entering a solution changes in proportion to the density of the solution

A

Harmonic Oscillation Densitometry

37
Q

Example of Harmonic Oscillation Densitometry

A

Yellow IRIS (International Remote Imaging System)

38
Q

Harmonic Oscillation Densitometry

Urine volume:
For IRIS Slideless microscope:
For IRIS Mass Gravity Meter:

A

Urine volume: 6 mL
For IRIS Slideless microscope: 4 mL
For IRIS Mass Gravity Meter: 2 mL

39
Q

Important in the identification of crystals and determination of unsatisfactory specimens

A

pH

40
Q

Normal pH
o Random:
o 1st morning:
o pH of 9.0-

A

o Random: 4.5- 8.0
o 1st morning: 5.0- 6.0
o pH of 9.0- unpreserved urine

41
Q

Causes of Acid Urine (8)

A

Diabetes Mellitus (Inc. Ketone bodies)
Starvation (Inc. Ketone bodies)
High protein diet
Cranberry juice (Tx for UTI)
Emphysema
dehydration
diarrhea
presence of acid-producing bacteria (E.coli)

42
Q

Causes of Alkaline Urine (7)

A

Renal tubular acidosis
Vegetarian diet
After meal- due to alkaline tide (withdrawal of H ions)
Vomiting
Old specimens
hyperventilation
presence of urease-producing bacteria

43
Q

Reagent Strip Reaction for pH (60 secs): principle

A

Double indicator system

44
Q

Reagent Strip Reaction for pH (60 secs): Reagents

A

Methy Red
Bromthymol Blue

45
Q

Reagent Strip Reaction for pH (60 secs) : Interferences

A

No known interfering substances
Correlate: Nitrite, Leukocytes, Microscopic

46
Q

Most indicative of renal disease

A

Protein

47
Q

Indication of presence of protein in urine

A

Presence of white foam when shaken

48
Q

Major serum protein found in the urine

A

Albumin

49
Q

Albumin
Major serum protein found in the urine
Normal values:
Henry:
Stras:

A

Henry:<150 mg/day
Stras:<100 mg/day or <10 mg/dL

50
Q

Other proteins beside from albumin

A

• Serum and tubular microglobulins
• Tamm-Horsfall protein (Uromodulin)
• Protein derived from prostatic and vaginal secretion

51
Q

Caused by conditions that affect the plasma prior to it reaching the kidney

A

PRE-RENAL (“Before”) or Proteinuria (Overflow Proteinuria)

52
Q

PRE-RENAL (“Before”) or Proteinuria (Overflow Proteinuria)

Intravascular Hemolysis:
Muscle injury:
Severe infection/Inflammation:
Multiple Myeloma:

A

Intravascular Hemolysis: Increase Hemoglobin
Muscle injury: increase Myoglobin
Severe infection/Inflammation: increase acute phase reactants
Multiple Myeloma: Proliferation of Ig producing plasma cells= BENCE-JONES PROTEIN

53
Q

Tests for Bence-Jones Protein (2)

A

o Serum electrophoresis
o Immunofixation electrophoresis

54
Q

Bence-Jones Protein

In Urine:
Precipitates @ ? –> ?
Dissolves @ ? (?)

A

In Urine:
Precipitates @ 40-60 °C –> producing cloudy urine Dissolves @ 100 °C (clear urine)

55
Q

A. Glomerular Proteinuria
1. Diabetic Nephropathy
-Decrease _____
-May lead to ______
Indicator: _______

A

-Decrease GFR
-May lead to renal failure
Indicator: Microalbuminuria (Proteinuria undetectable by routine reagent strip)

56
Q

Proteinuria undetectable by routine reagent strip

A

Microalbuminuria

57
Q

Micral Test:
Principle:
Reading time:
False (-):
Result: (+) ____, (-) ____

A

Micral Test:
Principle: Enzyme immunoassay
Reading time: 60 seconds/1 minute
False (-): diluted urine
Result: (+) Red, (-) white

58
Q

Albumin Excretion Rate (AER)= in ug/min or in mg/24 hrs
Normal AER:
Microalbuminuria:
Clinical albuminuria:

A

Normal AER: 0-20 ug/min
Microalbuminuria: 20-200 ug/min
Clinical albuminuria: >200 ug/min

59
Q

Orthostatic Proteinuria is also known as

A

Cadet/ Postural Proteinuria

60
Q

Proteinuria when standing due to increased pressure to renal veins

A

Orthostatic Proteinuria

61
Q

ORTHOSTATIC PROTEINURIA

FIRST MORNING:
2 HOURS AFTER STANDING:

A

FIRST MORNING: -
2 HOURS AFTER STANDING: +

62
Q

CLINICAL PROTEINURIA

FIRST MORNING:
2 HOURS AFTER STANDING:

A

FIRST MORNING: +
2 HOURS AFTER STANDING: +

63
Q

Normally filtered albumin can no longer be reabsorbed

A

TUBULAR PROTEINURIA

64
Q

TUBULAR PROTEINURIA disorders: (3)

A

• Fanconi’s syndrome
• Toxic agents/ heavy metals
• Severe viral infections

65
Q

Post-renal proteinuria (After) (5)

A
  1. Lower UTI/ Inflammation
  2. Injury/ trauma
  3. Menstrual contamination
  4. Prostatic fluid/ spermatozoa
  5. Vaginal secretions
66
Q

Reagent Strip Reaction for Protein (60 secs) Principle

A

Protein (Sorensen’s) error of indicator

67
Q

Reagent Strip Reaction for Protein (60 secs): Reagents

A

Multistix: Tetrabromphenol blue
Chemstrip: Tetrachlorophenol tetrabromosulfonphthalein

68
Q

Reagent Strip Reaction for Protein (60 secs): Interferences

A

False (+): high SG, highly buffered alkaline urine, pigmented specimen, antiseptics, phenazopyridine, detergents
False (-): protein other than albumin, microalbuminuria

69
Q

Reagent Strip Reaction for Protein (60 secs): Remark

A

Indicator is sensitive to Albumin
Correlated to blood, nitrite, leukocytes, microscopic

70
Q

A cold precipitation test that reacts equally with all forms of protein

A

Sulfosalicylic Acid (SSA) Precipitation Test

71
Q

Reporting SSA Turbidity

Turbidity: Protein Range
(mg/dL)
Negative:
Trace:
1+
2+
3+
4+

A

Negative: no increase in turbidity; less than 6
Trace: Noticeable turbidity; 6-30
1+: Distinct Turbidity, no granulation; 30-100
2+: turbidity, granulation, no flocculation; 100-200
3+: turbidity, granulation, flocculation; 200-400,
4+: clump of protein; >400

72
Q

Most frequently tested in urine

A

Glucose (Dextrose)

73
Q

Renal threshold for glucose

A

160-180 mg/dL (plasma concentration of a subs. At which tubular reabsorption stops

74
Q

Increase blood glucose= increase urine glucose

A

Hyperglycemia-associated

75
Q

Causes of hyperglycemia

A

DM
Cushing’s syndrome (inc cortisol)
Pheochromocytoma (inc catecholamines)
Acromegaly (inc growth hormone)
Hyperthyroidism (inc T3, T4)

76
Q

Normal glucose=increase urine glucose

A

Renal-associated

77
Q

Cause of Renal-associated

A

Defective tubular reabsorption of glucose and amino acids

78
Q

Reagent Strip Reaction for Glucose (30 secs): principle

A

Double sequential Enzyme Reaction

79
Q

Reagent Strip Reaction for Glucose (30 secs): reagents

A

Multistix: Glucose oxidase, Peroxidase, Potassium iodide (blue to green to brown) Chemstrip: Glucose oxidase, Peroxidase, Tetramethylbenzidine (yellow to green)

80
Q

Reagent Strip Reaction for Glucose (30 secs): interferences

A

False (+): Oxidizing agents, detergents
False (-): Ascorbic acid, ketones, high SG, Low temperature, improper preserve urine

81
Q

Reagent Strip Reaction for Glucose (30 secs): remarks

A

Correlated: ketones, proteins

AUBF Lec (8 decks)

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