Chemical Examination of Urine: pH and Protein

Question 1

major types of reagent strips used:

Answer 1

1. Multistix (Bayer)
2. Chemstrip (Roche-Boehringer Mannheim Diagnostics)

Question 2

reagent strips be stored at:

Answer 2

room temperature below 30°C (but never refrigerated)

Question 3

________ a frequent constituent of renal calculi, precipitates primarily in acidic and not alkaline urine.

Answer 3

calcium oxalate

Question 4

Maintaining acidic urine can be valuable in treating

Answer 4

UTIs caused by urea-splitting organisms

Question 5

a color change from red to yellow in the pH range 4 to 6

Answer 5

Methyl red

Question 6

turns from yellow to blue in the
range of 6 to 9

Answer 6

Bromthymol blue

Question 7

Sources of error/interference

Answer 7

No known interfering substances
Runover from adjacent pads
Old specimens
Bacterial growth

Question 8

Does normal urine contain very little protein? usually?

Answer 8

less than 10 mg/dL or 100 mg per 24 hours is excreted

Question 9

the major serum protein found in normal urine.

Answer 9

albumin

Question 10

produced by the renal tubular epithelial cells; and proteins from prostatic, seminal, and vaginal secretions. a glycoprotein, is produced routinely in the ascending loop of Henle

Answer 10

Tamm-Horsfall protein (THP), also known as
uromodulin,

Question 11

Clinical proteinuria is indicated at

Answer 11

30 mg/dL or greater (300 mg/L)

Question 12

3 major categories of proteinuria:

Answer 12

1. prerenal
2. renal
3. postrenal

Question 13

caused by conditions affecting the plasma before it reaches the kidney and therefore is not indicative of actual renal disease.

Answer 13

Prerenal Proteinuria

Question 14

increased levels of low-molecular weight plasma proteins, such as:

Answer 14

hemoglobin, myoglobin, and
the acute-phase reactants

Question 15

A primary example of proteinuria due to increased levels of serum protein is the excretion of

Answer 15

Bence Jones protein by people
with multiple myeloma

perform Solubility Test to confirm kani tong i-boil ang urine unya if naay coagulation or precipitation tas mag dissolve sa 100 C

si Bence Jones, abnormal protein man ni

Question 16

associated with true renal disease may be the result of damage to the glomerular membrane or tubular dysfunction.

Answer 16

Renal Proteinuria

Question 17

Additional parameters:

Answer 17

1. ascorbic acid
2. microalbumin
3. creatinine
4. calcium

Question 18

Improper technique includes:

Answer 18

a. unmixed specimen (sediments settle at the bottom and cannot be detected)
b. allowing the strip to remain in urine for an extended period of time
c. performing the reagent strip technique immediately after refrigeration (should be at RT)

Question 19

Urine Foam Shake Test indicates

Answer 19

bubbles indicate the possible presence of protein/bilirubin

if bubbles disappear, normal.

WHITE foam = ↑ protein
YELLOW foam = ↑ bilirubin or false bilirubin (bc of phenazopyridine = multivitamins)

Question 20

How to perform quality control of reagent strips?

Answer 20

must be checked with (+) and (-) control once every 24hrs or kada start ng shift. pwede rin kapag bagong open ang bottle, or if sus ang result or dili shoar na ok ang strip

so pag positive, dapat abnormal results
pag negative syempre normal

Question 21

pag buang buang ang result or erroneous dahil yan sa

Answer 21

a. interference ng oxidizing or reducing agents
1. ascorbic acid
2. formalin
3. detergents

b. pwede pud technical carelessness kay tanga man si medtech

c. pag color blind ka

Question 22

ang pH sa FIRST MORNING SPECIMEN kay?

Answer 22

5.0-6.0 acidic na pero maging alkaline pagtapos mo kain pero kay self-limiting man siya so mubalik ra pud sa normal if gikan alkaline.

ngano mag alkaline man? kay naa may alkaline tide in which si parietal cells mag release ng HCl exchange kay bicarbonate unya musulod siya sa intestine tas mafilter sa urine kaya maging alkaline

Question 23

ang pH sa RANDOM SPECIMEN kay?

Answer 23

4.5-8.0

pag 9.0 nana, hala kabalaka na kay murag gi tamper nana or possible old specimen ang gihatag saimo

Question 24

ang pH sa BLOOD kay?

Answer 24

7.35-7.45

Question 25

pH has no normal values kay ngano man?

Answer 25

1. acid-base content of the blood 2. patient's renal function 3. UTI (oh noesz muinom siyag cranberry juice mahimong acidic iyang ihi) 4. dietary intake (pwede rapud same sa taas) 5. age of the specimen (kay lagi basig old na specimen ba)

Question 26

unsay reason diay ngano acidic imong urine?

Answer 26

1. hala basig naa kay DIABETES MELLITUS 2. or gutom ka? mag ↑ imong ketone bodies ana if you're starving (wow) 3. high PROTEIN diet (sagana sa beef) 4. i cranberry juice mo ean

Question 27

unsay reason diay ngano alkaline imong urine?

Answer 27

1. renal tubular acidosis daw ana si kuan 2. Vegetarian diet (si alka mukaon ug gulay) 3. paghumag kaon lagi alkaline imong ihi 4. vomiting (yuck) 5. old specimen (usab usab) ge unsay pH?

Question 28

what is the principle of the reagent strip reactions of pH?

Answer 28

syempre double indicator system kay duha man ang reagent vogo unsa na reagent? 1. methyl red = red → yellow (4.0-6.0) 2. bromthymol blue = yellow → blue (6.0-9.0) ngano duha? kay wala may normal value lagi kazabot? need daghan variations sa color

Question 29

what parameter is most indicative of renal disease?

Answer 29

protein = since it should not be detected in the urine pero sometimes kay pag mag exercise ka or dugay na kayka mutindog, musaka gyud na imong protein (wowza)

Question 30

Normal protein in the urine:

Answer 30

<100mg/dL per day

Question 31

since proteins are low molecular weight serum proteins that are filtered in the glomerulus, what is the molecular weight of albumin?

Answer 31

69,000 kDa ang makasulod sa glomerulus ra kay 70,000 kDa !!!! remember so makasulod si albumin or dili??? answer: oo pero dili ngANO????? oo kay sakto raman siya diba 69 gani pero dili kay naa may shield of negativity (bawal pag negative ferson)

Question 32

major protein found which has low molecular weight

Answer 32

ALBUMIN mameh other proteins kay: 1. serum & tubular microglobulins 2. Tamm-Horsfall (by: tubules) 3. proteins from prostatic, seminal, and vaginal secretions

Question 33

proteinuria can also be seen in

Answer 33

1. strenuous exercise (tindog dugay) 2. dehydration (tindog na gani kag dugay, uhaw pa ka) 3. hypertension (uhaw na gani kas sgeg tindog mao na ma highblood ka) sige lang, REVERSIBLE man ni

Question 34

unsa pay makita sa proteinuria

Answer 34

1. pre-eclampsia (sa preggy naay high pressure (hydrostatic) unya magka organ damage 2. disorders affecting tubular reabsorption - Fanconi Syndrome = damage cells sa tubules and PCT. if naay damage, it means walay reabsorption unya ang mga substances kay makita na sa urine kay naa na may mga damage cells sa brush border sa PCT

Question 35

Benign conditions in proteins may be exposure to:

Answer 35

cold, strenuous exercise, high fever, and dehydration

Question 36

Orthostatic (Postural) Proteinuria:

Answer 36

benign, frequently seen in young adults in vertical position and mawala if naka horizontal position

Question 37

difference between clinical proteinuria and orthostatic proteinuria

Answer 37

CLINICAL PROTEINURIA = naay problem sa tubules and glomerulus (+) 1st morning and after standing for 2hrs ORTHOSTATIC PROTEINURIA = wala man kaayo (-) 1st morning and (+) after standing for 2hrs

Question 38

microalbuminuria:

Answer 38

only small amount of protein is excreted by patients with DM and can detected in the onset of renal complications & progression of renal disease

Question 39

Test for microalbuminuria?

Answer 39

MICRAL TEST which employs "antibody-enzyme conjugate" sensitivity: 1-10 mg/dL

Question 40

Tubular proteinuria is:

Answer 40

meaning ani, ang mga na filter na albumin kay dili na siya i-absorb (like: Fanconi Syndrome, toxic agents, viral infections)

Question 41

uNSA MAN NING POST-RENAL PROTEINURIA?

Answer 41

kani tong mga proteins na maka pass through sa lower urinary tract (ureter, bladder, urethra, prostate, & vagina) theres a production of exudates in bacterial/fungal infections, naa pud blood due to menstrual contamination (contains protein) or prostatic fluid ug large amount of spermatozoa

Question 42

unsay reagent strip reaction principle sa protein????????????

Answer 42

PROTEIN ERROR OF INDICATORS! ngano error ang tawag? kay ang protein prone man nis error color change should be bc of the indicators but instead, protein itself changes the colors Multistix = tetrabromphenol blue Chemstrip = tetrachlorophenol tetrabromosulfonphthalein

Question 43

reaction interference of protein?

Answer 43

1. major source would be the highly buffered alkaline urine since ma-override niya ang acid buffer system 2. allowing the urine to come in contact with reagent pad for prolonged period (would cause runover which results to false reactions) 3. highly pigmented urine & contamination of container = false positive reading

Question 44

test that detects protein in the urine?

Answer 44

Sulfosalicylic Acid Precipitation Test (SSA) (can also be a confirmatory in some certain situations)

Question 45

test that detects protein in the urine?

Answer 45

Sulfosalicylic Acid Precipitation Test (SSA) (can also be a confirmatory in certain situations but may not be relevant to current lab practice)

Question 46

reagent for SSA?

Answer 46

3% SSA reagent (Exton's reagent) + 3mL centrifuged urine

Question 47

if you're reading this, please MEMORIZE SSA grading

Answer 47

flocculation = solid particles flocculants = combination of protein & Exton's reagent/SSA granulation = small particles