ENHANCEMENT CLASS LAB: ROUTINE URINE ANALYSIS Flashcards
(117 cards)
1
Q
PHYSICAL EXAMINATION OF URINE
A
COLOR
CLARITY
ODOR (not performed)
SPECIFIC GRAVITY
2
Q
Varies from almost colorless to black
A
COLOR
3
Q
COLOR Variations may be due to:
A
○ Normal metabolic functions
○ Physical activity
○ Ingested materials
○ Pathologic conditions
4
Q
More solutes, less water
A
darker urine
5
Q
MAJOR PIGMENT OF URINE
A
UROCHROME
6
Q
Pigment which causes the urine to become yellow
A
UROCHROME
7
Q
UROCHROME WAS NAMED BY?
A
Thudichum in 1864
8
Q
Proportional to the metabolic rate
A
UROCHROME
9
Q
UROCHROME Increased during:
A
○ Fever
○ Thyroid condition (thyrotoxicosis)
○ Fasting states and starvation
○ Urine stands at room temperature
10
Q
Pink pigment
A
UROERYTHRIN
11
Q
Present in urines that have been refrigerated (precipitation of amorphous urates)
A
UROERYTHRIN
12
Q
Attaches to the urates producing a pink-color to the sediment
A
UROERYTHRIN
13
Q
From melanin metabolism
A
UROERYTHRIN
14
Q
From the oxidation of urobilinogen
A
UROBILIN
15
Q
Gives an orange-brown color to a urine that is not fresh
A
UROBILIN
16
Q
Recent fluid consumption
A
COLORLESS/STRAW
17
Q
Polyuria or diabetes insipidus, diabetes mellitus, diluted random specimen
A
PALE YELLOW
18
Q
Concentrated urine
A
DARK YELLOW
19
Q
Dehydrated
A
AMBER
20
Q
Bilirubin, acriflavine, pyridium, nitrofurantoin, phenindione
A
ORANGE
21
Q
white foam
A
Bilirubin
22
Q
yellow/orange foam
A
Pyridium
23
Q
Bilirubin oxidized to biliverdin
A
YELLOW-GREEN/
YELLOW-BROWN
24
Q
Pseudomonas infection
A
GREEN
25
Clorets, indicant, phenol, methylene blue, robaxin
BLUE-GREEN
26
RBCs, hemoglobin, myoglobin, porphyrin, rifampin, menstruation
PINK-RED
27
pink supernatant
Myoglobin
28
port wine color of urine
Porphyrin
29
red supernatant
RBC
30
Methemoglobin, homogentisic acid, melanin, argyrols, levodopa, flagyl
BROWN/BLACK
31
No visible particulates, transparent
CLEAR
32
Few particulates, print easily seen through urine
HAZY
33
Many particulates, print blurred through urine
CLOUDY
34
Print cannot be seen through urine
TURBID
35
May precipitate or be clotted
MILKY
36
Mix the urine sample 3 times using a _______
figure of eight motion
37
Place a sample at least ____on a test tube
¾
38
Check the COLOR of the urine sample ______ with a good light source
ON A PLAIN WHITE BACKGROUND
39
Check the CLARITY of the urine sample on a ___________
PRINTED WHITE BACKGROUND
40
CHEMICAL EXAMINATION OF URINE
● Glucose
● Bilirubin
● Ketones
● Specific Gravity
● Protein
● pH
● Blood
● Urobilinogen
● Nitrite leukocytes
41
MNEMONICS FOR PARAMETERS REACTION TIME:
Good Boy (30 sec) Kill (40 sec) Sharks (45 sec) para papa BUN (60 sec) leukocytes (120 sec)
● (Good boy) Glucose and Bilirubin: 30 seconds
● (kill) Ketones: 40 seconds
● (sharks) Specific Gravity: 45 seconds
● (para papa BUN) pH, protein, blood, urobilinogen,
nitrite: 60 seconds
● (leukocyte esterase) Leukocytes: 120 seconds
42
DOUBLE-INDICATOR SYSTEM
ph
43
PROTEIN ERROR OF INDICATOR
Protein
44
SODIUM NITROPRUSSIDE
REACTION
Ketones
44
PSEUDOPEROXIDASE REACTION
OF HEMOGLOBIN
Blood
45
DOUBLE SEQUENTIAL ENZYMATIC REACTION
Glucose
46
DIAZO REACTION
Bilirubin
47
EHRLICH’S REACTION
Urobilinogen
48
GREISS REACTION
Nitrite
49
GRANULOCYTES ESTERASES
REACTION
Leukocyte Esterase
50
pKa CHANGE OF
POLYELECTROLYTE
Specific Gravity
51
1. Dip the reagent strip completely in the urine
2. Remove excess urine from the strip by running the edge of the strip on the container when withdrawing it from the specimen
3. Blot the strip horizontally on an absorbent medium pad
4. Wait for the specified length of time for reactions totake place
5. Compare the colored reactions against the
manufacturer’s chart using a good light source
NOTE: Read HORIZONTALLY
CHEMICAL EXAMINATION PROCEDURES
52
● Multistix
● Chemstrip
REAGENT STRIP
53
The darker the color of the test pad, the less light will be reflected to the sample
REFLECTANCE PHOTOMETRY
54
APPEARANCE: smooth, non-nucleated, biconcave disks measuring approximately 7 mm in diameter
RBC
55
MOST DIFFICULT FOR STUDENTS TO
RECOGNIZE due to lack of characteristic
structures, variations in size, and close resemblance to other urine sediment constituents
RBC
56
RBC Clinical Significance:
○ Hematuria
○ Glomerular Membrane Damage
○ Malignancy of the urinary tract
○ Vascular injury within genitourinary tract
57
APPEARANCE: larger than RBCs, measuring an average of about 12 mm in diameter
○ Dirty center because of the nucleus
WBC
58
brownian movement;
swells and sparkles (GLITTER CELLS)
Hypotonic Urine
59
WBC Clinical Significance:
○ Pyuria
60
Eosinophils >1%
CONSIDERED SIGNIFICANT
61
increased eosinophil but no bacteria
Acute Interstitial Nephritis
62
increased neutrophils with bacteria
UTI
63
increased lymphocytes (T-cells)
Renal Transplant Rejection
64
SEC infected with Gardnerella
vaginalis
CLUE CELLS
64
FIRST STRUCTURES OBSERVED and good
reference for focusing of the microscope
POINT OF REFERENCE IN MICROSCOPY
65
APPEARANCE:
Largest cells in the sediment with abundant,
irregular cytoplasm and prominent nuclei
○ Usually has a centric nucleus
SQUAMOUS EPITHELIAL CELLS
65
POINT OF REFERENCE IN MICROSCOPY
Found in linings of urthra and vagina
SQUAMOUS EPITHELIAL CELLS
66
APPEARANCE:
Smaller than squamous cells and appear in
several forms, including spherical, polyhedral,
and caudate with centrally located nucleus
○ Comes in many shapes and forms
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
67
Increased in number following catheterization
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
68
Clumps of urothelial cells
○ Normally present in urine
SYNTHYTIA
69
Seen in deformed state in malignancy/viral infection
of the urinary tract
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
70
APPEARANCE: Rectangular (convoluted or columnar cell), round, oval, or cuboidal with an eccentric nucleus
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
71
MOST CLINICALLY
SIGNIFICANT EPITHELIAL
CELL
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
72
RTE with lipids/fats
OVAL FAT BODIES
73
Not very common in high
amount
○ >2=indication of renal
tubular injuries
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL)
74
RTE with no lipid vacuoles and is
often associated with injured cells
BUBBLE CELLS
75
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL) Clinical Significance:
○ Tubular Necrosis
○ Tubular Injury
○ Glomerular Disorders
76
NOT NORMALLY PRESENT IN URINE except Catheter or collection-container contamination
BACTERIA
77
APPEARANCE: Small
spherical and rod-shaped
BACTERIA
78
● Present in the form of cocci (spherical) or bacilli (rods)
● Most are motile
BACTERIA
79
most common cause of UTI and also causes diarrhea
○ Most common water contaminant
Escherichia coli
80
To be considered significant for UTI, bacteria should be accompanied by WBCs
BACTERIA
81
APPEARANCE:
Tapered oval head with
long, thin tail
SPERMATOZOA
82
Urine is toxic to spermatozoa; therefore,
they rarely exhibit the motility observed when examining a semen specimen
SPERMATOZOA
83
Present in cases of diabetes mellitus due to the fact that dead glucose serves as a food for yeast
SPERMATOZOA
84
APPEARANCE:
Small, oval, refractile structures with buds
and/or mycelia/branched (in severe infections)
YEAST
85
Candica albicans in:
○ Diabetic patients
○ Immunocompromised patients
○ Women with vaginal moniliasis
86
PARASITES IN URINE:
* Trichomonas vaginalis
* Schistosoma haematobium
* Enterobius vermicularis
87
● MOST COMMON PARASITE FOUND IN URINE
● APPEARANCE:
Pear-shaped flagellate with an undulating membrane
● Darting movement
Trichomonas vaginalis
88
Associated with
hematuria (cloudy,
red urine) and bladder
cancer
Schistosoma haematobium
89
MOST COMMON FECAL
CONTAMINANT FOUND IN
URINE
Enterobius vermicularis
90
● Lower power magnification is used for examination
● Represent a biopsy of an individual renal tubule
CAST
91
MOST DIFFICULT and MOST IMPORTANT urinary sediment
○ Because of its translucence
○ Should be seen in low lighting
CAST
91
Observation under subdued light, along the edges of
the cover slip
CAST
92
Major constituent of cast is
Tamm-Horsfall protein
(UROMODULIN)
93
If cast has no sediment
renal failure
94
● MOST FREQUENT SEEN CAST
● Clinical Significance:
○ Glomerulonephritis
○ Pyelonephritis
○ Chronic Renal Disease
○ Congestive Heart Failure
○ Stress
○ Exercise
HYALINE CAST
95
● Frequently seen cast that may be pathologic or not
● Clinical Significance:
○ Glomerulonephritis
○ Pyelonephritis
○ Stress
○ Exercise
COARSE/GRANULAR CAST
96
● Frequently found in the urine
● RARELY of clinical significance
● Detect disorders:
○ Liver disease
○ Inborn errors of metabolism
○ Renal damage cause by crystallization of
medication compounds within tubules
URINE CRYSTALS
97
NORMAL URINE CRYSTALS:
1. URIC ACID
2. CALCIUM OXALATE
3. AMORPHOUS URATES
4. TRIPLE PHOSPHATE
98
● ACIDIC
● Yellow-brown but maybe colorless
(six-sided shaped like crystine)
● Increased uric acid in the blood = increased uric acid in urine
● Leukemia (receiving chemotherapy),
Lesch-Nyhan Syndrome and Gout
URIC ACID
99
● ACIDIC/NEUTRAL (alkaline)
○ Dihydrate
■ Most common
○ Monohydrate
■ Renal calculi
■ Food high in oxalic acid
(tomatoes, asparagus, and
ascorbic acid)
■ Ethylene Glycol (antifreeze
poisoning)
● Uric acid and Calcium oxalate is often seen
in acidic urine
CALCIUM OXALATE
100
● ACIDIC
● Brick dust or yellow
● Present in pink urine
AMORPHOUS URATES
101
● ALKALINE
● (Ammonium magnesium phosphate)
● Prism shape–resembles a “coffin lid”
TRIPLE PHOSPHATE
102
ABNORMAL URINE CRYSTALS:
1. CRYSTINE CRYSTALS
2. CHOLESTEROL CRYSTALS
3. TYROSINE CRYSTALS
4. LEUCINE CRYSTALS
5. BILIRUBIN CRYSTALS
103
● Often seen in acidic urine
● Often associated with cystinosis
ABNORMAL URINE CRYSTALS
104
● ACID
● As colorless, hexagonal plates, and may
be thick or thin
● Metabolic disorder (inherited cystinuria
CRYSTINE CRYSTALS
105
● ACID
● Rectangular plate with a notch in one or
more corners
● Seen in conjunction with fatty casts and oval fat bodies
● Associated disorder: Lipiduria (nephrotic
syndrome)
● Only seen when REFRIGERATED
CHOLESTEROL CRYSTALS
106
CRYSTALS ASSOCIATED TO LIVER DISORDERS
1. TYROSINE CRYSTALS
2. LEUCINE CRYSTALS
3. BILIRUBIN CRYSTALS
107
● ACID/NEUTRAL
● Appear as fine colorless to
yellow needles that frequently form clumps or rosettes
TYROSINE CRYSTALS
108
● ACID/NEUTRAL
● Yellow-brown spheres that demonstrate
concentric circles and radial striations
● WHEN PRESENT, should be accompanied
by tyrosine crystals
● Liver disease
LEUCINE CRYSTALS
109
● ACID
● Clumped needles or granules with the
characteristic yellow color
● A POSITIVE CHEMICAL TEST RESULT for
bilirubin would be expected
● Liver disease (hepatitis)
BILIRUBIN CRYSTALS
110
R–RBC
O–Oval Fat Bodies
W–WBC
R–RTE CELLS
Average number per L
Average number per HPF
111
Cast
CrAb–Abnormal Crystals
Average number per LPF
112
T–Transitional Epithelial Cells
T–Trichomonas
Ba–Bacteria
Ya–Yeast
N–Normal Crystals
RFMoMa per HPF
113
Mucus
Secs–Squamous Epithelial Cells
RFMoMa per LPF
