pH Causes of Acidic Urine (4) SCHD

1. Diabetes mellitus 2. Starvation 3. High protein diet 4. Cranberry Juice

pH Causes of Alkalosis (5) RAVVO

1. Renal tubular acidosis 2. Vegetarian diet 3. After meal 4. Vomiting 5. Old specimens

Chemical Examination of Urine Flashcards by Kyra Catedral

• Absorbent pads impregnated with different chemicals and concentration to react to a specific urinary components.

• A color producing reaction when the strip comes in contact with urine.

• Reactions are interpreted by comparing the color produced
on the pad with the chart
provided by the manufacturer semi- quantitative)

• Usually______ parameters

Reagent strips

4 or 10

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Handling & Storage
1. Strips must be protected from deterioration caused by: (4)
2. Do not play with nor remove____ from containers.
3.____ should be removed prior to testing and bottles resealed immediately.
4. Bottles not opened in the presence of_____.
5. Strip storage within____
6. Respect____.
7. Do not touch the____ of the strips.

moisture, volatile chemicals, heat and light

desiccants

Strips

volatile fumes

30°C

expiration dates

pad

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Chemical Examination of Urine
Reagent strips must be tested with positive and negative controls

(4)

• Record all control results

minimum of once every 24 hours
every after new bottle is opened
questionable results are obtained
when there is concern about the integrity of the strip.

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_____should not be used as a negative control.

The manufacturers will provide the controls.

• Distilled water

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Errors caused by Improper Technique
1. Formed elements such as red and white cells sink to the bottom of the specimen and will be undetected in an______ specimen
2. Allowing the strip to_______ may cause leaching of reagents from the pad
3.________ can produce a run-over between chemicals on adjacent pads, producing distortion of color.

unmixed

remain in the urine for an extended period

Excess urine remaining on the strip after its removal from the specimen

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What to do

To ensure against run-over…

blotting the edge of the strip on absorbent paper and holding the strip horizontally while comparing it with the chart

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Errors caused by Improper Technique

The timing for the reactions to take place varies among manufacturers and ranges from______
A ______is essential for accurate interpretation of color reactions
The strip must be held close to the_____

immediate reaction for pH to 120 seconds for the leukocyte esterase. (60-120seconds)

good light source

color chart without actually placing on the chart

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Errors caused by Improper Technique

_______from different manufacturers are not interchangeable
Specimens that have been refrigerated must be______ prior to reagent strip testing as the
enzymatic reactions are_____-dependent

Reagent strips and color charts

allowed to return to room temperature

temperature

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Chemical Examination of Urine
2 major brands of Reagent Strips

Multistix Bayer Atlas (Siemens Medical Healthcare
Diagnostics)
Chemstrip (Roche - Boehringer Manheim Diagnostics)

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10 parameters

• pH
• Proteins
• Glucose
• Ketones

• Blood
• Bilirubin
• Urobilinogen
• Nitrite

• Leukocytes
• Specific gravity

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• The average adult on a normal diet excretes about______ of hydrogen ions in 24 hours to produce urine of about pH____.

In healthy individuals, urine pH may vary from____

50-100 mEq

4.5-8

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Dyes

• (pH range 4 to 6)
• (pH range of 6 to 9)

Methyl red

Bromthymol blue

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• No normal values because of the following patient info:
• Patient’s renal function
• Urinary Tract Infection
• Dietary intake
• Age of specimen

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• Measurement of urine pH and acidity must always be made on ______ specimens.

• The container should be filled to minimize the amount of dead space, and the urine covered tightly.

• The container should be kept____

freshly voided

cold, preferably on ice, but not frozen

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Causes of Acidic Urine (4)

SCHD

Diabetes mellitus
Starvation
High protein diet
Cranberry Juice

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Causes of Alkalosis (5)

RAVVO

Renal tubular acidosis
Vegetarian diet
After meal
Vomiting
Old specimens

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• Used in monitoring urine alkalinization in patients receiving high - dose methotrexate therapy or undergoing treatment for nephrolithiasis

pH Electrode

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• Used in the diagnosis and treatment of patients with disturbances of acid - base balance

pH Electrode

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• Accurate measurement of urinary pH using pH meter and glass electrode

pH Electrode

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Protein

- before the blood reaches the kidneys
- the problem developed within the kidneys
- below the kidneys

Pre - renal

Renal

Post - renal

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Overflow proteinuria

Normal Proteins:
Myoglobin, Hemoglobin, Acute Phase Reactants

• Muscle injury
• Intravascular hemolysis
• Infection
• Multiple Myeloma

Pre - renal

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Glomerular proteinuria
Tubular proteinuria

Selective or Non-selective

• Glomerular Diseases

Renal

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Urine includes proteins produced by the urinary tract or the urine is contaminated with proteins during excretion

Pus, menstrual blood, vaginal & prostatic secretions

• Inflammation
• Malignancy
• Contamination during urination

Post - renal

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● The presence of increased amounts of ____ in
the urine can be an important indicator of renal disease.

○____ should not be present in the
urine

Study These Flashcards

PROTEIN ; Albumin

Proteins CLINICAL SIGNIFICANCE a. Caused by conditions affecting the plasma prior to it reaching the kidney through increased levels of: Hemoglobin, Myoglobin, Acute phase reactants

Pre-renal Proteinuria

(Protein present in patient's with Multiple Myeloma)

Bence Jones Protein

BJP * perform_______ to confirm * Best detection and quantification for the abnormal protein is demonstrated using Electrophoresis and Immunofixation Electrophoresis

Solubility Test

Light chain Heavy chain

• Kappa • Lambda • IgG • IgA • IgM • IgD • IgE

Bence Jones Protein • Precipitates at temperatures between____ and redissolves at____

40° - 60° 100 °C

Gamma

Immunoglobulins IgA: closer to beta region IgM: between beta and gamma region IgG: throughout gamma region

Protein CLINICAL SIGNIFICANCE • Proteinuria associated with true renal disease resulting from either ***glomerular or tubular damage***

Renal Proteinuria

• Proteinuria also seen with strenuous exercises, dehydration and hypertension may be reversible.

Renal proteinuria

• Other conditions: pre-eclampsia, disorders affecting tubular reabsorption • Proteins seen in random samples may not be at all times pathologically significant. Benign conditions may be exposure to cold, strenuous exercise, high fever, and dehydration

Renal proteinuria

Renal Proteinuria - normally filtered albumin can no longer be reabsorbed (Fanconi syndrome, toxic agents, severe viral infections

• Tubular Proteinuria

Renal Proteinuria * excreted by patients with DM * detected in the onset of renal complications as well as progression of renal disease ***not detected though routine reagent strips***

• Microalbuminuria

Renal Proteinuria * Benign, frequently seen in young adults following periods spent in vertical position and disappearing after assumption of horizontal position

Orthostatic (Postural) Proteinuria

Orthostatic proteinuria RESULTS First Morning 2 hours after standing

Orthostatic Proteinuria - + Clinical Proteinuria + +

• Low concentration of albumin, that ***cannot be detected by protein reagent strip***

Microalbuminuria

Microalbuminuria • - test that has a sensitivity of ***1.5 - 2.0*** • Immunochemical • Positive result (color___) - depends

Micral Test red

• Proteins added to a urine specimen as it passes through the lower UT (ureters, bladder, urethra, prostate, and vagina) • Production of exudate in bacterial and fungal infections, presence of blood as result of menstrual contamination (contributes protein), or presence of prostatic fluid and large amounts of spermatozoa

Post - Renal Proteinuria

• Qualitative method that depends on formation of a precipitate for determination of the presence of protein

SULFOSALICYLIC ACID METHOD

SULFOSALICYLIC ACID METHOD _______+______ • Detects albumin, globulins, glycoproteins, and BJP

3mL of centrifuged urine + 3mL of 3% SSA

SSA Grading Grade Turbidity Protein Range (mg/dL) Negative No increase in turbidity Trace Noticeable turbidity 1+ Distinct turbidity with no granulation

<6 6-30 30-100

SSA Grading Grade Turbidity Protein Range (mg/dL) 2+ Turbidity with granulation but no flocculation 3+ Turbidity with granulation and flocculation 4+ Clumps of protein

100-200 200-400 >400

Glucose • Used to detect sufficient quantities of any ***reducing substances*** in the urine (lactose, fructose, galactose, maltose, and pentose) • Determine if there's a strong reducing substances that inhibits the enzymatic method.

Copper Reduction Method

• Clinitest Tablet Test principle

Copper reduction

• Contains: copper sulfate, sodium hydroxide, sodium carbonate, and citric acid.

Clinitest Tablet Test

Clinitest • Copper sulfate reacts to the reducing substances in the urine, converting____ to ____ •_____ is caused by the reaction of sodium hydroxide and water with citric acid.

cupric sulfate to cuprous oxide. Heat

Clinitest tablets • Detects_____ of reducing substances

250mg/dL

Glucose Clinitest Tablet Test (2 Types of Method)

(Five Drop Method) (Two Drop Method)

• are formed during the catabolism of fatty acids.

Ketones, or ketone bodies

• Ketone bodies represent: (3)

• Acetoacetic acid (diacetic acid) - 20% • B-hydroxybutyric acid - 78% • Acetone - 2%

Ketones • Used if there is an interfering urine color • Can be used for whole blood, plasma, serum, or urine. • Detects 5-10mg/dL of AAA in urine, and 20-25mg/dL of acetone in urine • Place one drop of the fluid to the tablet, then interpret.

Nitroprusside Tablet Test • Acetest Tablet Test

Nitroprusside tablet test • Contains

sodium nitroprusside, glycine and a strong alkaline buffer

Ketones Nitroprusside Tablet Test • Interpretation: • Urine - after____ • Serum or Plasma - after____ • Whole Blood - for____

30 seconds 2 minutes 10 minutes

in the urine sample is an indication of a possible bleeding episode in the renal tract.

Blood

Pseudoperoxidase Activity of Hemoglobin Based on the liberation of oxygen from____ in the reagent strip by the peroxidase-like activity of____ in free hemoglobin, lysed erythrocytes, or myoglobin.

peroxide heme

______ aka _______ is a method used to differentiate between myoglobinuria (myoglobin in urine) and hemoglobinuria (hemoglobin in urine).

Blondheim test, also known as the ammonium sulfate precipitation test,

Ammonium Sulfate Precipitation • Obsolete way to differentiate hemoglobin from myoglobin • Requires_____ added to_____ •_____ is tested for blood reaction using reagent strip

2.8g of ammonium sulfate 5mL centrifuged urine Supernatant

Chemical Examination of Urine Flashcards

(59 cards)