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AUBF > PRELIM-chemical examination of the urine > Flashcards

PRELIM-chemical examination of the urine Flashcards

1
Q

Simple, rapid means for performing medically significant chemical
analysis of urine

A

reagent strip

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2
Q

The
two major types of reagent strips are manufactured under
the trade names

A

Multistix (Siemens Healthcare Diagnostics,
Deerfield, IN)

Chemstrip (Roche Diagnostics, Indianapolis,
IN).

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3
Q

Chemical-impregnated absorbent pads are attached to a plastic strip

A

reagent strip

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4
Q

for the reporting, we follow _____ value. From trace, 1+, 2+, 3+, or 4

A

Semiquantitative

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5
Q

3 types of reagent strip

A
  • 4 parameters
    -10 parameters
  • 11 parameters
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6
Q

what are the 4 parameters in a 4-parameter type of reagent strip?

A

glucose - 35s
specific gravity - 45s
pH - 60s
protein 60s

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7
Q

what are the 10 parameters in a 10-parameter reagent strip?

A

glucose, SG, ph, protein ketone, blood, nitrite, bilirubin, urobilinogen, leukocytes

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8
Q

why do we need to blot the urine?

A

to prevent runover

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9
Q

what is the other substance we can measure in an 11-parameter reagent strip?

A

Ascorbic acid

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10
Q

what are the parameters corresponding time?

A

glucose - 30s
bilirubin - 30 s
ketone - 40 s
specific gravity - 45 s
blood - 60s
pH - 60 s
protein - 60s
urobilinogen - 60 s
nitrite - 60 s
leukocytes - 120s

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11
Q

Care of Reagent Strip

A
  • Store with desiccant in an opaque, tightly closed container.
  • Store below 30C; Do not freeze
  • Do not expose to volatile fumes
  • Do not use past the expiration date
  • Do not use if chemical pads are discolored
  • Remove strips immediately prior to
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12
Q

standard temperature we can store the reagent strip

A

below 30* C

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13
Q

Quality control of Reagent Strips

A
  • Test open bottles of reagent strips with known positive and
    negative controls every 24 hr.
    o Depends on the laboratory, sometimes every shifts
  • Resolve control results that are out of range by further testing
  • Test reagents used in backup tests with positive and negative
    control
  • Perform positive and negative controls on new reagent and newly
    opened bottles of reagent strips
  • Record all control results and reagent lot number
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14
Q

Major regulator of acid-base content of the body

A

Lungs and kidney

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15
Q

Why do we need to determine the pH of the urine? Or what is the clinical
significance of pH?

A

we can determine if the problem came from the tubules of the kidney or from the lungs.
If there’s no problem with the tubules, most probably the problem is with the lungs that is why some doctors request ABG or arterial blood gas analysis to check the reason for pH disturbance

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16
Q

which part of the tubule is affected is there’s a secretion of the HYDROGEN ION in the urine?

A

proximal tubules

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17
Q

which part of the tubule is affected is there’s a secretion of the AMMONIUM in the urine?

A

Distal convoluted tubule

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18
Q

what is the normal ph of the first morning urine in a healthy individual

A

pH 5.0-6

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19
Q

. In respiratory or metabolic acidosis not related to renal function disorders, the urine is ___

acidic or basilic?;

A

acidic

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20
Q

If respiratory or metabolic alkalosis is present, the urine is ___

A

alkaline

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21
Q

calcium oxalate, a frequent constituent of renal calculi, precipitates primarily in ____

A

acidic and
not alkaline urine.

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22
Q

maintaining urine in alkaline pH discourages formation of the calculi.

true or false

A

true

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23
Q

Maintaining an acidic urine can be valuable in treating
‘____ caused by urea-splitting organisms
because they do not multiply as readily in an acidic medium

A

urinary tract infections

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24
Q

has long been used as a home remedy for minor bladder in
fections because it inhibits the colonization of certain urinary
pathogens.

A

cranbrry juice

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25
Q

Collecting specimens in containers
other than the single-use laboratory-supplied containers
can produce a pH above 8.5 if alkaline detergent remains
in the container

true or false

A

true, that is why we should not re use containers

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26
Q

what is the normal ph level/range for a normal urine random sample in a healthy individual?

A

4.5 pH - 8.00 pH

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27
Q

what are the cause of the acidic pH in the urine?

A

Emphysema
Diabetes Mellitus
Starvation
Dehydration
Diarrhea
Presence of acid-producing bacteria
High protein diet
Cranberry juice
Medications
(Methenamine, Mandelate
[Mandelamine],
Fosfomycin tromethamine)

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28
Q

what are the cause of the alkaline pH in the urine?

A

Hyperventilation
Vomiting
Renal tubular acidosis
Presence of Urease-producing bacteria
Vegetarian Diet
Old Specimens

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29
Q

Clinical Significance of pH

A
  • Respiratory or metabolic acidosis/ketosis
  • Respiratory or metabolic alkalosis
    o Renal tubular acidosis → Detects in renal tubular
    secretion and reabsorption of acids and bases
  • Renal Calculi/stone formation
  • Treatment of urinary tract infections
  • Precipitation/Identification of crystals
  • Determination of unsatisfactory specimens
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30
Q

In acidic conditions, which carbonates are formed, is it amorphous urates or phosphate?

A

amorphous urate

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31
Q

In basic conditions, which carbonates are formed, is it amorphous urates or phosphate?

A

amorphous phosphate

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32
Q

the pH level on the reagent strip ranges from — to —

A

pH 5 to pH 9
orange to green

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33
Q

is there substance that can interfere with the pH test using the reagent strip?

A

No known substance to cause interference

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34
Q

what is the principle of pH in the reagent strip reaction?

A

Principle → Double-indicator system of methyl red and bromothymol blue

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35
Q

For the references in pH, for the methyl red, the pH level ranges from – to –

A

red to yellow (pH range 4-6)

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36
Q

For the references in pH, for the bromothymol blue, the pH level ranges from – to –

A

yellow to blue (pH range 6-9)

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37
Q

pH can be correlate with other test such as the

A

Nitrite
Leukocytes
Microscopic

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38
Q

the protein we detect in the urine is the

A

albumin

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39
Q

a low molecular weight, it is easily
excreted after the filtration of the glomerulus.

A

Albumin

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40
Q

it is an indicative of the renal disease particularly in the filtration

A

albumin/proteinuria

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41
Q

Other proteins
include small amounts of serum and tubular microglobulins are called
__

They are as well produced by the renal
tubular epithelial cells; and proteins from prostatic, seminal,
and vaginal secretions.

A

Tamm-Horsfall protein (uromodulin)

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42
Q

Uromodulin is routinely produced in
the ___

A

distal convoluted tubule

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43
Q

normal value of protein in urine

A

<10 mg

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44
Q

higher than 10 mg in urine is called

A

proteinuria

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45
Q

what is the clinical proteinuria level or range

A

≥ 30mg/dL or 300mg/L

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46
Q

a type of proteinuria that is Caused by conditions affecting the PLASMA prior to reaching the kidney

A

Pre-renal Proteinuria

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47
Q

pre renal transient reasons of increased level of albumin/glucose

A

hemoglobin,
myoglobin, and the acute phase reactants associated with
infection and inflammation.

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48
Q

Seen in case of multiple myeloma

A

Bence Jones Protein

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49
Q

a confirmatory test if the protein really is a myeloma or a bence jones protein is the

A

Serum electrophoresis

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50
Q

what is the screening test for bence jones protein?

A

Solubility test

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51
Q

characteristics of soluble test

A

o Coagulates at 40-60°C (Turbid)
o Dissolves when tempt reaches 100°C 9 (Clear)
o Filter at 100°C and observe for turbidity as it cools to 40
60°C

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52
Q

Proteinuria associated with true renal disease may be the result
of either glomerular or tubular damage.

A

Renal Proteinuria

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53
Q

glomerular damage might be caused by the following

A

o Amyloid material
o Toxic substances
o Immune complexes found in lupus erythematosus and
streptococcal glomerulonephritis

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54
Q

transient reasons of renal proteinuria

A

Strenuous exercise, dehydration or associated with hypertension
pre-eclampsia (pregnant women)

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55
Q

transient reason of pre-renal proteinuria

A

o Hemoglobin
o Myoglobin
o APR due to inflammation
o Not usually discovered in routine urine

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56
Q

a type of proteinuria wherein there will be some Disorders affecting tubular reabsorption

  • Filtered albumin can no longer be reabsorbed
A

Tubular (renal) proteinuria

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57
Q

a type of proteinuria wherein there will be a selective filtration that is impaired, there will be an increase in the rbcs and wbcs as well including CHON

A

Glomerular (renal) Proteinuria

58
Q

some reasons why there are renal tubular proteinuria

A

o Exposure to toxic substances and heavy metals
o Severe viral infections
o Fanconi Syndrome

59
Q

a type of proteinuria that is still part of the RENAL PROTEINURIA but Seen frequently in young adult whose standing for a long time

A

Orthostatic (Postural) Proteinuria

60
Q

a proteinuria that Appears in vertical position; disappears in horizontal position

A

Orthostatic (Postural) Proteinuria

61
Q

confirmatory test for orthostatic (postural) proteinuria

A

a first morning urine

62
Q

another type of proteinuria under the renal proteinuria that is associated with the Diabetes mellitus

A

Microalbuminuria

63
Q

in microalbuminuria, ___ leads to reduced glomerular filtration and
eventual renal failure

A

Diabetic nephropathy

64
Q

Onset of renal complications can first be predicted
by detection of ___

A

microalbuminuria

65
Q

a special reagent strip specific only with the albumin

A

micral test

66
Q

is microalbuminuria included on the reagent strip for the routine urinalysis?

A

no

67
Q

reference value of creatinine ration for microalbuminuria

A

Creatinine ration > 3.4mg/mmol

68
Q

organs affected by the post renal proteinuria

A

structures of the lower urinary tracts
o Ureters
o Bladder
o Urethra
o Prostate
o Vagina

69
Q

this type of proteinuria is can be affected by The presence of blood as the result of injury or menstrual
contamination

A

post-renal proteinuria

70
Q

this type of proteinuria is can be affected by The Presence of prostatic fluid and large amounts of spermatozoa

A

post-renal proteinuria

71
Q

based on the table
list the possible reason of pre-renal proteinuria

A

intravascular hemolysis
muscle injury
acute phase reactant
multiple myeloma

72
Q

based on the table
list the possible reason of tubular proteinuria

A

Fanconi syndrome
Toxic agent/heavy metal
severe viral infection

73
Q

based on the table
list the possible reason of renal proteinuria

A

Glomerular disorders
Immune complex disorders
Amyloidosis
Toxic agent
Diabetic Nephropathy
Strenuous activity
Dehydration
Hypertension
Pre-eclampsia
Orthostatic or postural
proteinuria

74
Q

based on the table
list the possible reason of post renal proteinuria

A

Lower urinary tract
infections/inflammation
Injury/trauma
Menstrual contamination
Prostatic fluid/spermatozoa
Vaginal secretion

75
Q

what is the principle of the protein (reagent strip)

A

Protein error of indicators

76
Q

give the reagents for protein reagent strip

A

Multistix: Tetrabromphenol blue
Chemstrip: or 3’,3”,5’,5”-tetrachlorophenol, 3,4,5,6-tetrabro-
mosulfonphthalein

77
Q

in order to check the intensity of the reaction, if the protein resulted in reagent strip as +1, we use the conventional method ___

A

SSA or sulfosalicylic acid test

78
Q

causes of the false-positive in protein reagent test

A

Highly buffered alkaline
urine
Pigmented specimens,
phenazopyridine
Quaternary
ammonium
compounds
Antiseptics, chlorhexidine
Loss of buffer from prolonged exposure of the
reagent strip to the specimen
high specific gravity

detergents ng container - that’s why it is not recommended to reuse urine containers

79
Q

causes of the false-negative in protein reagent test

A

proteins other than albumin
microalbuminuria

80
Q

what are the test we can correlate for the false-negative result of proteinuria

A

Blood
Nitrite
Leukocytes
Microscopic

81
Q

urine specimen used for micral test and immuno drip (microalbuinuria)

A

morning urine specimen

82
Q

urine collection for post renal proteinuria

A

midstream clean catch

83
Q

2 test of microalbuminuria

A

micral test and the immunodip

84
Q

principle of micral test

A

Enzyme Immunoassay -

Albumin in the urine binds to the antibody. The bound and unbound conjugates move up the strip by wicking action. Unbound conjugates are removed in a captive zone by
combining with albumin embedded in the strip. The urine
albumin-bound conjugates continue up the strip and reach an area containing enzyme substrate. The conjugated enzyme re-
acts with the substrate, producing colors ranging from white to red. The amount of color produced represents the amount
of albumin present in the urine. The color is compared with a
chart on the reagent strip bottle after 1 minute. Results range
from 0 to 10 mg/dL.

85
Q

____ reagent strips contain a gold-labeled antihu-man albumin antibody-enzyme conjugate.

A

Micral-Test

86
Q

The ___ reagent strip uses an immunochromo-graphic technique.

A

ImmunoDip

87
Q

Strips are individually packaged in specially designed containers. The container is placed in the urine spec-
imen for 3 minutes. A controlled amount of urine enters the
container through a vent hole. The urine encounters blue latex
particles coated with antihuman albumin antibody. Albumin
in the urine binds with the coated particles. The bound and
unbound particles continue to migrate up the strip. The mi-
gration is controlled by the size of the particles; unbound par-
ticles do not migrate as far as the bound particles. First a blue
band is formed by the unbound particles. The bound particles
continue to migrate and form a second blue band further up
the strip. The top band therefore represents the bound particles
(urine albumin) and the bottom band represents unbound
particles. The color intensity of the bands is compared against
the manufacturer’s color chart. albumin. A darker bottom band is negative, equal
band color is borderline, and a darker top band represents
positive results.

A

Immunodip

88
Q

how many minutes do we need to dip the immunodip container in the urine specimen?

A

3 minutes

89
Q

In the IMMUNODIP, The ___ therefore represents the bound particles
(urine albumin) and the bottom band represents unbound
particles.

A

top band

90
Q

how many seconds we need to dip the test for micral test in a urine specimen?

A

5 seconds

91
Q

principle for the albumin: creatinine ration

A

Sensitive albumin tests related to creatinine concentration to
correct for patient hydration

92
Q

interference in the creatinine ration

A

Interference: Visibly bloody or abnormally colored urine
* Creatinine: Cimetidine-false positive

93
Q

Heat and acetic acid’s reagent and + result

A

Reagent: Acetic Acid
o (+) Result: White Cloudiness

94
Q

Sulfosalicylic acid/exton’s test reagent and positive result

A

reagent: → Sulfosalicylic acid or sodium sulfate(+) Result: white ring at zone of contact

95
Q

Heller’s Ring Test ring test and + result

A

Reagent: Concentrated nitric acid
* (+) Result: White opaque ring

96
Q

Purdy’s Test’s reagent and + result

A

Reagent: 50% Acetic Acid
* (+) Result: White Cloudiness

97
Q

Picric Acid Test reagent and + test results

A

Reagent: Saturated solution of picric acid
* (+) Result: Precipitation

98
Q

robert’s ring test reagent and + results

A

Reagent: Magnesium sulfate or concentrated nitric acid
* (+) Result: White ring at the zone of Contract

99
Q

Potassium Ferrocyanide Test reagent and + results

A

Reagent: Glacial Acetic acid and K-Ferrocyanide
* (+) Result: Cloudiness (Proteases)

100
Q

reporting SSA turbidity

negative

A

no increase n turbidity
protein is < 6

101
Q

reporting SSA turbidity

trace

A

noticeable turbidity
protein in range 6-30 mg/dl

102
Q

reporting SSA turbidity

+1

A

distinct turbidity with no granulation
30-100 mg/dl

103
Q

reporting SSA turbidity

+2

A

turbidity with granulation with no flocculation
100-200 mg/dl

104
Q

reporting SSA turbidity

+3

A

turbidity with granulation and flocculation
200-400

105
Q

reporting SSA turbidity

+4

A

clumps of protein >400

106
Q

Esbach’s test reagent and positive result

A

Picric acid & Citric acid
Precipitation Grams/24hr

107
Q

Shevky and
Stafford test
reagent and specimen?

A

Tsuchiya’s
Precipitation Grams/24hr

108
Q

Kingsbury Clark
Test reagent and specimen

A

3% and 24 hr urine

109
Q

Kwilecki’s Test reagent and urine specimen

A

10% Ferric Chloride and 24 hr urine

110
Q

Purdy’s test reagent and urine specimen

A

50% Acetic Acide
10% K ferrocyanide and 24 hr urine specimen

111
Q

what is the glucose threshold of the renal reabsorbtion?

A

160 -180 mg/dl

112
Q

what is the clinical significance of glucose in the urine

A

it can be an indicative for the diabetes mellitus or the renal tubular nmalfunction

113
Q

Most informative glucose results are obtained from specimens
collected under controlled conditions

the patient should aonduct fasting or not?

A

needs a fasting, a morning fasting is not ideal. Discard the first urine then collect again for the best sample

114
Q

list the hyperglycemia associated in glucose determination

A

Diabetes mellitus
Pancreatitis
Pancreatic cancer
Acromegaly
Cushing syndrome
Hyperthyroidism
Pheochromocytoma
CNS damage
Stress
Gestational diabetes

115
Q

list the renal associated in glucose determination

A

Fanconi syndrome
Advance renal disease
Osteomalacia
Pregnancy

116
Q

interferences in glucose oxidase causing false positive results

A

Contamination by oxidizing
agents and detergents

117
Q

interferences in glucose oxidase causing false negative results

A

High levels of ascorbic acid
High levels of ketones
High Specific gravity
Low temperature
Improperly preserved
specimen

118
Q

what is the component of the absorbent pad for glucose reagent strip?

A

it is a mixture of glucose oxidase, peroxidase, chromogen, and buffer

119
Q

what is the principle for the glucose oxidase or the glucose reagent strip?

A

double sequential enzyme reaction

because of the reaction of the oxidase and the peroxidase

120
Q

Relies on the ability of Glucose and other substances to reduce
copper sulfate to cuprous oxide in the presence of Alkali and Heat

A

Copper Reduction Test

121
Q

Benedict’s Test’s reagent

A

CuSO4 - cupric sulfide
Sodium citrate
buffer
NaCO3

122
Q

positive results of benedict tests

A

(-) Blue
+/- (trace):
Green, no ppt.
1+: Green w/ ppt
2+: Yellow-green
w/ ppt
3+: Muddy
orange w/ ppt
4+: Orange to
brick red

123
Q

Clinitest’s reagent

A

cuso4 - cupric sulfide
Sodium citrate
buffer
NaCO3
NaOH

124
Q

Clinitest’s positive result

A

(Blue to
orange/red)

125
Q

Fehling’s Test
* A
* B

reagent and positive result

A

Cupric Salt/dH2O
Rochelle
Salt/KOH/dH2O

Yellow ppt

126
Q

steps for clinitest tablets

A
  1. Place five drops of urine in a clean test tube
  2. Add 10 drops of water to the urine in the test tube
  3. Place a clinitest tablet in the mixture of urine and water in the test
    tube
  4. Observe the reaction carefully. If sugar content isexcess of 2gm%
    there is a rapid production of an orange color which quickly turns
    to brown
  5. Wait 15 seconds after boiling
  6. Shake test tube gently to mix contents
  7. Compare the color produced with clinitest color chart
  8. Record the result
127
Q

Osazone Test
(Phenylhydrazine) reagent and positive result

A

Phenylhydrazine
HCl sodium
acetate

Bright yellow
needle crystal

128
Q

Nylander’s Test reagent and positive result

A

Bismuth
subnitrite

Brown-black
solution

129
Q

Moore Heller’s reagent and positive result

A

10% KOH

1% or less:
Canary Yellow
1-2%: Wine
yellow
2-3%: Cherry
Red
3-4%: Rum
>4%: Dark
Brown-Black

130
Q

test for fructose

A

Seliwanoff’s
Test

Borchardt’s
Test
(Resorcinol
and HCl)

Barfoed Test
(CuSO4 and
Hac)

131
Q

what are the test for pentose?

A

Bial Test

Cole Test
(FeCl3 and
Charcoal)

Tauber’s Test
(Benzidine
and Glacial
HAc)

Tollen’s Test
(Conc. HCl
and
Phoroglucin)

132
Q

what are the test for lactose

A

Rubner’s Test
(Lead acetate
and conc.
NH4OH)

Ormsby Test
(methylamine
HcL and
NaOH)

133
Q

what are the test for galactose

A

Mucin Acid
Test (Conc.
HNO3)

Tollen’s Test
(Conc. HCl
and
Phoroglucin)

Osazone Test

134
Q

what are the test for maltose and the positive result?

A

Barfoed’s - red color

135
Q

what is the principle for SG reagent strip

A

pKa change (Dissociation constant) of a polyelectrolyte in an
alkaline medium

136
Q

ranges of level of SG in the reagent strip

A

Blue (1.000) to shades of green-yellow (1.03)

137
Q

reagent for the SG in the 2 type of reagent strip - multistix and chemstrips

A

Multistix: Poly (Methyl vinyl ether/ Maleic anhydride)
bromthymol blue
o Chemstrips: Ethyleneglycoldiaminoethylethertetraacetic
acid, Bromthymol blue

138
Q

SG depends and only measure the body’s ______

A

ionic solute

139
Q

higher concentration of the urine, higher hydrogen ion. higher hydrogen ion, more urine components will lower the pH level. urine becoming more acidic

true or false?

A

true

140
Q
A
141
Q
A

AUBF (20 decks)

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