Urine Bilirubin Interpretation - Normal: - Urine Bilirubin - Urine Urobilinogen

Urine Bilirubin Interpretation - Normal: - Urine Bilirubin - (Neg) - Urine Urobilinogen - (+/-)

Urine Bilirubin Interpretation - Unconjugated Bilirubinemia: - Urine Bilirubin - Urine Urobilinogen

Unconjugated Bilirubinemia: - Urine Bilirubin - (Neg) - Urine Urobilinogen - (Neg)

Urine Bilirubin Interpretation - Conjugated Bilirubinemia: - Urine Bilirubin - Urine Urobilinogen

Conjugated Bilirubinemia: - Urine Bilirubin - (Pos/+) - Urine Urobilinogen - (Pos/+++)

Body Fluids: Urine Flashcards by Filip Garrett

Red Urine is seen in what conditions? (3)

*Urine dipstick results

Hematuria (RBCs)
Hemoglobinuria (Free Hgb)
Myoglobinuria

*All 3 will produce a positive hemoglobin result on dipstick

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Red urine with Negative Hemoglobin on dipstick causes? (5)

Porphyria
Rifampin
Pyridium
L-Dopa (aldomet)
Beets

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What conditions produce a Brownish/Black urine? (2)

Alkaptonuria

- Methemoglobinuria

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What causes Blue/Green Urine?

Pseudomonas infection

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Glycosuria with normal renal function:

“Renal Threshold”
Pregnancy

180 mg/dL serum glucose (“Renal Threshold”)

-Pregnancy Lower the threshold

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Glycosuria with renal tubular dysfunction:

Caused by
Serum glucose

Impaired Reabsorption

-Serum glucose may be normal

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The presence of what, inhibits several dipstick tests?

-Test (5)

Ascorbate Inhibits Dipstick tests for:

Glucose
Hemoglobin
Bilirubin
Nitrite
Leukocyte esterase

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What is the normal urine protein amount?

-predominantly what protein?

150 mg/day

-Tamm-Horsfall (Tubular) protein

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T/F: Vigorous excercise, dehydration and fever may cause increased urine protein.

True

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The urine dipstick is sensitive mainly to what protein?

Albumin

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What are the 3 major ketones in blood and urine?

Acetone
Acetoacetic Acid
B-Hydroxybutyrate

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What ketone is the urine dipstick mainly sensitive to?

*what other urine test is the same

Acetoacetic Acid

*Tablet Test (Acetest)

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Hematuria - Microscopic findings.

Erythrocytes in urine

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Hemoglobinuria - Microscopic findings.

-Stain

Hemosiderin-laden macrophages/monocytes

-Prussian Blue stain

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How is Myoglobinuria distinguished from Hematuria and Hemoglobinuria? (3)

Clinical History
Creatine Kinase
Normal Haptoglobin

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Urinary Bilirubin is indicative of what?

Conjugated Hyperbiliriubinemia

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What type of bilirubin does NOT pass through the Glomerulus?

Unconjugated bilirubin

*Urinary Bilirubin is indicative of Conjugated Hyperbilirubinemia

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Urobilinogen is the product of what?

Hydrolysis of bilirubin by Intestinal Bacteria

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Urine Bilirubin Interpretation - Normal:

Urine Bilirubin
Urine Urobilinogen

Urine Bilirubin Interpretation - Normal:

Urine Bilirubin - (Neg)
Urine Urobilinogen - (+/-)

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Urine Bilirubin Interpretation - Unconjugated Bilirubinemia:

Urine Bilirubin
Urine Urobilinogen

Unconjugated Bilirubinemia:

Urine Bilirubin - (Neg)
Urine Urobilinogen - (Neg)

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Urine Bilirubin Interpretation - Conjugated Bilirubinemia:

Urine Bilirubin
Urine Urobilinogen

Conjugated Bilirubinemia:

Urine Bilirubin - (Pos/+)
Urine Urobilinogen - (Pos/+++)

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The presence of urine Nitrate indicates what?

Presence of Nitrite producing organisms

-E. coli

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What are Nitrite Negative Agents of UTIs? (3)

Enterococci
N. gonorrhoea
M. tuberculosis

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What urine test is a reflection of the number of urinary neutrophils?

Leukocyte Esterase

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What are possible sources of a False-Positive Urine Leukocyte Esterase? (2)

- Trichomonads | - Eosinophils

The urine specific gravity is _______ when the urine is concentrated

Increased *The urine specific gravity is Increased when the urine is concentrated

What is isothenuria? - Specific Gravity - Cause/Result

Specific Gravity is fixed at 1.010 | -Tubular Damage results in the urine specific gravity equaling the glomerular filtrate

What is the normal Urine pH?

Urine pH = 6.0 | -mildly acidic

In general, patients with Acidosis (metabolic or respiratory) should be producing urine with a pH of __, whiles those with Alkalosis (metabolic or respiratory) should produce urine with pH of __.

- pH = 6.0 | - pH = >6.0

What happens to urine pH in Renal Tubular Acidosis (RTA)? (2)

- Urine is inappropriately Alkaline relative to blood pH | - Kidneys cannot acidify the urine beyond pH 6.5

Urine Crystal Morphology: | -Calcium oxalate

"Envelopes"

Urine Crystal Morphology/Polarization: | -Uric Acid

- Pleomorphic (Diamond, Square, Rod-shaped) | - Polarize in a variety of colors

Urine Crystals - Triple Phosphate: - Composition (2) - Morphology - Complication

Magnesium Ammonium Phosphate/Struvite - "Coffin Lids" - "Staghorn Calculi" (75% are Struvite)

Urine Crystals - Triple Phosphate: | -When do they form? (2)

- Alkaline pH | - Urea-splitting organisms (P. mirabilis)

What organisms is capable of urea-splitting and can cause Staghorn Calculi?

Proteus mirabilis

Urine Crystals with "Thorn Apples" morphology.

Ammonium burate

Urine Crystals - Morphology: -Cystine *related to what?

Hexagonal cystals *related to cystinuria

Urine Crystals - Morphology: | -Tyrosine (2)

-"Silky" or -"Sheaves of Wheat"

Urine Crystals - Morphology: | -Cholesterol

"Broken Panes of Glass"

Urine Crystals - Morphology: | -Sulfa

"Fans"

Urine Crystals - Morphology: | -Bilirubin

Yellow-Brown Needles

The majority of kidney stone are composed of what? - 2nd - 3rd

Calcium Oxalate (70%) - Calcium Phosphate - Struvite (magnesium ammonium phosphate or triple phosphate stones)

What promotes the formation of Calcium Oxalate crystals? (4)

- Low Urine Volume (ALL stone types) - Low Urinary Citrate - Hypercalciuria - Oxaluria

What causes Increased Oxaluria? (2)

- Crohn's Dz (s/p sm. bowel resection) | - Ingestion of Rubarbs, Spinach, Nuts

T/F: Urinary pH has little effect on calcium oxalate cyrstallization

True

What promotes the formation of Calcium Phosphate stones? (3)

- Low Urine Volume - Hypercalciuria - Elevated (Alkaline) pH

What promotes the formation of Urate stones? (2)

- Acidic pH | - Hyperuricosuria

What are the microscopic findings in Glomerular Bleeding? (3)

- Polymorphous RBCs - RBC casts - Erythrophagocytosis

What are the microscopic findings in Non-Glomerular Bleeding? (3)

- Uniform RBCs - NO RBC casts - NO erythrophagocytosis

Red Cell Casts: - Specific for? - Morphology (2)

Glomerulonephritis - Lumpy edges - Anucleate, slight reddish, pale discs

White Cell Casts: - Found in what condition? - Morphology

Tubulointerstitial Nephritis/Pyelonephritis | -Nucleate cells w/ typical lobated nuclei of neutrophils

Tubular Casts: - Indication of what? - Composed of? - Morphology

- Acute Tubular Necrosis - Renal Tubular Cells - Mononuclear, cuboidal cells

Granular Casts: - Nonspecific but typically present when? - Morphology - Often found with what other Cast

Significant Renal Disease - Acellular - Rough, Granular (fine or coarse) surface - Hyaline casts

Granular and Hyaline casts can been seen in what conditions? (4)

- Vigorous exercise - Dehydration - Heat-related Trauma - Renal disease

Waxy Casts: - Indicative of what? - Morphology (4)

Severe Renal Disease - Acellular - Blunt Ends - Pale Yellow color - Cracks along their lenght

How do you distinguise Waxy casts from that of Nonspecific Casts (Granular/Hyaline)?

Diameter is >2X that of nonspecific casts

Broad Casts: - Indicate - Morphology - Correspond to what?

- Endstage Renal Disease - Unusually broad (waxy,hyaline,or granular casts) - Widely dilated collecting ducts seen in advance atrophy

Fatty Casts: - Indicative of - Common feature - Morphoology - Polarized light

Nephrotic syndrome - Lipiduria is common feature - Cellular casts in which lipid droplets are absorbed - Maltese Cross appearance w/polarized light

Urine Microscopy in Acute Renal Failure - Acute Tubular Necrosis (ATN): - RBCs - Casts - Erythrophagocytosis (+/-) - Granulocytes (+/-)

Acute Tubular Necrosis (ATN): - RBCs - normal numbers (nonglomerular) - Casts - Tubular - Erythrophagocytosis - NO - Granulocytes - Scant

Urine Microscopy in Acute Renal Failure - Rapidly Progressive Glomerulonephritis (RPGN): - RBCs - Casts - Erythrophagocytosis (+/-) - Granulocytes (+/-)

Rapidly Progressive Glomerulonephritis (RPGN): - RBCs - Increased (Glomerular) - Casts - Red Cell - Erythrophagocytosis - PRESENT - Granulocytes - Scant

Urine Microscopy in Acute Renal Failure - Acute Interstitial Nephritis (AIN): - RBCs - Casts - Erythrophagocytosis (+/-) - Granulocytes (+/-)

Acute Interstitial Nephritis (AIN): - RBCs - Normal numbers (nonglomerular) - Casts - Tubular Casts - Erythrophagocytosis - NO - Granulocytes - Numerous (neuts/eosinophils)

Body Fluids: Urine Flashcards

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