Clinical Significance of Chemical composition Flashcards
(97 cards)
1
Q
What is the normal pH range of urine?
A
4.5 to 8.0
2
Q
What is the typical pH of 1st morning urine?
A
5.0 - 6.0
3
Q
What is the pH of unpreserved urine?
A
≥ 9.0
4
Q
What occurs after meals due to withdrawal of H* ions for HCL secretion?
A
Alkaline tide
5
Q
What contains quinic acid that causes urinary excretion of hippuric acid?
A
Cranberry juice
6
Q
What is most indicative of renal disease?
A
Protein
7
Q
What does protein produce in shaken urine?
A
White foam
8
Q
What is the normal urinary protein level?
A
<10mg/dL or <100 mg/day; 150 mg/day
9
Q
What is considered mild/minimal proteinuria?
A
<1g/day
10
Q
What is considered moderate proteinuria?
A
1 to 3 or 4 g/day
11
Q
What is considered large/heavy proteinuria?
A
> 3 or 4 g/day
12
Q
What does protein in normal urine consist of?
A
1/3 albumin and 2/3 globulin
13
Q
What is the major serum protein found in urine?
A
Albumin
14
Q
What percentage of filtered protein is reabsorbed?
A
95-99%
15
Q
What is the most abundant protein in normal urine?
A
Tamm-Horsfall protein (uromodulin)
16
Q
What conditions are categorized as pre-renal proteinuria?
A
Intravascular hemolysis, Muscle injury, Severe infection and inflammation, Multiple myeloma
17
Q
What is Multiple Myeloma characterized by?
A
Ig-producing plasma cells
18
Q
What protein is produced in Multiple Myeloma?
A
Bence Jones proteins (BJP)
19
Q
BJP is identical to what?
A
Immunoglobulin light chains (identical kappa and lambda)
20
Q
What tests are used for detecting BJP?
A
Serum electrophoresis, Immunofixation electrophoresis
21
Q
Urine precipitates at ____ and dissolves at ___
A
40-60 deg C (cloudy); 100 deg C (clear)
22
Q
Glomerular proteinuria is indicated in
A
Diabetic nephropathy, Orthostatic/Cadet/Postural/Cyclic proteinuria, Tubular proteinuria
23
Q
Diabetic nephropathy is characterized by
A
Decreased glomerular filtration; microalbuminuria is present
24
Q
Albumin excretion rate in ug/min or mg/24 hrs: Normal
A
0-20 ug/min (negative in strip)
25
Albumin excretion rate in ug/min or mg/24 hrs: Microalbuminuria
20-200 ug/min or 30-300 mg/24 hrs (negative protein strip)
26
Albumin excretion rate in ug/min or mg/24 hrs: Clinical albuminuria
> 200ug/min (positive protein reagent strip)
27
Orthostatic proteinuria is due to
Increased pressure to renal veins when standing
28
In testing cadet proteinuria, what should be done?
Patient must empty bladder before going to bed and collect specimen immediately upon waking and another one 2 hours after standing
29
Orthostatic proteinuria result in first morning and after 2 hrs standing
First morning - negative; 2 hrs after standing - positive
30
Clinical proteinuria result in first morning and 2 hrs after standing
Positive in first morning and 2 hrs standing
31
Nephrotic syndrome, toxic agents, dehydration, strenuous exercise, hypertension, amyloidosis, pre-eclampsia is a type of what proteinuria
Renal proteinuria
32
Originally discovered in workers exposed to cadmium dust (a heavy metal)
Tubular proteinuria
33
Causes of tubular proteinuria
Fanconi's syndrome, toxic agents/heavy metals, viral infections
34
Post renal proteinuria is caused by
Lower UTI/inflammation, menstrual contamination, injury/trauma, vaginal secretions, prostatic fluid/spermatozoa
35
Most frequently tested in urine
Glucose
36
Other sugars in urine caused by fruits, honey, syrups, fructose intolerance
Fructose (levulose)
37
Infants with galactosemia secrete in urine
Galactose
38
Increased sugar during pregnancy, lactation, strict milk diet, lactose intolerance
Lactose (Glucose + Galactose)
39
Increased sugar in fruits, benign essential pentosuria (xylulose, arabinose)
Pentose
40
Increased sugar found in intestinal disorders, sucrose intolerance
Sucrose (Glucose + Fructose) non-reducing sugar
41
Clinical significance of urine glucose: hyperglycemia associated
Increased blood and urine glucose
42
Clinical significance of urine glucose: Renal associated glycosuria
Normal blood glucose, increased urine glucose
43
Causes of hyperglycemia in blood and urine
Diabetes mellitus, Cushing syndrome (increased cortisol), Pheochromocytoma (increased catecholamine), Acromegaly (increased growth hormone), Hyperthyroidism (increased T3 and T4)
44
Causes of Renal glycosuria
Impaired tubular secretion of glucose, Fanconi syndrome (defective tubular reabsorption of glucose and amino acid)
45
Nonspecific test for reducing sugars (glucose, galactose, lactose, fructose, but not sucrose)
Copper reduction test
46
Reporting of Benedict's test color bluish green
Trace
47
Reporting of Benedict's test color green color, green or yellow precipitate
1+
48
Reporting of Benedict's test color yellow to green color, yellow precipitate
2+
49
Reporting of Benedict's test color yellow-orange color, yellow-orange precipitate
3+
50
Reporting of Benedict's test color reddish yellow color, brick red or red precipitate
4+
51
False positive of Benedict's test
Reducing agents (ascorbic acid, uric acid)
52
False negative of Benedict's test
Oxidizing agents (detergents)
53
Clinitest tablet uses how much urine
5 drops
54
Reaction from Clinitest tablet should be read at
15 seconds after bubbling stops
55
Occurs when >2g/dL sugar is present
Pass-through phenomenon
56
Clinitest tablet contains
CuSO4 - main reacting agent, Na Citrate - heat production, NaCO3 - eliminates interfering room air, NaOH - heat production
57
To prevent pass-through reaction, what is used
2 drops of urine (use separate color chart)
58
Pass-through reaction color
Blue > Green > Yellow > Brick red >>>>> blue or green-brown
59
Pass-through reaction occurs due to
Reoxidation of cuprous oxide to cupric oxide and other cupric complexes
60
Glucose oxidase 1+ positive; Clinitest Negative interpretation
Small amount of glucose is present
61
4+ glucose oxidase; negative Clinitest
Possible oxidizing agent interference on reagent strip
62
Glucose oxidase negative; Clinitest positive
Non-glucose reducing substance is present; possible interfering substance for reagent strip (e.g., ascorbic acid)
63
Result of incomplete fat metabolism due to inability to metabolize carbohydrates
Ketones
64
Renal threshold for ketones
70 mg/dL
65
Ketones are seen in
Type 1 DM, Vomiting, Starvation, Malabsorption
66
Cloudy red urine; sensitive indicator of renal disease
Hematuria
67
Hematuria is seen in
Glomerulonephritis, renal calculi, tumors, strenuous exercise, trauma
68
Microscopic hematuria shows
Intact RBCs (>5 RBCs/uL is significant)
69
Hemoglobinuria is characterized as __ in urine
Clear red
70
Hemoglobinuria is seen in
Intravascular hemolysis, transfusion reactions, hemolytic anemia, severe burns, brown recluse spider bites
71
Microscopic hemoglobinuria
No RBCs seen
72
Portion of hemoglobin that is toxic to renal tubules
Heme
73
Myoglobinuria is seen in
Rhabdomyolysis, muscular trauma, crush syndromes, extensive exertion, cholesterol-lowering statin medications
74
Amount of myoglobin that produces red urine
>25 mg/dL
75
>1.5 myoglobin of urine is indicative of
Renal failure risk
76
Lysis of RBCs in the urine usually shows
Mixture of hemoglobin and hematuria
77
Plasma examination of hemoglobin result
Red or pink; decreased haptoglobin levels
78
Plasma examination of myoglobin
Pale yellow plasma; increased aldolase activity
79
Blondheim's test (ammonium sulfate test) hemoglobin
Precipitated (reagent is negative)
80
Blondheim's test (ammonium sulfate test) myoglobin
No precipitate (reagent strip is positive)
81
Early indicator of liver disease in urine
Bilirubin
82
Clinical significance of urine bilirubin
Hepatitis, cirrhosis, biliary obstruction (gallstones, carcinoma)
83
Bile pigment resulted from hemoglobin degradation
Urobilinogen
84
Normal value of urobilinogen (UBG)
<1 mg/dL or Erlich unit
85
Specimen for urobilinogen
Afternoon urine 2-4 pm
86
Watson Schwartz test is used for
Differentiating urobilinogen and porphobilinogen (PBG) and other Erlich reactive compounds
87
Watson Schwartz test for urobilinogen
Soluble in chloroform; soluble in butanol
88
Watson Schwartz test for porphobilinogen (PBG)
Insoluble in chloroform and butanol
89
Watson Schwartz test for other Erlich reactive compounds
Insoluble in chloroform; soluble in butanol
90
Hoesch Test: rapid screening test for porphobilinogen procedure
2 drops urine + 2 mL Hoesch reagent (Erlich reagent 6M or 6N HCl) = red color
91
Condition with increased B1, negative urine bilirubin, 3+ urine urobilinogen
Extravascular hemolytic disease (pre-hepatic jaundice)
92
Condition with increased blood B1/B2, +/- CB in urine, 2+ urine urobilinogen
Liver damage
93
Condition with increased CB in blood, 3+ urine bilirubin (B2), decreased or normal urobilinogen
Bile duct obstruction (post-hepatic/obstructive jaundice)
94
Rapid screening test for UTI or bacteriuria
Nitrite
95
Nitrate converters are generally
Gram-negative such as Enterobacteriaceae
96
Specimen for nitrite determination
4-hour collection or first morning urine (preferred)
97
Significant in UTI or inflammation; screening of urine culture specimen
Leukocytes
