Ch 5 Urinalysis Flashcards by Chris Weber

Clinical reasons for performing urinalysis testing

An important indicator of health
A screening test for various functions
Cost effective
Non-invasive procedure
Simple to perform

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A screening test to detect and assess:

Renal function/disorder

Endocrine or Metabolic function/disorder

Urinary tract infection

Systemic diseases

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Methods of Urine Collection

Non-instrumented

Instrumented

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Non-instrumented Collection

First-morning void

Random urine specimen

Clean catch urine specimen

24-hour urine specimen

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Instrumented collection

Urethral catheterization

Suprapubic Needle Aspiration

Catheterization and Bladder Irrigation

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UA’s should be analyzed while:

Fresh, within 1-2 hours

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If unable to test the urine specimen at time of delivery, you should:

Refrigerate the specimen within 3-6 hours

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What will happen to the UA if left at room temperature?

Decompose due to bacteria and deliver inaccurate results

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Produces ammonia

Urea splitting bacteria

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Ammonia combined with hydrogen irons will:

Increase pH

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Glucose in the urine that is used by bacteria for energy will result in:

False negative for glycosuria

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Will deteriorate if left without any preservative

Urinary elements, like blood cells and casts

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Most concentrated

Increase number of abnormal elements

Decreased deterioration of formed elements

Recommended specimen for chemical and microscopic examination

First morning void

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Collected anytime

Most convenient and most common

Can detect abnormalities but not as sensitive as first morning void

Random UA

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Specimen of choice for bacterial cultures

Perform cultures within 12 hours after collection, only if refrigerated
Genitalia must be cleaned with mild antiseptic solution
Collect midstream in a sterile container

Clean catch UA

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Gives quantitative results

Preservatives may be needed

24-hour UA

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Not recommended for bacteriologic examination

Use only if no other way to collect urine

Commonly used on obese patients with difficulty in urine collection

Urethral Catheterization

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Used in place of catheter for obtaining a single UA

Avoids vaginal and urethral contamination

Performed for bladder outlet obstruction (urinary retention)

Suprapubic Needle Aspiration

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Vigorous transcatheter agitation

Yields optimum cellular sample of bladder epithelium for cytologic study

50-72 mL saline inserted into bladder

Catheterization and Bladder irrigation

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Urine sample analysis:

Physical
Chemical
Microscopic

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Physical analysis includes:

Volume

Color

Turbidity

Odor

Specific Gravity

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Normal volume in a 24-hour period ranges from:

600-2000 mL

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Average 24-hour volume

1500 mL

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Amount of volume of urine is directly related to:

Fluid intake

Temperature and climate

Amount of perspiration

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Gives color to urine

Pigment (urochrome) concentration

Normal color

Straw (light yellow) to dark amber

Color can vary because of:

Foods or medications

Blue green

Methylene blue

Dark orange

Pyridium

Milky white

Chyle

Olive green to brown black

Phenols (poisonous compound, antimicrobial agent)

Yellow to brown (green foam when shaken)

Bile

Red or red-brown (smokey)

Blood

Turbid alkaline is due to:

Amorphous phosphate Amorphous carbonate

Turbid Acidic urine is due to:

Amorphous urates

Pinkish turbidity frequently indicates the presence of:

Urates

Normal urine has a characteristic odor due to:

Volatile acids

Ammonia odor is due to:

breakdown of urea by bacteria

Not considered to be of special diagnostic importance

Odor

Sweet or fruity smell

Ketones

Pungent smell

Ammonia produced by bacteria

Maple syrup smell

Congenital metabolic disease

Musty or mousy smell

Infant with phenylketonuria

Specific gravity of random urine

1.003-1.035

Specific Gravity of 24-hour urine

1.015-1.025

Chemical Analysis includes:

1) Glucose 2) Ketones 3) Occult blood 4) Bilirubin 5) Urobilinogen 6) pH 7) Protein 8) Nitrite 9) Leukocyte esterase (LE)

Normal glucose

Negative

Urine glucose is dependent on

Blood glucose Glomerular filtration Degree of tubular reabsorption

Glucosuria will appear in urine once _____ in blood is exceeded

160-180 mg/dL

Glucose may indicate

Diabetes mellitus Hyperglycemia condition

Normal ketones

Negative

Ketonuria is a result of:

incomplete fatty acid utilization

Ketones may indicate:

Diabetes mellitus

Increase ketone in the blood or urine

Ketosis

Ketosis is found in conditions like:

Decreased carbohydrates Diabetes Dietary imbalance (High fat/low carb) Eclampsia Prolonged vomiting Diarrhea

Intact RBCs present in the urine may indicate:

Damage/trauma to kidney or urinary tract Renal Diseases - Glomerulonephritis - Malignant HTN - Polycystic kidney disease Menstrual contamination or exercise

Normal bilirubin

Negative

Any condition that causes ______ will cause bilirubin in urine

Jaundice

Yellow to brown (greenish foam when shaken)

Bilirubin

Bilirubinuria indicates

Hepatocellular disease Intra or extra-hepatic biliary obstruction

Normal Urobilinogen

<1 EU or <1 mg/dL

Any increase indicates liver disease and hemolytic disease

Urobilinogen

Range for pH

4.6 to 8.0

Average pH

6.0

Pathologic conditions that may cause acidic urine

Respiratory and metabolic acidosis UTI (E. Coli) Uremia Severe diarrhea Starvation

Pathologic conditions that cause alkaline urine:

UTIs (Proteus and Pseudomonas species) Respiratory and metabolic alkalosis

Normal protein

Negative

Important indicator for renal disease

Protein

Two mechanisms that cause proteinuria:

Glomerular damage Defect in the reabsorption process of the tubules

Minimal proteinuria

(<0.5 g/day)

Moderate proteinuria

0.5-3.5 g/day

Severe proteinuria

>3.5 g/day

Polycystic kidneys Chronic pyelonephritis Inactive chronic glomerulonephritis Benign orthostatic proteinuria

Minimal proteinuria

Nephrosclerosis Tubular interstitial disease Preeclampsia Diabetes nephropathy Malignant HTN Pyelonephritis with HTN Toxic nephropathies

Moderate Proteinuria

Glomerulonephritis Lupus nephritis Amyloid disease Lipoid nephrosis Intercapillary glomerulosclerosis Severe venous congestion of the kidney

Severe proteinuria

Normal nitrate

Negative

Nitrite is formed by:

Breakdown of nitrates (E. coli)

Enzyme Released by neutrophils in urine Indirect test for bacteriuria

Leukocyte esterase (LE)

Associated with an inflammatory process in or around the urinary tract

Leukocyturia

Macroscopic analysis

Appearance

Chemical analysis

Dip stick

Microscopic analysis

Looking for Formed elements

Most UA consist of:

Macroscopic analysis Chemical analysis Microscopic analysis

Normal RBC Range (high power field)

0-3

Normal WBC range (high power field)

0-2

Normal epithelial cell range (HPF)

0-1

Normal bacterial range

Negative to trace

Critical values:

Strong positive for glucose and ketones Glucose >1000 mg/dL, with small, medium, or large ketones Urine Colony Count >50,000 colonies/mL

Normal secretion range of proteins

10-100 mg

Clinical proteinuria is defined as the loss of

>500mg/day

Mild proteinuria may be the result of:

HTN Lower UTI Fever Exercise

Moderate proteinuria may be the result of:

CHF Chronic glomerulonephritis Acute glomerulonephritis Diabetic nephropathy Pyelonephritis

Significant (Severe) Proteinuria may be the result of:

Amyloid Chronic glomerulonephritis (severe) Diabetic nephropathy Lupus nephritis

Persistent pH >7.0 is associated with what kind of stones?

Calcium carbonate Calcium phosphate Magnesium-ammonium phosphate

Persistent pH's below 5.5 are associated with what kind of stones?

Crystine Uric acid

Increase in urobilinogen is usually from:

Hemolytic anemia Cirrhosis Viral Hepatitis

Absent in total biliary obstructions

Urobilinogen

Obstructions in the bile duct

Bilirubin (dark yellow to greenish brown)

Dipsticks for blood are dependent on the presence of:

Hemoglobin RBCs Myoglobin

Dipstick can detect as few as ____ RBCs (HPF)

1-2

Presence of how many RBCs is abnormal

A normal healthy person may have RBCs from:

Exercise

Persistent RBCs may indicate:

Glomerulonephritis Kidney stones Cancer Infection

May lead to a false positive of RBCs and is highly suggestive of rhabdomyolysis

Myoglobin

Significant pyuria is defined by

>3 WBCs

Indirect indicators for UTI

Leukocyte esterase and WBCs Nitrite

Ketones and ketonuria along with glucose is suggestive of uncontrolled:

Type 1 diabetes

Microorganisms found is urine is most likely from:

Contamination

Number of epithelial cells found that is normal

Increased epithelial cells may indicate

Acute necrosis or inflammation (Glomerulonephritis)

Ch 5 Urinalysis Flashcards

(110 cards)