Chemical Examination of Urine (DJIP) Flashcards
1
Q
Major types of reagent strips
A
- Multistix
- Chemstrip
2
Q
Source of errors of using reagent strips
A
-Unmixed specimen o Keeping strip in urine too long o Excess urine on strip o Imprecise timing o Light source o Reagents strips and color charts from different manufacturers are not interchangeable o Sample must be at room temperature
3
Q
True or false. Enzymatic
reactions are temperature dependent
A
true
4
Q
pH of first morning urine
A
pH 5.0-6.0
5
Q
Defects in renal tubular secretion and reabsorption of
acids and bases
A
—renal tubular acidosis
6
Q
Normal pH range
A
4.5-8.0
7
Q
pH condition observed after meals
A
Alkaline tide
8
Q
Chemical finding most indicative of renal disease
A
protein
9
Q
Causes of acidic urine
A
·Emphysema · Diabetes mellitus · Starvation · Dehydration · Diarrhea · Acid producing bacteria (E. coli) · High protein diet · Cranberry juice · Medications: Methenamine mandelate, fosfomycin tromethamine
10
Q
Causes of alkaline urine
A
· Hyperventilation · Vomiting · Renal tubular disease · Urease producing bacteria · Vegetarian diet · Old specimens
11
Q
Clinical proteinuria level
A
≥ 30 mg/dL
12
Q
3 major categories of proteinuria
A
- prerenal
- renal
- postrenal
13
Q
Kind of protein increased in Intravascular hemolysis
A
Hemoglobin
14
Q
Kind of protein increased in muscle injury
A
myoglobin
15
Q
Kind of protein increased in multiple myeloma
A
bence-jones protein
16
Q
bence jones protein coagulate at what temp
A
40-60C
17
Q
bence jones protein dissolve at what temp
A
100
18
Q
kind of renal proteinuria when there are:
- Fanconi syndrome
- Toxic agents/heavy metals
- Severe viral infections
A
Tubular proteinuria
19
Q
Due to vertical posture
A
Orthostatic (Postural) proteinuria
20
Q
Due to increased pressure on renal vein
A
Orthostatic (Postural) proteinuria
21
Q
solution to postural proteinuria
A
empty bladder before going to bed
and obtain a first morning specimen, then
obtain a second specimen after a few hours in
vertical position
22
Q
-Diabetic nephropathy
- Leads to reduced glomerular filtration and
renal failure
A
Microalbuminuria
23
Q
kind of proteinuria in Bacterial and fungal infections (UTI) [produce
exudates]
A
Postrenal proteinuria
24
Q
Reagent of Multistix (protein)
A
:tetrabromphenol blue
25
Reagent of chemstrip (protein)
3’,3’’,5’,5’’-tetrachlorophenol-
| 3,4,5,6-tetrabromosulfonphthalein
26
sources of false positive when using a reagent strip
- Highly buffered alkaline urine
- Pigmented sx (phenazopyridine)
- 4° ammonium compounds (detergents)
- Antiseptics, chlorhexidine
- Loss of buffer due to prolonged exposure
- High specific gravity
27
sources of false negative when using a reagent strip
- Proteins other than albumin
| - Microalbuminuria
28
Reagents of micral test
Gold-labeled antibody
· B-galactosidase
· Chlorophenol red galactoside
29
confirmatory test for albumin
Sulfosalicylic Acid Precipitation Test (SSA)
30
Most frequent chemical analysis
glucose
31
Reagent strip rxns for glucose
Blue-green to orange-red color
32
tablet used for glucose measurement
clinitest
33
true or false. Tablets are very hygroscopic
true
34
Intermediate products of fat metabolism
ketones
35
inadequate intake of carbohydrates
starvation
36
inadequate
| absorption of carbohydrates
Malabsorption/pancreatic disorders
37
reagent strip reactions for ketones
purple
38
tablet used for ketone test
acetest
39
```
give the Clinical significance:
- Due to trauma or damage of genitourinary organs
Renal calculi
Glomerulonephritis
Pyelonephritis
Tumors
Trauma
Exposure to toxic chemicals
Anticoagulants
Strenuous exercise
Menstruation
```
hematuria
40
give the clinical signifance:
Heme-containing protein found in muscle tissue
- Clear red-brown urine
- Suspected in patients with conditions associated
with muscle destruction (eg. Rhabdomyolysis)
myoglobinuria
41
Reagent strip reactions (blood)
o Pseudoperoxidase activity of hemoglobin to catalyze
reaction with hydrogen peroxide and the chromogen
tetramethylbenzidene
o Green-blue color
42
o Early indicator of liver disease; detected before jaundice
bilirubin
43
tablet for bilirubin test
ictotest
44
ictotest reagent tablet composition
◦ P-nitrobenzene-diazonium-p-toluenesulfonate
◦ SSA
◦ Sodium carbonate
◦ Boric acid
45
positive result for bilirubin in ictotest
: blue to purple color
46
Found in urine because as it is filtered by the glomerulus en
route to the liver
Urobilinogen
47
Classic test for differentiating urobilinogen,
| porphobilinogen and Ehrlich-reactive compounds
Watson-Schwartz test
48
read niyo nlng mga results about Watson-Schwartz test
```
Interpretation
Tube #1:
◦ Upper layer = urine
If colorless: porphobilinogen or Ehrlich-reactive
compounds
◦ Bottom layer = chloroform
If red: urobilinogen3A – MT | 2013-2014 Page 14
◦ If both layers are red, reextract urine layer from
tube #1, place 2 mL chloroform and 4 mL sodium
acetate into a new tube and repeat!
- If upper layer (urine) is colorless and the
chloroform layer is red
= excess urobilinogen
- If both layers are red
= porphobilinogen & urobilinogen
Tube #2
◦ Upper layer = butanol
If red: urobilinogen or Ehrlich-reactive
compounds
◦ Bottom layer = urine
If colorless: porphobilinogen
```
49
Rapid screening or monitoring of urinary
| porphobilinogen
Hoesch screening test
50
Sources of error in Hoesch screening test
◦ Methyldopa
◦ Indicant
◦ Highly-pigmented urines
51
Rapid screening test for UT
nitrite
52
Reagent strip reactions (nitrite)
- Greiss reaction
| - Pink colored azodye
53
true or false. nitrite reagent strip measures degree of bateuria
false
54
Sensitivity reagent strip of nitrite is standardized to correspond with a
quantitative bacterial criterion of ________ organisms/mL
100,000
55
(LE) causes of Inflammation of the urinary tract
Trichomonas
Chlamydia
Yeast
Inflammation of renal tissues
56
true or false. LE catalyze hydrolysis of acid ester on reagent pad
true
57
Based on the change in pKa of a polyelectrolyte in an
| alkaline medium
Specific Gravity
58
rgt strip rxn for sp gr
o Release of H+
directly proportional to number of ions
o pH is thus lowered
o blue to green to yellow
59
source of false positive in specific gravity rgt strip
High concentrations of protein
60
source of false negative in specific gravity rgt strip
Highly alkaline urine
61
other term for macroscopic screening, being used to decide whether microscopic exam is needed
chemical sieving
62
positive for nitrite may signify what in microscopic?
bacteria/WBCs
63
positive for protein may signify what in microscopic?
casts
64
positive for glucose may signify what in microscopic?
yeast
65
used to count number of RBCs, WBCs, casts, and epithelial cells present in a 12-hour urine sample
Addis count
66
may cause precipitation of amorphous urates and phosphates and other nonpathologic crystals
refrigeration
67
solution to crystals caused by refrigeration
warming to 37 degrees
68
standard volume for urine sedimentation
10-15 mL
69
RBCs must be identified at
HPO
70
RBCs in hypersthenuric urine appear
crenated
71
large empty cells are called ________; lysed RBCs in hyposthenuric urine which released its hemoglobin content
ghost cells
72
usually associated with glomerular bleeding
dysmorphic RBCs
73
indicates damage to the glomerular membrane or vascular injury within the genitourinary tract
presence of RBCs
74
urine in macroscopic hematuria appears
cloudy with red to brown color
75
predominnt WBC in urine
neutrophil
76
neutrophils may be called _______ due to the sparkling appearnce caused by brownian movement
glitter cells
77
the presence of eosinophils in the urine is primarily associated with
drug induced interstitial nephritis
78
preffered stain for eosinophil in urine
Hansel stain
79
may resemble RBCs because of their size
lymphocytes
80
___ are usually larger than WBCs and more polyhedral in shape, woth an eccentrically located nucleus
RTE
81
increase in urine WBCs
pyuria
82
indicates presence of inflammation or infection in the genitourinary tract
pyuria
83
represents normal sloughing off of cells
epithelial cells
84
largest found in a ruine sediment
squamous epithelial cells
85
contains irregular, abundant cytoplasm, prominent nucleus about the size of a RBC
squamous epith cell
86
indicative of bacterial infection by Gardnerella vaginalis
clue cells
87
difference of a transitional epith cell from RTE cells
transitional has centrally located nucleus
88
rectangular shape and reffered to as columnar or convoluted cells
PCT RTE
89
smaller than those from PCT and are round and oval
DCT RTE
90
cuboidal and never round
collecting duct RTE
91
the presence of ________ RTE cells per hpf indicates ______
2
tubular injury
92
RTE cells absorb lipids present in the glomerular filtrate, and then appear highly refractile
oval fat bodies
93
stain for oval fat bodies
sudan III
| oil red o
94
most frequently associated with damage to the glomerulus caused by nephrotic syndrome
lipiduria
95
RTE cells containing non-lipid filled vacuoles
bubble cells
96
acidic crystals include
```
cystine
cholesterol
leucine
tyrosine
bilirubin
sulfonamide
ampicillin
uric acid
amorphous urates
calcium oxalate
```
97
color of cystine crystal
colorless
98
color of bilirubin crystal
yellow
99
color of leucine crystal
yellow
100
most frequent parasite in urine
trichomonas vaginalis
101
a major constituent of mucus in urine
Tamm-Horsfall protein
102
formed within the lumens of the DCT and collecting tubes
casts
103
appearancce of cast
tubular with rounded ends
104
presence of casts in urien is called
cylindruria
105
hyaline cast is colored ___
colorless
106
specific finding indicating bleeding in the nephron
RBC casts
107
primary marker for distinguishing upper UTI from lower UTI
WBC casts
108
indicates advanced tubular destructon
epithelial cell casts
109
representative of extreme urine stasis indicating chronic renal failuer
waxy casts
110
also called renal failure casts, similar to waxy casr
broad cast
111
formed by the precipitation of urine solution
crystals
112
most common crystal found in the urine
urates
113
alkaline crystals include
```
amorphous phosphates
calcium phosphate
triple phosphate
ammonium biurate
calcium carbonate
```
114
color of amorphous urates
brick dust or yellow brown
115
appears like throny apple
ammonium biurate
116
dumbbell shaped
calcium carbonate
117
appears dumbbell shaped, oval and envelope
calcium oxalate
118
appears like coffin lids
triple phosphate
119
with notched corners
cholesterol crystals
120
appears in fine needle clumps
tyrosine
121
hexagonal shaped crystal
cystine crystal
122
varies upon refrigeration
ampicillin crystals
123
appears in rosette form
sulfa crystal
124
artifacts may include
pollen grain
diaper fiber
fecal material
vegetable fiber
